以替加环素和多黏菌素B为基础的联合药敏对预防CRKP耐药的研究

Study on Prevention of CRKP Resistance by Combination Regimen Based on Tigacycline and Polymyxin B

目的 探讨分别以替加环素和多黏菌素B为基础的联合药敏对预防KPC型碳青霉烯类耐药肺炎克雷伯菌(CRKP)对替加环素和多黏菌素B耐药能力的研究。方法 筛选2018年1月1日—2019年2月28日某院检验科临床分离的KPC型碳青霉烯类耐药的肺炎克雷伯菌17株,选择5株,采用体外抗生素联合传代培养方法,以评价替加环素和多黏菌素B的MIC(最小抑菌浓度)变化情况。结果 联合用药能够降低菌株的替加环素或多黏菌素B的MIC,与用药前相比,差异具有统计学意义(P<0.05)。联合用药可预防多黏菌素B耐药,第一周时,替加环素联合利福平均延缓了替加环素的MIC增长,单独低剂量使用替加环素或多黏菌素B,在第一周时有4株菌耐药。结论 早期联合治疗可抑制KPC型CRKP的生长,随着抗生素暴露时间的延长,细菌易耐药,应加强院感防控和抗生素合理使用,防止细菌进一步耐药。

Objective To investigate the effect of combined drug sensitivity based on tigacycline and polymyxin B on the prevention of KPC carbapenase-resistance of Klebsiella pneumoniae to tigacycline and polymyxin B.Methods A total of seventeen strains of KPC carbapenemase-resistant Klebsiella pneumoniae were screened after being isolated from a hospital's clinical laboratory between January 1,2018,and February 28,2019.In vitro,the antibiotic combined culture method was used to evaluate the minimum inhibitory concentration(MIC)changes of tigecycline and polymyxin B.Results Combined medication could reduce the MIC of tigecycline or polymyxin B,and the difference was statistically significant compared with prior treatment(P<0.05).Polymyxin B resistance can be avoided with combination treatment.In the first week,tigecycline combined with rifampicin all delayed the increase of MIC of tigecycline.4 strains were resistant to tigecycline or polymyxin B at low doses alone in the first week.Conclusions Early combination therapy can inhibit the growth of KPC-producing Klebsiella pneumoniae.Bacteria are more resistant to antibiotics with longer exposure times.To stop germs from developing additional medication resistance,hospital infection prevention and control as well as the prudent use of antibiotics should be strengthened.