替加环素对肺炎克雷伯菌的防耐药突变浓度研究  

Research on the mutant prevention concentration of tigecycline for Klebsiella pneumoniae

作　　者：钟雪[1] 陈东科[2] 许宏涛[2] 冯婉玉[1] 

机构地区：[1]北京大学人民医院药剂科,北京100044 [2]北京医院检验科

出　　处：《中国感染与化疗杂志》2017年第6期643-647,共5页Chinese Journal of Infection and Chemotherapy

摘　　要：目的考察替加环素对肺炎克雷伯菌的潜在耐药性。方法测定替加环素对于药敏背景不同的肺炎克雷伯菌防突变浓度(MPC)和最低抑菌浓度(MIC)。比较MIC与MPC之间的相关性,考察是否能用MIC推测MPC值。结合MPC和防耐药突变窗(MSW)与替加环素药动学参数评估替加环素单药治疗对于肺炎克雷伯菌的潜在耐药性。结果碳青霉烯类耐药、喹诺酮类耐药组肺炎克雷伯菌对替加环素的MPC较碳青霉烯类敏感、喹诺酮类敏感组高出8倍。替加环素对于肺炎克雷伯菌的MPC范围在4~512 mg/L,MPC90为64 mg/L,远高于替加环素血药浓度。结论替加环素长期单药治疗对于肺炎克雷伯菌的潜在耐药率较高,不宜单独使用,提示临床应加强监测替加环素菌株敏感性及替加环素疗效。Objective To investigate the potential tigecycline resistance of Klebsiella pneumoniae during treatment. Methods The minimum inhibitory concentrations(MICs) and the mutant prevention concentrations(MPCs) of tigecycline were determined for K. pneumoniae isolates with four different resistant profiles. Correlations between MICs and MPCs were analyzed. We combined with the pharmacokinetic parameters of tigecycline to estimate the potential of emerging resistance to tigecycline monotherapy in K. pneumoniae. Results The MPCs of tigecycline for the carbapenem-and fluoroquinolone-resistant isolates were found to be 8-fold higher than those for carbapenem-and quinolones-susceptible isolates. Our data showed that the MPCs range and MPC90 values of tigecycline were 4-512 mg/L and 64 mg/L, respectively, which were much higher than the therapeutic concentrations of tigecycline in serum and tissues. Conclusions Long-term tigecycline monotherapy may predispose the emergence of resistance in K. pneumoniae, which is not recommended. It is desirable to carry out ongoing monitoring of K. pneumoniae susceptibility and tigecycline treatment effect.

关 键 词：替加环素 肺炎克雷伯菌 防耐药突变浓度 

分 类 号：R446.5[医药卫生—诊断学]