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作 者:王元春 张丽华 吴庆荣 杨建林 卓倩 WANG Yuanchun;ZHANG Lihua;WU Qingrong;YANG Jianlin;ZHUO Qian(Ganzhou Fifth People′s Hospital,Jiangxi Province,Ganzhou 341000,China)
出 处:《临床合理用药杂志》2023年第30期33-37,共5页Chinese Journal of Clinical Rational Drug Use
基 金:赣州市科技局指导性计划项目(GZ2020ZSF301)。
摘 要:目的 评价临床常用抗菌药物组合对耐碳青霉烯类肺炎克雷伯菌(CRKP)的体外抗菌作用。方法 选取2018年6月—2019年10月赣州市第五人民医院临床分离的7株非重复CRKP菌株,应用WalkAway-96 plus细菌鉴定及药敏分析系统及PCR技术鉴定临床分离出的非重复CRKP及其耐药基因情况并测序;应用微量肉汤稀释法检测6种药物的最低抑菌浓度(MIC),进一步应用微量棋盘法分别检测和计算药物组合的联合抑菌指数(FICI)。结果 7株菌株均为产肺炎克雷伯菌碳青霉烯酶(KPC)的肺炎克雷伯菌,测序结果也证实为KPC基因,同时体外抗菌活性实验结果表明,多黏菌素B与亚胺培南、米诺环素、替加环素、多西环素联合的FICI均≤0.5,显示出明显协同作用;而亚胺培南与多西环素、替加环素联合的FICI均>2.0,显示出拮抗作用。结论 多黏菌素B联合亚胺培南/替加环素/米诺环素/多西环素对CRKP具有较好的抗菌活性,而亚胺培南联合米诺环素/多西环素/替加环素对CRKP的抗菌活性未改变或者降低。Objective To evaluate the antibacterial effect in vitro of antibacterial drug combinations commonly used in clinic for CRKP.Methods Seven non-repeat strains clinically isolated in Ganzhou Fifth People′s Hospital from June 2018 to October 2019 were collected,and their drug resistance gene profiles were identified and sequenced by applying WalkAway-96 plus Bacterial Identification and Drug Sensitivity Analysis System and PCR technology;The MIC of the 6 kinds of drugs were measured by micro-broth dilution method,and the FICI of the drug combinations was further measured and calculated separately by the micro-checkerboard method.Results Seven strains were all KPC-producing Klebsiella pneumonia and the sequencing results also confirmed the KPC gene.In vitro antibacterial activity studies also showed that,the combination of polymyxin B with imipenem,minocycline,tigecycline and doxycycline showed a significant synergistic effect with FICI≤0.5,respectively,while the combination of imipenem with doxycycline and tigecycline showed an antagonistic effect with FICI>2.0,respectively.Conclusion The combination of polymyxin B and imipenem/tiglicycline/minocycline/doxycycline show better antibacterial activity against CRKP,whereas the antibacterial activity is unchanged or reduced when imipenem combined with minocycline/doxycycline/tiglicycline.
关 键 词:耐碳青霉烯类肺炎克雷伯菌 肺炎克雷伯菌 抗菌药物 联合用药 抗菌活性
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