Celikbilek Nevreste, Ozdem Birsen, Gürelik Feryal C, Güvenman Selda, Güner H Rahmet, Açıkgöz Ziya Cibali
Ankara Atatürk Training and Research Hospital, Clinic of Medical Microbiology, Ankara, Turkey.
Mikrobiyol Bul. 2011 Jul;45(3):512-8.
In this study, vancomycin, teicoplanin, linezolide and daptomycin susceptibility rates of 67 methicillin-resistant Staphylococcus aureus (MRSA) isolates obtained from various clinical samples between November 2006 and August 2010 in our laboratories, were investigated by E-test method and MIC values of the drugs were determined. Seventeen (25%) of the samples were from outpatient wards, 50 (75%) from inpatients of which 24 (48%) were from intensive care units. Distribution of MRSA isolated clinical samples were as follows: 16 (23.4%) blood, 28 (42.2%) wound swab, 15 (21.8%) tracheal aspirate, 2 (3.1%) urine, 2 (3.1%) urethral discharge, and one for each (1.6%) cerebrospinal fluid, joint fluid, catheter tip and nasal swab. Except one (1.5%) which was probably intermediate-resistant to vancomycin (since not confirmed by microdilution test or population analysis, this isolate was considered as "probable" intermediate-resistant), all of the isolates were found susceptible to all tested antibiotics. MIC(50) and MIC(90) values were determined as 0.75 and 1.5 µg/ml for vancomycin, 2 and 3 µg/ml for teicoplanin, 0.38 and 0.5 µg/ml for linezolide and 0.094 and 0.19 µg/ml for daptomycin, respectively. The MIC ranges were 0.25-3 µg/ml for vancomycin, 0.125-4 µg/ml for teicoplanin, 0.094-3 µg/ml for linezolide and 0.047-0.25 µg/ml for daptomycin. There was no statistically significant difference between MICs of outpatient, inpatient and intensive care unit isolates for any of the tested drugs (p> 0.05). Based on MIC90 values, daptomycin seems 4-16 times more effective than the other three drugs. It was concluded that considering their in-vitro antibacterial activity, these antibiotics can be used as alternatives to each other for the treatment of MRSA infections.
本研究采用E试验法，对2006年11月至2010年8月间从我们实验室的各种临床样本中分离出的67株耐甲氧西林金黄色葡萄球菌（MRSA）进行了万古霉素、替考拉宁、利奈唑胺和达托霉素的药敏率调查，并测定了这些药物的MIC值。17份（25%）样本来自门诊病房，50份（75%）来自住院患者，其中24份（48%）来自重症监护病房。MRSA分离临床样本的分布如下：血液16份（23.4%）、伤口拭子28份（42.2%）、气管吸出物15份（21.8%）、尿液2份（3.1%）、尿道分泌物2份（3.1%）、脑脊液、关节液、导管尖端和鼻拭子各1份（1.6%）。除1株（1.5%）可能对万古霉素中介耐药（由于未通过微量稀释试验或群体分析确认，该菌株被视为“可能”中介耐药）外，所有分离株对所有测试抗生素均敏感。万古霉素的MIC(50)和MIC(90)值分别测定为0.75和1.5 µg/ml，替考拉宁为2和3 µg/ml，利奈唑胺为0.38和0.5 µg/ml，达托霉素为0.094和0.19 µg/ml。万古霉素的MIC范围为0.25 - 3 µg/ml，替考拉宁为0.125 - 4 µg/ml，利奈唑胺为0.094 - 3 µg/ml，达托霉素为0.047 - 0.25 µg/ml。对于任何一种测试药物，门诊、住院和重症监护病房分离株的MIC之间均无统计学显著差异（p > 0.05）。基于MIC90值，达托霉素似乎比其他三种药物有效4 - 16倍。得出的结论是，考虑到它们的体外抗菌活性，这些抗生素可相互替代用于治疗MRSA感染。
