中华检验医学杂志
中華檢驗醫學雜誌
중화검험의학잡지
CHINESE JOURNAL OF LABORATORY MEDICINE
2011年
11期
984-987
,共4页
杨青%邹燕萍%单志明%魏泽庆%沈萍%孔海深%俞云松
楊青%鄒燕萍%單誌明%魏澤慶%瀋萍%孔海深%俞雲鬆
양청%추연평%단지명%위택경%침평%공해심%유운송
内酰胺酶类%克雷伯菌,肺炎%微生物敏感性试验
內酰胺酶類%剋雷伯菌,肺炎%微生物敏感性試驗
내선알매류%극뢰백균,폐염%미생물민감성시험
beta-Lactamases%Klebsiella pneumoniae%Microbial sensitivity tests
目的 探讨联合使用抗菌药物对产KPC-2酶肺炎克雷伯菌的体外抗菌效应,寻找有效的组合方案.方法 收集2008 -2009年分离自浙江大学医学院附属第一医院,宁波李惠利医院、浙江省人民医院、杭州市第三医院、绍兴市第二医院、杭州市第一医院、复旦大学附属华山医院、南京军区总医院等8家医院确证产KPC-2酶的24株肺炎克雷伯菌,采用MLST技术分型,琼脂稀释法测定阿米卡星、米诺环素、亚胺培南、阿莫西林/克拉维酸、头孢他啶、美罗培南、庆大霉素、头孢西丁、头孢吡肟、利福平、多黏菌素B、环丙沙星对24株菌株的MIC值,Etest测定替加环素、哌拉西林/三唑巴坦的MIC值.采用棋盘琼脂稀释法测定头孢吡肟联合阿莫西林/克拉维酸、头孢吡肟联合阿米卡星、环丙沙星联合阿米卡星、环丙沙星联合头孢吡肟、亚胺培南联合阿米卡星、亚胺培南联合环丙沙星、亚胺培南联合多黏菌素B、亚胺培南联合米诺环素、多黏菌素B联合利福平、头孢他啶联合阿莫西林/克拉维酸对菌株的抑菌效果.结果 24株产KPC-2酶肺炎克雷伯菌分为5个ST型,其中ST11型是最主要的克隆群(15株).菌株对多黏菌素B、替加环素均敏感,对米诺环素耐药率为4.2%.最佳组合方案为头孢吡肟联合阿莫西林/克拉维酸,出现协同作用有19株;其次为亚胺培南联合阿米卡星、头孢他啶联合阿莫西林/克拉维酸,出现协同作用均为13株.结论 产KPC-2酶肺炎克雷伯菌对替加环素、多黏菌素B、米诺环素较敏感,头孢吡肟联合阿莫西林/克拉维酸、亚胺培南联合阿米卡星、头孢他啶联合阿莫西林/克拉维酸在体外以协同作用为主,其疗效值得临床进一步观察.
目的 探討聯閤使用抗菌藥物對產KPC-2酶肺炎剋雷伯菌的體外抗菌效應,尋找有效的組閤方案.方法 收集2008 -2009年分離自浙江大學醫學院附屬第一醫院,寧波李惠利醫院、浙江省人民醫院、杭州市第三醫院、紹興市第二醫院、杭州市第一醫院、複旦大學附屬華山醫院、南京軍區總醫院等8傢醫院確證產KPC-2酶的24株肺炎剋雷伯菌,採用MLST技術分型,瓊脂稀釋法測定阿米卡星、米諾環素、亞胺培南、阿莫西林/剋拉維痠、頭孢他啶、美囉培南、慶大黴素、頭孢西丁、頭孢吡肟、利福平、多黏菌素B、環丙沙星對24株菌株的MIC值,Etest測定替加環素、哌拉西林/三唑巴坦的MIC值.採用棋盤瓊脂稀釋法測定頭孢吡肟聯閤阿莫西林/剋拉維痠、頭孢吡肟聯閤阿米卡星、環丙沙星聯閤阿米卡星、環丙沙星聯閤頭孢吡肟、亞胺培南聯閤阿米卡星、亞胺培南聯閤環丙沙星、亞胺培南聯閤多黏菌素B、亞胺培南聯閤米諾環素、多黏菌素B聯閤利福平、頭孢他啶聯閤阿莫西林/剋拉維痠對菌株的抑菌效果.結果 24株產KPC-2酶肺炎剋雷伯菌分為5箇ST型,其中ST11型是最主要的剋隆群(15株).菌株對多黏菌素B、替加環素均敏感,對米諾環素耐藥率為4.2%.最佳組閤方案為頭孢吡肟聯閤阿莫西林/剋拉維痠,齣現協同作用有19株;其次為亞胺培南聯閤阿米卡星、頭孢他啶聯閤阿莫西林/剋拉維痠,齣現協同作用均為13株.結論 產KPC-2酶肺炎剋雷伯菌對替加環素、多黏菌素B、米諾環素較敏感,頭孢吡肟聯閤阿莫西林/剋拉維痠、亞胺培南聯閤阿米卡星、頭孢他啶聯閤阿莫西林/剋拉維痠在體外以協同作用為主,其療效值得臨床進一步觀察.
