黏菌素联用不同药物对老年患者多药耐药鲍氏不动杆菌体外联合药敏研究

In vitro drug susceptibility testing for colistin combined with different antibiotics against multidrug-resistant Acinetobacter baumannii strains isolated from elderly patients

目的对老年患者多耐药和泛耐药鲍氏不动杆菌进行体外联合药敏试验,为临床治疗提供可靠的理论依据。方法采用琼脂稀释法对2012年1月-2013年12月114株多药耐药鲍氏不动杆菌进行体外联合药敏试验,联合方案共3种:头孢哌酮/舒巴坦(SCF)+多黏菌素E(PE)、多黏菌素E+美罗培南(MEM)、米诺环素(MH)+多黏菌素E,计算抑菌浓度(FIC)指数判断联用效果。结果 SCF和PE联合,94.7%表现为协同或相加,以相加为主;PE和MEM联合,99.1%表现为协同或相加,其中约40.0%为协同;PE和MH联合,99.1%表现为协同或相加,以协同作用为主,所有组合均无拮抗作用。结论 PE与SCF、MEM、MH体外联合应用效果显著,联用能有效降低单药最低抑菌浓度(MIC)值。

OBJECTIVE To conduct the in vitro drug susceptibility testing of multidrug-resistant and pandrug-resistant Acinetobacter baumannii strains isolated from elderly patients so as to provide reliable theoretical basis for clinical treatment.METHODS The in vitro combined drug susceptibility testing was performed for 114 strains of multidrug-resistant A.baumannii strains isolated from Jan 2012 to Dec 2013 by using agar dilution method.The three combinations included the cefoperazone-sulbactam（SCF）plus polymyxin E（PE）,PE plus meropenem（MEM）,and minocycline（MH）plus PE.The FIC indices were calculated to judge the combination effects.RESULTS When PE was combined with SCF,94.7% of the isolates displayed synergism or addition effect,the major effect was addition.When PE was combined with MEM,99.1% of the isolates displayed synergism or addition effect,about40.0% of which were synergism.When PE was combined with MH,99.1% of the isolates displayed synergism or addition effect,the major effect was synergism.There was no antagonism in all of combinations.CONCLUSIONPE combined with SCF,MEM,or MH can achieve remarkable effect,and the drug combinations can effectively reduce the MIC of single drug.