亚胺培南联合多黏菌素B对不同表型铜绿假单胞菌体外抗菌活性的研究

doi:10.3969/j.issn.1673-8640.2013.01.001

检验医学 ›› 2013, Vol. 28 ›› Issue (1): 1-6.DOI: 10.3969/j.issn.1673-8640.2013.01.001

• 临床应用研究.论著 • 下一篇

亚胺培南联合多黏菌素B对不同表型铜绿假单胞菌体外抗菌活性的研究

1.上海交通大学医学院附属仁济医院检验科，上海 200001；2.上海交通大学医学院附属瑞金医院临床微生物科，上海 200025

出版日期:2013-01-30 发布日期:2013-01-10
作者简介:杨海慧，女，1974年生，学士，主管技师，主要从事病原微生物检测工作。

Study on in vitro antibacterial activity of the combined therapy of imipenem with polymyxin B against Pseudomonas aeruginosa with different phenotypes

1. Department of Clinical Laboratory，Renji Hospital，Shanghai Jiaotong University School of Medicine，Shanghai 200001，China；2.Department of Clinical Microbiology，Ruijin Hospital ，Shanghai Jiaotong University School of Medicine，Shanghai 200025，China

Online:2013-01-30 Published:2013-01-10

摘要/Abstract

摘要： 目的　探讨多黏菌素B与亚胺培南联用对不同耐药表型铜绿假单胞菌的体外抗菌活性。方法　自仁济医院西部及瑞金医院临床标本中分离铜绿假单胞菌133株，运用纸片扩散（K-B）法分析其耐药表型，采用琼脂稀释法检测亚胺培南和多黏菌素B单用及联用时对不同表型铜绿假单胞菌的最低抑菌浓度（MIC），计算部分抑菌浓度（FIC），判断联合效应。分别探讨2个不同的配比浓度，即亚胺培南∶多黏菌素B为1∶0.5和1∶1时的抗菌效果。结果　对2种药物组合进行KAPPA一致性检验，药物敏感性结果一致性微弱。亚胺培南与多黏菌素B以1∶1联用时协同率为51.13%，明显高于1∶0.5时的19.55%。运用Fisher′s精确概率法分析不同表型间的联合抑菌效应，亚胺培南与多黏菌素B以1∶1浓度配比时，对各表型间均有较高的协同率，不存在明显的统计学差异；而1∶0.5时差异明显。结论　体外联合应用亚胺培南与多黏菌素B对铜绿假单胞菌的抗菌效果明显优于单用亚胺培南。以1∶1联用时的协同率优于1∶0.5，且对不同耐药表型的铜绿假单胞菌作用稳定，值得向临床推广。

关键词: 铜绿假单胞菌, 联合用药, 耐药, 亚胺培南, 多黏菌素B

Abstract: Objective　To investigate the in vitro antibacterial activity of the combined therapy of imipenem with polymyxin B against Pseudomonas aeruginosa with different phenotypes. Methods　A total of 133 clinically isolated Pseudomonas aeruginosa were collected from Renji Hospital（West Department）and Ruijin Hospital，and the phenotypes were determined by disc diffusion（K-B）method. The minimum inhibitory concentrations（MIC）of imipenem，polymyxin B and imipenem with polymyxin B against Pseudomonas aeruginosa were calculated by agar dilution method，and the fractional inhibitory concentrations（FIC）were calculated. The combined effect was analyzed. There were 2 ratios，1∶0.5 and 1∶1 with imipenem to polymyxin B. Results　The drug sensitivities of those 2 therapies turned out to be inconsistent when conducting Kappa test. The synergistic rate of 1∶1 with imipenem to polymyxin B was 51.13%，which was much higher than 1∶0.5 with imipenem to polymyxin（19.55%）. Fisher′s exact test demonstrated that 1∶1 with imipenem to polymyxin B maintained high synergistic rate between different phenotypes，and there was no statistically significant difference. However，the difference was significant regarding to 1∶0.5 with imipenem to polymyxin B. Conclusions　Comparing with monotherapy，the combined therapy of imipenem with polymyxin B significantly increases the sensitivity of Pseudomonas aeruginosa in vitro. The combined therapy applying 1∶1 with imipenem to polymyxin B with a higher synergistic rate than that applying 1∶0.5 with imipenem to polymyxin B and a good stability may be a good choice for the antibiotics resistant Pseudomonas aeruginosa with different phenotypes.

Key words: Pseudomonas aeruginosa, Drug combination, Resistance, Imipenem, Polymyxin B

杨海慧 1，韩立中 2，刘怡菁 1，陈旭 2，应春妹 1，赵贝棣 1，祝燕萍 1，卫颖珏 1. 亚胺培南联合多黏菌素B对不同表型铜绿假单胞菌体外抗菌活性的研究[J]. 检验医学, 2013, 28(1): 1-6.

YANG Haihui 1，HAN Lizhong 2，LIU Yijing 1，CHEN Xu 2，YING Chunmei 1，ZHAO Beidi 1，ZHU Yanping 1，WEI Yingjue 1. Study on in vitro antibacterial activity of the combined therapy of imipenem with polymyxin B against Pseudomonas aeruginosa with different phenotypes[J]. , 2013, 28(1): 1-6.

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亚胺培南联合多黏菌素B对不同表型铜绿假单胞菌体外抗菌活性的研究

Study on in vitro antibacterial activity of the combined therapy of imipenem with polymyxin B against Pseudomonas aeruginosa with different phenotypes

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