Balaji V, Jeremiah S S, Baliga P R
Department of Clinical Microbiology, Christian Medical College, Vellore - 632 004, Tamil Nadu, India.
Indian J Med Microbiol. 2011 Jul-Sep;29(3):230-42. doi: 10.4103/0255-0857.83905.
The increasing prevalence of multidrug-resistant nosocomial pathogens such as Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae poses a great challenge to the treating physicians. The paucity of newer effective antimicrobials has led to renewed interest in the polymyxin group of drugs, as a last resort for treatment of gram-negative bacterial infections. There is a dearth of information on the pharmacological properties of colistin, leading to difficulties in selecting the right dose, dosing interval, and route of administration for treatment, especially in critically-ill patients. The increasing use of colistin over the last few years necessitates the need for accurate and reliable in vitro susceptibility testing methods. Development of heteroresistant strains as a result of colistin monotherapy is also a growing concern. There is a compelling need from the clinicians to provide options for probable and possible colistin combination therapy for multidrug-resistant bacterial infections in the ICU setting. Newer combination drug synergy determination tests are being developed and reported. There are no standardized recommendations from antimicrobial susceptibility testing reference agencies for the testing and interpretation of these drug combinations. Comparison and analysis of these reported methodologies may help to understand and assist the microbiologist to choose the best method that produces accurate results at the earliest. This will help clinicians to select the appropriate combination therapy. In this era of multidrug resistance it is important for the microbiology laboratory to be prepared, by default, to provide timely synergistic susceptibility results in addition to routine susceptibility, if warranted. Not as a favour or at request, but as a responsibility.
多重耐药医院病原体（如鲍曼不动杆菌、铜绿假单胞菌和肺炎克雷伯菌）的日益流行给治疗医生带来了巨大挑战。新型有效抗菌药物的匮乏使得人们对多粘菌素类药物重新产生兴趣，将其作为治疗革兰氏阴性菌感染的最后手段。关于黏菌素药理特性的信息匮乏，导致在选择正确的剂量、给药间隔和给药途径进行治疗时存在困难，尤其是在重症患者中。在过去几年中，黏菌素的使用日益增加，因此需要准确可靠的体外药敏试验方法。由于黏菌素单药治疗导致异质性耐药菌株的出现也日益受到关注。临床医生迫切需要为重症监护病房环境中多重耐药细菌感染提供可能的黏菌素联合治疗方案。新的联合药物协同作用测定试验正在开发和报道。抗菌药敏试验参考机构对于这些药物组合的检测和解释没有标准化的建议。对这些报道的方法进行比较和分析可能有助于理解并协助微生物学家选择最早产生准确结果的最佳方法。这将有助于临床医生选择合适的联合治疗方案。在这个多重耐药的时代，微生物学实验室默认有必要在必要时除常规药敏试验外及时提供协同药敏结果。这不是出于帮忙或应要求，而是作为一项责任。
