氟喹诺酮类药物体外诱导铜绿假单胞菌耐药性的研究  

Drug resistance of Pseudomonas aeruginosa in vitro evoked by fluoroquinolones

作　　者：张瑞琴[1] 康建邦[1] 李晓霞[1] 尹冬虹[1] 高雅婷[2] 张智琪[2] 段金菊[1] 侯锐钢[1] 

机构地区：[1]山西医科大学第二医院药学部,太原030001 [2]山西医科大学研究生院药学系,太原030001

出　　处：《药物不良反应杂志》2017年第2期103-108,共6页Adverse Drug Reactions Journal

基　　金：山西省卫生和计划生育委员会科技攻关项目（2015047）

摘　　要：目的 比较铜绿假单胞菌（PA）经不同浓度环丙沙星（CIP）、左氧氟沙星（LEV）和诺氟沙星（NOR）体外共培养后耐药性的变化,从中优选治疗PA感染的药物.方法 将0.5、1.0、2.0和4.0倍最小抑菌浓度（MIC）的CIP、LEV、NOR分别与对CIP、LEV、NOR敏感且MIC基本相同的 7株临床分离非重复PA共培养,进行体外诱导耐药试验.采用E试验法和琼脂稀释法测定CIP、LEV、NOR对不同浓度药物诱导耐药后PA的MIC.结果 CIP对经不同浓度CIP、LEV、NOR诱导耐药后PA的MIC由诱导前的0.09 μg/ml 升至0.25~16.00 μg/ml （3~178倍）,NOR由诱导前的0.50 μg/ml 升至2.00~64.00 μg/ml（4~128倍）,LEV由诱导前的0.50 μg/ml 升至2.00~32.00 μg/ml（2~64倍）.CIP对经不同浓度CIP、NOR和LEV诱导耐药后对PA的MIC差异无统计学意义（P〉0.05）;NOR对浓度为4.0倍MIC的CIP诱导后PA的MIC明显高于诱导浓度为0.5倍MIC CIP诱导后PA的MIC（P=0.006）,NOR对浓度为4.0倍MIC的LEV诱导后PA的MIC明显高于浓度为1.0倍MIC LEV诱导后PA的MIC（P=0.006）;LEV对浓度为2.0倍MIC的CIP诱导后PA的MIC明显高于浓度为0.5倍MIC CIP诱导后PA的MIC（均P=0.006）;LEV对浓度为4.0倍MIC的NOR和LEV诱导后PA的MIC明显高于浓度为0.5倍MIC NOR和LEV诱导后PA的MIC（均P=0.007）.结论 PA与不同浓度CIP、LEV、NOR共培养后可出现不同程度的耐药,CIP的耐药性变化最小,提示CIP仍是治疗PA的优选氟喹诺酮类药物之一.Objective To observe and compare the resistance changes of ciprofloxacin （CIP）, levofloxacin （LEV）, norfloxacin （NOR） to Pseudomonas aeruginosa （PA）, and choose the drug which had the best curative effect for PA from the drugs mentioned above.Methods Seven strain of non-repetitive PA which had sensitiveness to ciprofloxacin （CIP）, levofloxacin （LEV）, norfloxacin （NOR） and the same minimal inhibitory concentration （MIC） of the three drugs were co-cultured with CIP, LEV, NOR in concentrations of 0.5, 1.0, 2.0, and 4.0 times of MIC for evoked drug resistance, respectively.The MIC of CIP, LEV, and NOR to PA which evoked drug resistance by 3 kinds of concentration were detected by the methods of Epsilometer Test and Two-fold Agar Dilution.Results The MIC value of CIP to PA after evoking by 3 concentrations increased from 0.09 μg/ml before evoking to 0.25-16.00 μg/ml.The MIC after evoking was 3 to 178 times that before evoking.The MIC value of NOR to PA after evoking increased from 0.50 μg/ml before evoking to 2.00-64.00 μg/ml.The MIC after evoking was 4 to 128 times that before evoking.The MIC value of LEV to PA after evoking by 3 concentrations increased from 0.50 μg/ml before evoking to 2.00-32.00 μg/ml.The MIC after evoking was 2 to 64 times that before evoking.The differences of MIC of CIP to PA after evoking by different concentrations of CIP, NOR and LEV were not statistically significant （all P〉0.05）.The MIC value of NOR to PA after evoking by 4.0＆#215;MIC CIP was higher than that of evoking by 0.5＆#215;MIC CIP （P=0.006）.The MIC value of NOR to PA after evoking by 4.0＆#215;MIC LEV was higher than that evoked by 1.0＆#215;MIC LEP （P=0.006）.The MIC value of LEV to PA after evoking by 4.0＆#215;MIC CIP was higher than that of evoking by 0.5＆#215;MIC CIP （P=0.006）.The MIC value of LEV to PA after evoking by 4.0＆#215;MIC NOR and LEV were higher than those evoked by 0.5＆#215;MIC NOR and LEV （all P=0.007）.Conclusion PA can be evoked to develop r

关 键 词：铜绿假单胞菌 喹诺酮类 抗药性 微生物敏感性试验 

分 类 号：R446.5[医药卫生—诊断学]