抗碳青霉烯类鲍曼不动杆菌血分离株的体外时间杀菌研究,包括多粘菌素或替加环素耐药分离株。
In vitro time-kill studies of antimicrobial agents against blood isolates of imipenem-resistant Acinetobacter baumannii, including colistin- or tigecycline-resistant isolates.
机构信息
Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Division of Infectious Diseases, Korea University Anam Hospital, Korea University, College of Medicine, Seoul, Republic of Korea.
出版信息
J Med Microbiol. 2012 Mar;61(Pt 3):353-360. doi: 10.1099/jmm.0.036939-0. Epub 2011 Oct 20.
The emergence of colistin or tigecycline resistance as well as imipenem resistance in Acinetobacter baumannii poses a great therapeutic challenge. The bactericidal and synergistic effects of several combinations of antimicrobial agents against imipenem-, colistin- or tigecycline-resistant A. baumannii isolates were investigated by in vitro time-kill experiments. Six imipenem-resistant A. baumannii blood isolates were examined in this study, including colistin- and tigecycline-susceptible, colistin-resistant but tigecycline-susceptible, and colistin-susceptible but tigecycline-resistant isolates. Time-kill studies were performed using five antimicrobial agents singly or in combinations (imipenem plus colistin, imipenem plus ampicillin-sulbactam, colistin plus rifampicin, colistin plus tigecycline, and tigecycline plus rifampicin) at concentrations of 0.5× and 1× their MICs. Only imipenem was consistently effective as a single agent against all six A. baumannii isolates. Although the effectiveness of combinations of 0.5× MIC antimicrobial agents was inconsistent, combination regimens using 1× MIC of the antimicrobial agents displayed excellent bactericidal activities against all six A. baumannii isolates. Among the combinations of 0.5× MIC antimicrobial agents, the combination of colistin and tigecycline showed synergistic or bactericidal effects against four of the isolates. This in vitro time-kill analysis suggests that antimicrobial combinations are effective for killing imipenem-resistant A. baumannii isolates, even if they are simultaneously resistant to either colistin or tigecycline. However, the finding that the combinations of 0.5× MIC antimicrobial agents were effective on only some isolates may warrant further investigation of the doses of combination agents needed to kill resistant A. baumannii.
黏菌素或替加环素耐药以及鲍曼不动杆菌对亚胺培南耐药的出现带来了巨大的治疗挑战。通过体外时间杀伤实验研究了几种抗菌药物组合对耐亚胺培南、黏菌素或替加环素鲍曼不动杆菌分离株的杀菌和协同作用。本研究共检测了 6 株耐亚胺培南鲍曼不动杆菌血源分离株,包括黏菌素和替加环素敏感、黏菌素耐药但替加环素敏感、以及黏菌素敏感但替加环素耐药分离株。使用 5 种抗菌药物(亚胺培南单药、亚胺培南加氨苄西林/舒巴坦、黏菌素加利福平、黏菌素加替加环素、替加环素加利福平)单独或联合(0.5×和 1×MIC)进行时间杀伤研究。只有亚胺培南作为单一药物对所有 6 株鲍曼不动杆菌分离株始终有效。尽管 0.5×MIC 抗菌药物联合治疗的效果不一致,但使用 1×MIC 抗菌药物联合治疗方案对所有 6 株鲍曼不动杆菌分离株显示出极好的杀菌活性。在 0.5×MIC 抗菌药物联合治疗中,黏菌素和替加环素联合治疗对 4 株分离株显示出协同或杀菌作用。这项体外时间杀伤分析表明,抗菌药物联合治疗对杀灭耐亚胺培南鲍曼不动杆菌分离株是有效的,即使它们同时对黏菌素或替加环素耐药。然而,发现 0.5×MIC 抗菌药物联合治疗方案仅对一些分离株有效,可能需要进一步研究联合用药剂量以杀灭耐药鲍曼不动杆菌。