联合抗菌药物对产AmpC酶鲍曼不动杆菌的应用性研究  

Research of Combined Antimicrobial Agents Against Produced AmpC Engyme Acinetobacter Baumannii.

作　　者：徐修礼[1] 张鹏亮[1] 孙怡群[1] 樊新[1] 刘家云[1] 郝晓柯[1] 

机构地区：[1]第四军医大学西京医院全军临床检验医学中心,西安710032

出　　处：《医学研究杂志》2009年第3期55-58,共4页Journal of Medical Research

摘　　要：目的了解抗菌药物对产AmpC酶鲍曼不动杆菌(ABA)的耐药性以及抗菌药物对ABA的体外联合抗菌活性,为临床治疗产AmpC酶ABA提供合理用药的实验依据。方法常规培养分离细菌,应用VITEK-Ⅱ全自动细菌分析仪鉴定细菌。常规药敏试验采用K-B纸片法,MIC测定采用琼脂平板倍比稀释法,按CLSI规定标准进行。结果75株ABA产AmpC酶的阳性率为42.67%,其中产质粒型AmpC酶的占41.33%,产诱导型AmpC酶的占29.33%;产酶菌株中质粒型AmpC酶的占96.88%,产诱导型AmpC酶的占68.75%,同时产诱导型和质粒型AmpC酶的阳性率占59.38%。产酶菌株对亚胺培南(IPM)、美罗培南(MEM)、多粘菌素B(PL)B的抑菌率分别为84.38%、87.5%和90.63%;阿米卡星联合哌拉西林/他唑巴坦(TZP)、头孢哌酮/舒巴坦(SCF)的协同作用分别为40.63%、34.38%。结论临床对产AmpC酶ABA引起的感染,应慎用碳青霉烯类药物(如IPM或MEM等),建议使用含酶抑制剂复合药物(如TZP或SCF)联合AMK或PLB或米诺环素来治疗,以有效的控制感染和防止耐药株在医院内感染的扩散。Objective To study the drug resistance and antibactial activity in vitro of produced AmpC enzyme Acinetobacter baumannii（ABA） against combined antimicrobial agents in order to provide laboratory data for clinical treatment. Methods All strains were isolated and identified by routine procedure and VITEK -2 automatic bacterial identification instrument. Routine drug susceptibility test used K - B paper method and minimum inhibitory concentration detection used agar dilution method following the instruction and standard of CLSI. Results The positive rates of 75 strains ABA produced AmpC enzyme were 42.67% , of which poduced inducable AmpC enzyme and plasmid AmpC were 41.33% and 29.33% . In 32 strains produced AmpC enzyme ABA, positive rates of produced inducable AmpC enzyme and plasmid AmpC enzyme were 68.75% and 96. 88% ,and produced both inducable AmpC enzyme and plasmid AmpC enzyme 59.38% . The inhibitory bacterial rates of lmipenem,Meropenem and Polymixin B were 78.95% ,73.68% and 90. 63% respectively. The synergy of Piperacilin/Tazobactam,Cefoperazone/sulbactam plus Amikaein were 40. 63% and 34. 38% respectively. Conclusion Clinical use of Carbapenems（ Imipenem or Meraopenem） against produced AmpC enzyme ABA showld be prudent, and we should first select enzyme - inhibitory drug（ Piperacillin/Tazobactam or Cefoperazone/Sulbactam） with Amikacin Polymyxin or polymixin B for treatment in order to avoid the drug resistant chains production and the epidemic of noscomial infection.

关 键 词：鲍曼不动杆菌 AMPC酶 抗菌药物 最低抑菌浓度 联合用药 

分 类 号：R446.5[医药卫生—诊断学] R378[医药卫生—临床医学]