替加环素、环丙沙星、阿米卡星三联对耐碳青霉烯类鲍曼不动杆菌的抑菌效果观察

The antibacterial effect of tigecycline,ciprofloxacin and amikacin triple regimen against carbapenem-resistant Acinetobacter baumannii

目的:探讨替加环素(TGC)、环丙沙星(CIP)、阿米卡星(AMK)三联抑制耐碳青霉烯类鲍曼不动杆菌(CRAB)的效果。方法:选取2017年1月-12月河南省新乡市中心医院收集的80株CRAB菌株用于实验,棋盘稀释法测定替加环素、环丙沙星、阿米卡星联合对CRAB的最低抑菌浓度(MIC),计算部分抑菌浓度指数(FICI)和分级生物膜清除浓度指数(FECI)。结果:(1)TGC单用时MIC50、MIC90均高于联用时,敏感率均低于联用时;AMK单用时MIC_(50)、MIC_(90)均高于联用时,敏感率均低于联用时;CIP单用时,MIC50均高于联用时,MIC90与TGC、CIP联用相同,但高于三联用药时;CIP单用时敏感率与TGC、CIP联用相同,但低于三联用药时;(2)协同抑菌率较高的是TGC+AMK+CIP三联,其次是TGC+AMK,TGC+CIP表现为不相关;全部联合组合未发现拮抗现象;(3)TGC+AMK、TGC+CIP、TGC+AMK+CIP方案FECI≤0.5比例分别为7.50%、31.25%、32.50%,三联方案最高;TGC+AMK、TGC+CIP、TGC+AMK+CIP均具有生物膜清除协同效应,TGC+CIP、TGC+AMK+CIP未发现拮抗现象。结论:TGC、AMK、CIP三联较两联、单独用药对CRAB抑菌效果及生物膜清除均更有优势。

Abstract:OBJECTIVE To explore the effects of tigecycline(TGC),ciprofloxacin(CIP)and amikacin(AMK)triple-scavenging of carbapenem-resistant Acinetobacter baumannii(CRAB).METHODS Eighty cases of CRAB strains collected from Xinxiang Central Hospital of Henan Province from January to December 2017 were selected for the experiment.The checkerboard assay was used to determine the minimum inhibitory concentration(MIC)of CRAB by combination of TGC,CIP and AMK,and the fractional inhibitory concentration index(FICI)and fractional eradication concentration index(FECI)were calculated.RESULTS When TGC was used alone,the MIC50 and MIC90were higher than those of combined use,and the sensitivity rate was lower than that of combined use.When the AMK was used alone,the MIC50 and MIC90were higher than those of combined use,and the sensitivity rate was lower than that of combined use.When the CIP was used alone,the MIC50was higher than that of combined use,and the MIC90was the same as TGC combined with CIP,but was higher than that of triple combined use.The sensitivity rate of single CIP was the same as TGC combined with CIP,but was lower than that of triple combined use.The higher rate of synergistic inhibition was TCG+AMK+CIP triplets,followed by TGC+AMK,and TGC+CIP showed no correlation.No antagonistic effect was found in any combined combinations.TGC+AMK,TGC+CIP,TGC+AMK+CIP had synergistic effects on biofilm removal,and TGC+CIP and TGC+AMK+CIP showed no antagonistic effects.CONCLUSION S TGC,AMK and CIP triplets are more advantageous than two drug combination,single CRAM and CIP in the antibacterial effect of CRAB and removal of biofilm.