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[多黏菌素-氨苄西林/舒巴坦联合用药对耐亚胺培南鲍曼不动杆菌菌株的疗效评估]

[Evaluation of Colistin-Ampicillin/Sulbactam Combination Efficacy in Imipenem-Resistant Acinetobacter baumannii Strains].

作者信息

Cıkman Aytekin, Ceylan Mehmet Reşat, Parlak Mehmet, Karahocagil Mustafa Kasım, Berktaş Mustafa

机构信息

Erzincan Mengucek Gazi Education and Research Hospital, Microbiology Department, Erzincan, Turkey.

出版信息

Mikrobiyol Bul. 2013 Jan;47(1):147-51. doi: 10.5578/mb.4523.

Abstract

The increasing emergence of multi-drug resistant Acinetobacter baumannii strains as nosocomial pathogens lead to the use of antimicrobial combinations in the treatment of infections due to these bacteria. The aim of this study was to determine the MIC values of colistin and ampicillin/sulbactam and their in vitro synergistic activities by E-test in order to evaluate the effect of this combination against imipenem-resistant A.baumannii isolates. A total of 33 A.baumannii strains isolated from clinical specimens as etiologic agents of nosocomial infections and identified as imipenem-resistant were included in the study. Identification of the isolates was performed by conventional methods and their imipenem resistance was detected with BD Phoenix automated system (Becton Dickinson, USA). MIC values and in vitro synergistic activity of colistin and ampicillin/sulbactam combination were analyzed by E-test (AB Biodisk, Sweden) on Mueller-Hinton agar medium. Synergistic, additive, indifferent and antagonist effects of A.baumannii strains were evaluated by fractional inhibitory concentration (FIC) index. The combination was considered to be synergistic when the FIC index was ≤ 0.5, additive when it was 1- > 0.5 and antagonistic when ≥ 2. Of the 33 strains included in the study, 21 were resistant to colistin; 30 were resistant and 3 were moderately susceptible to ampicillin/sulbactam. MIC50 and MIC90 values and MIC range of A.baumannii strains for colistin were 8, 32 and 0.13-128 µg/ml; for ampicillin/sulbactam those values were 48, 256 and 12-256 µg/ml, respectively. According to the FIC indices, 15 strains showed synergistic, four additive, five indifferent and nine antagonistic activity to colistin and ampicillin/sulbactam combination. Among the 12 colistin-susceptible strains, nine showed antagonistic, two indifferent and one synergistic activity to the tested combination while among the 21 colistin-resistant strains 14 showed synergistic, four additive and three indifferent activity. As a result, the combination of colistin with ampicillin/sulbactam, demonstrated high synergistic activity in vitro. While the synergistic effect of this combination was more significant in colistin-resistant strains, antagonistic effect of colistin-susceptible strains was found to be notable. Therefore, colistin resistance should be primarily determined before using colistin and ampicillin/sulbactam combination in A.baumannii infections since this combination seemed to be more effective in case of colistin resistance. However, these data should be supported by further advanced clinical studies.

摘要

多重耐药鲍曼不动杆菌菌株作为医院病原体日益增多,这导致在治疗由这些细菌引起的感染时使用抗菌药物联合治疗。本研究的目的是通过E试验确定黏菌素和氨苄西林/舒巴坦的最低抑菌浓度(MIC)值及其体外协同活性,以评估该联合治疗对耐亚胺培南鲍曼不动杆菌分离株的效果。本研究共纳入33株从临床标本中分离出的作为医院感染病原体且被鉴定为耐亚胺培南的鲍曼不动杆菌菌株。采用常规方法对分离株进行鉴定,并使用BD Phoenix自动化系统(美国BD公司)检测其对亚胺培南的耐药性。在Mueller-Hinton琼脂培养基上通过E试验(瑞典AB生物盘公司)分析黏菌素和氨苄西林/舒巴坦联合治疗的MIC值和体外协同活性。通过分数抑菌浓度(FIC)指数评估鲍曼不动杆菌菌株的协同、相加、无关和拮抗作用。当FIC指数≤0.5时,该联合治疗被认为具有协同作用;当FIC指数为1至>0.5时,具有相加作用;当FIC指数≥2时,具有拮抗作用。在本研究纳入的33株菌株中,21株对黏菌素耐药;30株对氨苄西林/舒巴坦耐药,3株对其中度敏感。鲍曼不动杆菌菌株对黏菌素的MIC50和MIC90值以及MIC范围分别为8、32和0.13至128 μg/ml;对氨苄西林/舒巴坦的这些值分别为48、256和12至256 μg/ml。根据FIC指数,15株菌株对黏菌素和氨苄西林/舒巴坦联合治疗表现出协同作用,4株表现出相加作用,5株表现出无关作用,9株表现出拮抗作用。在12株对黏菌素敏感的菌株中,9株对测试联合治疗表现出拮抗作用,2株表现出无关作用,1株表现出协同作用;而在21株对黏菌素耐药的菌株中,14株表现出协同作用,4株表现出相加作用,3株表现出无关作用。结果表明,黏菌素与氨苄西林/舒巴坦联合治疗在体外表现出较高的协同活性。虽然该联合治疗在耐黏菌素菌株中的协同作用更为显著,但对黏菌素敏感菌株的拮抗作用也较为明显。因此,在鲍曼不动杆菌感染中使用黏菌素和氨苄西林/舒巴坦联合治疗前,应首先确定黏菌素耐药情况,因为该联合治疗在耐黏菌素情况下似乎更有效。然而,这些数据需要进一步的高级临床研究加以支持。

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