목적 탐토연합사용항균약물대산KPC-2매폐염극뢰백균적체외항균효응,심조유효적조합방안.방법 수집2008 -2009년분리자절강대학의학원부속제일의원,저파리혜리의원、절강성인민의원、항주시제삼의원、소흥시제이의원、항주시제일의원、복단대학부속화산의원、남경군구총의원등8가의원학증산KPC-2매적24주폐염극뢰백균,채용MLST기술분형,경지희석법측정아미잡성、미낙배소、아알배남、아막서림/극랍유산、두포타정、미라배남、경대매소、두포서정、두포필우、리복평、다점균소B、배병사성대24주균주적MIC치,Etest측정체가배소、고랍서림/삼서파탄적MIC치.채용기반경지희석법측정두포필우연합아막서림/극랍유산、두포필우연합아미잡성、배병사성연합아미잡성、배병사성연합두포필우、아알배남연합아미잡성、아알배남연합배병사성、아알배남연합다점균소B、아알배남연합미낙배소、다점균소B연합리복평、두포타정연합아막서림/극랍유산대균주적억균효과.결과 24주산KPC-2매폐염극뢰백균분위5개ST형,기중ST11형시최주요적극륭군(15주).균주대다점균소B、체가배소균민감,대미낙배소내약솔위4.2%.최가조합방안위두포필우연합아막서림/극랍유산,출현협동작용유19주;기차위아알배남연합아미잡성、두포타정연합아막서림/극랍유산,출현협동작용균위13주.결론 산KPC-2매폐염극뢰백균대체가배소、다점균소B、미낙배소교민감,두포필우연합아막서림/극랍유산、아알배남연합아미잡성、두포타정연합아막서림/극랍유산재체외이협동작용위주,기료효치득림상진일보관찰.
Objective To investigate the synergistic efficacy of different antibiotic combinations against KPC-2 carbapenemase producing Klebsiella pneumoniae strains in vitro and search for effective antibiotic combination.Methods During 2008 - 2009,a total of 24 strains of K.pneumoniae producing KPC-2 carbapenemase were collected from 8 hospitals in the First Affiliated Hospital of Medical School of Zhejiang University,Ningbo LiHuiLi Hospital,Zhejiang People's Hospital,Hangzhou Third Hospital,the Second Hospital of Shaoxing,Hangzhou First Hospital,Fudan University Huashan Hospital,General Hospital of Nanjing Military Region.MLST technique was used for epidemiological analysis.The MIC of antibiotics,such as amikacin,minocycline,imipenem,amoxicillin/clavulanic-acid,ceftazidime,meropenem,gentamicin,cefoxitin,cefepime,rifampicin,polymyxinB,ciprofloxacin were determined by an agar dilution method,the MIC of tigecycline and piperacillin/tazobactain were determined by Etest.The antibacterial activities of cefepime in combination with amoxicillin/clavulanic-acid,amikacin,or ciprofloxacin,amikacin with ciprofloxacin,imipenem with amikacin,ciprofloxacin,polymyxinB,or minocycline,polymyxin B with rifampicin,ceftazidime with amoxicillin/clavulanic-acid were assessed by chequerboard synergy agar dilution tests against all the isolates.Results MLST showed 5 STs among 24 strains of KPC-2 carbapenemase producing K.pneumoniae,and the most prevalent clone was ST11 (15 strains).All isolates were susceptible to polymyxin B and tigecycline,and the resistance rate of minocycline was 4.2%.The synergetic effects were observed in cefepime-amoxicillin/clavulanic acid,imipenem-amikacin,ceftazidime-amoxicillin/clavulanic acid combinations as 19 isolates,13 isolates,and 13 isolates,respectively.Conclusions KPC-2 carbapenemase producing K.pneumoniae is sensitive to polymyxin B,tigecycline and minocycline.The synergetic effect is predominant in cefepime-amoxicillin/clavulanic acid,imipenem-amikacin ceftazidime-amoxicillin/clavulanic acid combinations in vitro,their clinical efficacy are worthy of further observation.