米诺环素联合11种抗生素对多重耐药鲍曼不动杆菌体外药敏研究

Study on in vitro drug sensitivity of minocycline combined with 11 antibiotics against Multidrug resistant Acinetobacter baumannii

目的:研究米诺环素与11种抗生素联合对多重耐药鲍曼不动杆菌(MDR-AB)体外抗菌活性的影响,为临床治疗多重耐药鲍曼不动杆菌的感染提供参考。方法:选取本院临床收集的35株多重耐药鲍曼不动杆菌(MDR-AB),用微量肉汤稀释法测定包括米诺环素内的12种抗生素单药的最低抑菌浓度(MIC),再采用棋盘法测定米诺环素与11种抗生素联合的MIC值,计算药物联合的部分抑菌浓度指数(FIC)。结果:米诺环素可使联合的11种抗生素MIC值降低,其中依替米星、美罗培南及磷霉素的MIC值降为原来的1/2;阿米卡星、庆大霉素、左氧氟沙星及替加环素均降为原来的1/4;头胞哌酮/舒巴坦、多黏菌素及哌拉西林/舒巴坦降为原来的1/8;舒巴坦降为原来的1/16;米诺环素与依替米星、阿米卡星、庆大霉素、磷霉素表现为拮抗作用;与替加环素、多黏菌素B、头胞哌酮/舒巴坦、左氧氟沙星及舒巴坦表现为协同、相加作用;与美罗培南、哌拉西林/舒巴坦表现为相加和无相关作用。结论:米诺环素与多黏菌素B联合效果最好;其次为替加环素、左氧氟沙星、舒巴坦、头胞哌酮/舒巴坦。米诺环素与依替米星、阿米卡星、庆大霉素、磷霉素联合无效。米诺环素可使联合的抗生素有效地降低MIC值,甚至可使抗生素的MIC值降至敏感范围。

Objective： To study the antibacterial activity of minocycline in eombination with 11 antibiotics against muhidrug resistant Acinetobacter baumannii （MDR-AB） in vitro, to provide a reference for the clinical treatment of multidrug resistant Acinetobacter baumannii infection. Methods： Thirty-five strains of muhidrug resistant Acinetobacter baumannii （MDR-AB） were collected. The minimum inhibitory concentrations （MICs） of 12 kinds of antibiotics monotherapy including minoeyeline were determined using the broth dilution method, the MICs of minoeyeline combined with 11 antibiotics were determined using the checkerboard method, and the fractional inhibitory concentration （FIC） of the antibacterial drugs in combination was calculated. Results： Minocycline reduced the MICs of 11 combined antibiotics. The MICs of etimiein, meropenem and fosfomyein decreased to 1/2 of the original value, to 1/4 for amikaein, gentamiein, levofloxacin and tigeeycline, 1/8 for cefoperazone/sulbaetam, polymyxin and piperacillin/sulbaetam, and 1/16 for sulbaetam. Antagonistic action was shown between minocycline and etimiein, amikacin, gentamiein, fosfomyein; synergistic effect or additive effect was present between minocycline and tigeeycline, polymyxin B, cefoperazone/sulbaetam, levofloxacin and sulbaetam; there was additive effect or no correlation between minoeyeline and meropenem, piperacillin/sulbaetam. Conclusion： The effect of minocycline combination therapy is the best with polymyxin B, followed by tigecycline, levofloxacin, sulbaetam, eefoperazone/sulbactam. Minocycline is ineffective in combination with netilmicin, amikacin, gentamicin, and fosfomycin. Minocycline can effectively reduce the MIC values of combined antibiotics, and even reduce the MICs to a sensitive range