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目的探讨环丙沙星、依诺沙星、阿米卡星与临床常用的抗铜绿假单胞菌的β-内酰胺类抗菌药物体外联合的抗菌活性。方法对2001年1月至2006年11月烧伤病房细菌培养与药物敏感试验结果进行回顾性分析,了解铜绿假单胞菌的流行情况。采用棋盘法设计,微量肉汤稀释法测定不同浓度组合的抗菌药物对2006年1～12月在烧伤病房采集的33株铜绿假单胞菌的最低抑菌浓度(MIC),判定联合应用效应。结果6年间我院烧伤病房共分离出652株细菌,其中革兰阴性(G-)杆菌478株,占73.3%,革兰阳性(G+)球菌174株,占26.7%。检出最多的细菌是铜绿假单胞菌149株,鲍曼不动杆菌149株。不同浓度组合的抗菌药物对铜绿假单胞菌的最低抑菌浓度研究提示:环丙沙星、依诺沙星分别与头孢他啶、头孢吡肟、亚胺培南、美罗培南联合主要表现为协同和相加作用。发生协同的比率,环丙沙星组分别为36.4%、30.3%、27.3%、33.3%,依诺沙星组分别为24.2%、27.3%、18.2%、27.3%。阿米卡星与头孢他啶联合用药主要表现为协同作用,协同比率为57.6%,所有的联合均无拮抗作用。结论阿米卡星与头孢他啶联合发生协同的比率高于环丙沙星和依诺沙星,环丙沙星组发生协同的比率大于依诺沙星组,二者差异并无统计学意义(P>0.05)。细菌对抗菌药物耐药的种类越多,联合用药发生协同的比率越少。
Objective To investigate the antibacterial activity of ciprofloxacin, enoxacin and amikacin combined with β-lactam antibiotics against Pseudomonas aeruginosa in vitro and in vivo. Methods The results of bacterial culture and drug susceptibility test in burn ward from January 2001 to November 2006 were analyzed retrospectively to understand the prevalence of Pseudomonas aeruginosa. The minimum inhibitory concentration (MIC) of 33 strains of Pseudomonas aeruginosa collected from burn wards from January to December in 2006 was determined by the checkerboard method and the micro broth dilution method was used to determine the combined effect of antimicrobial agents with different concentrations. Results A total of 652 strains of bacteria were isolated from the burn ward in our hospital in 6 years, of which 478 were Gram-negative bacilli (73.3%) and 174 (+) were Gram-positive cocci (26.7%). The most common bacteria were 149 strains of Pseudomonas aeruginosa and 149 strains of Acinetobacter baumannii. The study on the minimum inhibitory concentrations of antibacterials against Pseudomonas aeruginosa in different concentrations suggested that the combination of ciprofloxacin and enoxacin with ceftazidime, cefepime, imipenem and meropenem mainly showed synergistic and Additive effect. The rate of synergism was 36.4%, 30.3%, 27.3% and 33.3% for ciprofloxacin group and 24.2%, 27.3%, 18.2% and 27.3% for enoxacin group. Combination of amikacin and ceftazidime showed synergistic effect, with a synergistic ratio of 57.6%. All the combinations showed no antagonism. Conclusions The synergistic ratio of amikacin and ceftazidime is higher than that of ciprofloxacin and enoxacin. The synergistic rate of cocaffeine and enrofloxacin is higher than that of enoxacin (P <0.05). There is no significant difference between the two > 0.05). The more types of bacterial resistance to antimicrobial drugs, the lower the rate of synergistic combination.