体外协同抗生素组合对多重耐药铜绿假单胞菌的疗效。
In-vitro efficacy of synergistic antibiotic combinations in multidrug resistant Pseudomonas aeruginosa strains.
机构信息
Department of Clinical Microbiology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey.
出版信息
Yonsei Med J. 2010 Jan;51(1):111-6. doi: 10.3349/ymj.2010.51.1.111. Epub 2009 Dec 29.
PURPOSE
Combination antibiotic treatment is preferred in nosocomial infections caused by Pseudomonas aeruginosa (P. aeruginosa). In vitro synergism tests were used to choose the combinations which might be used in clinic. The aim of this study was to investigate the synergistic efficacy of synergistic antibiotic combinations in multidrug resistant P. aeruginosa strains.
MATERIALS AND METHODS
Synergistic efficacies of ceftazidime-tobramycin, piperacillin/tazobactam-tobramycin, imipenem-tobramycin, imipenem-isepamycin, imipenem-ciprofloxacin and ciprofloxacin-tobramycin combinations were investigated by checkerboard technique in 12 multiple-resistant and 13 susceptible P. aeruginosa strains.
RESULTS
The ratios of synergy were observed in ceftazidime-tobramycin and piperacillin/tazobactam-tobramycin combinations as 67%, and 50%, respectively, in resistant strains, whereas synergy was not detected in other combinations. The ratios of synergy were observed in ceftazidime-tobramycin, piperacillin/tazobactam-tobramycin, imipenem-tobramycin, imipenem-ciprofloxacin and imipenem-isepamycin combinations as 31%, 46%, 15%, 8%, 8%, and respectively, in susceptible strains, whereas synergy was not detected in ciprofloxacin-tobramycin combination. Antagonism was not observed in any of the combinations.
CONCLUSION
Although the synergistic ratios were high in combinations with ceftazidime or piperacillin/tazobactam and tobramycin, the concentrations in these combinations could not usually reach clinically available levels. Thus, the solution of the problems caused by multiple resistant P. aeruginosa should be based on the prevention of the development of resistance and spread of the causative agent between patients.
目的
在铜绿假单胞菌（绿脓杆菌）引起的医院感染中，联合抗生素治疗是首选。体外协同作用试验用于选择可能在临床上使用的组合。本研究旨在研究多药耐药铜绿假单胞菌菌株中联合抗生素组合的协同疗效。
材料和方法
采用棋盘试验法检测 12 株多重耐药和 13 株敏感铜绿假单胞菌对头孢他啶-妥布霉素、哌拉西林/他唑巴坦-妥布霉素、亚胺培南-妥布霉素、亚胺培南-依帕米星、亚胺培南-环丙沙星和环丙沙星-妥布霉素组合的协同作用。
结果
在耐药株中，头孢他啶-妥布霉素和哌拉西林/他唑巴坦-妥布霉素组合的协同率分别为 67%和 50%，而其他组合未检测到协同作用。在敏感株中，头孢他啶-妥布霉素、哌拉西林/他唑巴坦-妥布霉素、亚胺培南-妥布霉素、亚胺培南-环丙沙星和亚胺培南-依帕米星组合的协同率分别为 31%、46%、15%、8%和 8%，而环丙沙星-妥布霉素组合未检测到协同作用。任何组合均未观察到拮抗作用。
结论
虽然头孢他啶或哌拉西林/他唑巴坦与妥布霉素联合使用的协同率较高，但这些组合中的浓度通常无法达到临床可用水平。因此，解决多药耐药铜绿假单胞菌引起的问题应基于预防耐药的发展和病原体在患者之间的传播。
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