Nastro Marcela, Rodríguez Carlos Hernan, Monge Renata, Zintgraff Jonathan, Neira Liliana, Rebollo Mirta, Vay Carlos, Famiglietti Angela
J Chemother. 2014 Aug;26(4):211-6. doi: 10.1179/1973947813Y.0000000136. Epub 2013 Dec 6.
Colistin (COL) is one of the few antimicrobials that retain activity against carbapenemase-producing Gram-negative bacteria (GNB). However, the emergence of COL resistance has renewed the use of combination therapy. The aim of this study was to determine the activity of COL plus rifampicin (RIF) against clinical isolates of COL-resistant, carbapenemase-producing GNB. We employed 36 COL-resistant carbapenemase-producing isolates (27 Klebsiella pneumoniae, 5 Serratia marcescens, and 4 Acinetobacter baumannii) belonging to 36 patients. E-test/agar dilution of all strains was performed with E-test strips of COL placed on agar plates with and without RIF. In 11 patients, the synergy was confirmed by time-kill studies. Synergy was detected in 34 isolates, whereas indifference was detected in two S. marcescens. The E-test/agar dilution method showed comparable results to the time-kill studies. Seven patients infected with these isolates (two meningitis, four sepsis, and one urinary tract infection) were treated with the combination successfully.
黏菌素（COL）是少数对产碳青霉烯酶革兰氏阴性菌（GNB）仍具活性的抗菌药物之一。然而，黏菌素耐药性的出现使得联合治疗的应用再度兴起。本研究的目的是确定黏菌素联合利福平（RIF）对耐黏菌素、产碳青霉烯酶GNB临床分离株的活性。我们使用了来自36例患者的36株耐黏菌素、产碳青霉烯酶分离株（27株肺炎克雷伯菌、5株黏质沙雷氏菌和4株鲍曼不动杆菌）。将含黏菌素的E-test试纸条置于添加和未添加利福平的琼脂平板上，对所有菌株进行E-test/琼脂稀释法检测。在11例患者中，通过时间杀菌试验证实了协同作用。在34株分离株中检测到协同作用，而在2株黏质沙雷氏菌中检测到无差异作用。E-test/琼脂稀释法的结果与时间杀菌试验结果相当。7例感染这些分离株的患者（2例脑膜炎、4例败血症和1例尿路感染）接受联合治疗后取得成功。
