马冬梅 陶庆春 齐宏伟

[摘要] 目的 研究双黄连和米诺环素、哌拉西林/他唑巴坦和头孢哌酮/舒巴坦联合应用对广泛耐药鲍曼不动杆菌的联合抑菌效果。 方法 收集2016年10月～2017年6月从北京中医药大学第三附属医院（以下简称“我院”）临床标本分离出的30株广泛耐药鲍曼不动杆菌，应用肉汤稀释法测定双黄连与米诺环素、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦的最低抑菌浓度（MIC），计算部分抑菌浓度（FIC）指数，判定中西药联合抑菌效果。 结果 双黄连和米诺环素联用FIC指数：0.5～1占6.7%、>1～2占63.3%、>2占30.0%；双黄连和哌拉西林/他唑巴坦联用FIC指数：0.5～1占16.7%、>1～2占83.3%；双黄连和头孢哌酮/舒巴坦联用FIC指数：≤ 0.5占23.3%、0.5～1占73.3%、>1～2占3.3%。 结论 双黄连联合米诺环素和哌拉西林/他唑巴坦对广泛耐药鲍曼不动杆菌多数表现为无关作用和拮抗作用，体外联合抑菌作用较差；而双黄连与头孢哌酮/舒巴坦联合应用体外抑菌作用较好。

[关键词] 广泛耐药鲍曼不动杆菌；部分抑菌浓度；双黄连粉针剂；抑菌效果

[中图分类号] R446.5 [文献标识码] A [文章编号] 1673-7210（2018）09（a）-0148-04

[Abstract] Objective To study antibacterial effect of Shuanghuanglian combined with minocycline and Piperacillin /Taz-obactam and Cefoperazone / Sulbactam on extensively drug-resistant Acinetobacter baumannii in vitro. Methods A total of 30 strains extensively drug-resistant Acinetobacter baumannii were collected from clinical specimens from October 2016 to June 2017 in Beijing University of Chinese Medicine Third Affiliated Hospital. The minimum inhibitory concentration （MIC） of Shuanghuanglian and minocycline， Piperacillin / Tazobactam， Cefoperazone / Sulbactam （Cefoperazone / Sulbactam） in 30 strains extensively drug-resistant Acinetobacter baumannii was tested by the broth dilution method， and the partial inhibitory concentration （FIC） index was calculated， and the combined bacteriostasis effect of Chinese and Western medicine was determined. Results The FIC index of Shuanghuanglian combined with minocycline： 0.5-1 accounted for 6.7%， >1-2 accounted for 63.3%， and >2 accounted for 30.0%； the FIC index of Shuanghuanglian combined with Piperacillin / Tazobactam： 0.5-1 accounted for 16.7%， >1-2 accounted for 83.3%； the FIC index of Shuanghuanglian combined with Cefoperazone / Sulbactam： ≤ 0.5 accounted for 23.3%， 0.5-1 accounted for 73.3%， >1-2 accounted for 3.3%. Conclusion Shuanghuanglian combined with minocycline and Piperacillin / Tazobactam has a non-independent and antagonistic effect on the extensively drug-resistant Acinetobacter baumannii， and the combined antibacterial effect in vitro is poor. The combined antibacterial effect of Shuanghuanglian combined with Cefoperazone / Sulbactam is better.

[Key words] Extensively drug-resistant Acinetobacter baumannii； Fractional inhibitory concentration； Shuanghuanglian powder injection； Antibacterial effect

鮑曼不动杆菌属于条件致病菌广泛存在于自然界、医院环境及人体皮肤等部位。近年来，全国细菌耐药监测结果显示，鲍曼不动杆菌耐药率呈上升趋势[1-3]。本次体外抑菌试验选用的双黄连粉针剂为临床常用中药制剂。有研究表明，双黄连粉针剂具有较好的抗菌效果[4-5]；头孢哌酮/舒巴坦和哌拉西林/他唑巴坦都是临床常用抗生素，多用于鲍曼不动杆菌及其他革兰阴性杆菌抗感染治疗；目前，米诺环素在北京中医药大学第三附属医院（以下简称“我院”）及全国细菌耐药检测数据显示，鲍曼不动杆菌对其耐药率较低[1-3]。