三种碳青霉烯类抗菌药物联用头孢哌酮舒巴坦对耐碳青霉烯鲍曼不动杆菌的抗菌活性分析

目的：探讨亚胺培南、美罗培南、厄他培南3种碳青霉烯类抗菌药物与头孢哌酮舒巴坦联用，对耐碳青霉烯鲍曼不动杆菌的抗菌活性。方法分别检测亚胺培南、美罗培南、厄他培南对36株耐碳青霉烯鲍曼不动杆菌的最小抑菌浓度（MIC）值，及3种抗菌药物与头孢哌酮舒巴坦联用的部分抑菌浓度（FIC）指数，计算3种碳青霉烯抗菌药物与头孢哌酮舒巴坦联用累计抑菌率曲线。结果36株泛耐药鲍曼不动杆菌，亚胺培南、美罗培南MIC50为16 mg/L，亚胺培南MIC90为64 mg/L；美罗培南MIC90为128 mg/L。厄他培南MIC50为32 mg/L，MIC90为256 mg/L。亚胺培南、美罗培南、厄他培南与头孢哌酮舒巴坦联用，FIC指数≤0.5、0.5～1、1～2和＞2者分别为1株、16株、14株、5株；1株、17株、13株和5株；0株、1株、30株和5株。三种药物与头孢哌酮舒巴坦联用后，亚胺培南累计抑菌率曲线左移，美罗培南累计抑菌率曲线改变不明显；厄他培南联用后，累计抑菌率曲线轻度右移。结论亚胺培南、美罗培南与头孢哌酮舒巴坦联用对耐碳青霉烯鲍曼不动杆菌多数呈相加或无关作用，厄他培南与头孢哌酮舒巴坦联用呈无关作用；3种碳青霉烯抗菌药物与头孢哌酮舒巴坦对部分耐碳青霉烯鲍曼不动杆菌具有拮抗作用。

The antibacterial activity of three carbon carbapenem antibiotics combined with cefoperazone sulbactam against carbapenem-resistant Acinetobacter bacillus

Objective To investigate antibacterial activity of the imipenem, meropenem and ertapenem with cefoperazone sulbactam against the carbapenem-resistant Acinetobacter baumannii. Methods The minimal inhibitory concentration （MIC） values of imipenem, meropenem and ertapenem against 36 carbapenem-resistant Acinetobacter baumannii were detected, and the fractional inhibitory concentration （FIC） index and cumulative inhibition rate curve of three antibiotics with cefoperazone sulbactam were calculated. Results Against 36 carbapenem-resistant Acinetobacter baumannii, the MIC50 of imipenem, meropenem and ertapenem were 16 mg/L, 16 mg/L and 32 mg/L, MIC90 were 64 mg/L, 128 mg/L and 256 mg/L, respectively. The number of strains with different FIC indexs （≤ 0.5, 0.5-1, 1-2 and 〉 2） after imipenem, meropenem, ertapenem combined with cefoperazone sulbactam were 1, 16, 14, 5 strains and 1, 17, 13, 5 strains and 0, 1, 30, 5 strains, respectively. The cumulative inhibition rate curves of cefoperazone sulbactam with imipenem turned to left, with ertapenem turned to right slightly, and with meropenem had no significantly change. Conclusions The antibacterial activity of the imipenem or meropenem with cefoperazone sulbactam were additive or unrelated, and ertapenem with cefoperazone sulbactam were unrelated in the antibacterial effect against the carbapenem-resistant Acinetobacter baumannii. Three carbapenem antibiotics with cefoperazone sulbactam were antagonistic for some carbapenem-resistant Acinetobacter baumannii.