2013—2014年50株鲍曼不动杆菌耐药性分析及联合药敏实验研究  

Analysis of drug resistance and combination drug sensitivity test of 50 acinetobacter baumanni strains in 2013-2014

作　　者：曹诗悦[1] 张静萍[1] 张岩岩[1] 朱婉[1] 

机构地区：[1]中国医科大学附属第一医院感染科,辽宁沈阳110001

出　　处：《临床军医杂志》2017年第5期485-492,共8页Clinical Journal of Medical Officers

基　　金：辽宁省科技厅基金资助项目(2013225303)

摘　　要：目的分析鲍曼不动杆菌耐药情况及联合应用抗菌药物,筛选出优化治疗方案,制定广泛耐药鲍曼不动杆菌感染的有效治疗方法,为临床合理应用抗菌药物提供有效依据。方法收集2013—2014年中国医科大学附属第一医院住院患者标本,整理临床资料,对收集的标本进行细菌培养和分离,筛选出50株临床资料完善的鲍曼不动杆菌。采用美国临床和实验室标准协会(CLSI)推荐的琼脂二倍稀释法测定抗菌药物的最低抑菌浓度(MIC)值。根据《中国鲍曼不动杆菌感染诊治与防控专家共识》和《中国鲍曼不动杆菌感染诊治与防控专家共识解读》选择常用药物,并根据CLSI 2012年颁布的抗菌药物临界浓度标准进行耐药性分析。在耐药性分析的基础上,筛选出40株多重耐药鲍曼不动杆菌分离株,分别测定了7种抗菌药物和5种联合用药方案的药敏试验。联合用药方案为:替加环素+头孢哌酮/舒巴坦;多粘菌素+米诺环素;多粘菌素+亚胺培南;多粘菌素+多尼培南;替加环素+亚胺培南。比较联合用药与单独用药的抑菌效果。结果 50株鲍曼不动杆菌主要分布在重症监护室(ICU)、神经外科和普通外科。根据药敏值将50株鲍曼不动杆菌分成非多重耐药鲍曼不动杆菌10株、多重耐药鲍曼不动杆菌40株,其中,40株多重耐药鲍曼不动杆菌中包括广泛耐药鲍曼不动杆菌10株。分离株对米诺环素、替加环素耐药率最低,均为0,多粘菌素2年的耐药率分别为20%和16%。其他抗菌药物耐药率均在50%以上。左氧氟沙星的耐药率分别为56%和64%。2014年头孢哌酮/舒巴坦(2:1)和2013年亚胺培南的耐药率均为96%,为各种抗菌药物耐药率之最高值。联合用药结果显示,在替加环素+头孢哌酮舒巴坦组中,协同作用、相加作用和无关作用分别占7.5%、30.0%和62.5%;多粘菌素+米诺环素组中,协同作用、相加作用和无关作用分别占22.5%、27.5%和50.0%Objective To investigate the combination of antibacterial agents which was used, the optimized therapeutic regimens were screened and effective therapy was established for broad drug resistant acinetobacter baumannii, which provided a basis for a reasonable application of antimicrobial agents in clinic. Methods The samples of the hospitalized patients who were admitted between 2013 and 2014 were collected and clinical data were collated. The bacteria were isolated and cultured from the collected samples and 50 strains of acinetobacter baumannii were screened. The minimal inhibitory concentrations （ MIC ） of the antibiotics were measured using the agar double dilution method recommended by the Clinical and Laboratory Standards Institute（ CLSI）. The common drugs were selected ac- cording to＂ Chinese Expert Consensus for the Diagnosis ,Treatment ,Prevention and Control of Acinetobacter baumannii＂ and＂The Inter- pretation of Chinese Expert Consensus for the Diagnosis, Treatment, Prevention and Control of Acinetobacter banmannii＂ and the drug resistance of the antibiotics was analyzed according to the critical concentration standard antimicrobial drugs issued by CLSI. On the basis of the drug-resistance analysis of acinetobacter baumannii,40 isolates of multi-drug resistant acinetobacter baumannii strains were screened. The 7 antibacterial agents and 5 regimens of combined antibiotics application were assayed for drug sensitivities,respective- ly. The five combined antibiotics application regimens included tigecycline plus cefoperazone/sulbactam ;polymyxin plus minocycline; polymyxin plus imipenem ; polymyxin plus doripenem and tigecycline plus imipenem. The inhibitory effects of alone or combined antibi- otics application on acinetobacter banmannii were compared. Results The 50 strains of Acinetobacter baumannii with intact clinical data were isolated in 2013-2014, which were mainly distributed to the intensive care units （ICU）, the neurosurgery and general surgery departments. The 50 strains of a

关 键 词：鲍曼不动杆菌 多重耐药 广泛耐药 药物敏感性 联合应用抗菌药物 

分 类 号：R515[医药卫生—内科学]