替加环素与5种抗生素对多重耐药鲍曼不动杆菌体外联合药敏实验的研究

摘要

分析亚胺培南、头孢哌酮-舒巴坦、头孢曲松、左氧氟沙星、庆大霉素5种临床常用鲍曼不动杆菌治疗的抗生素单用和分别与替加环素联用的体外敏感性实验的研究,以期发现较好的联合用药方案,为临床合理使用抗生素提供用药参考.采用微量肉汤稀释法测定5种抗生素对鲍曼不动杆菌的MIC值,再采用棋盘法测定5种抗生素分别与替加环素联用MIC值,并计算FIC指数.结果显示,替加环素与亚胺培南、头孢哌酮舒巴坦、左氧氟沙星、头孢曲松具有协同和相加作用,替加环素与庆大霉素具有拮抗作用.临床在选择抗生素治疗鲍曼不动杆菌所引起的重症感染时,可根据该药敏实验结果与亚胺培南或头孢哌酮舒巴坦或左氧氟沙星或头孢曲松与替加环素联合使用,但应避免与庆大霉素联合使用.%The effects of imipenem,cefoperazone-sulbactam,ceftriaxone,levofloxacin and gentamycin these five common used antibiotics to treat Acinetobacter baumannii singly and combinationally with tegercycline respectively were analyzed to study the sensitive experiments in vitro in order to find out a better administration plan,to provide references for a reasonable administration of the antibiotics.The broth microdilution method was adopted to detect MIC of the five antibiotics against A.baumannii.Then the antibiotics respectively with tigecycline was determined by the chessboard adopting broth microdilution method,and calculated the FIC index (fractional inhibitory concentration) to determine drug combination MIC.The results showed that tigecycline with imipenem,cefoperazone sulbactam,levofloxacin and ceftriaxone had synergistic and additive effect.Tigecycline and gentamicin has antagonistic effect.Clinical selection of antibiotics to treat severe infections caused by 4.baumannii can be used according to the sensitivity test results of imipenem,or cefoperazone-sulbactam,or levofloxacin,or ceftriaxone combined with tigecycline,however,combined administration with gentamicin should be avoided.