β-内酰胺类抗菌药物诱导异质性万古霉素中介金黄色葡萄球菌及其药敏试验研究

发布时间：2019-06-18 08:03

【摘要】：目的体外观察β-内酰胺类抗菌药物能否诱导产生异质性万古霉素中介金黄色葡萄球菌(hVISA),并对其进行药敏试验。方法挑选医院2015年8月-10月临床MRSA 5株,选择头孢他啶、哌拉西林/他唑巴坦、美罗培南3种常用β-内酰胺药物,逐步诱导菌株,应用菌群分析曲线法检测hVISA,E-test法测定hVISA对万古霉素、利奈唑胺、替加环素、达托霉素的MIC,棋盘格法测定联合药敏试验。结果 3种β-内酰胺类抗菌药物诱导产生的hVISA菌株分别为3株、3株、1株。7株hVISA对万古霉素的MIC范围在2~4mg/L,联合利福平、左氧氟沙星、夫西地酸药物后,hVISA对万古霉素的MIC范围分别为1~4mg/L,1~4mg/L,1~2mg/L,对利奈唑胺、替加环素、达托霉素的MIC范围分别为0.25~1mg/L,0.125~0.5mg/L,0.064~0.25mg/L。结论体外β-内酰胺类抗菌药物可以诱导产生hVISA,头孢类与半合成青霉素类较碳青霉烯类抗菌药物更容易诱导产生hVISA,联合用药不能显著降低hVSA对万古霉素的MIC值,新型治疗MRSA药物利奈唑胺、替加环素、达托霉素对hVISA均较为敏感,可有效治疗hVISA感染。
[Abstract]:Objective to observe whether 尾-lactam antibiotics can induce heterogeneous vancomycin mediated Staphylococcus aureus (hVISA), in vitro and to test its drug sensitivity. Methods five clinical MRSA strains were selected from August to October 2015. Three common 尾-lactam drugs, ceftazidime, piperacillin / tazobactam and meropenem, were selected to induce the strains step by step. The combined drug sensitivity test of hVISA to vancomycin, linazodine, tegacycline and tetromycin was detected by hVISA,E-test method. Results the MIC range of vancomycin induced by three 尾-lactam antibiotics was 3, 3 and 1, respectively. the MIC range of 7 strains of hVISA to vancomycin was 2: 4 mg / L, and the MIC range of hVISA to vancomycin was 1: 4 mg / L, 1 / 4 mg / L, 1 / 2 mg / L, 0.25 mg / L and 0.25 mg / L, respectively. 0.064 脳 0.25 mg 路L ~ (- 1) 路L ~ (- 1). Conclusion 尾-lactam antibiotics can induce the production of hVISA, cephalosporins and semi-synthetic penicillins more easily than carbapenem antibiotics in vitro. The combined use of hVISA, can not significantly reduce the hVISA, to vancomycin. The new MRSA drugs, linidazolam, tegacycline and tetracycline are sensitive to hVISA, and can effectively treat hVISA infection.
【作者单位】：滨州市人民医院呼吸内科;山东大学齐鲁医院呼吸科;
【分类号】：R446.5

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