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抗菌药物与苯丙氨酸-精氨酸-β-萘酰胺联合应用对鲍曼不动杆菌耐药突变选择窗的影响

中国医师杂志 2015年第7期17卷 1036-1038页

作者：刘明涛闫鹏鹏李超李凯述滨州市人民医院山东省滨州256600 无棣县人民医院

目的探讨体外头孢哌酮舒巴坦（CFP）、亚胺培南西司他汀（IMP）、阿米卡星（AMK）、环丙沙星（CIP）四种抗鲍曼不动杆菌药物分别与外排泵抑制剂苯丙氨酸-精氨酸-β-萘酰胺（PAβN）联合应用,对鲍曼不动杆菌耐药突变选择窗的影响.方法 E... 详细信息

目的探讨体外头孢哌酮舒巴坦（CFP）、亚胺培南西司他汀（IMP）、阿米卡星（AMK）、环丙沙星（CIP）四种抗鲍曼不动杆菌药物分别与外排泵抑制剂苯丙氨酸-精氨酸-β-萘酰胺（PAβN）联合应用,对鲍曼不动杆菌耐药突变选择窗的影响.方法 E-test测定四种药物体外单药对鲍曼不动杆菌的最低抑菌浓度（MIC）;棋盘格法测定抗菌药物联合PAβN的MIC;琼脂平板二倍稀释法测定单药以及联合PAβN后防耐药突变浓度（MPC）,并计算相应的选择指数SI（MPC/MIC）,根据SI下降的程度来判断减少耐药突变体的能力;并选择CFP、IMP、CIP分别联合AMK,分别测定联合前后的SI,比较联合抗菌药物与联合PAβN在防鲍曼不动杆菌耐药突变的能力.结果 CFP、IMP、AMK、CIP单独应用对鲍曼不动杆菌SI分别为＞32,＞64,16,16;与PAβN联合后分别为16、8、8、***、IMP、CIP分别与AMK联合后的SI分别为4,2,4.结论四种抗菌药物分别与外排抑制剂PAβN联用时,可以缩小抗菌药物单药对鲍曼不动杆菌的耐药突变选择窗,有利于减少耐药突变体的产生,但其作用明显弱于抗菌药物联合应用.

关键词：抗菌药/投药和剂量头孢哌酮/投药和剂量亚胺培南/投药和剂量西司他汀类/投药和剂量丁胺卡那霉素/投药和剂量环丙沙星/投药和剂量苯甲酰精氨酸-2-萘酰胺/投药和剂量鲍氏不动杆菌/药物作用不动杆菌感染/药物疗法抗药性,细菌

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Underlying characteristics of patients harboring highly resistant Acinetobacter baumannii

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AMERICAN JOURNAL OF INFECTION CONTROL 2002年第7期30卷 386-390页

作者： Mahgoub, S Ahmed, J Glatt, AE St Vincent Catholic Med Ctr Div Infect Dis Jamaica NY 11432 USA St Vincent Catholic Med Ctr Div Infect Control Jamaica NY 11432 USA New York Med Coll New York NY 10029 USA

