耐碳青霉烯类铜绿假单胞菌的产酶及联合药敏试验  

The analysis of zymogenic state against Carbapenems-resistant Pseudomonas aeruginosa using a susceptibility test

作　　者：叶明[1] 杨喜民[1] 王刚[1] 雷光文[1] 

机构地区：[1]解放军第三医院检验科,陕西宝鸡721004

出　　处：《东南国防医药》2011年第2期135-137,共3页Military Medical Journal of Southeast China

摘　　要：目的研究耐碳青霉烯类铜绿假单胞菌(CR-PA)的产酶现状和抗菌药物的体外联合抗菌活性,为治疗CR-PA感染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。结果从感染的标本中分离出190株铜绿假单胞菌,CR-PA占9.5%,均来自呼吸道标本。其中有10株同时产金属β-内酰胺酶(MBLs)、AmpC酶,4株仅产MBLs。头孢吡肟、头孢派酮/舒巴坦、亚胺培南与阿米卡星的协同率分别为33.3%、61.1%、27.8%。结论 CR-PA主要来源于呼吸道标本,其产酶率高,耐药性严重。建议临床对CR-PA引起的感染应使用含酶抑制剂复合药物(如哌拉西林/他唑巴坦、头孢派酮/舒巴坦)联合阿米卡星来治疗。Objective To analyze the zymogenic state and antimicrobial agent combination activity in vitro test of Carbapenems-resistant Pseudomonas aeruginosa（CR-PA）,in order to provide laboratory data for clinical treatment.Methods All strains were isolated and identified by routine procedure and VITEK-Compact 2 automatic bacterial identification system.Routine antimicrobial susceptibility tests were performed with K-B method and MICs were detected with agar dilution method according to CLSI.Results There were 190 strains Pseudomonas aeruginosa isolated from clinical infectious specimen.CR-PA was 9.47% in all of that came from respiratory tract specimen.There were 10 strains produced Metallo-β-lactmases and AmpC,4 strains produced Metallo-β-lactmases.The synergy rate of Cefpirome,Cefoperazone/Sulbactam,Imipenem plus Amikaein were 33.3%,61.1%,and 27.8% respectively.Conclusion CR-PA mostly came from respiratory tract specimen.The zymogenic rates and drug resistance of CR-PA were high,mostly due to multiplex drug-resistance mechanism.Clinical treatment should first select enzyme-inhibitory drugs（Piperacillin/Tazobactam or Cefoperazone/ sulbactam） combined with Amikacin against CR-PA.

关 键 词：耐碳青霉烯类铜绿假单胞菌 抗生素 金属Β-内酰胺酶 AMPC酶 最低抑菌浓度 联合用药 

分 类 号：R978.1[医药卫生—药品]