头孢他啶/阿维巴坦、多黏菌素B和替加环素对耐碳青霉烯类肺炎克雷伯菌的体外抗菌活性分析

In vitro antibacterial activity of ceftazidime/avibatan,polymyxin B and tigecycline against carbapenem resistant Klebsiella pneumoniae

目的评价头孢他啶/阿维巴坦(CAZ-AVI)、多黏菌素B和替加环素对耐碳青霉烯类肺炎克雷伯菌(CRKP)的体外抗菌效应研究,指导临床正确选择并合理使用抗菌药物。方法收集2018—2021年期间从广东地区8家三级综合医院临床分离的对碳青霉烯类耐药的肺炎克雷伯菌172株,采用聚合酶链反应(PCR)以及NG-Test■CARBA5检测菌株的5种常见碳青霉烯酶耐药基因;采用微量肉汤稀释法药敏试验分别检测CAZ-AVI、多黏菌素B和替加环素的单药最低抑菌浓度(minimal inhibitory concentration,MIC)值。结果172株CRKP对CAZ-AVI耐药率为13.4%,对多黏菌素B的耐药率为1.7%,对替加环素耐药率为1.2%。PCR检测172株CRKP菌株产碳青霉烯酶基因,其中产碳青霉烯酶菌株166株(96.5%)。以PCR检测产碳青霉烯酶基因为参考方法,NG-Test■CARBA5检测碳青霉烯酶基因型KPC、NDM、VIM、IMP和OXA-48-like,显示特异性为100%,灵敏度为99.4%。结论CAZ-AVI、多黏菌素B以及替加环素对本地区CRKP菌株具有较好的体外抗菌活性,对采用NG-Test■CARBA5试验检测CRKP产碳青霉烯酶的耐药基因型,有利于早期指导临床实现个体化精准治疗。

Objective To evaluate the in vitro antibacterial effect of ceftazidime/averbactam(CAZ-AVI),polymyxin B and tegacyclin on carbapenem resistant Klebsiella pneumoniae,and to guide the clinical correct selection and rational use of antibacterial drugs.Methods 172 strains CRKP were collected from 8 tertiary general hospitals in Guangdong Province from 2018 to 2021.Polymerase chain reaction(PCR)and NG-Test®CARBA5 were used for the detection of the five common carbapenemase resistance genes.The minimal inhibitory concentration(MIC)values of CAZ-AVI,polymyxin B and tigecycline were detected by broth microdilution method.Results The resistance rates of 172 CRKP strains to CAZ-AVI,polymyxin B and tigecycline were 13.4%,1.7%and 1.2%,respectively.166 strains(96.5%)among the 172 CRKP strains carried carbapenemase resistance genes by PCR detection which was used as the standard method.NG-Test®CARBA5 were used to detect carbapenem genotypes KPC,NDM,VIM,IMP and oxa-48-like.The specificity was 100%and the sensitivity was 99.4%.Conclusion CAZ-AVI,polymyxin B and tigecycline had good in vitro antibacterial activity against CRKP strains in local region.NG-Test®CARBA5 test is a rapid and accurate method to detect carbapenemase genotypes,which is conducive for early guiding clinical practice and realizing individualized and accurate treatment.