利福平、利奈唑胺与糖肽类抗生素对预防耐甲氧西林金黄色葡萄球菌耐药的比较  

Pharmacodynamic investigation of rifampicin , linezolid and glycopeptide antibiotics against methicillin-resistant Staphylococcus aureus

作　　者：尹琦[1] 张雯雁[1] 叶杨芹[1] 沈李花[1] 毛培文[1] 梁永杰[1] 

机构地区：[1]同济大学附属东方医院呼吸内科,上海200127

出　　处：《上海医学》2013年第1期27-29,共3页Shanghai Medical Journal

基　　金：上海市医学会临床医学科研专项资金资助项目(SMJ2010007)

摘　　要：目的比较万古霉素、替考拉宁、利奈唑胺和利福平对耐甲氧西林金黄色葡萄球菌(MRSA)的防耐药突变选择能力。方法采用E-test法和混菌法(接种细菌浓度>1×1010CFU/mL)测定4种抗生素对MRSA的最低抑菌浓度(MIC)和预防耐药(突变)浓度(MPC),比较4种抗生素的MPC/MIC比值,即选择指数(SI);并结合最大血清浓度(Cmax),比较MPC/目标Cmax比值。结果万古霉素、替考拉宁、利奈唑胺、利福平对MRSA的MIC值分别为0.5、1.0、0.5、≤0.5μg/mL,对MRSA的MPC值分别为51.2、25.6、9.6、>1024.0μg/mL,SI值分别为102.4、25.6、19.2、>2048.0,MPC/目标Cmax比值分别为1.28、0.57、0.64、>107.80。结论利奈唑胺、替考拉宁较万古霉素、利福平对MRSA的"突变选择窗"较窄,在预防细菌产生耐药突变方面有较明显的优势。Objective To compare the selective power Of anti-drug-resistant mutant of vancomycin, teicoplanin, linezolid and rifampicin to methicillin-resistant Staphylococcus aureus （MRSA）. Methods The minimum inhibitory concentration （MIC） to MRSA was determined by E-test method. Mutant prevention concentration （MPC） was measured by mix-bacterial method （the inoculated bacterial concentration 〉 1 × 10^10 CFU/mL）. Selection index （MPC/MIC） and the ratio of MPC to target maximum serum concentration （MPC/Cmax） of the four antibiotics were compared. Results MIC values of vancomycin, teicoplanin, linezolid and rifampin against MRSA were 0.5, 1.0, 0.5 and ≤0.5 μg/ml; MPC values were 51.2, 25.6, 9.6 and 〉 1 024.0 μg/mL; Selection indices were 102.4, 25.6, 19.2 and 〉2 048.0; MPO/Omax were 1.28, 0.57, 0.64 and 〉 107.80, respectively. Conclusion Linezolid and teicoplanin have narrower mutant selection window than vancomycin and rifampin, and they have obvious advantages in preventing bacterial antibiotic resistance.

关 键 词：万古霉素 替考拉宁 利奈唑胺 利福平 耐甲氧西林金黄色葡萄球菌 最低抑菌浓度 预防耐药(突变)浓度 突变选择窗 选择指数 

分 类 号：R446.5[医药卫生—诊断学]