多黏菌素联合用药对多黏菌素耐药鲍曼不动杆菌、铜绿假单胞菌和肺炎克雷伯菌的体外协同作用。

In vitro synergy of colistin combinations against colistin-resistant Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae isolates.

机构信息

SRSMC, UMR CNRS 7565, Nancy, France.

出版信息

Antimicrob Agents Chemother. 2012 Sep;56(9):4856-61. doi: 10.1128/AAC.05996-11. Epub 2012 Jul 2.

Abstract

Colistin resistance, although uncommon, is increasingly being reported among Gram-negative clinical pathogens, and an understanding of its impact on the activity of antimicrobials is now evolving. We evaluated the potential for synergy of colistin plus trimethoprim, trimethoprim-sulfamethoxazole (1/19 ratio), or vancomycin against 12 isolates of Acinetobacter baumannii (n = 4), Pseudomonas aeruginosa (n = 4), and Klebsiella pneumoniae (n = 4). The strains included six multidrug-resistant clinical isolates, K. pneumoniae ATCC 700603, A. baumannii ATCC 19606, P. aeruginosa ATCC 27853, and their colistin-resistant derivatives (KPm1, ABm1, and PAm1, respectively). Antimicrobial susceptibilities were assessed by broth microdilution and population analysis profiles. The potential for synergy of colistin combinations was evaluated using a checkerboard assay, as well as static time-kill experiments at 0.5× and 0.25× MIC. The MIC ranges of vancomycin, trimethoprim, and trimethoprim-sulfamethoxazole (1/19) were ≥128, 4 to ≥128, and 2/38 to >128/2,432 μg/ml, respectively. Colistin resistance demonstrated little impact on vancomycin, trimethoprim, or trimethoprim-sulfamethoxazole MIC values. Isolates with subpopulations heterogeneously resistant to colistin were observed to various degrees in all tested isolates. In time-kill assays, all tested combinations were synergistic against KPm1 at 0.25× MIC and 0.5× MIC and ABm1 and PAm1 at 0.5× MIC. In contrast, none of the tested combinations demonstrated synergy against any colistin-susceptible P. aeruginosa isolates and clinical strains of K. pneumoniae isolates. Only colistin plus trimethoprim or trimethoprim-sulfamethoxazole was synergistic and bactericidal at 0.5× MIC against K. pneumoniae ATCC 700603. Colistin resistance seems to promote the in vitro activity of unconventional colistin combinations. Additional experiments are warranted to understand the clinical significance of these observations.

摘要

多黏菌素耐药性虽然罕见,但在革兰氏阴性临床病原体中越来越常见,对其对抗微生物药物活性的影响的理解也在不断发展。我们评估了多黏菌素联合甲氧苄啶、甲氧苄啶-磺胺甲噁唑(1/19 比例)或万古霉素对 12 株鲍曼不动杆菌(n=4)、铜绿假单胞菌(n=4)和肺炎克雷伯菌(n=4)的潜在协同作用。这些菌株包括 6 株多药耐药临床分离株,分别为肺炎克雷伯菌 ATCC 700603、鲍曼不动杆菌 ATCC 19606、铜绿假单胞菌 ATCC 27853 及其多黏菌素耐药衍生株(分别为 KPm1、ABm1 和 PAm1)。通过肉汤微量稀释法和群体分析谱评估抗菌药物敏感性。使用棋盘试验以及 0.5×和 0.25×MIC 的静态时间杀伤实验评估多黏菌素联合的协同作用。万古霉素、甲氧苄啶和甲氧苄啶-磺胺甲噁唑(1/19)的 MIC 范围分别为≥128、4 至≥128 和 2/38 至>128/2,432μg/ml。多黏菌素耐药性对万古霉素、甲氧苄啶或甲氧苄啶-磺胺甲噁唑的 MIC 值影响不大。在所有测试的分离株中,均观察到对多黏菌素异质性耐药的亚群。在时间杀伤试验中,所有测试的组合在 0.25×MIC 和 0.5×MIC 时对 KPm1、在 0.5×MIC 时对 ABm1 和 PAm1 均表现出协同作用。相比之下,没有一种组合对任何多黏菌素敏感的铜绿假单胞菌分离株和肺炎克雷伯菌临床分离株表现出协同作用。只有多黏菌素联合甲氧苄啶或甲氧苄啶-磺胺甲噁唑在 0.5×MIC 时对肺炎克雷伯菌 ATCC 700603 具有协同作用和杀菌作用。多黏菌素耐药性似乎促进了非常规多黏菌素联合的体外活性。需要进一步的实验来理解这些观察结果的临床意义。

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索