黄芩苷联合妥布霉素对耐碳青霉烯类铜绿假单胞菌的体外抗菌活性分析

Analysis of in vitro antibacterial activity of baicalin combined with tobramycin against carbapenem-resistant Pseudomonas aeruginosa

目的分析2018年1月—2021年12月嘉兴市中医医院临床分离耐碳青霉烯类铜绿假单胞菌的菌株分布及细菌耐药情况,探讨中药黄芩苷联合妥布霉素对碳青霉烯类铜绿假单胞菌的体外抗菌活性,为推动黄芩苷在临床抗感染应用提供理论基础。方法收集30株非重复分离的CRPA用于后续研究,采用微量肉汤稀释法检测妥布霉素、黄芩苷、妥布霉素联合黄芩苷对CRPA菌株的MIC值,计算分级抑制浓度指数FICI值。结果分离的CRPA共189株,分离率最高的为痰及创面,其次为腹水、尿液、咽拭子、导管引流。分布前三位的科室分别为重症监护病房,烧伤科及肺病科。药敏试验显示本院PA对头孢曲松、头孢唑啉耐药率最高,保持在90%以上;对亚胺培南、美罗培南耐药率有逐年提高的趋势。对黏菌素及氨基糖苷类庆大霉素、阿米卡星、妥布霉素的耐药率最低。黄芩苷联合妥布霉素作用于CRPA的MIC值均小于单独用药,而妥布霉素联合后MIC值与其单药MIC值相比可降低2个~8个倍比浓度不等。FICI≤0.5有27株;0.5<FICI≤4有3株;FICI>4为0株,FICI≤0.5为协同作用。结论CRPA检出率有逐年提高的趋势,增加幅度明显。黄芩苷对妥布霉素治疗CRPA具有降低妥布霉素药量以达到有效浓度的作用。

Objective This paper aims to analyze the distribution and drug resistance of carbapenem resistant Pseudomonas aeruginosa isolates in Jiaxing Hospital of Traditional Chinese Medicine from January 2018 to December 2021,and discuss the in vitro antibacterial activity of baicalin combined with tobramycin against carbapenem Pseudomonas aeruginosa,so as to provide theoretical basis for promoting the clinical application of baicalin in anti-infection.Methods Thirty non-repetitive isolated CRPA strains were collected for follow-up study.Microbroth dilution method was used to detect the MIC values of tobramycin,baicalin and tobramycin combined with baicalin against CRPA strains and calculate the FICI value of the fractional inhibition concentration index.Results A total of 189 CRPA strains were isolated.The highest isolation rate was observed in sputum and wounds,followed by ascites,urine,pharyngeal test paper,and catheter drainage.The top three departments were intensive care unit,burn department and lung disease department.The drug susceptibility test showed that the resistance rate of PA to ceftriaxone and cefazolin in our hospital was the highest,maintaining above 90%.The resistance rate to imipenem and meropenem was a trend of increasing year by year.The resistance rate to colistin and aminoglycoside gentamicin,amikacin and tobramycin was the lowest.The MIC value of baicalin combined with tobramycin on CRPA was less than that of single drug.The MIC value of tobramycin combined with tobramycin can be reduced by 2-8 times compared with the MIC value of tobramycin alone.There were 27 strains with FICI≤0.5,3 strains with 0.5<FICI≤4,0 strain with FICI>4;FICI≤0.5 was synergistic.Conclusion The detection rate of CRPA tends to increase year by year,with a significant increase.Baicalin can reduce the dosage of tobramycin in the treatment of CRPA to achieve the effective concentration.