耐碳青霉烯大肠埃希菌的体外联合药敏研究  

Study on combined drug sensitivity in vitro of carbapenem-resistant Escherichia coli

作　　者：冯雪君 倪冬英 付琳 周雪 李红胜 FENG Xue-jun;NI Dong-ying;FU Lin;ZHOU Xue;LI Hong-sheng(Clinical Laboratory,the Second Affiliated Hospital of Jiaxing University,Zhejiang 314000,China;不详)

机构地区：[1]嘉兴市第二医院检验科,浙江314000 [2]嘉兴市中医医院检验科

出　　处：《中国卫生检验杂志》2023年第15期1828-1830,1846,共4页Chinese Journal of Health Laboratory Technology

基　　金：嘉兴市科技计划项目(2022AD30033)。

摘　　要：目的评估亚胺培南联合克拉维酸或头孢他啶对耐碳青霉烯大肠埃希菌(CRECO)的体外抗菌作用。方法收集2020年6月—2022年11月全院临床标本分离的33株CRECO,测定16种常用抗菌药物的最低抑菌浓度,通过抑制剂增强试验法初步筛选碳青霉烯酶型,采用棋盘微量肉汤法进行联合药敏试验,计算部分抑菌浓度指数判定联合效果。结果33株CRECO菌株呈现多重耐药,只对黏菌素和替加环素具较好的体外敏感性。碳青霉烯酶型初筛显示90.91%的CRECO产B类金属酶β-内酰胺酶,而产A类碳青霉烯酶占9.09%。棋盘法联合药敏结果显示,亚胺培南与克拉维酸联合药敏前后MIC值下降(P<0.01),对75.76%的CRECO产生协同作用,24.24%存在相加作用,没有发生无关和拮抗作用;亚胺培南与头孢他啶联合药敏前后MIC值下降(P<0.01),相对应有6.06%的协同作用,84.85%的相加作用,9.09%的无关作用,没有发生拮抗作用。结论耐碳青霉烯大肠埃希菌耐药性严重,体外试验显示亚胺培南联合克拉维酸或头孢他啶对其具有协同杀菌或抑菌活性,可以为临床治疗提供参考。Objective This paper aims to evaluate the in vitro antibacterial effect of imipenem combined with clavulanic acid or ceftazidime against carbapenem-resistant Escherichia coli(CRECO).Methods Thirty-three strains of CRECO isolated from clinical specimens of the whole hospital collected from June 2020 to November 2022 to determine the minimum inhibitory concentration of 16 commonly used antibacterial drugs.The enzyme type of carbapenem was screened by inhibitor enhancement test,and the combined drug sensitivity test was carried out by checkerboard microbroth method,and the inhibitory concentration index was calculated to determine the combined effect.Results Thirty-three CRECO strains showed multiple drug resistance,and only had good sensitivity to colistin and tigecycline in vitro.The preliminary screening of carbapenemase type showed that 90.91% of CRECO produced β-lactamase of class B metalloenzyme and 9.09% of carbapenemase of class A.The results of chessboard method showed that the MIC value of imipenem combined with clavulanic acid decreased(P<0.01)before and after the combination of imipenem,and clavulanic acid had a synergistic effect on 75.76% of CRECO,24.24%had an additive effect,and no unrelated or antagonistic effect occurred.The MIC value before and after the combination of imipenem and ceftazidime decreased(P<0.01),with 6.06% synergistic effect,84.85% additive effect,9.09%unrelated effect,and without antagonistic effect.Conclusion Carbapenem-resistant Escherichia coli had serious drug resistance.In vitro tests showed that imipenem combined with clavulanic acid or ceftazidime had synergistic bactericidal or antibacterial activity on it,which could provide reference for clinical treatment.

关 键 词：大肠埃希菌 碳青霉烯酶 体外联合药敏 

分 类 号：R446.5[医药卫生—诊断学]