350株耐碳青霉烯类肺炎克雷伯菌耐药特征及基于头孢他啶/阿维巴坦的联合药敏试验报告

Drug resistance characteristics of 350 strains of carbapenem-resistant Klebsiella pneumoniae based on combined drug susceptibility testing for ceftazidime-avibactam

  • 摘要: 目的 了解医院耐碳青霉烯肺炎克雷伯菌(CRKP)耐药情况,探索CRKP联合药敏方式。方法 收集临沂市人民医院临床标本中分离的350株CRKP菌株,采用全自动微生物分析仪、改良碳青霉烯灭活试验(mCIM)和乙二胺四乙酸(EDTA)协同碳青霉烯灭活试验(eCIM)、免疫层析法及聚合酶链反应分析其耐药特征,采用常规纸片扩散法、纸片优加法和微量肉汤稀释棋盘法对产NDM菌株进行基于头孢他啶/阿维巴坦的联合药敏试验。结果 CRKP对替加环素和多黏菌素耐药率较低(0.57%,2.44%); 285株携带blaKPC耐药基因的CRKP对头孢他啶/阿维巴坦耐药率0.35%,12株携带blaOXA基因菌株对其完全敏感,而53株携带blaNDM基因菌株对其完全耐药; 与携带blaKPC耐药基因菌株相比,携带blaNDM基因菌株对阿米卡星、氨曲南、环丙沙星、庆大霉素、左氧氟沙星等耐药率较低(P<0.05)。联合药敏结果显示,头孢他啶/阿维巴坦与氨曲南联合时全部具有协同作用,与磷霉素联合仅有1株有协同作用,与左氧氟沙星、替加环素、阿米卡星和美罗培南联合时均无协同作用。结论 CRKP抗感染治疗的抗菌药物选择有限,产丝氨酸酶菌株感染可选择头孢他啶/阿维巴坦,产金属酶的菌株感染建议选择头孢他啶/阿维巴坦联合氨曲南; 用药过程中应根据实验室结果精准治疗、及时调整用药。

     

    Abstract: OBJECTIVE To understand the drug resistance rates of carbapenem-resistant Klebsiella pneumoniae (CRKP) strains and explore the combined drug susceptibility testing for the CRKP strains. METHODS Totally 350 strains of CRKP that were isolated from clinical specimens in Linyi People's Hospital were collected as the subjects. The characteristics of drug resistance of the strains were observed by means of full-automatic microbial analyzer, modified carbapenem inactivation method (mCIM), ethylene diamine tetraacetic acid (EDTA)-carbapenem inactivation method (eCIM), immunochromatography and polymerase chain reaction (PCR). The combined antimicrobial susceptibility testing for the NDM-producing strains based on ceftazidime-avibactam was performed by conventional disk diffusion method, disk enhancement method and microbroth dilution chessboard method. RESULTS The drug resistance rates of CRKP strains to tigecycline and polymyxin were 0.57% and 2.44%, respectively; the drug resistance rate of the 285 CRKP strains producing blaKPC drug resistance genes to ceftazidime-avibactam was 0.35%, while the 12 strains producing blaOXA gene were completely sensitive to it, and the 53 strains producing blaNDM gene were totally resistant to it. The drug resistance rates of the strains producing blaNDM gene to amikacin, aztreonam, ciprofloxacin, gentamicin and levofloxacin were lower than those of the strains producing blaKPC drug resistance gene(P<0.05). The result of the joint drug susceptibility testing showed that ceftazidime-avibactam combined with aztreonam had synergistic effect, and its combination with fosfomycin has the synergistic effect on only 1 strain; it did not have synergistic effect when it was combined with levofloxacin, tigecycline, amikacin or meropenem. CONCLUSIONS There are limited antibiotics for treatment of CRKP infections, ceftazidime-avibactam can be chosen for treatment of the infections with serine hydrolase-producing strains, ceftazidime-avibactam combined with aztreonam is recommended for treatment of the infections with metalloenzyme-producing strains. It is necessary to carry out the precise treatment and adjust the medication based on the result of clinical laboratory test.

     

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