左氧氟沙星联合头孢哌酮/舒巴坦对耐碳青霉烯类鲍曼不动杆菌防耐药突变浓度的影响  

The influence of levofloxacin combined with cefoperazone/sulbactam on against carbapenem-resistant acinetobacter baumannii in mutant prevention concentration

作　　者：张欣悦 边锋芝[2] 柳春梅[3] 杨菁 张华金[1] 宫英[1] 孙成春 ZHANG Xin-yue;BIAN Feng-zhi;LIU Chun-mei(Jinan Forth Municipal People's Hospital,Jinan,Shandong 250031,China)

机构地区：[1]济南市第四人民医院药学部,山东济南250031 [2]济南市第四人民医院检验科,山东济南250031 [3]济南市第四人民医院针灸科,山东济南250031 [4]解放军第960医院药剂科

出　　处：《实用医药杂志》2019年第8期737-740,共4页Practical Journal of Medicine & Pharmacy

基　　金：济南市卫计委科技发展计划青年项目(20170215

摘　　要：目的探讨左氧氟沙星(levofloxacin,LVX)、头孢哌酮/舒巴坦(cefoperazone/sulbactam,CFS)单用及联合使用对耐碳青霉烯类鲍曼不动杆菌(carbapenem-resistant Acinetobacter baumannii,CRAB)防耐药突变浓度(mutant prevention concentration,MPC)的影响,为防止细菌耐药的产生提供理论依据。方法采用棋盘法设计,微量肉汤稀释法测定抗菌药物对鲍曼不动杆菌标准菌株ATCC19606和60株临床分离CRAB的最低抑菌浓度(MIC),计算部分抑菌浓度(FIC)指数。用肉汤富集浓度为1013 CFU/L CRAB,采用琼脂平板稀释法测定LVX和CFS单用及联合使用鲍曼不动杆菌对标准菌株ATCC19606和60株临床分离CRAB的MPC,并计算相应的选择指数(SI)。结果 LVX联合CFS后,主要表现为协同和相加作用,无拮抗作用。对鲍曼不动杆菌标准菌株ATCC19606:LVX和CFS联用前后,MPC分别由8.0 mg/L、16.0 mg/L降为1.0 mg/L、2.0 mg/L;SI均下降了7/8,且均有统计学意义。对60株临床分离菌株:LVX和CFS联用前后,MPC分别由64~256 mg/L、128~256 mg/L降为8~64 mg/L、64~128 mg/L;SI均明显下降。结论 LVX与CFS联用后,可降低其单用对CRAB的MPC,缩小耐药突变选择窗,防止耐药突变菌株的产生。Objective To study the influence of mutant prevention concentration(MPC) induced by levofloxacin(LVX) or cefoperazone/sulbactam(CFS) alone and combined with each other against carbapenem-resistant Acinetobacter baumannii(CRAB) in vitro,and provide a theoretical basis for preventing the generation of bacterial resistance. Methods This study was designed by using the checkerborad method. The MIC of antibiotics against standard acinetobacter baumannii strains ATCC19606 and 60 isolates of CRAB was determined by broth microdilution anifungal susceptibility test. The FIC index was calculated. The clinical isolates were enriched in broth,and the bacterial concentration were adjusted to 1013 colony forming units per liter. The MPC of moxifloxacin or cefoperazone/sulbactam alone and combined with each other against standard strains ATCC19606 and 60 clinical CRAB was determined by agar plates dilution method and the corresponding selection index (SI) was calculated. Results Synergistic and addictive came up rather than antagonism after combined application of MFX with CFS. For the standard strains: before and after the combination of LVX and CFS,MPC was reduced from 8mg/L,16mg/L to 1mg/L,2mg/L respectively;The SI of combination therapy compared with monotherapy decreased 7/8. For the 60 clinical CRAB: the MPC of LVX or CFS used alone was 64-256mg/L and 128-256mg/L respectively,it fell to 8-64mg/L and 64-128mg/L after the combined;SI decreased obviously. Conclusion The MPC reduced,mutant selection window less,so preventing the generation of drug-resistant mutants are resuled from combined application of LVX with CFS,compared with applying alone each other.

关 键 词：耐碳青霉烯类鲍曼不动杆菌 防耐药突变浓度 突变选择窗 联合用药 

分 类 号：R969.2[医药卫生—药理学]