I-Infectious Diseases Society of America njengamanje incoma i-amoxicillin ne-ampicillin, ama-antibiotic e-aminopenicillin (AP), njengemithi yokuzikhethela yokwelapha.i-enterococcusUTIs.2 Ukuvama kwe-enterococcus emelana ne-ampicillin kuye kwanda.

Ikakhulukazi, izehlakalo ze-vancomycin-resistanti-enterococci(I-VRE) icishe yaphindeka kabili eminyakeni yamuva, kanti u-30% wama-entococcal isolate asemtholampilo abikwa ukuthi amelana ne-vancomycin.3 Ngokusekelwe ezingeni lamanje le-Clinical and Laboratory Standards Institute,I-Enterococcusizinhlobo ezine-minimal inhibitory concentration (MIC) ≥ 16 μg/mL zithathwa njengokumelana ne-ampicillin.

Ilabhorethri ye-Microbiology isebenzisa le ndawo efanayo ngaphandle kokubheka indawo yokutheleleka. I-Pharmacokinetic, i-pharmacodynamics, kanye nedatha yesilingo somtholampilo isekela ukusetshenziswa kwe-aminopenicillin antibiotics ekwelapheni i-enterococcus UTIs, ngisho nalapho i-isolate ine-MIC edlula i-breakpoint susceptibility.4,5

Ngenxa yokuthi ama-antibiotic e-AP asulwa ngezinso, singakwazi ukuzuza ukugxila okuphezulu kakhulu emchameni kunasegazini. Olunye ucwaningo lwakwazi ukukhombisa ukugcwala komchamo okumaphakathi okungu-1100 μg/mL okuqoqwe emahoreni ayi-6 ngemuva komthamo owodwa we-amoxicillin wama-500 mg.

Olunye ucwaningo lwahlaziya ukumelana ne-ampicillini-enterococcus faecium(E. Faecium) umchamo uhlukaniswa nama-MIC abikiwe angu-128 μg/mL (30%), 256 μg/mL (60%), kanye no-512 μg/mL (10%).4 Ngokusebenzisa idatha yalezi zivivinyo, kunengqondo ukusho ukuthi ukugxila kwe-AP ukufinyelela ukugxila okwanele emgudwini womchamo ukuze welaphe izifo eziningi ezibikiwe zokungazweli.

Kolunye ucwaningo, kwatholakala ukuthi i-ampicillin-resistantE. faeciumukuhlukaniswa komchamo kwakunama-MIC ahlukahlukene, ane-MIC emaphakathi engu-256 μg/mL5. Izihlukanisi ezi-5 kuphela ezazinenani le-MIC >1000 μg/mL, kodwa ngayinye yalezi zihlukanisi yayingaphakathi kokuhlanjululwa oku-1 kuka-512 μg/mL.

Ama-antibiotics e-penicillin abonisa ukubulala okuncike esikhathini futhi impendulo efanele izokwenzeka inqobo nje uma ukugxila komchamo kungaphezu kwe-MIC okungenani u-50% wesikhathi somthamo.5 Ngakho-ke, singaphetha ngokunengqondo ngokuthi imithamo yokwelapha ye-AP antibiotics ngeke iphumelele phathaI-Enterococcusizinhlobo, kodwa futhi ukumelana ne-ampicillini-enterococcusihlukaniswe kuma-UTI aphansi, inqobo nje uma idosi efanelekile.

Ukufundisa ama-prescribers kungenye yezindlela esinganciphisa ngazo inani lama-antibiotic abanzi asetshenziswa ukwelapha lezi zifo, njenge-linezolid ne-daptomycin. Enye indlela ukwakha umthetho olandelwayo esikhungweni ngasinye ukuze usize ukuqondisa abanikezeli bemithi ekunqumeni okuqondiswe kumhlahlandlela.

Enye yezindlela ezinhle kakhulu zokulwa nale nkinga iqala elebhu ye-microbiology. Izindawo zokunqamuka eziqondene nomchamo zingasinikeza idatha ethembeke kakhudlwana yokuba sengozini; nokho, lokhu akutholakali kabanzi ngalesi sikhathi.

Izibhedlela eziningi ziye zayeka ukuhlola ukuthambekela kwazo okujwayelekilei-enterococcusumchamo uyahlukanisa futhi ubike konke njengokungenwa kalula yi-aminopenicillin.6 Olunye ucwaningo lwahlola imiphumela yokwelashwa phakathi kweziguli ezilashelwe i-VRE UTI nge-AP antibiotic uma kuqhathaniswa nalezo ezilashwa nge-non-beta-lactam antibiotic.

Kulolu cwaningo, ukwelashwa kwe-AP kubhekwe njengokusebenza kuzo zonke izimo, ngaphandle kokuthi i-ampicillin isengozini. Eqenjini le-AP, i-ejenti ejwayeleke kakhulu ekhethelwe ukwelashwa okuqondile kwakuyi-amoxicillin elandelwa yi-ampicillin efakwa emthanjeni, i-ampicillin-sulbactam, ne-amoxicillin-clavulanate.

Eqenjini elingeyona i-beta-lactam, i-ejenti ejwayeleke kakhulu ekhethelwe ukwelashwa okuqondile kwakuyi-linezolid, elandelwa yi-daptomycin ne-fosfomycin. Izinga lokwelapha emtholampilo laliyiziguli ezingama-83.9% eqenjini le-AP kanye nama-73.3% eqenjini elingelona i-beta-lactam.

Ukwelashwa komtholampilo ngokwelashwa kwe-AP kwabonwa ku-84% wazo zonke izimo kanye naku-86% weziguli ezine-isolates amelana ne-ampicillin, kungekho mehluko wezibalo otholiwe phakathi kwemiphumela yalabo abalashwa ngama-non-β-lactam.