舒巴坦联用不同抗菌药物对呼吸道感染的多药耐药鲍氏不动杆菌体外抗菌活性研究  

In vitro activity of sulbactam in combination with different antibiotics against multidrug-resistant Acinetobacter baumannii isolated from respiratory tract specimens

作　　者：周光[1] 佘丹阳[2] 管希周[2] 罗燕萍[1] 陈刚[1] 褚佳琪 李丰田[1] 张樱[1] 

机构地区：[1]解放军总医院微生物科,北京100853 [2]解放军总医院呼吸内科,北京100853

出　　处：《中华医院感染学杂志》2014年第1期81-83,共3页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金青年科学基金项目(81301464);北京自然科学基金面上项目(7122166)

摘　　要：目的评价舒巴坦/亚胺培南、舒巴坦/美罗培南、舒巴坦/米诺环素、舒巴坦/利福平对临床分离自呼吸道感染的105株耐碳青霉烯类鲍氏不动杆菌体外抗菌效应,为临床联合用药提供治疗依据。方法采用棋盘法设计,琼脂稀释法测定不同浓度组合的抗菌药物对105株临床分离的多药耐药鲍氏不动杆菌最低抑菌浓度(MIC),并计算部分抑菌浓度指数(FIC)判定联合效应。结果舒巴坦/亚胺培南、舒巴坦/美罗培南、舒巴坦/米诺环素、舒巴坦/利福平联用后,其MIC50和MIC90降低,联合效应主要表现为相加作用,无拮抗作用,与亚胺培南联用后,相加作用最高86.41%,其次是与美罗培南联用76.19%;部分菌株显示协同作用,其中与米诺环素联用协同作用最高20.19%,其次是与美罗培南联用17.14%。结论舒巴坦与亚胺培南或美罗培南或米诺环素或利福平联用后主要表现为协同和相加作用,对于严重的多药耐药鲍氏不动杆菌感染,可采用高剂量的舒巴坦联合治疗方案。OBJECTIVE To evaluate the in vitro antibacterial effect of sulbactam-imipenem,sulbactam-meropenem, sulbactam-minocycline,or sulbactam-rifampin against 105isolates of carbapenem-resistant Acinetobacter baumannii isolated from respiratory tract specimens so as to provide guidance for the clinical combination use of antibiotics.METHODS By means of checkerboard microdilution method,the agar dilution method was used to determine the minimum inhibitory concentrations（MICs）of different combinations of antibiotics against the 105 clinical isolates of multidrug-resistant A.baumannii,and the fractional inhibitory concentration index（FIC）was calculated to determine the combination effect.RESULTS The MIC50 and MIC90 of sulbactam in combination with imipenem, meropenem,minocycline,or rifampin were significantly reduced;the checkerboard results indicated the additive effect was the main effect among the four combinations and that antagonism was not found in any of the tests;the additive effect reached the highest（86.41%）when it was combined with imipenem,followed by the combination with meropenem（76.19%）.Some of the strains demonstrated the synergistic effect,the synergistic effect of the combination with minocycline reached the highest（20.19%）,followed by the combination with meropenem（17.14%）.CONCLUSION The sulbactam in combination with imipenem,meropenem,minocycline,or rifampin may result in the addictive and synergistic effects;higher dose of sulbactam in combinations is recommended for the treatment of severe multidrug-resistant A.baumannii infection.

关 键 词：鲍氏不动杆菌 舒巴坦 抗菌药物 联合药敏 

分 类 号：R978.1[医药卫生—药品]