多粘菌素B联合用药对耐碳青霉烯肺炎克雷伯菌体外抗菌活性研究  

Study on antibacterial activity of polymyxin B combination drug against carbapenem-resistant Klebsiella pneumonia in vitro experiments

作　　者：徐玉辉[1] 张诗昊[1] 刘慧 XU Yu-hui;ZHANG Shi-hao;Liu Hui(Ganzhou People’s Hospital,Ganzhou Jiangxi 341000,China)

机构地区：[1]江西省赣州市人民医院,江西赣州341000

出　　处：《中国消毒学杂志》2020年第4期260-262,共3页Chinese Journal of Disinfection

基　　金：江西省卫生厅科技计划项目(20194044)。

摘　　要：目的探讨多粘菌素B联合用药对耐碳青霉烯肺炎克雷伯菌(CRKP)的体外抗菌活性及防耐药突变的作用。方法选择32株CRKP,采用E-test、微量肉汤稀释法检测多粘菌素B单药及联合用药的最低抑菌浓度(MIC),计算部分抑菌浓度指数(FICI);测定单药及联合用药的防突变浓度(MPC),计算选择指数(SI)。结果多粘菌素B联合亚胺培南时MIC50、MIC90分别为1μg/mL、8μg/mL,较多粘菌素B单药时下降4倍、2倍,FICI≤0.5、0.5<FICI≤1的比率为46.9%、53.1%。联合左氧氟沙星时MIC50、MIC90为0.5μg/mL、4μg/mL,较单药时下降8倍、4倍,FICI≤0.5、0.5<FICI≤1比率为40.6%、59.4%。结论多粘菌素B联合用药可以提高对CRKP的抗菌活性,降低对肺炎克雷伯菌的MPC和SI,缩小耐药突变选择窗,最终减少细菌发生耐药突变的可能。Objective To explore the antibacterial activity of polymyxin B combination drug against carbapenem-resistant Klebsiella pneumonia( CRKP) and the effect on drug resistance mutations in vitro. Methods 32 strains of CRKP were selected,the minimum inhibitory concentration( MIC) of polymyxin B single drug and combination drug was detected by E-test and micro broth dilution method,and the fractional inhibitory concentration index( FICI) was calculated;the mutant prevention concentration( MPC) of polymyxin B single drug and combination drug was determined,and the selective index( SI) was calculated. Results MIC50 and MIC90 of polymyxin B combined with imipenem were 1 μg/m L and 8 μg/m L,respectively,and decreased by 4 times and 2 times compared with polymyxin B single drug. The ratios of FICI≤0. 5 and 0. 5< FICI≤1 were 46. 9% and 53. 1%. When combined with levofloxacin,MIC50 and MIC90 were 0. 5 μg/m L and 4 μg/m L,which decreased by 8 times and 4 times compared with single drug. The ratios of FICI ≤0. 5 and 0. 5 < FICI ≤1 were40. 6% and 59. 4%. Conclusion Polymyxin B combination drug can improve the antibacterial activity against CRKP,vreduce the MPC and SI against Klebsiella pneumoniae,narrow the selection window of drug resistance mutations,and ultimately reduce the possibility of drug resistance mutations in bacteria.

关 键 词：多粘菌素B 耐碳青霉烯肺炎克雷伯菌 体外抗菌活性 防耐药突变 

分 类 号：R969[医药卫生—药理学]