Roussel-Delvallez M, Wallet F, Delpierre F, Courcol R J
Laboratoire de Bactériologie-Hygiène, Hôpital A. Calmette, Lille, France.
J Chemother. 1996 Oct;8(5):365-8. doi: 10.1179/joc.1996.8.5.365.
Pseudomonas aeruginosa and Acinetobacter baumannii are frequently isolated in hospital outbreaks of nosocomial infections. In our hospital, among 1018 strains isolated one year in an intensive care unit, 84 strains (8.3%) of P. aeruginosa and 155 strains (15.2%) of A. baumannii were considered responsible for infections. The major problem related to these bacteria is their multiresistant characteristic which confers great difficulty in treating infections. We carried out a 24 h time-kill study to assess the bactericidal effect of three beta-lactams [imipenem (IPM), ticarcillin+clavulanic acid (TCC), piperacillin+tazobactam (PTB)] in combination with each other and with sulbactam (SUL) and amikacin (AKN) against 8 P. aeruginosa strains and 8 A. baumannii strains. The initial inoculum was 10(6) cfu/ml. Antibiotics were tested at clinically achievable concentrations: TCC (112 mg/l), PTB (100 mg/l), IPM (25 mg/l) and AKN (15 mg/l). The results showed: IMP + TCC + AKN = PTB + SUL + AKN = PTB + TCC + AKN > > IMP + SUL + AKN against P. aeruginosa; and PTB + SUL + AKN = PTB + TCC + AKN > IMP + SUL + AKN or IMP + TCC + AKN against A. baumannii. When infection due to these multiresistant strains was suspected, PTB + AKN combined with either TCC or SUL was bactericidal against both strains. These combinations appeared to be an alternative therapy in the treatment of undocumented nosocomial infections in intensive care units. These in vitro results are being evaluated in patients and seem to give good results for the moment.
铜绿假单胞菌和鲍曼不动杆菌在医院医院感染暴发中经常被分离出来。在我们医院，某一年在重症监护病房分离出的1018株菌株中，84株（8.3%）铜绿假单胞菌和155株（15.2%）鲍曼不动杆菌被认为是感染的致病菌。与这些细菌相关的主要问题是它们的多重耐药特性，这给感染治疗带来了很大困难。我们进行了一项24小时的时间杀菌研究，以评估三种β-内酰胺类药物[亚胺培南（IPM）、替卡西林+克拉维酸（TCC）、哌拉西林+他唑巴坦（PTB）]相互联合以及与舒巴坦（SUL）和阿米卡星（AKN）联合对8株铜绿假单胞菌菌株和8株鲍曼不动杆菌菌株的杀菌效果。初始接种量为10(6) cfu/ml。抗生素在临床可达到的浓度下进行测试：TCC（112 mg/l）、PTB（100 mg/l）、IPM（25 mg/l）和AKN（15 mg/l）。结果显示：对于铜绿假单胞菌，IMP + TCC + AKN = PTB + SUL + AKN = PTB + TCC + AKN >> IMP + SUL + AKN；对于鲍曼不动杆菌，PTB + SUL + AKN = PTB + TCC + AKN > IMP + SUL + AKN或IMP + TCC + AKN。当怀疑是由这些多重耐药菌株引起的感染时，PTB + AKN联合TCC或SUL对两种菌株均有杀菌作用。这些联合用药似乎是治疗重症监护病房不明医院感染的一种替代疗法。这些体外研究结果正在患者中进行评估，目前似乎取得了良好的效果。
