Two hundred and seven clinical isolates of Pseudomonas aeruginosa were collected at Tenri Hospital between April 2003 and March 2004. We determined the minimum inhibitory concentration (MIC) of 16 antimicrobial agents, including prulifloxacin, pazufloxacin and biapenem which were recently published in Japan, against these isolates according to the guidelines of the Clinical and Laboratory Standards Institute. For the fluoroquinolones, the rank order of activity was prulifloxacin (MIC₅₀, 0.5μg/ml) >ciprofloxacin (1μg/ml) > pazufloxacin (2μs/ml) =levofloxacin (2μg/ml) >gatifloxacin (4μg/ml). For the carbapenems, the rank order of activity was meropenem (MIC50, 1μg/ml) =biapenem (1μ) >imipenem (2μg/m) >panipenem (8μg/ml). For the cephalosporins and monobactam, the overall rank order of activity was cefozopran (MIC50, 4μg/ml) = ceftazidime (4μg/ml) >cefepime (8μg/ml) =piperacillin/tazobactam (8μg/ml) >aztreonam (16μg/ml) =cefoperazone/sulbactam (16μg/ml) =cefpirome (16μg/ml). The rates of susceptibility to antimicrobial agents as per the criteria of the Japanese Society of Antimicrobial Chemotherapy were especially high for cefozopran (63%), biapenem and meropenem (61%), and pazufloxacin (53%) and ciprofloxacin (53%). These findings suggest that prulifloxacin, pazufloxacin and biapenem, which are newly introduced, are clinically effective in the treatment of infection caused with P. aeruginosa.

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It is important to take into consideration the duration for which the plasma concentration of the drug is higher than the Minimal Inhibitory Concentration during treatment with carbapenem antibiotics, because the antibiotics are time-dependent drugs. A preliminary study of the administration of carbapenem antibiotics on the basis of the pharmacokinetics/pharmacodynamics (PK/PD) was conducted.
Subjects: Ten patients with intraabdominal infection.
Methods: The patients were divided into two groups: the first group was assigned to administration of acarbapenem antibiotic (meropenem) at a daily dose of 0.5 g in 3 divided doses, each dose by intravenous infusion over 3 hours (Group 3 H), and the other group was assigned to administration of each dose over 30 minutes (Group 30 M). The body temperature (BT), white blood cell count (WBC), serum C-reactive protein (CRP) level, and the systemic inflammatory reactive syndrome (SIRS) score before and 96 hours after the drug administration were compared between Group 3 H and Group 30 M.
Results: There were 5 patients (mean age, 67.4±14.6 years) in Group 3 H and 5 patients (mean age, 60.0±12.8 years) in Group 30 M. The evaluated parameters (BT, WBC, CRP, SIRS score) before the drug administration in Groups 3 H and 30 M were not significant. Group 3 H showed significant decreases in the SIRS scores at 96 hours after the drug administration, however, there were no significant differences in the BT, WBC or CRP between the two groups.
Discussion: Group 3 H showed early improvement in the SIRS scores. Administration of carbapenem antibiotics based on the PK/PD is important, and requires further studies.

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Antimicrobial susceptibility of 13 antimicrobial drugs for the injection and O-group antigen serotype were measured for the 766 Pseudomonas aeruginosa strains that had been isolated from various clinical materials in 29 facilities in the Hyogo prefecture from April to September in 2004. Metallo β-lactamase detection was also performed. The antimicrobial activity was excellent in the order of GM, MEPM, AMK, CPFX and CAZ. Susceptible category of the breakpoint by National Committee for Clinical Laboratory Standards (CLSI/NCCLS) was excellent in the order of AMK, GM, PIPC, CZOP, and MEPM. As for the susceptibility of Carbapenem, it is confirmed that susceptible of MEPM was detected in 47 strains (36.4%) and metallo β-lactamase producing P aeruginosa was in 3 strains (0.4%) and multi-drug resistant P aeruginosa were in 7 strains only (0.9%) among 129 strains of the IPM resistant (I or R). The results of the susceptibility test against P aeruginosa were different in each facility, but there were several stocks having the identical O-antigen serotype and anti-biogram pattern in some facilities. The nosocomial infection measures including the antimicrobial propriety use are necessary.

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[in Japanese]

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