Background: Highly resistant (HR) Acinetobacter baumannii (AB) are frequently hospital-acquired and may be important causes of severe nosocomial infections. Objective: Determine risk factors associated with such colonization/infection. Method: Retrospective review in 2000 of all AB isolates from sterile (blood, cerebrospinal fluid [CSF]) and nonsterile (respiratory, urine, and miscellaneous) sites. HR was defined as resistance to amikacin and/or imipenem and/or ampicillin-sulbactam. Isolates were analyzed as representing infection or colonization. A database including prior hospitalization, prior antibiotic use, nursing home residency, and procedures undergone was compiled. Results: One hundred twenty-two cases of AB were identified. Eighty-four met the definition of HR;6 (4.9%) were completely resistant to all antibiotics. Four (4.7%) isolates were from sterile body sites (3 blood, 1 CSF);43 (51.2%) were from respiratory sites;20 (23.8%) were from urinary sites;and 17 (20.2%) were from "other" sites. Only 4 (20%) of the urinary, 6 (35.2%) of the miscellaneous, and 23 (53.4%) of the respiratory isolates were deemed true pathogens;all blood/CSF isolates were considered pathogens. Associated risk factors included prior antibiotic usage (71%);prior hospitalization (24%);prior nursing home residency (34%);ventilator use (77%);tracheostomy placement (56%);and Foley catheterization (85%). Twenty-seven (63%) of 43 respiratory, 8 (40%) of 20 urinary, and 6 (35%) of 17 "other" body isolates were treated. Outcome was not statistically significant in treated versus untreated patients. All patients with CSF/blood isolates underwent successful microbiologic eradication with 50% survival. The overall mortality rate was 10%. Conclusion: Antibiotics, Foley catheters, and tracheostomy/ventilator usage were strongly associated with AB isolation. Prior hospitalization and nursing home residency were less common risk factors. Outcome was not different in treated versus untreated patien

关键词：不动杆菌感染/药物疗法不动杆菌感染/微生物学鲍氏不动杆菌/药物作用鲍氏不动杆菌/遗传学鲍氏不动杆菌/分离和提纯抗菌药/药理学抗菌药/治疗应用带病原状态/药物疗法带病原状态/微生物学抗药性多种细菌呼吸道感染/药物疗法呼吸道感染/微生物学回顾性研究危险因素治疗结果泌尿道感染/药物疗法泌尿道感染/微生物学女(雌)性人类男(雄)性

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In vivo activity of levofloxacin alone or in combination with imipenem or amikacin in a mouse model of Acinetobacter baumannii pneumonia

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JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY 2000年第5期46卷 827-830页

作者： Joly-Guillou, ML Wolff, M Farinotti, R Bryskier, A Carbon, C Hop Louis Mourier Microbiol Serv F-92701 Colombes France Hop Bichat Claude Bernard Clin Reanimat Maladies Infect F-75018 Paris France Hop Bichat Claude Bernard Serv Pharm F-75018 Paris France Hop Bichat Claude Bernard EPI 99 33 F-75018 Paris France Hoechst Marion Roussel F-92000 Romainville France

We evaluated the in vivo activity of levofloxacin alone or in combination with imipenem or amikacin in a mouse model of Acinetobacter baumannii pneumonia using a susceptible strain and one with low-level resistance (MIC/MBC of levofloxacin: 0.06/0.06 and 4/4 mg/L, respectively), As demonstrated previously with other pathogens, the AUC/MIC ratio predicted the efficacy of fluoroquinolones against A. baumannii. This parameter correlated with bactericidal effect and survival. Combination therapy did not enhance the efficacy of levofloxacin.

关键词：不动杆菌感染/药物疗法不动杆菌感染/微生物学丁胺卡那霉素/治疗应用抗菌药/治疗应用抗感染药/治疗应用曲线下面积疾病模型动物药物疗法联合/治疗应用亚胺培南/治疗应用小鼠近交C3H 微生物敏感性试验/方法氧氟沙星/治疗应用肺炎细菌性/药物疗法肺炎细菌性/微生物学噻烯霉素类/治疗应用动物女(雌)性小鼠

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Evaluation of antibiotic synergy against Acinetobacter baumannii:: a comparison with Etest, time-kill, and checkerboard methods

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DIAGNOSTIC MICROBIOLOGY AND INFECTIOUS DISEASE 2000年第1期38卷 43-50页

作者： Bonapace, CR White, RL Friedrich, LV Bosso, JA Med Univ S Carolina Coll Pharm Anti Infect Res Lab Charleston SC 29425 USA

Acinetobacter baumannii is becoming increasingly resistant to antibiotics, often requiring combination therapy. Numerous methods exist to detect the presence of in vitro synergy with the time-kill and checkerboard tests being widely used. The Epsilometer test (E test) is a new method that is less labor intensive, but has not been evaluated using a wide range of antimicrobials and organisms. We assessed synergy using the time-kill and checkerboard tests and compared the results to the E test method using 10 clinical isolates of A. baumannii. Antimicrobial combinations evaluated consisted of trovafloxacin or tobramycin in combination with cefepime or piperacillin. Synergy was detected with all combinations by either the checkerboard or time-kill method. Synergy was not detected by the Etest method. The agreement between the time-kill test and Etest method was 72% (range 42-97%);for the time-kill and checkerboard tests, agreement was 51% (range 30-67%). The Etest method appears promising although further testing should be performed with additional antimicrobial agents and organisms. (C) 2000 Elsevier Science Inc. All rights reserved.

