碳青霉烯类联合黏菌素对耐药阴沟肠杆菌复合群的体外抗菌活性评估  

Evaluation of in vitro antibacterial activity of carbapenems combined with colistin against drug-resistant Enterobacter cloacae complex

作　　者：徐春泉[1] 方人驰 曾未良 刘世星 林奕帅 陈丽琼[1] 周铁丽[1] Xu Chunquan;Fang Renchi;Zeng Weiliang;Liu Shixing;Lin Yishuai;Chen Liqiong;Zhou Tieli(Laboratory Medicine Center,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China;Laboratory Medicine Center,the First Affiliated Hospital College of Medicine,Zhejiang University,Hangzhou 310003,China;School of Laboratory Medicine and Life Sciences,Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第一医院医学检验中心,325000 [2]浙江大学医学院附属第一医院检验科,310003 [3]温州医科大学检验医学院生命科学学院,325000

出　　处：《中华微生物学和免疫学杂志》2020年第12期898-902,共5页Chinese Journal of Microbiology and Immunology

摘　　要：目的研究黏菌素与3种碳青霉烯类药物分别联用时对碳青霉烯类和黏菌素共同耐药阴沟肠杆菌复合群的体外抗菌活性。方法收集2011—2018年间自温州医科大学附属第一医院临床患者各类标本中分离的阴沟肠杆菌复合群菌株,Vitek 2-Compact全自动微生物分析仪检测菌株对临床常用抗菌药物的敏感性;共筛选出对碳青霉烯类和黏菌素共同耐药的阴沟肠杆菌复合群菌株19株,采用琼脂稀释法检测碳青霉烯类和黏菌素对19株菌株的最低抑菌浓度(MIC),微量棋盘稀释法评估黏菌素分别与3种碳青霉烯类药物联用对碳青霉烯类和黏菌素共同耐药阴沟肠杆菌复合群菌株的体外抗菌活性。结果19株菌株对一、三代头孢菌素的耐药率均高于90%;对厄他培南、美罗培南和亚胺培南的耐药率分别为100%、26.3%和31.6%;黏菌素与亚胺培南、美罗培南和厄他培南对阴沟肠杆菌复合群的联合用药主要表现为协同作用或相加作用,美罗培南/黏菌素与亚胺培南/黏菌素组合各对1株菌株表现为无关作用。结论碳青霉烯类与黏菌素的联合使用对碳青霉烯类和黏菌素共同耐药阴沟肠杆菌复合群具有较好的作用效果,可作为此类多重耐药菌株感染的潜在治疗策略。Objective To study the in vitro antibacterial activity of three carbapenems in combination with colistin against Enterobacter cloacae complex resistant to both carbapenems and colistin.Methods Strains of the Enterobacter cloacae complex were isolated from various clinical specimens in the First Affiliated Hospital of Wenzhou Medical University from 2011 to 2018.Their susceptibility to common antimicrobials was detected by Vitek 2-Compact automatic microbial analyzer.A total of 19 isolates of the Enterobacter cloacae complex that were resistant to carbapenems and colistin were screened out.The minimum inhibitory concentrations of carbapenems and colistin to the 19 isolates were detected with agar dilution method.Checkerboard method was used to evaluate the in vitro antibacterial activity of three combination therapy strategies to the co-resistant Enterobacter cloacae complex.Results The resistance rates of the 19 strains to the first-and third-generation cephalosporins were higher than 90%.Their resistance rates to ertapenem,meropenem and imipenem were 100%,26.3%and 31.6%,respectively.The combined effect of colistin with imipenem,meropenem or ertapenem on the Enterobacter cloacae complex was mainly synergistic or additive.Both meropenem and imipenem combined with colistin showed unrelated effect to one strain.Conclusions The combination of carbapenems with colistin had better antibacterial effects on the Enterobacter cloacae complex resistant to both carbapenems and colistin,suggesting a potential treatment strategy for infections caused by multidrug-resistant Enterobacter cloacae complex.

关 键 词：碳青霉烯类 黏菌素 阴沟肠杆菌复合群 联合治疗 

分 类 号：R446.5[医药卫生—诊断学]