尿液pH对常见泌尿系感染细菌抗生素敏感性的影响
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摘要
目的探讨尿液pH对常见泌尿系感染细菌抗生素敏感性的影响。方法配制不同pH的人工尿液,以大肠杆菌、表皮葡萄球菌、金黄色葡萄球菌、产超广谱β-内酰胺酶(extended-spectrumβ-lactamases,ESBL)的肺炎克雷伯菌和产ESBL的铜绿假单胞菌为研究菌种,环丙沙星、左氧氟沙星、磷霉素氨丁三醇和头孢呋辛为研究药物,采用药敏试验中的微量肉汤稀释法比较不同抗生素在不同pH的人工尿液培养基中的抗菌效力。结果环丙沙星对大肠杆菌、表皮葡萄球菌和产ESBL的肺炎克雷伯菌的抗菌效果随着pH升高而升高;左氧氟沙星对大肠杆菌和表皮葡萄球菌的抗菌效果亦随着pH升高而升高;磷霉素对大肠杆菌、表皮葡萄球菌和金黄色葡萄球菌的抗菌效果随着pH的升高而降低;头孢呋辛对大肠杆菌和金黄色葡萄球菌的抗菌效果亦随着pH的升高而降低。结论通过调节尿液pH能够改变致病菌对抗生素的敏感性,以期在临床上提高抗生素对泌尿系感染的治疗效果。
Objective To investigate the effect of urinary pH on bacterial antibiotics susceptibility to common urinary tract infections.Methods Artificial urine with different pH was prepared E.coli,Staphylococcus epidermidis,Staphylococcus aureus,ESBL-producing Klebsiella pneumoniae and ESBL-producing Pseudomonas aeruginosa were selected as the study species,while ciprofloxacin,levofloxacin,fosfomycin and cefuroxime were as the research antibiotics.The micro-broth dilution method in the susceptibility test was conducted to study the antibacterial efficacy of different antibiotics on the different bacteria in the artificial urine medium with different pH values.Results The antibacterial effects of ciprofloxacin on Escherichia coli,Staphylococcus epidermidis and ESBL-producing Klebsiella pneumoniae were enhanced with the increase of pH.The antibacterial effects of levofloxacin on Escherichia coli and Staphylococcus epidermidis were enhanced with the increase of pH too.Whereas when using fosfomycin in the treatment of E.coli,Staphylococcus epidermidis and Staphylococcus aureus,the lower the pH was,the higher the antibacterial activity was.And the antibacterial activity of cefuroxime on E.coli and Staphylococcus aureus decreased with the increase of pH.Conclusion The sensitivity of pathogenic bacteria to antibiotics can be changed by adjusting urinary pH,in order to improve the therapeutic effect of antibiotics on urinary tract infection in the clinic.
Objective To investigate the effect of urinary pH on bacterial antibiotics susceptibility to common urinary tract infections.Methods Artificial urine with different pH was prepared E.coli,Staphylococcus epidermidis,Staphylococcus aureus,ESBL-producing Klebsiella pneumoniae and ESBL-producing Pseudomonas aeruginosa were selected as the study species,while ciprofloxacin,levofloxacin,fosfomycin and cefuroxime were as the research antibiotics.The micro-broth dilution method in the susceptibility test was conducted to study the antibacterial efficacy of different antibiotics on the different bacteria in the artificial urine medium with different pH values.Results The antibacterial effects of ciprofloxacin on Escherichia coli,Staphylococcus epidermidis and ESBL-producing Klebsiella pneumoniae were enhanced with the increase of pH.The antibacterial effects of levofloxacin on Escherichia coli and Staphylococcus epidermidis were enhanced with the increase of pH too.Whereas when using fosfomycin in the treatment of E.coli,Staphylococcus epidermidis and Staphylococcus aureus,the lower the pH was,the higher the antibacterial activity was.And the antibacterial activity of cefuroxime on E.coli and Staphylococcus aureus decreased with the increase of pH.Conclusion The sensitivity of pathogenic bacteria to antibiotics can be changed by adjusting urinary pH,in order to improve the therapeutic effect of antibiotics on urinary tract infection in the clinic.
引文
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[11] 祝丹.复杂尿路感染常见致病菌的分布及抗菌药物的应用[J].中华实验和临床感染病杂志(电子版),2016,10(2):223-226.
[12] 李健,王晶.左氧氟沙星与环丙沙星对泌尿系统感染患者的临床疗效及尿中菌落数清除的比较[J].抗感染药学,2018,15(3):448-450.
[13] 赵莹,李欣欣.磷霉素氨丁三醇耐药分析及其对尿路感染作用[J].现代仪器与医疗,2016,22(2):116-118.
[14] 戴丽,施国农,夏立义,等.2013-2016年头孢类抗菌药物临床用药分析[J].中华医院感染学杂志,2017,27(23):5315-5317,5321.
[15] 石磊,段博文,高进贤,等.大肠埃希菌对喹诺酮类药物的耐药机制分析[J].中华医院感染学杂志,2017,27(20):4568-4571.
[2] Gerber GS,Brendler C.Evaluation of the urologic patient:history,physical examination,and urinalysis[EB/OL].[2019-05-24].https://abdominalkey.com/evaluation-of-the-urologic-patient-history-physical-examination-and-urinalysis/.
[3] 周江宁.检测尿液pH值对院内尿路感染指导性用药的应用[J].江西医学检验,2007,25(2):186-186.
[4] 周鹏,卢根生,张庆华,等.尿路感染致病菌分布及尿液pH值改变在临床防治中的作用[J].第三军医大学学报,2010,32(10):1099-1101.
[5] Yang L,Wang KJ,Li H,et al.The influence of urinary pH on antibiotic efficacy against bacterial uropathogens[J].Urology,2014,84(3):e1-731.
[6] Clinical and Laboratory Standards Institute.M100 Performance standards for antimicrobial susceptibility testing,26th edition[S].Wayne:Clinical and Laboratory Standards Institute,2016.
[7] 马华兰,付晓,黄俊,等.医院内泌尿系统感染病原菌分布及耐药性分析[J].中华医院感染学杂志,2013,23(13):3274-3275.
[8] 解泽强,陈亮,张曼.2009-2015年泌尿系感染病原菌种类构成及耐药性变迁[J].中华医院感染学杂志,2017,27(13):2991-2994.
[9] 李丽荣,姜皓,李岩,等.泌尿系感染患者病原菌分布及耐药现状分析[J].中国实验诊断学,2018,22(9):1572-1574.
[10] 胡付品,郭燕,朱德妹,等.2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[11] 祝丹.复杂尿路感染常见致病菌的分布及抗菌药物的应用[J].中华实验和临床感染病杂志(电子版),2016,10(2):223-226.
[12] 李健,王晶.左氧氟沙星与环丙沙星对泌尿系统感染患者的临床疗效及尿中菌落数清除的比较[J].抗感染药学,2018,15(3):448-450.
[13] 赵莹,李欣欣.磷霉素氨丁三醇耐药分析及其对尿路感染作用[J].现代仪器与医疗,2016,22(2):116-118.
[14] 戴丽,施国农,夏立义,等.2013-2016年头孢类抗菌药物临床用药分析[J].中华医院感染学杂志,2017,27(23):5315-5317,5321.
[15] 石磊,段博文,高进贤,等.大肠埃希菌对喹诺酮类药物的耐药机制分析[J].中华医院感染学杂志,2017,27(20):4568-4571.