耐碳青霉烯类鲍曼不动杆菌联合药敏试验研究  

Combination tests of drug sensitivity for carbapenem-resistant Acinetobacter baumannii

作　　者：苏爱美 韦涌涛[1] 王东平[1] SU Aimei;WEI Yongtao;WANG Dongping(Department of Clinnical Laboratory,Qingdao Eighth People's Hospital,Qingdao 266100,Shandong,China)

机构地区：[1]青岛市第八人民医院检验科,山东青岛266100

出　　处：《临床检验杂志》2024年第4期267-271,共5页Chinese Journal of Clinical Laboratory Science

摘　　要：目的了解耐碳青霉烯类鲍曼不动杆菌(CRAB)的分布特征和耐药状况,评价以黏菌素(COL)为基础,分别与头孢哌酮/舒巴坦(SCF)、替加环素(TGC)、亚胺培南(IPM)、美罗培南(MEM)、阿米卡星(AK)和左氧氟沙星(LEV)联合的体外抗菌效果,为临床抗感染治疗提供参考。方法收集2022年我院75株非重复分离的CRAB菌株,用WHONET 5.6软件分析其临床分布和耐药情况。从中筛选25株,采用微量肉汤稀释法测定各药物单独及联合时的最低抑菌浓度(MIC),用棋盘法抑菌试验计算部分抑菌浓度指数(FIC)判定联合效应。结果2022年我院共分离鲍曼不动杆菌145株,其中CRAB 75株,检出率51.7%。CRAB在>70岁老年患者中检出率最高(40.0%),主要来源于血液(41.3%)和痰液(37.3%)标本,ICU是主要分离科室。75株CRAB对5种抗菌药物哌拉西林(PRL)、哌拉西林/他唑巴坦(TZP)、头孢曲松(CRO)、IPM和MEM均100%耐药;对3种药物氨苄西林/舒巴坦(SAM)、头孢吡肟(FEP)和复方磺胺甲噁唑(SXT)的耐药率均>95%;对LEV、SCF、AK、TGC和COL的耐药率分别为86.7%、82.7%、77.4%、2.4%和0.0%。25株CRAB的联合药敏试验显示,COL分别与SCF和TGC的协同率最高(92%和80%),协同率与相加率之和均为100%;COL与IPM、MEM、AK、LEV联合的协同率依次为64%、72%、56%和48%,均无拮抗作用。结论CRAB呈高度耐药,老年和ICU患者是高危人群。COL与SCF联合具有最佳协同作用,COL与LEV联合效果最差,值得临床参考。Objective To analyze the distribution and drug resistance patterns of carbapenem-resistant Acinetobacter baumannii(CRAB),and evaluate the antimicrobial effects in vitro of colistin(COL)combined with cefoperazone/sulbactam(SCF),tigecycline(TGC),imipenem(IPM),meropenem(MEM),amikacin(AK),and levofloxacin(LEV)against CRAB to provide guidance for anti-infective therapy.Methods A total of 75 non-duplicate CRAB strains isolated from clinical specimens in 2022 were collected.WHONET 5.6 software was used for retrospective analysis of their clinical distribution and resistance profiles.Among them,25 strains were selected for combined antimicrobial susceptibility tests using broth microdilution to determine minimum inhibitory concentrations(MICs).The fractional inhibitory concentration(FIC)index was calculated based on checkerboard method to assess the combined effects.Results In 2022,a total of 145 Acinetobacter baumannii strains were isolated,including 75 CRAB(detection rate of 51.7%).CRAB was most prevalent in the patients over 70 years old(40.0%),mainly from blood(41.3%)and sputum(37.3%)specimens,and the intensive care unit was the top isolating department.All the 75 CRAB strains were resistant to piperacillin,piperacillin/tazobactam,ceftriaxone,IPM and MEM with resistance rates of 100%.The resistance rates for ampicillin/sulbactam,cefepime and trimethoprim/sulfamethoxazole were all exceeded 95%.The resistance rates were 86.7%for LEV,82.7%for SCF,77.4%for AK,2.4%for TGC,and 0.0%for COL.The results of combined tests of 25 strains revealed the synergy rates of 92%and 80%for COL+SCF and COL+TGC respectively with sums of both synergy and additive rates of 100%.Synergy rates for COL combined with IPM,MEM,AK and LEV were 64%,72%,56%and 48%respectively.No antagonism was observed in any combination.Conclusion The drug resistance of CRAB exhibited high levels at our hospital,and the elderly and ICU patients were the major susceptible populations.Among all the combinations tests,COL+SCF showed optimal synergy while COL+LEV only h

关 键 词：耐碳青霉烯类鲍曼不动杆菌 棋盘法 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]