目的 探究舒巴坦(SUL)、头孢哌酮/舒巴坦(CFS)、替加环素(TIG)分别联合5种抗生素对70株多重耐药鲍曼不动杆菌(MDR-AB)的体外活性.方法 2016年7月—2017年3月,选取锦州医科大学附属第一医院收集的MDR-AB菌株用于实验.采用棋盘法和微量肉汤稀释法测定SUL、CFS、美罗培南(MER)、比阿培南(BPM)、亚胺培南(IPM)、TIG、多粘菌素B(PMB)和左氧氟沙星(LVX)单用及联用对70株MDR-AB的最低抑菌浓度(MIC),计算部分抑菌浓度(FIC)指数判定药物联合效果,并进行统计分析.结果 70株MDR-AB对SUL、CFS、MER、BPM、IPM均表现为耐药.SUL、CFS、TIG与其他5种药物组合后表现为协同、相加或不相关作用,无拮抗作用.SUL+MER和CFS+MER、SUL+BPM和CFS+BPM、SUL+IPM和CFS+IPM、SUL+PMB和CFS+PMB的疗效比较,差异均无统计学意义(χ2=0.574、3.257、5.180、6.959,P>0.05).SUL分别联合TIG、MER、BPM、IPM、PMB的疗效比较,差异有统计学意义(χ2=101.501,P<0.05).TIG分别联合MER、BPM、IPM、SUL、PMB和LVX的疗效比较,差异有统计学意义(χ2=54.460,P<0.05).TIG敏感菌株与耐药菌株联合LVX的FIC指数分布比较,差异有统计学意义(χ2=13.490,P<0.05).结论 CFS治疗MDR-AB时SUL起主要作用;SUL及TIG联合MER的协同率较高;TIG+LVX对TIG耐药菌株的协同率较高.%Objective To study the in vitro activity of sulbactam(SUL),cefoperazone/sulbactam(CFS) and tigecycline(TIG) in combination with other 5 antibiotics separately against 70 strains of multi-drug resistant Acinetobacter baumannii(MDR-AB) isolated from hospitalized patients.Methods From July 2016 to March 2017, the MDR-AB strain collected from the First Affiliated Hospital of Jinzhou Medical University was used for the experiment.The minimum inhibitory concentrations(MIC) of SUL,CFS,meropenem(MER),biapenem(BPM),imipenem(IPM),TIG,polymyxin B(PMB), levofloxacin(LVX),alone and in combination,for 70 strains of MDR-AB were determined by broth microdilution method and checkerboard titration method.The effect of the combination of drugs was determined by the fractional inhibitory concentration(FIC) index,which was calculated according to the MIC results.And statistical analysis of the results of FIC index was performed. Results All the strains of MDR-AB showed resistance to SUL,CFS,MER,BPM and IPM.The combination of SUL,CFS or TIG with other 5 antibiotics showed synergistic,additive or unrelated effects and no antagonistic effects.The differences in curative effect between SUL+MER and CFS+MER,SUL+BPM and CFS+BPM,SUL+IPM and CFS+IPM,SUL+PMB and CFS+PMB were not significant(χ2=0.574,3.257,5.180,6.959,P>0.05).The curative effect between the 5 SUL combinations(SUL+TIG,SUL+MER,SUL+BPM,SUL+IPM,and SUL+PMB) differed significantly(χ2=101.501,P<0.05).Moreover,the 5 TIG combinations(TIG+MER,TIG+BPM,TIG+IPM,TIG+SUL,TIG+PMB and TIG+LVX) presented obviously different curative effect(χ2=54.460,P<0.05).The differences between the effects of TIG+LVX on TIG-resistant and TIG-sensitive strains were significant(χ2=13.490,P<0.05).Conclusion The main component which plays a major role against MDR-AB in CFS is SUL.Either TIG or SUL combined with MER has higher synergistic rate.TIG+LVX against TIG-resistant strains has higher synergistic rate.
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