联合用药对鲍曼不动杆菌体外抗菌活性考察

In vitro antibacterial activity of combined antimicrobial agents against Acinetobacter baumannii

目的:初步探究12种临床常用抗菌药物对鲍曼不动杆菌的体外抗菌活性以及几种抗菌药物的体外联合抗菌活性,为临床治疗鲍曼不动杆菌提供联合用药的实验依据。方法:河北医科大学第二医院检验科分离自临床感染患者的40株耐药鲍曼不动杆菌,采用微量肉汤稀释法测定12种临床常用抗菌药物及异帕米星与头孢哌酮钠/舒巴坦钠、头孢吡肟、比阿培南两两联用药的最低抑菌浓度(MIC)。结果:12种临床常用抗菌药物中除异帕米星对鲍曼不动杆菌显示一定的体外抗菌活性外,其余11种全部表现为强耐药;而联合用药的实验结果显示:异帕米星与头孢哌酮钠/舒巴坦钠联合后FIC均小于1,表现为协同和相加作用,比阿培南的联合抑菌指数(FIC)>1占40%,头孢吡肟的FIC>1占30%,表现为无关作用。结论:鲍曼不动杆菌对临床常用抗菌药物已经产生了很强的耐药性,临床可优先选择异帕米星与头孢哌酮钠/舒巴坦钠,也可根据患者具体情况选用头孢吡肟、比阿培南的联合进行治疗,以防耐药株的产生和医院感染的扩散,并注意消毒与隔离,防止交叉感染。

OBJECTIVE To determine the in vitro activities of 12 antimicrobials against clinical isolates of Acinetobacter bau mannii and the combined antibiotics activity in vitro to provide laboratory data for clinical treatment. METHODS A total of 4（I strains of Acinetobacter baumannii were isolated from clinical specimens in Second Hospital of Hebei Medical University. MIC of 12 antimicrohials and isepamicin combined cefoperazone/sulhactam , eefepime, biapenem were tested by microdilution technique. RESULTS Among the 12 antimicrobials, in addition to isepamicin against Acinetobacterbaumannii showed some activity in vitro antibacterial activity, the remaining 11 all showed strong resistance; The combination therapy experimentaI results showed that FIC of isepamicin combined cefoperazone/sulbactam 100%〈1, cefepime 70% were %1, biapenem 60%were % 1. CONCLUSION Acinetobacter baumannii has been a very strong resistance on antimicrobial. In clinic, isepamicin and ceofperazone/sulbactam combination therapy can be used for the treatment to avoid the production of drug resistant strains and the epidemic of nosocomial infortinn