我院2011年抗菌药物联用对耐亚胺培南鲍曼不动杆菌的体外抗菌活性分析

目的：对我院耐亚胺培南鲍曼不动杆菌的分布与耐药性进行分析，并检测头孢哌酮／舒巴坦和米诺环素联用对其的抗菌活性，为临床治疗提供合理用药依据。方法：收集我院2011年住院患者各类标本中分离出的142株非重复的耐亚胺培南鲍曼不动杆菌，采用Micro Scan Walk Away 40微生物分析仪进行菌株鉴定和药敏试验，部分药物及联用药敏试验采用K-B纸片法。结果：2011年我院耐亚胺培南鲍曼不动杆菌占鲍曼不动杆菌的80．7％，检出率最高的标本是痰（78．9％），其次为伤口分泌物（7．7％）。耐亚胺培南鲍曼不动杆菌分布广泛，ICU检出率最高（45．8％），其次为神经外科（14．1％）、呼吸科（12．0％）。耐亚胺培南鲍曼不动杆菌对头孢哌酮／舒巴坦的耐药率最低（12．0％），其次为米诺环素（31．7％）。头孢哌酮／舒巴坦和米诺环素联合对耐亚胺培南鲍曼不动杆菌的抗菌活性以协同和相加作用为主，二者无拮抗作用。结论：耐亚胺培南鲍曼不动杆菌耐药严重，为多重耐药菌株。临床在治疗鲍曼不动杆菌引起的感染时，应慎用碳青霉烯类抗生素，以免耐亚胺培南鲍曼不动杆菌的产生及扩散；建议使用头孢哌酮／舒巴坦和米诺环素联合治疗。

Analysis of in Vitro Antibacterial Activity of Combined Use of Antibacterial Agents against Imipenem-resis- tant Acinetobacter baumanii in Our Hospital in 2011

OBJECTIVE： To analyze the distribution and drug resistance of imipenem-resistant Acinetobacter baumanii （IRABA）, to test antibacterial activity of ceforperazone/sulbactam and minocycline to it, and to provide reference for clinical therapy. METHODS： 142 unduplicated strains of IRABA were collected from inpatient specimens of our hospital in 2011. All isolated IRABA were tested by Micro Scan Walk Away 40 automatic microbial analysis system to carry on species identification and antimicrobial susceptibility test. Susceptibility test of some antibacterial agents and combined use of antibacterial agents were performed by K-B disk diffusion method. RESULTS： IRABA accounted for 80.7% of ABA, and relevance ratio ofphlegrn （78.9%） was the highest, followed by wound secre- tion of 7.7%. IRABA had a wide distribution, and relevance ratio of ICU （45.8%） ranked the first, followed by neurosurgery depart- ment of 14.1% and respiratory department of 12.0%. Drug resistance rate of IRABA towards ceforperazone/sulbactam （12.0%） was the lowest, followed by minocycline of 31.7%. Antibacterial activity of ceforperazone/sulbactam combined with minocycline was main- ly connected with synergism and addition, which can not be affected by antagonism. CONCLUSION： IRABA resists antibacterial agents seriously and it is multi-drug resistant strain. It should be careful to use carbapenem for treating ABA-induced infection to avoid production and spreading of IRABA. It is suggested to use ceforperazone/sulbactam combined with minocycline as treatment.