关键词：不动杆菌属/药物作用不动杆菌感染/药物疗法抗菌药/药理学抗感染药/药理学头孢菌素类/药理学药物协同作用药物疗法联合/药理学荧光喹诺酮类微生物敏感性试验萘啶类/药理学青霉素类/药理学哌拉西林/药理学可重复性结果妥布拉霉素/药理学人类

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Pathophysiology of surgical site infection in total hip arthroplasty

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AMERICAN JOURNAL OF INFECTION CONTROL 1999年第6期27卷 536-542页

作者： Seibert, DJ

This article is a case report of a 69-year-old man who underwent a right total hip replacement procedure and developed a surgical site infection. Areas of concern in prevention and treatment of hip arthroplasty infection are presented, focusing on the pathophysiologic process involved. A review of the patient risk factors and the pathophysiologic action potentiating risk for infection include host immunity, nutritional status, diabetes, age, use of steroids or immunosuppressive drugs, rheumatoid arthritis, and urinary tract or other infections. The case report identifies the patient's age, multiple instrumentation of the bladder resulting in bacteriuria and the reinfusion of 400 cc of autologous shed blood via cell saver, a controversial risk subject, as the primary risk factors for surgical site infection in this patient. Readmission to the hospital on day 16 after the operation was completed on identification of 2 pathogenic organisms, methicillin-resistant Staphylococcus aurens and Acinetobacter calcoaceticus bio anitratus. The infection was successfully treated with oral ciprofloxacin and intravenous administration of tobramycin, preventing progression from superficial to deep infection and preserving the prothesis.

关键词：不动杆菌感染/诊断不动杆菌感染/药物疗法不动杆菌感染/病因学抗菌药关节成形术置换髋/方法药物疗法联合/治疗应用随访研究骨关节炎髋/诊断骨关节炎髋/外科学危险因素葡萄球菌感染/诊断葡萄球菌感染/药物疗法葡萄球菌感染/病因学外科伤口感染/诊断外科伤口感染/药物疗法外科伤口感染/病因学治疗结果老年人人类男(雄)性

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Successful treatment of ventriculitis due to carbapenem-resistant Acinetobacter baumannii with intraventricular colistin sulfomethate sodium

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CLINICAL INFECTIOUS DISEASES 1999年第4期28卷 916-917页

作者： Fernandez-Viladrich, P Corbella, X Corral, L Tuba, F Mateu, A Univ Barcelona Bellvitge Hosp Infect Dis Serv Dept Infect Dis Barcelona 08907 Spain Univ Barcelona Bellvitge Hosp Dept Intens Med Barcelona 08907 Spain Univ Barcelona Bellvitge Hosp Dept Microbiol Barcelona 08907 Spain

Presents a case of successful treatment of ventriculitis caused by carbapenem-resistant Acinetobacter baumannii with intraventricular colistin sulfomethate sodium. Description of the clinical characteristics of patien... 详细信息

关键词：不动杆菌属/药物作用不动杆菌感染/药物疗法不动杆菌感染/微生物学抗菌药/治疗应用脑疾病/药物疗法脑疾病/微生物学卡巴配能类/药理学中枢神经系统细菌感染/药物疗法中枢神经系统细菌感染/微生物学脑室/微生物学黏菌素/类似物和衍生物黏菌素/治疗应用抗药性微生物脑炎/药物疗法脑炎/微生物学注射脑室内治疗结果青少年成年人女(雌)性人类男(雄)性中年人

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