铜绿假单胞菌纸片扩散法联合药敏试验研究

Study on the Pseudomonas Aeruginosa Combined Drug Sensitivity Test with Disk Diffusion Method

目的研究一种基于纸片扩散法(K-B法)的铜绿假单胞菌(PA)的联合药敏实验,为PA感染治疗提供参考。方法收集某院2016~2018年住院患者中分离的黏液型铜绿假单胞菌(m PA)和耐碳青霉烯类铜绿假单胞菌(CRPA),并从中随机选择m PA 20株、CRPA 30株做K-B法联合药敏试验,根据抑菌环形态判断两药间相互作用,计算协同+累加率。结果m PA对12种抗菌药物的敏感率>60%,普遍高于CRPA,而CRPA仅对PB、AK及CIP敏感率>50%。联合药敏试验显示:m PA联合药敏的协同+累加率也是普遍高于CRPA,其中有21组联合药敏的协同+累加率>50%,且联合效果较好是CIP+TZP、AK+SCF、CIP+CAZ、AK+CAZ,对m PA的协同+累加率均为90%。对CRPA的协同+累加率分别是86.7%、86.7%、83.3%、83.3%。有7组联合药敏的协同+累加率<40%,其中IMP分别与CAZ、TZP、SCF的联合无协同+累加作用,临床医生要避免此类药物联合运用。结论K-B法联合药敏试验能快速提供联合用药体外抗菌的直观效果,可为临床医生治疗多药耐药菌感染提供参考。

OBJECTIVE To study a combined drug sensitivity test of Pseudomonas aeruginosa(PA)based on paper diffusion(K-B)method,to provide reference for the treatment of PA infection.METHODS The mucoid pseudomonas aeruginosa(m PA)and carbapenem-resistant pseudomonas aeruginosa(CRPA)isolated from hospitalized patients in a hospital from 2016 to 2018 were collected and 20 m PA strains and 30 CRPA strains among them were randomly selected to test K-B method combined with drug susceptibility test.According to the bacteriostatic ring shape,the interaction between the two drugs was judged and the synergy and additive rate were calculated.RESULTS The sensitivity rate of m PA to 12 antimicrobial agents were more than 60%,which was generally higher than that of CRPA,and the sensitivity rate of CRPA only to polymyxin B(PB),amikacin(AK)and ciprofloxacin(CIP)were reached 50%or more.The combined drug sensitivity test showed that,the synergy and additive rate of the combined drug sensitivity of mucinous PA was also generally higher than that of the combined drug sensitivity of CRPA.Among them,the synergy and additive rate of the combined drug sensitivity of 21 groups were higher than 50%,and the better combined effect were ciprofloxacin/piperacillin(CIP+TZP),amikacin/cefoperazone/sulbactam(AK+SCF),ciprofloxacin/ceftazidime(CIP+CAZ),amikacin/ceftazidime(AK+CAZ).And the synergy and additive rate of mucinous PA was 90%,the synergy and additive rate of CRPA were86.7%,86.7%,83.3%and 83.3%,Respectively.There were 7 groups combined drug sensitivity,their synergy and additive rate were low than 40%.Among them,the combination of IMP with CAZ,TZP and SCF had no synergy and additive effect,so clinicians could avoid the combined use of such drugs.CONCLUSION The K-B method combined drug sensitivity test can quickly provide the direct effect of the combined use of antibacterial drugs in vitro,and can provide reference for clinicians in the treatment of multidrug-resistant bacteria infection.