临床常用抗菌药物组合对耐碳青霉烯类肺炎克雷伯菌的体外抗菌作用  

Antibacterial effect in vitro of antibacterial drug combinations commonly used in clinic for carbapenem resistant Klebsiella pneumonia

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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)

机构地区:[1]江西省赣州市第五人民医院,341000

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 

分 类 号:R978[医药卫生—药品]

 

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