依拉环素联合其他抗菌药物对碳青霉烯类耐药肠杆菌科和鲍曼不动杆菌的协同作用。
Synergism of eravacycline combined with other antimicrobial agents against carbapenem-resistant Enterobacteriaceae and Acinetobacter baumannii.
机构信息
Institute of Clinical Pharmacology, Peking University First Hospital, Beijing, China.
Institute of Clinical Pharmacology, Peking University First Hospital, Beijing, China.
出版信息
J Glob Antimicrob Resist. 2022 Sep;30:56-59. doi: 10.1016/j.jgar.2022.05.020. Epub 2022 May 31.
OBJECTIVES
This study aimed to investigate the synergistic activity of eravacycline combined with other antimicrobial agents against carbapenem-resistant Enterobacteriaceae and Acinetobacter baumannii collected from China.
METHODS
Sixty carbapenem-resistant strains, including 20 Escherichia coli, 20 Klebsiella pneumoniae, and 20 Acinetobacter baumannii were investigated for the synergy analysis. Imipenem, ceftazidime, cefoperazone-sulbactam, ciprofloxacin, amikacin, and polymyxin B were selected to investigate their efficacy in combination with eravacycline against 60 carbapenem-resistant strains. Minimum inhibitory concentrations (MICs) of the drugs were determined by broth microdilution method. The efficacy of eravacycline in combination with these agents was determined by the chequerboard method.
RESULTS
Antimicrobial susceptibility testing revealed that polymyxin B was most effective against all carbapenem-resistant strains, with resistance rates between 0% and 15%. Eravacycline showed potent activity against E. coli with an 85% susceptibility rate, and may also have activity against K. pneumoniae and A. baumannii with low MIC values. The chequerboard method showed that eravacycline-polymyxin B was the most effective combination against E. coli and K. pneumoniae, with more than 30% synergy. The most active combination against A. baumannii was eravacycline-ceftazidime and eravacycline-imipenem, which showed synergy in more than 50% of isolates.
CONCLUSION
Eravacycline combined with β-lactams or polymyxin B can lead to synergistic effects against clinically common carbapenem-resistant Gram-negative bacteria. The synergistic effects of eravacycline-based combinations varied in different species. A combination of eravacycline and polymyxin B may be considered for the treatment of carbapenem-resistant E. coli and K. pneumoniae; eravacycline in combination with ceftazidime or a carbapenem antimicrobial may be considered for the treatment of carbapenem-resistant A. baumannii.
目的
本研究旨在探讨依拉环素与其他抗菌药物联合应用对中国分离的耐碳青霉烯类肠杆菌科细菌和鲍曼不动杆菌的协同作用。
方法
对 60 株耐碳青霉烯类菌株（包括 20 株大肠埃希菌、20 株肺炎克雷伯菌和 20 株鲍曼不动杆菌）进行协同分析。选择亚胺培南、头孢他啶、头孢哌酮-舒巴坦、环丙沙星、阿米卡星和多黏菌素 B 来研究它们与依拉环素联合应用对 60 株耐碳青霉烯类菌株的疗效。采用肉汤微量稀释法测定药物的最小抑菌浓度（MIC）。棋盘法测定依拉环素与这些药物联合应用的疗效。
结果
药敏试验结果显示，多黏菌素 B 对所有耐碳青霉烯类菌株最有效，耐药率在 0%至 15%之间。依拉环素对大肠埃希菌具有强大的活性，敏感性率为 85%，对肺炎克雷伯菌和鲍曼不动杆菌也可能具有低 MIC 值的活性。棋盘法显示，依拉环素-多黏菌素 B 对大肠埃希菌和肺炎克雷伯菌的联合作用最为有效，协同作用超过 30%。对鲍曼不动杆菌最有效的联合用药是依拉环素-头孢他啶和依拉环素-亚胺培南，超过 50%的分离株表现出协同作用。
结论
依拉环素与β-内酰胺类或多黏菌素 B 联合应用可对临床常见的耐碳青霉烯类革兰阴性菌产生协同作用。依拉环素联合用药的协同作用在不同种属之间存在差异。依拉环素与多黏菌素 B 的联合用药可能适用于治疗耐碳青霉烯类大肠埃希菌和肺炎克雷伯菌；依拉环素与头孢他啶或碳青霉烯类抗菌药物联合应用可能适用于治疗耐碳青霉烯类鲍曼不动杆菌。
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