耐碳青霉烯类铜绿假单胞菌耐药性及联合药敏试验研究  

Resistance and combination drug sensitivity test of carbapenem-resistant Pseudomonas aeruginosa

作　　者：韦涌涛[1] 王松霞[2] 苏爱美 王东平[1] Wei Yongtao;Wang Songxia;Su Aimei;Wang Dongping(Department of Clinical Laboratory,Qingdao Eighth People’s Hospital,Qingdao 266100,China;Department of Blood Transfusion,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 [2]青岛市第八人民医院输血科,青岛市266100

出　　处：《中华实验和临床感染病杂志（电子版）》2024年第1期43-48,共6页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

摘　　要：目的分析耐碳青霉烯类铜绿假单胞菌(CRPA)耐药性,探讨黏菌素(COL)分别联合美罗培南(MEM)、头孢他啶(CAZ)、哌拉西林/他唑巴坦(TZP)及环丙沙星(CIP),阿米卡星(AK)分别联合TZP和CIP,TZP联合CIP对CRPA体外联合药物敏感性,筛选出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样本中分离的非重复CRPA共22株,采用微量肉汤稀释法测定抗菌药物对菌株的最低抑菌浓度(MIC),棋盘法进行联合药敏试验,计算部分抑菌浓度指数(FIC)判定联合效果。结果22株CRPA对哌拉西林(PRL)、头孢哌酮/舒巴坦(SCF)、氨曲南(ATM)、亚胺培南(IPM)和MEM 5种抗菌药物耐药率均>90%,对头孢吡肟(FEP)、TZP、左氧氟沙星(LEV)、CAZ、CIP、庆大霉素(CN)、妥布霉素(TOB)及AK耐药率分别为81.8%(18/22)、77.3%(17/22)、77.3%(17/22)、72.7%(16/22)、68.2%(15/22)、63.6%(14/22)、63.6%(14/22)和54.5%(12/22),对头孢他啶/阿维巴坦(CZA)耐药率为9.1%(2/22),对COL耐药率为0(0/22)。CRPA联合药敏显示:COL+MEM协同率为59.1%(13/22),协同率与相加率之和为100%(22/22)。COL+CAZ、COL+TZP、COL+CIP、AK+TZP、AK+CIP及TZP+CIP协同率分别为45.4%(10/22)、54.5%(12/22)、31.8%(7/22)、22.7%(5/22)、31.8%(7/22)和9.1%(2/22),协同率与相加率之和分别为81.8%(18/22)、90.9%(20/22)、77.3%(17/22)、77.3%(17/22)、68.2%(15/22)和59.1%(13/22),所有组合均未出现拮抗作用。结论CZA可单药用于CRPA敏感株,联合用药组中,COL+MEM组合的协同率与相加率最高,TZP+CIP协同率与相加率之和最低,可作为临床经验用药参考。Objective To analyze drug resistance of carbapenem resistant Pseudomonas aeruginosa(CRPA),and to investigate the in vitro susceptibility test result of colistin(COL)combined with meropenem(MEM),ceftazidime(CAZ),piperacillin/tazobactam(TZP),ciprofloxacin(CIP)and amikacin(AK)combined with TZP,CIP and TZP combined with CIP to CRPA for screen the effective anti-infective therapy.Methods Total of 22 strains of CRPA were isolated from clinic specimens from Qingdao Eighth People’s Hospital from January 2022 to December 2022.The minimal inhibitory concentration(MIC)of antimicrobial agents against CRPA strains was determined by micro broth dilution method.Combined antimicrobial susceptibility test was performed by the chessboard dilution method.Fractional inhibitory concentration(FIC)index was calculated to determine the combined effect.Results The resistance rates of CRPA to piperacillin(PRL),cefoperazone/sulbactam(SCF),Aztreonam(ATM),imipenem(IPM)and MEM were higher than 90%.The resistance rates to cefepime(FEP),TZP,levofloxacin(LEV),CAZ,CIP,gentamicin(CN),tobramycin(TOB)and AK were 81.8%(18/22),77.3%(17/22),77.3%(17/22),72.7%(16/22),68.2%(15/22),63.6%(14/22),63.6%(14/22)and 54.5%(12/22),respectively.The resistance rates to CZA and COL were 9.1%(2/22)and 0(0/22),respectively.The results of antimicrobial synergy study showed that the synergistic rates of COL and MEM were 59.1%(13/22),and the sum of synergistic rates and additive rates were 100%(22/22).The synergistic rates of COL+CAZ,COL+TZP,COL+CIP,AK+CIP,TZP+CIP were 45.4%(10/22),54.5%(12/22),31.8%(7/22),22.7%(5/22),31.8%(7/22)and 9.1%(2/22),and the sum of synergistic rates and additive rates were 81.8%(18/22),90.9%(20/22),77.3%(17/22),77.3%(17/22),68.2%(15/22)and 59.1%(13/22),respectively.No antagonism effect was observed for all combinations.Conclusions CZA alone is effective for CRPA sensitive strains.Among all the combinations,COL+MEM had the highest synergy rate and addition rate,TZP and CIP has the lowest synergy rate and addition rate,which could provide refer

关 键 词：耐碳青霉烯类铜绿假单胞菌 耐药性 联合药敏试验 部分抑菌浓度指数 

分 类 号：R446.5[医药卫生—诊断学]