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达托霉素对耐万古霉素肠球菌和耐甲氧西林金黄色葡萄球菌菌株的体外活性

[In vitro activity of daptomycin against VRE and MRSA strains].

作者信息

Aktaş Gülseren, Derbentli Sengül

机构信息

Istanbul University Faculty of Istanbul Medicine, Department of Medical Microbiology, Istanbul, Turkey.

出版信息

Mikrobiyol Bul. 2014 Jan;48(1):123-8.

Abstract

Infections with multidrug-resistant (MDR) gram-positive bacteria are gradually increasing in the world. Methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) are among the leading pathogens isolated from nosocomial infections. The increased use of vancomycin in the treatment has led to the development of isolates with reduced susceptibility and resistance. Daptomycin is a novel lipopeptide antibiotic which has a rapid bactericidal activity against infections caused by gram-positive bacteria including MRSA and VRE. The aim of this study was to evaluate the in vitro activity of daptomycin against VRE and MRSA strains isolated from clinical samples of hospitalized patients. A total of 229 isolates of which 118 were VRE and 111 were MRSA have been included in the study. All of the VRE strains were isolated from rectal swab samples and two of them were also resistant to linezolid with the MIC values of 8 µg/ml and 12 µg/ml. Bacterial identification was performed by conventional methods and susceptibility testing of daptomycin was performed by using the broth microdilution method as recommended by CLSI. The MIC values were interpreted according to CLSI susceptibility criteria for daptomycin. Daptomycin MIC50 and MIC90 values for VRE were found as 1 µg/ml and 2 µg/ml, respectively, with a MIC range of 0.125-2 µg/ml. Daptomycin MIC50 and MIC90 values for MRSA were determined as 0.12 µg/ml and 0.5 µg/ml, respectively, and the overall distribution of MIC values ranged between ≤ 0.032-1 µg/ml. All VRE including two linezolid-resistant strains and all MRSA strains (100%) were found susceptible to daptomycin. It was concluded that daptomycin is one of the few alternative agents for the treatment of infections caused by VRE and MRSA, nevertheless it was suggested that daptomycin MICs should better be monitored to prevent treatment failure due to the presence of non-susceptible strains and possible emergence of strains with decreased susceptibility during long-term therapy.

摘要

耐多药(MDR)革兰氏阳性菌感染在全球范围内正逐渐增加。耐甲氧西林金黄色葡萄球菌(MRSA)和耐万古霉素肠球菌(VRE)是医院感染中分离出的主要病原体。治疗中万古霉素使用的增加导致了敏感性降低和耐药性菌株的出现。达托霉素是一种新型脂肽抗生素,对包括MRSA和VRE在内的革兰氏阳性菌引起的感染具有快速杀菌活性。本研究的目的是评估达托霉素对从住院患者临床样本中分离出的VRE和MRSA菌株的体外活性。该研究共纳入229株菌株,其中118株为VRE,111株为MRSA。所有VRE菌株均从直肠拭子样本中分离得到,其中两株对利奈唑胺也耐药,其MIC值分别为8μg/ml和12μg/ml。采用常规方法进行细菌鉴定,并按照CLSI推荐的肉汤微量稀释法进行达托霉素的药敏试验。根据CLSI达托霉素药敏标准解释MIC值。VRE的达托霉素MIC50和MIC90值分别为1μg/ml和2μg/ml,MIC范围为0.125 - 2μg/ml。MRSA的达托霉素MIC50和MIC90值分别确定为0.12μg/ml和0.5μg/ml,MIC值的总体分布范围在≤!0.032 - 1μg/ml之间。所有VRE(包括两株耐利奈唑胺菌株)和所有MRSA菌株(100%)对达托霉素敏感。得出的结论是,达托霉素是治疗VRE和MRSA引起的感染的少数替代药物之一,不过建议更好地监测达托霉素的MIC,以防止因存在不敏感菌株以及长期治疗期间可能出现敏感性降低的菌株而导致治疗失败。

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