March Gabriel A, Bratos Miguel A
Service of Microbiology and Immunology, University Clinic Hospital of Valladolid, Ramón y Cajal Avenue n°3, 47003, Valladolid, Spain.
Service of Microbiology and Immunology, University Clinic Hospital of Valladolid, Ramón y Cajal Avenue n°3, 47003, Valladolid, Spain; Department of Microbiology, Faculty of Medicine, University of Valladolid, Av. Ramón y Cajal n°7, 47005, Valladolid, Spain.
J Microbiol Methods. 2015 Dec;119:31-6. doi: 10.1016/j.mimet.2015.09.014. Epub 2015 Sep 28.
The aim of the work was to describe the different in vitro models for testing synergism of antibiotics and gather the results of antibiotic synergy against multidrug-resistant Acinetobacter baumannii (MDR-Ab). The different original articles were obtained from different web sites. In order to compare the results obtained by the different methods for synergy testing, the Pearson chi-square and the Fischer tests were used. Moreover, non-parametric chi-square test was used in order to compare the frequency distribution in each analysed manuscript. In the current meta-analysis 24 manuscripts, which encompassed 2016 tests of in vitro synergism of different antimicrobials against MDR-Ab, were revised. Checkerboard synergy testing was used in 11 studies, which encompasses 1086 tests (53.9%); time-kill assays were applied in 12 studies, which encompass 359 tests (17.8%); gradient diffusion methods were used in seven studies, encompassing 293 tests (14.5%). And, finally, time-kill plus checkerboard were applied in two studies, encompassing 278 tests (13.8%). By comparing these data, checkerboard and time-kill methods were significantly more used than gradient diffusion methods (p<0.005). Regarding synergy rates obtained on the basis of the applied method, checkerboard provided 227 tests (20.9%) with a synergistic effect; time-kill assays yielded 222 tests (61.8%) with a synergistic effect; gradient diffusion methods only provided 29 tests (9.9%) with a synergistic effect; and, finally, time-kill plus checkerboard yielded just 15 tests (5.4%) with a synergistic effect. When comparing these percentages, synergy rates reported by time-kill methods were significantly higher than that obtained by checkerboard and gradient diffusion methods (p<0.005). On the basis of the revised data, the combinations of a bactericidal antibiotic plus Tigecycline, Vancomycin or Teicoplanin are not recommended. The best combinations of antibiotics are those which include bactericidal antibiotics such as Carbapenems, Fosfomycin, Amikacin, Polymyxins, Rifampicin and Ampicillin/Sulbactam.
这项工作的目的是描述用于测试抗生素协同作用的不同体外模型，并收集针对多重耐药鲍曼不动杆菌（MDR-Ab）的抗生素协同作用结果。不同的原始文章来自不同的网站。为了比较不同协同作用测试方法所获得的结果，使用了Pearson卡方检验和Fischer检验。此外，为了比较每篇分析稿件中的频率分布，使用了非参数卡方检验。在当前的荟萃分析中，对24篇稿件进行了修订，这些稿件涵盖了2016次不同抗菌药物对MDR-Ab的体外协同作用测试。11项研究使用了棋盘法协同作用测试，共1086次测试（53.9%）；12项研究应用了时间杀菌试验，共359次测试（17.8%）；7项研究使用了梯度扩散法，共293次测试（14.5%）。最后，两项研究应用了时间杀菌加棋盘法，共278次测试（13.8%）。通过比较这些数据，棋盘法和时间杀菌法的使用频率明显高于梯度扩散法（p<0.005）。关于基于所应用方法获得的协同率，棋盘法有227次测试（20.9%）具有协同效应；时间杀菌试验有222次测试（61.8%）具有协同效应；梯度扩散法仅有29次测试（9.9%）具有协同效应；最后，时间杀菌加棋盘法仅有15次测试（5.4%）具有协同效应。比较这些百分比时，时间杀菌法报告的协同率明显高于棋盘法和梯度扩散法（p<0.005）。根据修订后的数据，不推荐使用杀菌性抗生素加替加环素、万古霉素或替考拉宁的组合。最佳的抗生素组合是那些包括杀菌性抗生素的组合，如碳青霉烯类、磷霉素、阿米卡星、多粘菌素、利福平和氨苄西林/舒巴坦。
