CAJ | 학술논문

目的：评价美罗培南与多西环素、环丙沙星、舒巴坦及头孢哌酮/舒巴坦联合用药对泛耐药鲍曼不动杆菌的体外抗菌效应。方法采用棋盘法设计，微量肉汤稀释法测定不同浓度组合的抗菌药物对50株临床分离的泛耐药鲍曼不动杆菌的最低抑菌浓度，并计算部分抑菌浓度（FIC）指数判定联合效应。结果美罗培南与多西环素联用后，其MIC50显著下降，FIC指数分布：FIC≤0.5占38%，0.5<FIC≤1占62%，1<FIC≤2为0，FIC>2为0。美罗培南与环丙沙星联用后，其MIC50下降不明显，FIC指数分布：FIC≤0.5为0，0.5<FIC≤1占56%，1<FIC≤2为44%，FIC>2为0。美罗培南与舒巴坦联用后，其MIC50明显下降，FIC指数分布：FIC≤0.5为26%，0.5<FIC≤1占74%，1<FIC≤2为0，FIC>2为0。美罗培南与头孢哌酮/舒巴坦联用后，其MIC50有所下降，FIC指数分布：FIC≤0.5为10%，0.5<FIC≤1占90%，1<FIC≤2为0，FIC>2为0。结论美罗培南与多西环素、舒巴坦或者头孢哌酮/舒巴坦联合，对泛耐药鲍曼不动杆菌均表现为协同和相加作用，没有无关作用和拮抗作用，具有良好的体外抗菌活性；而美罗培南与环丙沙星联合表现出的相加作用和无关作用比例相当，对泛耐药鲍曼不动杆菌的体外抗菌活性较差。
목적：평개미라배남여다서배소、배병사성、서파탄급두포고동/서파탄연합용약대범내약포만불동간균적체외항균효응。방법채용기반법설계，미량육탕희석법측정불동농도조합적항균약물대50주림상분리적범내약포만불동간균적최저억균농도，병계산부분억균농도（FIC）지수판정연합효응。결과미라배남여다서배소련용후，기MIC50현저하강，FIC지수분포：FIC≤0.5점38%，0.5<FIC≤1점62%，1<FIC≤2위0，FIC>2위0。미라배남여배병사성련용후，기MIC50하강불명현，FIC지수분포：FIC≤0.5위0，0.5<FIC≤1점56%，1<FIC≤2위44%，FIC>2위0。미라배남여서파탄련용후，기MIC50명현하강，FIC지수분포：FIC≤0.5위26%，0.5<FIC≤1점74%，1<FIC≤2위0，FIC>2위0。미라배남여두포고동/서파탄련용후，기MIC50유소하강，FIC지수분포：FIC≤0.5위10%，0.5<FIC≤1점90%，1<FIC≤2위0，FIC>2위0。결론미라배남여다서배소、서파탄혹자두포고동/서파탄연합，대범내약포만불동간균균표현위협동화상가작용，몰유무관작용화길항작용，구유량호적체외항균활성；이미라배남여배병사성연합표현출적상가작용화무관작용비례상당，대범내약포만불동간균적체외항균활성교차。
Objective To study the in vitro antibacterial activity of meropenem combined with doxycycline, ciprofloxacin, sulbactam or cefoperazone/sulbactam against clinically isolated extensively drug-resistant Acinetobacter baumannii (XDRAB). Methods Using a checker board synergy design, the minimal inhibitory concentration (MIC) of antibiotics against 50 isolates of XDRAB was determined by broth microdilution antifungal susceptibility test. The fractional inhibitory concentration (FIC) index was calculated to determine the combined effect of the antibiotics. Results Meropenem showed significantly reduced MIC50 and enhanced antimicrobial activities when combined with doxycycline, sulbactam or cefoperazone/sulbactam. The FIC results suggested that the main actions of doxycycline, sulbactam, and cefoperazone/sulbactam were synergistic (38%, 26%, and 10%, respectively) and addictive (62%, 74%, and 90%, respectively) without indifferent or antagonistic effects. The main actions of meropenem combined with ciprofloxacin were additive (56%) and indifference (44%) with synergistic and antagonistic effects. Conclusion Meropenem combined with doxycycline, sulbactam or cefoperazone/sulbactam shows excellent activity against clinical isolates of XDRAB.