米诺环素联合多黏菌素B对鲍曼不动杆菌的体外抗菌活性研究

目的了解鲍曼不动杆菌（ABA）的产酶现状和耐药性及抗菌药物对ABA的体外抗菌活性，为临床治疗ABA提供合理用药的实验室依据。方法从临床感染标本中分离出75株鲍曼不动杆菌，均来自呼吸道标本。常规培养分离细菌，应用VITEK-2全自动细菌鉴定分析仪鉴定细菌。常规药敏试验采用K-B纸片法，最低抑菌浓度（MIC）测定采用琼脂平板倍比稀释法和E-test浓度梯度法，按CLSI规定的标准进行。结果75份标本中产金属β-内酰胺酶（MBLs）的菌株占96．00％，产诱导型AMPC酶的占29．33％，产质粒型AMPC酶的占41．33％。多黏菌素B（PLB）和米诺环素（MNO）对产MBLsABA、产诱导型AMPC酶ABA和产质粒型AMPC酶ABA的抑菌率分别是97．22％、100．00％、100．00％和19．43％、4．55％、6．45％。PLB和MNO联合对ABA的协同作用为57．33％。结论ABA的产酶率和耐药性越来越高，其引起的院内感染临床应高度重视。对多药耐药ABA导致的感染建议应用PLB或联合MNO（或替加环素）及舒巴坦治疗，以有效控制感染和防止耐药株在医院内感染的扩散。

The study of antibacterial activity in vitro of minocycline combined with polymixin B to acinetobacter baumannii

Objective To understand the enzyme production status and drug resistance of acinetobacter baumannii （ABA） , and in vitro antibacterial activity for antibacterial drugs against ABA, to provide laboratory basis of rational drug utili- zation for the clinic treatment of ABA. Methods Separated 75 cases ABA from clinical infection specimen, all came from re- spiratory specimen. Trained and separated the bacteria routinely,identified the bacteria by VITEK-2 antomatic bacteria identifi- cation analyzer. Conventional drug sensitive test adopted K-B paper disk method, minimum inhibitory concentration （MIC） de- tection used agar double dilution method and E-test method following the instruction of CLSI. Results The ABA produced me- tallic lS-lactamase （ MBLs ） ,inducible AmpC and plasmid AmpC acounted for 96.00% ,29.33 % and 41.33 % respectively. The bacteria inhibitive rate of polymixin B （ PLB ） and minocycline （ MNO ） against ABA of MBLs, inducible AmpC and plasmid AmpC were 97. 22% ,100.00% , 100.00% and 19.43% ,4.55% ,6.45% respectively. The synergy of PLB with MNO was 57.33%. Conclusion The producing enzyme rates and drug resistance of ABA are becoming more and more higher, clinic should pay high attention to the nosocomial infection caused by ABA . Combined utilization of PLB with MNO （or tigecycline） and sulbactam should be suggested to against ABA, in order to control infection effectively and to prevent drug resistant strains infection diffusing in hospital.