耐碳青霉烯类肠杆菌耐药性及联合药敏试验研究  

Resistance and combined drug sensitivity test of carbapenem-resistant Enterobacteriaceae

作　　者：苏爱美 韦涌涛[1] 王东平[1] Aimei Su;Yongtao Wei;Dongping Wang(Department of Clinical Laboratory,Qingdao Eighth People’s Hospital,Qingdao 266100,China)

机构地区：[1]青岛市第八人民医院检验科,青岛市266100

出　　处：《中华实验和临床感染病杂志（电子版）》2023年第5期333-340,共8页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

摘　　要：目的探讨医院耐碳青霉烯类肠杆菌(CRE)耐药性,观察两种抗菌药物联合对产KPC、NDM酶的CRE菌株体外敏感性,筛选有效的抗感染治疗方案。方法收集2022年1月至12月青岛市第八人民医院临床标本中分离的非重复CRE共37株,采用WHONET 5.6软件统计耐药率,微量肉汤稀释法测定抗菌药物对菌株的最低抑菌浓度(MIC),棋盘法对头孢他啶/阿维巴坦(CZA)联合氨曲南(ATM),亚胺培南(IPM)分别联合黏菌素(COL)、替加环素(TGC)、厄他培南(ETP)、头孢他啶(CAZ)、头孢哌酮/舒巴坦(SCF)、阿米卡星(AK)和左氧氟沙星(LEV)进行联合药敏试验,计算部分抑菌浓度指数(FIC)判定协同率与相加率。结果CRE对COL、CZA和TGC的耐药率为0%(0/37)、27.0%(10/37)和35.1%(13/37),对AK和ATM的耐药率为78.4%(29/37)和94.6%(35/37),对头孢曲松(CRO)、CAZ、头孢吡肟(FEP)、环丙沙星(CIP)、LEV、庆大霉素(CN)、氨苄西林/舒巴坦(SAM)、哌拉西林/他唑巴坦(TZP)、SCF、ETP、IPM和美罗培南(MEM)的耐药率均为100%(37/37)。CZA对27株产KPC菌株的MIC均≤1μg/ml,为敏感;对10株产B类金属酶NDM菌株的MIC均>128μg/ml,为耐药,联合ATM后协同率为100%(10/10)。IPM+SCF的协同率为75.7%(28/37),协同率与相加率之和均为100%(37/37)。IPM+AK的协同率与相加率最低,为34.4%(10/29)。KPC酶型菌株中,IPM+SCF的协同率为66.7%(18/27),协同率与相加率之和为100%(27/27),IPM+AK的协同率与相加率之和最低,为28.6%(6/21);NDM酶型菌株中,IPM+SCF的协同率为100%(10/10),IPM+AK的协同率与相加率之和最低,为37.5%(3/8)。所有联合方案均无拮抗作用。结论CZA单独或联合ATM对CRE菌株有效,IPM+SCF的协同率与相加率之和最高,可作为临床经验用药参考。Objective To analyze the drug resistance of carbapenem resistant Enterobacteriaceae(CRE)in hospital,and to observe the susceptibility test result in vitro of the combined two drugs to KPC-and NDM-producing CRE to screen effective anti-inflamation therapy.Methods Total of 37 non-repetitive CRE strains were isolated from clinical specimens from Qingdao Eighth People’s Hospital from January 2022 to December 2022.The drug resistance rate was calculated by whonet 5.6 software.The minimal inhibitory concentration(MIC)of antimicrobial agents against CRE strains was determined by micro broth dilution method.Ceftazidime/avibactam(CZA)combined with aztreonam(ATM),as well as imipenem(IPM)respectively combined with colistin(COL),tigecycline(TGC),ertapenem(ETP),ceftazidime(CAZ),cefoperazone/sulbactam(SCF),amikacin(AK),or levofloxacin(LEV)was performed by the chessboard dilution method.Fractional inhibitory concentration(FIC)index was calculated to determine the synergy rate and additive rate.Results The resistance rates of CRE to COL,TGC and CZA were 0(0/37),27.0%(10/37)and 35.1%(13/37),the resistance rates to AK and ATM were 78.4%(29/37)and 94.6%(35/37),the resistance rates to Ceftriaxone(CRO),CAZ,cefepime(FEP),Ciprofloxacin(CIP),LEV,gentamicin(CN),ampicillin/sulbactam(SAM),piperacillin/tazobactam(TZP),SCF,ETP,IPM and Meropenem(MEM)were 100%(37/37).The MICs of CZA to 27 KPC-producing strains were≤1μg/ml(sensitive),and to 10 class B metallo-enzyme NDM-producing strains were>128μg/ml(resistant),the synergy rate of CZA was 100%(10/10)after combined with ATM.The synergy rate of IPM combined with SCF was the highest(75.7%,28/37),and the sum of synergy rate and addition rate was 100%(37/37).The sum of synergy rate and addition rate of IPM combined with AK was the lowest(34.4%,10/29).Among the KPC enzyme types strains,the synergy rate of IPM combined with SCF was 66.7%(18/27),the sum of synergy rate and addition rate was 100%(27/27).The sum of synergy rate and addition rate of IPM combined with AK was the lowest(28.6%,6/21).A

关 键 词：耐碳青霉烯类肠杆菌 棋盘法 联合药敏 部分抑菌浓度指数 

分 类 号：R446.5[医药卫生—诊断学]