Multiple combination bactericidal antibiotic testing for patients with cystic fibrosis infected with Burkholderia cepacia
Multiple combination bactericidal antibiotic testing for patients with cystic fibrosis infected with Burkholderia cepacia
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DOI：
10.1164/ajrccm.161.4.9907147
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发表时间：
2000-04-01
影响因子：
24.7
通讯作者：
MacDonald, NE
中科院分区：
文献类型：
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作者：
Aaron, SD;Ferris, W;MacDonald, NE
大多数洋葱伯克霍尔德杆菌菌株对囊性纤维化（CF）中常用的许多或全部抗菌药物具有耐药性，因此选择合适的抗生素来治疗肺部病情加重是很困难的。我们开发了一种快速体外测试洋葱伯克霍尔德杆菌分离株的多种抗生素组合的技术。对于 119 种多重耐药洋葱伯克霍尔德杆菌菌株中的每一种，我们的多重组合杀菌试验 (MCBT) 研究了使用 225 +/- 97 种单一、双重和三重抗生素组合的 10 至 15 种抗菌药物的杀菌活性。在 119 个分离株中，50% 对所有测试的角抗生素具有耐药性，8% 对所有两种药物抗生素组合具有耐药性，但所有菌株均被至少一种杀菌三药组合抑制。单独使用时，美罗培南、头孢他啶和大剂量妥布霉素（200 μg/ml）分别仅对 47%、15% 和 14% 的体外分离菌具有杀菌作用。使用双抗生素组合可提高杀菌活性；美罗培南-米诺环素、美罗培南-阿米卡星和美罗培南-头孢他啶组合分别对 76%、73% 和 73% 的分离株具有杀菌作用。然而，47% 的分离株表现出拮抗作用（当在单一杀菌抗生素中添加第二种抗生素时，微生物会生长）。含有妥布霉素、美罗培南和另一种抗生素的三联抗生素组合最为有效，对 81% 至 93% 的分离株具有杀菌作用。我们得出的结论是，在体外，三联抗生素组合比双联和单联抗生素组合更有可能对洋葱伯克霍尔德氏菌具有杀菌作用。 MCBT 测试是一种有用的技术，可帮助临床医生为患者决定适当的非拮抗性联合抗生素治疗。 CF 感染了洋葱伯克霍尔德杆菌。
Most Burkholderia cepacia strains are resistant to many, or all, of the antibacterial agents commonly used in cystic fibrosis (CF), and selection of appropriate antibiotics for treatment of pulmonary exacerbations is therefore difficult. We developed a technique for rapid in vitro testing of multiple antibiotic combinations for B. cepacia isolates. For each of 119 multi-drug-resistant isolates of B. cepacia our multiple combination bactericidal test (MCBT) studied the bactericidal activity of 10 to 15 antimicrobial agents using 225 +/- 97 single, double, and triple antibiotic combinations. Of the 119 isolates, 50% were resistant to all angle antibiotics tested, 8% were resistant to all two-drug antibiotic combinations, but all were inhibited by at least one bactericidal triple-drug combination. When used alone, meropenem, ceftazidime and high-dose tobramycin (200 mu g/ml) were bactericidal against only 47, 15, and 14% of in vitro isolates, respectively. Using a double antibiotic combination improved bactericidal activity; meropenem-minocycline, meropenem-amikacin, and meropenem-ceftazidime combinations were bactericidal against 76, 73, and 73% of isolates, respectively. However, 47% of isolates demonstrated antagonism (growth of an organism when a second antibiotic was added to a bactericidal single antibiotic). Triple antibiotic combinations that contained tobramycin, meropenem, and an additional antibiotic were most effective, and were bactericidal against 81 to 93% of isolates. We conclude that triple-antibiotic combinations are more likely than double and single antibiotic combinations to be bactericidal against B. cepacia in vitro. MCBT testing is a useful technique to help clinicians decide on appropriate nonantagonistic combination antibiotic therapy for patients with. CF infected with B. cepacia.