摘要
目的观察亚胺培南与替加环素、黏菌素、阿米卡星、环丙沙星、利福平、头孢他啶、厄他培南、克拉维酸联合对携带blaKPC-2碳青霉烯类耐药肺炎克雷伯菌(CRKP)的体外抗菌作用。方法10株携带blaKPC-2的肺炎克雷伯菌分离自复旦大学附属华山医院神经外科术后肺部感染和中枢神经系统感染患者的痰液和脑脊液标本。测定14种常用抗菌药物对其最低抑菌浓度(MIC)。采用棋盘稀释法进行联合药敏试验,计算部分抑菌浓度指数(FIC)判定联合效果。采用体外时间-杀菌曲线观察联合杀菌作用。结果10株菌株对黏菌素和替加环素具较好的体外敏感性。棋盘法结果显示所有抗菌药物联合组合均未见对受试菌产生拮抗作用。其中亚胺培南与克拉维酸联合对7株受试菌具有协同作用,其次是亚胺培南与厄他培南的联合,以及亚胺培南与头孢他啶或利福平联合。时间-杀菌曲线结果显示亚胺培南联合克拉维酸、利福平或头孢他啶对受试菌同样具有相同的协同杀菌作用。结论体外试验显示亚胺培南联合头孢他啶、利福平或克拉维酸对产KPC酶的CRKP具有协同抑菌或杀菌活性,此可供临床参考。
Objective To investigate the in vitro antibacterial activity of imipenem combined with tigecycline,colistin, amikacin,ciprofloxacin,rifampin,cefepime,ertapenem or clavulanic acid against clinical isolates of KPC-producing carbapenemresistant Klebsiella pneumoniae (CRKP).Methods Ten CRKP strains carrying blaKPC-2 were collected from Huashan Hospital, Fudan University.The susceptibility of 14 antibiotics against these isolates were tested by broth microdilution method.Imipenem combination (with one of the 8 antibiotics) susceptibility testing was performed by checkerboard dilution method.The fractional inhibitory concentration (FIC) index was calculated to evaluate the activity of different combinations.Results All the 10 strains were still susceptible to tigecycline and colistin.According to the results of checkerboard dilution,no antagonism effect was observed for all the combinations.The combination of imipenem with clavulanic acid showed significant additive effect against CRKP,followed by the combination of imipenem and ertapenem.The combination of imipenem and rifampin/cefepime also had good additive effect.The synergistic effect of imipenem combined with cefepime,rifampin or clavulanic acid was confirmed by in vitro time-killing assay.Conclusions Imipenem combined with rifampin,cefepime or clavulanic acid could be a choice for treating CRKP infection in clinical practice.
作者
郝敏
秦晓华
HAO Min;QIN Xiaohua(Institute of Antibiotics,Huashan Hospital,Fudan University,Key Laboratory of Clinical Pharmacology of Antibiotics,National Health Commission,Shanghai 200040,China)
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2019年第4期410-416,共7页
Chinese Journal of Infection and Chemotherapy
基金
国家自然科学基金(No.81401699)
关键词
KPC
碳青霉烯类
肺炎克雷伯菌
体外联合药敏
KPC
carbapenem
Klebsiella pneumoniae
in vitro combination susceptibility testing
