阿奇霉素与其他抗菌药物联用减少铜绿假单胞菌耐药突变体的研究  

Antibiotics combined with azithromycin can reduce the drug resistant mutants of pseudomonas aeruginosa in vitro

作　　者：刘明涛[1] 于瑞丛[2] 孙恩华[2] 毕少杰[1] 李玉[1] 

机构地区：[1]山东大学齐鲁医院呼吸科,济南250012 [2]山东大学齐鲁医院细菌室,济南250012

出　　处：《中国实用内科杂志》2009年第9期824-826,共3页Chinese Journal of Practical Internal Medicine

基　　金：山东省科技攻关项目(2006GG2202013)

摘　　要：目的探讨体外阿奇霉素分别与美罗培南(MEM)、头孢他啶(CAZ)、阿米卡星(AMK)、环丙沙星(CIP)4种抗药物联用,是否有利于减少铜绿假单胞菌耐药突变体的出现。方法2009年2月10日至25日在山东大学齐鲁医院临床检测细菌室,分别应用E-test法测定4种药物及阿奇霉素单药以及联用后对铜绿假单胞菌的最低抑菌浓度(MIC),琼脂平板二倍稀释法测定抗菌药物单药以及联用后防耐药突变浓度(MPC),并计算相应的防耐药突变选择指数SI(SI=MPC/MIC),根据SI下降的程度来判断减少耐药突变体的能力。同时分别测定用MEM、CAZ、环丙沙星分别联合AMK,AMK联合CIP后的SI,比较联合抗菌药物与联合阿奇霉素在防铜绿假单胞菌耐药突变的能力。结果MEM、CAZ、AMK、CIP单药对铜绿假单胞菌SI分别为>32,>32,16,16,与阿奇霉素联合后SI分别为8,16,16,8。MEM、CAZ、CIP分别与AMK联合后的SI分别为4,4,8。AMK与CIP联合后AMK的SI为4。结论MEM、CAZ、CIP分别与阿奇霉素联用时,可以缩小单药应用时对铜绿假单胞菌突变选择窗,有利于减少耐药突变体的产生,但防耐药突变作用大大弱于合AMK。AMK与阿奇霉素联合不能缩小单药的SI,与CIP联合能大大降低AMK的SI。Objective To study whether meropenem（ MEM ）, ceflazidime （ CAZ ）, amikacin （ AMK）, ciprofloxaein （ CIP）, combined with azithromycin will reduce the drug resistant mutants of Pseudomonas aeruginosa in vitro. Methods The alone and combined MIC were determined by E-test. Both alone mutant prevent concentration （MPC）and combined were determined by agar plates dilution method, and then the value of selective index（MPC/MIC） will be acquired. According to the degree that SI drops to determine the capacity in preventing the arise of drug-resistant mutants. Then we determined the SI of MEM, CAZ, CIP combined with AMK,AMK combined with CIP, in order to compare with that of combined azithromycin in capacity of preventing the mutants＇arise. Results The SI of MEM, CAZ,AMK, CIP were 〉 32, 〉 32,16, 16. Combined with azithromycin were8,16,16,8. MEM, CAZ, CIP combined with AMK were 1,4,8. AM K combined with CIP were 4. Conclusion Compared with sole, MEM, CAZ, CIP combined with azithromycin can reduce the MPC and SI of antibiotics alone to pseudomonas aeruginosa and restrain the drug-resistant mutants. But the capacity of preventing mutants arise were weaker than combined with AMK. AMK combined with azithromycin can＇t reduce the SI. But when combined with CIP,the SI of AMK were reduced greatly.

关 键 词：阿奇霉素 铜绿假单胞菌 突变选择指数 

分 类 号：R5[医药卫生—内科学]