碳青霉烯类药物联合舒巴坦或头孢哌酮对铜绿假单胞菌的药敏影响

目的 探讨碳青霉烯类药物联合应用舒巴坦或头孢哌酮等抗生素对铜绿假单胞菌(PA)的药敏影响。方法 临床收集PA菌株，K-B法行单药药敏及联合药敏测定；MIC法测定比阿培南、亚胺培南联合磷霉素、阿米卡星、舒巴坦、头孢哌酮、头孢哌酮舒巴坦、环丙沙星对铜绿假单胞菌的影响并计算联合用药分级抑菌浓度(FIC)指数。结果 K-B法单药药敏将120株PA分为敏感菌56株，多耐药菌株 36株，泛耐药菌株 13株，广耐药菌株15株；K-B联合药敏提示，与比阿培南联合最有效的药物依次为磷霉素、舒巴坦、阿米卡星、头孢哌酮；与亚胺培南联合最有效的药物为磷霉素、舒巴坦、阿米卡星；但亚胺培南联合头孢哌酮舒巴坦、头孢哌酮出现拮抗；联合MIC法检测结果与K-B法结果相似，与亚胺培南、比阿培南联合最有效的依次均为磷霉素、阿米卡星、舒巴坦；但亚胺培南联合头孢哌酮或头孢哌酮舒巴坦出现拮抗。结论 体外联合药敏发现，碳青霉烯类药物联合磷霉素、舒巴坦或阿米卡星对PA感染协同率最高，但亚胺培南联合头孢哌酮有拮抗作用。

Drug sensitivity of carbapenems combined with sulbactam or cefoperazone on Pseudomonas Aeruginosa

Objective To compare drug sensitivity of carbapenems combined with sulbactam or cefoperazone on Pseudomonas Aeruginosa(PA) in vitro. Methods After the collection of PA strains, antimicrobial susceptibility test were conducted. The PA strains were divided into sensitive group, multidrug resistant (MDR) group, extensively drug resistant (XDR) group and pan-drug resistant(PDR) group according to the results of antibiotic sensitivity test. The sensitivities of biapenem or imipenem combined with sulbactam, cefoperazone, fosfomycin, amikacin, cefperazone-sulbactam, ciprofloxacin were examined by Kirby-Bauer (K-B) disc agar diffusion method and minimal inhibitory concentration (MIC) assay，then the fractional inhibitory concentration (FIC) indexes were calculated. Results One hundred and twenty clinical PA strains were collected, including 56 sensitive strains, 36 MDR strains, 13 XDR strains and 15 PDR strains. Biapenem showed synergistic effects with sulbactam, fosfomycin, amikacin and cefoperazone seperately. Synergistic effects were observed in the combinations of imipenem and fosfomycin, sulbactam, amikacin. The antagonistic effects were observed in the combinations of imipenem and cefopcrazone or cefperazone-sulbactam. Conclusion Carbapenems combined with fosfomycin，amikacin or sulbactam can be used in the treatment of resistant PA infections, but imipenem combined with cefoperazone is not recommended.