头孢哌酮-舒巴坦联合多黏菌素E等6种抗菌药物对碳青霉烯类耐药鲍曼不动杆菌体外抗菌作用研究  

In vitro synergistic antimicrobial activity of cefoperazone-sulbactam combined with other six antimicrobial agents against carbapenem-resistant Acinetobacter baumannii

作　　者：胡永煜 吴湜 郑永贵 杨洋 郭燕 胡付品 HU Yongyu;WU Shi;ZHENG Yonggui;YANG Yang;GUO Yan;HU Fupin(Institute of Antibiotics,Huashan Hospital,Fudan University,Key Laboratory of Clinical Pharmacology of Antibiotics,National Health Commission,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院抗生素研究所,国家卫健委抗生素临床药理重点实验室,上海200040 [2]平煤神马医疗集团总医院

出　　处：《中国感染与化疗杂志》2022年第2期189-193,共5页Chinese Journal of Infection and Chemotherapy

基　　金：CHINET中国细菌耐药监测网(2018QD099,2018QD100)。

摘　　要：目的研究头孢哌酮-舒巴坦与多黏菌素E、阿米卡星、美罗培南、替加环素、左氧氟沙星和利福平联合用药对碳青霉烯类耐药鲍曼不动杆菌的体外抗菌活性,为治疗碳青霉烯类耐药鲍曼不动杆菌感染提供理论依据。方法取临床分离的碳青霉烯类耐药鲍曼不动杆菌100株,将头孢哌酮-舒巴坦分别与上述6种抗菌药物联合,采用棋盘法对6种联合用药进行药敏试验测定,药敏试验的结果和临床意义以联合抑菌指数(FIC)判断。结果头孢哌酮-舒巴坦联合多黏菌素E对97%碳青霉烯类耐药鲍曼不动杆菌菌株表现出协同或相加作用,两药联合的最低抑菌浓度(MIC)分别为两单药MIC的1/4。头孢哌酮-舒巴坦联合美罗培南对93%的菌株有协同或相加作用,两药联合的MIC分别为两单药MIC的1/4。头孢哌酮-舒巴坦与替加环素联合对4%、49%和47%的菌株产生协同、相加和无关作用。头孢哌酮-舒巴坦与阿米卡星、左氧氟沙星、利福平联合对75%、68%和65%的菌株产生相加作用,头孢哌酮-舒巴坦与这3种药物联合产生协同作用的菌株≤13%。未发现头孢哌酮-舒巴坦与以上6种药物联合发生拮抗作用。结论头孢哌酮-舒巴坦与多黏菌素E、阿米卡星、美罗培南、替加环素、左氧氟沙星和利福平体外联合的药敏试验结果良好,多数具有“协同”或“相加”作用,提示头孢哌酮-舒巴坦与这些药物联合的药敏试验结果可为碳青霉烯类耐药鲍曼不动杆菌感染治疗提供重要的实验室参考依据。Objective To study the in vitro antibacterial activity of cefoperazone-sulbactam combined with amikacin,polymyxin E,meropenem,tigecycline,levofloxacin,or rifampin against carbapenem-resistant Acinetobacter baumannii(CRAB)for better treatment of CRAB infections.Methods The antimicrobial activity of cefoperazone-sulbactam in combination with other antibacterial agent were tested against 100 clinically isolated CRAB strains by checkerboard testing.The results and clinical significance were interpreted in terms of fractional inhibitory concentration(FIC)index.Results The results of antimicrobial synergy study showed that cefoperazone-sulbactam and polymyxin E combination had a synergistic or additive effect on 97%of the CRAB strains,resulting in 1/4 of the MIC values of cefoperazone-sulbactam or polymyxin E alone.Cefoperazone-sulbactam and meropenem combination showed a synergistic or additive effect on 93%of the strains,resulting in 1/4 of the MIC values of cefoperazone-sulbactam or meropenem alone.Cefoperazone-sulbactam and tigecycline combination achieved synergistic,additive,or indifferent effect on 4%,49%and 47%of the strains,respectively.Cefoperazone-sulbactam combined with amikacin,levofloxacin,or rifampicin demonstrated additive effect on 75%,68%,and 65%of the strains,respectively;but achieved synergistic effect on fewer strains(13%).No antagonistic effect was found when cefoperazone-sulbactam was combined with any of the other six antibacterial agents.Conclusions Cefoperazone-sulbactam combined with polymyxin E,amikacin,meropenem,tigecycline,levofloxacin,or rifampicin has good in vitro activity against CRAB strains,evidenced by"synergistic"or"additive"effect on most strains.These results suggest that these cefoperazone-sulbactam combination therapies may be promising for CRAB infections.

关 键 词：碳青霉烯类耐药鲍曼不动杆菌 头孢哌酮-舒巴坦 多黏菌素E 美罗培南 替加环素 阿米卡星 棋盘法 

分 类 号：R378[医药卫生—病原生物学]