多黏菌素B与12种传统抗菌药物对耐碳青霉烯肺炎克雷伯菌体外抗菌的协同作用  

Synergistic effect of polymyxin B combined with 12 types of traditional antibiotics on in vitro antimicrobial action against carbapenem-resistant Klebsiella pneumoniae

作　　者：梁荣鑫 吴涵 潘云军 尹义平 李艳红 LIANG Rongxin;WU Han;PAN Yunjun;YIN Yiping;LI Yanhong(Shiyan People's Hospital,Renmin Hospital,Hubei University of Medicine,Shiyan,Hubei 442000,China)

机构地区：[1]十堰市人民医院湖北医药学院附属人民医院检验科,湖北十堰442000 [2]十堰市人民医院湖北医药学院附属人民医院呼吸与危重症医学科,湖北十堰442000

出　　处：《中华医院感染学杂志》2025年第6期818-822,共5页Chinese Journal of Nosocomiology

基　　金：湖北省科技厅自然科学基金资助项目(2024AFC035)。

摘　　要：目的对比分析12种传统抗菌药物与多黏菌素B联合用药对耐碳青霉烯肺炎克雷伯菌(CRKP)体外抗菌作用协同率。方法从2020-2023年十堰市人民医院各临床科室检出的312株CRKP中随机抽取30株,采用Carba NP试验检测碳青霉烯酶,采用荧光定量聚合酶链反应(PCR)检测KPC、OXA-48、OXA-23、NDM、VIM和IMP六种基因型,采用微量肉汤稀释法检测细菌耐药性,采用微量棋盘稀释法检测多黏菌素B与12种传统抗菌药物体外抗菌协同作用。结果医院分离的CRKP均产碳青霉烯酶,且以KPC基因型为主;对头孢菌素类、碳青霉烯类、喹诺酮类抗菌药物耐药率达100.00%,未检出多黏菌素B耐药菌株。米诺环素、利福平与多黏菌素B体外抗菌作用协同率最高,分别为73.33%、50.00%,左氧氟沙星、环丙沙星最低,均为0,美罗培南、亚胺培南与多黏菌素B体外抗菌作用协同率分别为36.67%、30.00%,头孢他啶、头孢吡肟、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦与多黏菌素B体外抗菌作用协同率均<30.00%。结论治疗CRKP引起的感染,多黏菌素B联合用药可优先考虑米诺环素和利福平。碳青霉烯类比头孢菌素类抗菌药物与多黏菌素B联合运用具有更高的抗菌作用协同率。左氧氟沙星、环丙沙星与多黏菌素B体外抗菌无协同作用。OBJECTIVE To observe and compare the synergistic rates of combined use of polymyxin B with 12 types of traditional antibiotics against carbapenem-resistant Klebsiella pneumoniae(CRKP)in vitro antimicrobial action.METHODS Totally 30 strains of CRKP were randomly drawn from 312 strains of CRKP that were isolated from the clinical departments of Shiyan People′s Hospital between 2020 to 2023.The carbapenemases were detected by Carba NP test.The six genotypes KPC,OXA-48,OXA-23,NDM,VIM and IMP were detected by means of fluorescent quantitative polymerase chain reaction(PCR),the drug resistance of the strains was detected by micro broth dilution method,and the synergistic effect of polymyxin B combined with 12 types of traditional antibiotics on in vitro antimicrobial action was detected by using micro chessboard dilution method.RESULTS All of the isolated CRKP strains produced carbapenemases,with the KPC genotype dominant.The drug resistance rates to cephalosporins,carbapenems and quinolones reached up to 100.00%,and no polymyxin B-resistant strains were detected.The synergistic rates of minocycline and rifampicin combined with polymyxin B to the in vitro antimicrobial action were the highest,which were 73.33%and 50.00%,respectively;the synergistic rates of levofloxacin and ciprofloxacin combined with polymyxin B were the lowest,and both were 0.The synergistic rates of meropenem and imipenem combined with polymyxin B to the in in vitro antimicrobial action were 36.67%and 30.00%,respectively.The synergistic rates of ceftazidime,cefepime,piperacillin-tazobactam and cefoperazone-sulbactam combined with polymyxin B to the in vitro antimicrobial action were less than 30.00%.CONCLUSIONS Polymyxin B combined with minocycline and rifampicin should be taken as the first choice for treatment of the CRKP-induced infection.The synergistic rate of the carbapenems combined with polymyxin B is higher than that of the cephalosporins combined with polymyxin B to the antimicrobial action.Levofloxacin and ciprofloxacin combined with po

关 键 词：耐碳青霉烯肺炎克雷伯菌 耐药基因 耐药率 多黏菌素B 联合用药 

分 类 号：R378.996[医药卫生—病原生物学]