头孢他啶/阿维巴坦对耐碳青霉烯类肺炎克雷伯菌的体外抗菌活性研究  

Antibacterial activity of ceftazidime/avibactam against carbapenem-resistant Klebsiella pneumoniae in vitro

作　　者：郑晓者 杨冬晨 牛敏[2] 杜艳[2] 刘淑敏[2] ZHENG Xiaozhe;YANG Dongchen;NIU Min;DU Yan;LIU Shumin(Department of Genetics and Metabolism,Children s Hospital,Zhejiang University School of Medicine,Hangzhou 310000,China;Department of Clinical Laboratory,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,China)

机构地区：[1]浙江大学医学院附属儿童医院遗传与代谢科,浙江杭州310000 [2]昆明医科大学第一附属医院医学检验科,云南昆明650032

出　　处：《现代医学》2024年第8期1197-1204,共8页Modern Medical Journal

基　　金：国家自然科学基金资助项目(82260415)。

摘　　要：目的:明确头孢他啶/阿维巴坦(CZA)对耐碳青霉烯类肺炎克雷伯菌的体外抗菌活性。方法:收集昆明医科大学第一附属医院2022年1至12月期间从临床各科室分离的非重复碳青霉烯类耐药肺炎克雷伯菌株(CRKP),分析其临床分布特征和药敏信息;并进行耐药基因酶型检测,采用微量肉汤稀释法测定CZA对不同酶型菌株的MIC 50、MIC 90和MIC range;另外,对产NDM型金属酶的CRKP采用微量棋盘稀释法和时间杀菌试验测定CZA联合氨曲南(ATM)体外协同作用。结果:共收集到143株非重复CRKP,标本类型分布以呼吸道标本为主,科室分布主要集中在ICU;药敏结果显示对包括碳青霉烯类在内的多种抗生素耐药率>95%;143株CRKP中bla KPC阳性及bla OXA-48阳性CRKP对CZA敏感率均为100%,bla NDM阳性CRKP对CZA的耐药率为100%,但CZA+ATM联合用药对其具有较强的体外协同抑菌作用。结论:使用CZA治疗CRKP所致感染时,有必要先明确其酶型,为临床抗感染治疗提供用药指导。Objective:To analyze the antibacterial activity of ceftazidime/avibactam(CZA)against carbapenem-resistant Klebsiella pneumoniae(CRKP)in vitro.Methods:Non-repetitive CRKP strains isolated from clinical departments in the First Affiliated Hospital of Kunming Medical University from January to December 2022 were collected,analyze the clinical distribution and sensitivity of CRKP;PCR was used to detect common carbapenemase genes in CRKP,CZA MIC against CRKP carrying different carbapenemase was determined by the micro broth dilution method,expressed as MIC 50,MIC 90 and MIC range;additionally,micro-checkerboard dilution method and time-kill assay were used to detect the antibacterial activity of CZA combined with aztreonam(ATM)on the NDM-producing CRKP.Results:A total of 143 non-repetitive CRKP strains were collected,the specimen was dominated by respiratory specimens,mainly concentrated in ICU;CRKP are characterized by extensive drug resistance,including resistance rate of Carbapenem was>95%;143 CRKP carrying bla KPC and bla OXA-48 were 100%sensitive to CZA,bla NDM were 100%resistant to CZA,however,CZA combined with ATM showed a strong synergistic bactericidal effect on NDM-producing CRKP in vitro.Conclusion:It is necessary to detect the enzyme type of CRKP in the process of treatment with CZA,to provide drug guidance for clinical anti-infection treatment.

关 键 词：碳青霉烯类耐药肺炎克雷伯菌 头孢他啶/阿维巴坦 氨曲南 协同作用 

分 类 号：R378[医药卫生—病原生物学]