In Vitro Synergistic Activity of Antimicrobial Agents in Combination against Clinical Isolates of Colistin-Resistant Acinetobacter baumannii.
In Vitro Synergistic Activity of Antimicrobial Agents in Combination against Clinical Isolates of Colistin-Resistant Acinetobacter baumannii.
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DOI：
10.1128/aac.00839-16
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发表时间：
2016-11
影响因子：
4.9
通讯作者：
Chong YP
中科院分区：
文献类型：
--
作者：
Bae S;Kim MC;Park SJ;Kim HS;Sung H;Kim MN;Kim SH;Lee SO;Choi SH;Woo JH;Kim YS;Chong YP
临床鲍曼不动杆菌分离株对粘菌素的耐药性日益受到关注。由于目前对这些菌株的治疗选择非常有限，我们研究了各种抗微生物组合对粘菌素耐药A的体外活性。鲍曼不动杆菌。9株临床分离的粘菌素耐药菌株（8株来自菌血症病例，1株来自肺炎病例）。2010年1月至2012年12月期间，在韩国首尔牙山医疗中心采集鲍曼不动杆菌。为了筛选潜在的协同作用，使用多重组合杀菌试验（MCBT）对12种市售制剂中的两种抗菌剂的多重组合进行了测试。为了验证这些结果，进行了纸板试验。9株耐粘菌素菌株中，6株为泛耐，3株为广泛耐药。使用MCBT时，最有效的联合用药为粘菌素-利福平和粘菌素-替考拉宁;两种联合用药对9种菌株中的8种菌株均显示出协同作用。多粘菌素-氨曲南、多粘菌素-美罗培南和多粘菌素-万古霉素组合对7种菌株显示出协同作用。多粘菌素是抗多粘菌素耐药菌的抗菌药物组合中最常见的成分。鲍曼不动杆菌。然后在基于粘菌素的组合中进行生物板测试。值得注意的是，粘菌素-利福平对所有9种菌株均显示出协同作用（100%）。粘菌素-万古霉素和粘菌素-替考拉宁均显示出协同或部分协同作用。粘菌素联合另一种β-内酰胺类药物（氨曲南、头孢他啶或美罗培南）显示出相对中等的效果。粘菌素与氨苄西林-舒巴坦、替加环素、阿米卡星、阿奇霉素或甲氧苄啶-磺胺甲恶唑联合使用显示出有限的协同作用。使用MCBT和棋盘测试，我们发现只有基于粘菌素的组合，特别是与利福平、糖肽或β-内酰胺类的组合，可能对粘菌素耐药A产生治疗益处。鲍曼不动杆菌。
Emerging resistance to colistin in clinical Acinetobacter baumannii isolates is of growing concern. Since current treatment options for these strains are extremely limited, we investigated the in vitro activities of various antimicrobial combinations against colistin-resistant A. baumannii. Nine clinical isolates (8 from bacteremia cases and 1 from a pneumonia case) of colistin-resistant A. baumannii were collected in Asan Medical Center, Seoul, South Korea, between January 2010 and December 2012. To screen for potential synergistic effects, multiple combinations of two antimicrobials among 12 commercially available agents were tested using the multiple-combination bactericidal test (MCBT). Checkerboard tests were performed to validate these results. Among the 9 colistin-resistant strains, 6 were pandrug resistant and 3 were extensively drug resistant. With MCBT, the most effective combinations were colistin-rifampin and colistin-teicoplanin; both combinations showed synergistic effect against 8 of 9 strains. Colistin-aztreonam, colistin-meropenem, and colistin-vancomycin combinations showed synergy against seven strains. Colistin was the most common constituent of antimicrobial combinations that were active against colistin-resistant A. baumannii. Checkerboard tests were then conducted in colistin-based combinations. Notably, colistin-rifampin showed synergism against all nine strains (100%). Both colistin-vancomycin and colistin-teicoplanin showed either synergy or partial synergy. Colistin combined with another β-lactam agent (aztreonam, ceftazidime, or meropenem) showed a relatively moderate effect. Colistin combined with ampicillin-sulbactam, tigecycline, amikacin, azithromycin, or trimethoprim-sulfamethoxazole demonstrated limited synergism. Using MCBT and checkerboard tests, we found that only colistin-based combinations, particularly those with rifampin, glycopeptides, or β-lactams, may confer therapeutic benefits against colistin-resistant A. baumannii.