联合抗菌药物对产金属β-内酰胺酶鲍氏不动杆菌的应用性研究

Antimicrobial Agents Combination Against Metallo-β-lactamases Producing Acinetobacter baumannii:An Applied Research

目的了解抗菌药物对产金属β-内酰胺酶鲍氏不动杆菌(ABA)的体外联合抗菌活性,为临床治疗提供合理用药的试验依据。方法常规培养分离细菌,应用VITEK-2全自动细菌分析仪鉴定细菌,常规药敏试验采用K-B纸片法,MIC测定采用琼脂平板倍比稀释法,按CLSI规定标准进行。结果 75株鲍氏不动杆菌产金属β-内酰胺酶的阳性率为96.00%;多黏菌素B、亚胺培南、美罗培南、哌拉西林/他唑巴坦对产金属β-内酰胺酶ABA的抑菌率分别为98.61%、79.17%、73.61%、30.56%,其他常用抗菌药物(如头孢吡肟、左氧氟沙星、头孢他啶、米诺环素、头孢哌酮/舒巴坦、阿米卡星)的抑菌率均<30.00%;头孢哌酮/舒巴坦联合多黏菌素B、米诺环素、阿米卡星对产金属β-内酰胺酶ABA的协同作用分别为25.00%、30.56%、43.06%;哌拉西林/他唑巴坦联合多黏菌素B、米诺环素、阿米卡星对产金属β-内酰胺酶ABA的协同作用分别为22.22%、30.56%、38.89%。结论临床对产金属β-内酰胺酶的ABA引起的一般感染,可根据药敏试验结果选择有效的敏感药物进行降阶梯治疗,应慎用碳青酶烯类抗菌药物;而对重症感染或多药耐药菌株引起的感染,建议使用多黏菌素B或联合用药(头孢哌酮/舒巴坦或哌拉西林/他唑巴坦联合阿米卡星或米诺环素等),以有效地控制感染和防止耐药株在医院感染的扩散。

OBJECTIVE To understand in vitro the antibacterial combination activity on the metallo-β-lactamases producing Acinetobacter baumannii（MABA） in order to provide laboratory data for clinical treatment with domestic drug.METHODS All strains were isolated and identified by routine procedure and VITEK-2 automatic bacterial identification instrument.Routine drug susceptibility was tested by K-B paper diffusion method and MIC detection by agar plate dilution method following the instruction of CLSI.RESULTS The positive rate of produced metallo-β-lactamases in 75 A.baumannii（ABA） strains was 96.00%.The inhibitory rate of polymyxin B,imipenem,meropenem,and piperacillin/tazobactam to metallo-β-lactamases-producing ABA were 98.61%,79.17%,73.61% and 30.56%,respectively.Other drugs inhibitory rate（cefpirome,levofloxacin,ceftazidime,minocycline,cefoperazone/sulbactam,and amikacin） was less than 30.00%.The synergy of cefoperazone/sulbactam combined with polymyxin B,minocycline,and amikacin to metallo-β-lactamases-producing ABA were 25.00%,30.56%,and 43.06%.The synergy of piperacillin/tazobactam combined with polymyxin B,minocycline,and amikacin to metallo-β-lactamases-producing ABA were 22.22%,30.56%,and 38.89%.CONCLUSIONS Clinic should be according to the results of drug susceptibility test to select the effective antimicrobial agent to treat the common infection caused by MABA which prudently using carbapenems drug.But of drug combination（cefoperazone/sulbactam or piperacillin/tazobactam combines with amikacin or minocycline） or polymyxin B is suggested for treating severe infection or multi-drug resistant ABA infection in order to control them effectively and to prevent diffusion of drug resistant strains in nosocomial infection.