头孢西丁等8种抗菌药物单用或联用对产ESBLs肺炎克雷伯菌的体外抗菌活性比较

Comparison of in vitro Antibacterial Activity of 8 Antibacterial Drugs as Cefoxitin Alone or Combined Use against ESBLs-producing Klebsiella pneumoniae

目的:探讨头孢西丁等8种抗菌药物单用或联用对产ESBLs肺炎克雷伯菌体外抗菌活性的影响。方法:收集2013年7月-2014年1月我院收治的患者痰、血、尿液、大便标本,从中分离得到50株产超广谱β-内酰胺酶(ESBLs)的肺炎克雷伯菌,采用微量肉汤稀释法、棋盘法分别测定哌拉西林/他唑巴坦、美洛西林/舒巴坦、异帕米星、美罗培南、头孢他啶、头孢噻肟、左氧氟沙星与头孢西丁单独及联用时对临床分离的50株产ESBLs肺炎克雷伯菌的最低抑菌浓度(MIC),计算联合抑菌浓度(FIC)指数,应用FIC指数来计算及判读抗菌药物联用对产ESBLs肺炎克雷伯菌体外抗菌作用的效果。结果:哌拉西林/他唑巴坦、美洛西林/舒巴坦与头孢西丁联合应用后,能显著降低各自的MIC值,分别有62.5%与53.5%的菌株表现为协同作用;37.5%与46.5%的菌株表现为相加作用。结论:对产ESBLs肺炎克雷伯菌的感染,可使用哌拉西林/他唑巴坦、美洛西林/舒巴坦与头孢西丁进行联合治疗。

OBJECTIVE： To investigate in vitro antibacterial activity of 8 kinds of antibacterial drugs as cefoxitin alone or com- bined use against ESBLs-producing Klebsiella pneumoniae. METHODS： The sputum, blood, urine and stool specimens of patients in our hospital from Jul. 2013 to Jan. 2014 were collected to obtain 50 isolated strains of extended-spectrum β-lactamases （ES- BLs）-producing K. pneumoniae. Broth dilution technique and checkerboard method were used to test minimum inhibitory concentra- tion （MIC） of piperracillin/tazobactam, mezlocillin/sulbactam, isepamicin, meropenem, ceftazidine, cefotaxime sodium and levo- floxacin use alone or combined with cefoxitin against 50 strains of ESBLs-producing K. pneumoniae to calculate fractional inhibitory concentration （FIC） index. The in vitro antibacterial effect of combined use of antibacterial drugs against ESBLs-producing K. pneu- moniae was calculated and interpreted on the basis of FIC index. RESULTS： Piperracillin/tazobactam or mezlocillin/sulbactam com- bined with cefoxitin could reduce their MIC significantly; 62.5% and 53.5% strains showed a synergistic effect and 37.5% and 46.5 % showed an additive effect. CONCLUSIONS： ESBLs-producing K. pneumoniae infection can be treated with piperracillin/tazo- bactam or mezlocillin/sulbactam combined with cefoxitin.