摘要
目的探讨常用抗菌药物对产青霉烯-2(KPC-2)酶肺炎克雷伯菌的体外抗菌效应研究,为肺炎克雷伯菌临床治疗提供参考。方法收集2012年1月-2015年12月确诊肺炎克雷伯菌感染患者标本中分离20株产KPC-2酶肺炎克雷伯菌,测定菌株对头孢吡肟(FEP)、头孢西丁(FOX)、阿莫西林/克拉维酸(AMC)、头孢他啶(CAZ)、亚胺培南(IPM)、美洛培南(MEM)、环丙沙星(CIP)及米诺环素(MI)的最低抑菌浓度(MIC),分析FEP+CIP、FEP+AMC、IPM+MI、IPM+CIP、CAZ+AMC联合作用(PIC指数)。结果 20株产KPC-2酶肺炎克雷伯菌对AMC、CAZ完全耐药,耐药率为100.00%,对FOX、CIP耐药率为75.00%,对FEP、IPM、MEM耐药率分别为30.00%、25.00%、30.00%,对MI完全敏感,耐药率为0.00%;FEP+CIP时2株出现协同、12株出现相加、40株出现无关、2株出现拮抗,构成比分别为10.00%、60.00%、20.00%、10.00%,FEP+AMC时17株出现协同、2株出现相加、1株出现拮抗,构成比分别为85.00%、10.00%、5.00%,IPM+MI时10株出现相加、4株出现无关、6株出现拮抗,构成比分别为50.00%、20.00%、30.00%,IPM+CIP时2株出现协同、8株出现相加、7株出现无关、3株出现拮抗,构成比分别为10.00%、40.00%、35.00%、15.00%,CAZ+AMC时12株出现协同、6株出现相加、2株出现拮抗,构成比分别为60.00%、30.00%、10.00%;对FEP+CIP、FEP+AMC、IPM+MI、IPM+CIP、CAZ+AMC的耐药率分别为20.00%、20.00%、90.00%、50.00%、80.00%。结论产KPC-2酶肺炎克雷伯菌对MI敏感,对AMC、CAZ完全耐药,FEP+AMC、CAZ+AMC在体外效应以协同作用为主,其机制值得进一步研究。
OBJECTIVE To observe the in vitro antibacterial activity of commonly used antibiotics against KPC-2 carbapenemase-producing Klebsiella pneurnoniae so as to provide guidance for clinical treatment of K. pneumoni- ae. METHODS A total of 20 strains of KPC-2 carbapenemase-producing K. pneumoniae were isolated from the specimens that were obtained from the patients who were diagnosed with K. pneumoniae infection from Jan 2012 to Dec 2015. The minimum inhibitory concentrations （MICs） of the cefepime （FEP）, cefoxitin （FOX）, amoxicillin- clavulanic acid （AMC）, ceftazidime （CAZ）, imipenem （IPM）, meropenem （MEM）, ciprofloxacin （CIP）, and minocycline （MI） were determined. The PIC indexes of FEP plus CIP, FEP plus AMC, IPM plus MI, IPM plus CIP, and CAZ plus AMC were observed. RESULTS The drug resistance rates of the 20 strains of KPC-2 carbapen- emase-producing K. pneumoniae to AMC and CAZ were 100.00% the drug resistance rates to FOX and CIP were 75.00% the drug resistance rates to FEP, IPM, and MEM were 30. 00%, 25.00%, and 30.00%, respectively; the drug resistance rate to MI was O. 00%. When FEP was combined with CIP, there were 2 （10.00%） strains of synergy, 12 （60. 00%） strains of addictive, 20 （20. 00%） strains of irrelevance, and 2 （10. 00%） strains of antagonism. When FEP was combined with AMC, there were 17 （85.00%） strains of synergy, 2 （10. 00 % ） strains of addictive, and 1 （5.00 %） strain of antagonism. When IPM was combined with MI, there were 10 （50.00~） strains of addictive, 4 （20.00%） strains of irrelevance, and 6 （30.00%） strains of antagonism. When IPM was combined with CIP, there were 2 （10.00%） strains of synergy, 8 （40.00~） strains of addictive, 7 （35. 00 %） strains of irrelevance, and 3 （15.00%） strains of antagonism. When CAZ was combined with AMC, there were 12 （60.00%） strains of synergy, 6 （30.00%） strains of addictive, and 2 （10.00%） strains of antagonism. The drug resistance rates to FEP plu
作者
简雪峰
程国平
王媛媛
白娇红
孙灵云
JIAN Xue-feng CHENG Guo-ping WANG Yuan-yuan BAI Jiao-hong SUN Ling-yun(The First Affiliated Hospital of Renan University of Science and Technology, Luoyang, Henan 471003, China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2017年第5期969-971,991,共4页
Chinese Journal of Nosocomiology
基金
河南省科技计划项目(162102310061)
关键词
KPC-2酶
肺炎克雷伯菌
抗菌药物
体外
抗菌效应
KPC-2 carbapenemase
Klebsiella pneumoniae
Antibiotic
In vitro
Antibacterial effect
