11种抗菌药物体外联合对耐碳青霉烯类肠杆菌药物敏感性分析  

Analysis for drug sensitivity of 11 antimicrobial in vitro combination regimenagainst carbapenem-resistant Enterobacteriaceae

作　　者：王东平[1] 苏爱美 韩欣怡 WANG Dongping;SU Aimei;HAN Xinyi(Department of Clinical Laboratory,Qingdao Eighth People's Hospital,Qingdao266100,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6期430-435,共6页Chinese Journal of Clinical Laboratory Science

摘　　要：目的观察两药联合对耐碳青霉烯类肠杆菌(CRE)的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2023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CRE60株,胶体金免疫层析法检测碳青霉烯酶型,微量肉汤稀释法测定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),黏菌素(COL)分别联合替加环素(TGC)、美罗培南(MEM)、头孢哌酮/舒巴坦(SCF)、阿米卡星(AK)、左氧氟沙星(LEV),TGC分别联合MEM、SCF和AK,MEM分别联合SCF、厄他培南(ETP)进行联合药敏试验,部分抑菌浓度指数(FIC)判定联合效果。结果60株CRE均检出碳青霉烯酶,其中肺炎克雷伯菌碳青霉烯酶(KPC)49株、新德里金属β-内酰胺酶(NDM)10株,亚胺培南酶(IMP)1株。CZA对49株产KPC菌株的MIC均≤8mg/L,全敏感;对11株产NDM、IMP酶菌株的MIC均>128mg/L,全耐药;联合ATM后协同率为100%。MEM+SCF的协同率最高,为63.4%,协同率与相加率之和为96.7%。TGC+AK的协同率与相加率最低,为31.7%。KPC酶型和NDM酶型菌株中,MEM+SCF的协同率与相加率之和最高,分别为100.0%和80.0%,COL+LEV的协同率与相加率之和最低,分别为32.6%和30.0%。11种联合方案均无拮抗作用,对CRE菌株的MIC_(范围)、MIC_(50)和MIC_(90)值与各个单药相比均有不同程度的减低。结论CZA单独或联合ATM对CRE菌株有效。MEM+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 observe the susceptibility test result in vitro of the combination of two drugs to carbapenem-resistant Enter-obacteriaceae(CRE)for screening the effective anti-infective therapy.Methods A total of 60 CRE strains which were isolated from the specimens from the clinic of Qingdao Eighth People's Hospital from January 2023 to December 2023.Carbapenem enzyme type was detected by colloidal gold immunochromatography.The minimal inhibitory concentration(MIC)was determined by micro broth dilution method.Ceftazidime/avibactam(CZA)combinedwithaztreonam(ATM),COL combinedwithtigecycline(TGC),meropenem(MEM),cefoperazone/sulbactam(SCF),amikacin(AK)and levofloxacin(LEV),TGC combined with MEM,SCF and AK,MEM combined with SCF and ertapenem(ETP)were performed by the checkerboard dilution method respectively.Fractional inhibitory con-centration(FIC)index was used to determine the combined effects.Results Carbapenem enzyme was detected in all the 60 CRE strains,including 49 Klebsiella pneumoniae carbapenemases(KPC)-type,10 New Delhi metallo-β-lactamase(NDM)-type and 1 Imi-penem enzyme(IMP)-type.The MICs of CZA to 49 KPC-producing strains were≤8 mg/L,showing all sensitive,and to 11 NDM-and IMP-producing strains were>128 mg/L,showing all resistant.The synergy rate of CZA was 100%after combining with ATM.MEM combined with SCF had the highest synergy rate of 63.4%,and the sum of synergistic rate and addition rate was 96.7%.The syn-ergistic rate and additive rate of TGC combined with AK were the lowest,which was 31.7%.Among KPC and NDM enzyme types strains,the sum of synergy rate and addition rate of MEM combined with SCF were the highest,which were 100.0%and 80.0%respec-tively.The sum of synergy rate and addition rate of COL combined with LEV were the lowest,which were 32.6%and 30.0%.None of the Il combination regimens showed antagonistic effect.The MIC_(range),MIC_(50) and MIC_(90) of combination regimens for CRE strains were decreased to some extent compared with those of each single drug.Conclusion CZA alone or in com

关 键 词：耐碳青霉烯类肠杆菌 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]