다제내성 Acinetobacter baumannii 균주의 항균제 병합 효과
In Vitro Activity of Antimicrobial Combination against Multidrug-resistant Strains of Acinetobacter baumannii
2
조회
0
다운로드
2
인용
0
참고문헌
초록
배경 : A. baumannii 는 최근 증가하고 있는 병원감염의 주요한 원인균 중 하나로 최근 carbapenem에 내성을 보이는 균주가증가하고 있어 치료에 큰 문제가 되고 있다. 이에 colistin 같은기존에 쓰이지 않았던 치료제를 사용하거나 두가지 이상의 항균제를 병합하는 방법이 시도되고 있다. 본 연구는 다제내성A. bau-mannii 균주를 대상으로 항균제 병합 효과를 알아보고자 하였다.방법 : 2003년 2월부터 2004년 2월까지 imipenem에 내성이거나 중간인 다제내성 A. baumannii 29균주를 대상으로 하였다. 한천희석법으로 최소억제농도를 구하였다. Checkerboard법을 이용해 ampicillin-sulbactam과 amikacin, tobramycin 및 meropen-em과 colistin과 rifampin, ceftazidim 및 meropenem에 대하여항균제 병합의 효과를 관찰하였다. 결과 : Ceftazidime과 cefepime의 MIC90는 2,048 g/mL과512 g/mL로 매우 높았고 colistin의 MIC 90는 0.5 g/mL로낮았다. 항균제 병합 효과는 ampicillin-sulbactam과 tobramycin,ampicillin-sulbactam과 meropenem, colistin과 rifampin에서 각1균주 및 colistin과 ceftazidime에 대해 2균주가 부가 효과를 보였다. 나머지 대부분 항균제 병합에서 무관한 것으로 나타났고 상승이나 길항인 경우는 없었다. 결론 : 이상의 결과로 다제내성 A. baumannii 균주에 대한 치료제로 colistin을 고려할 수 있을 것이다. 이러한 다제내성 균주의 효과적인 치료를 위해 추후 다양한 클론의 더 많은 균주를 대상으로 항균제 병합 연구가 필요하고, 임상연구가 뒷받침되어야 할 것이다.
Abstract
Background : Acinetobacter baumannii has been reported as a major cause of nosocomial infections with increasing frequency. Recently, the emergence of carbapenem-resistant strains has become a major problem in treatment. The use of nontraditional agents such as colistin and a combination therapy have been tried. The purpose of this study was to evaluate the activity of antimicrobial combinations against multidrug-resistant (MDR) A. baumannii. Methods : Twenty-nine strains of MDR A. baumannii, either resistant or intermediate to imipenem, were collected from February 2003 to February 2004. Minimum inhibitory concentrations (MICs) were determined by the agar dilution method. The checkerboard method was used to assess the activity of ampicillin-sulbactam in combination with amikacin, tobramycin or meropenem and colistin in combination with ceftazidime, meropenem, or rifampin. Results : The MIC90 of ceftazidime and cefepime were 2,048 g/mL and 512 g/mL, respectively, while the MIC90 of colistin was 0.5 g/mL. The antimicrobial combinations that showed an additive effect for one or two strains were colistin with rifampin or ceftazidime and ampicillin-sulbactam with tobramycin or meropenem. Other antimicrobial combinations showed indifferent effects against most strains. There were no synergistic or antagonistic combinations. Conclusions : These data suggested that colistin may be an alternative drug for MDR A. baumannii. For the effective treatment of patients infected with these resistant strains, further studies are needed to evaluate antimicrobial combinations against a large number of heterogeneous isolates, and these studies must be followed by clinical trials.
참고문헌 (24)
- "Worldwide emergence of car-bapenem-resistant Acinetobacter spp", 41, pp.576~7 (1998)
- "Multiresistant Acinetobacterinfections:a role for sulbactamcombinations in overcoming an emerging worldwide problem", 8, pp.144~53 (2002)
- "Riskfactors for acquisition of imipenem-resistant Acinetobacter bauman-nii:a case-control study", 48, pp.224~8 (2004)
- "In vitro activity of beta-lactams incombination with other antimicrobial agents against resistant strainsof Pseudomonas aeruginosa", 21, pp.8~12 (2003)
- "Considerations in control andtreatment of nosocomial infections due to multidrug-resistant Acine-tobacter baumannii", 36, pp.1268~74 (2003)
- "In vitro double andtriple synergistic activities of Polymyxin B,imipenem,and rifampinagainst multidrug-resistant Acinetobacter baumannii", 48, pp.753~7 (2004)
- "National Committee for Clinical Laboratory Standards Methods forDilution Antimicrobial Susceptibility Tests for Bacteria That GrowAerobically", pp.76~ (2003)
- "Contemporary assessment of antimi-crobial susceptibility testing methods for polymyxin B and colistin:review of available interpretative criteria and quality control guide-lines", 39, pp.183~90 (2001)
- "In-vitro activity of the combinationof colistin and rifampicin against multidrug-resistant strains of Acine-tobacter baumannii", 41, pp.494~5 (1998)
- "Interac-tions of colistin and rifampin on multidrug-resistant Acinetobacterbaumannii", 40, pp.117~20 (2001)
- "Antibiotics in Laboratory Medicine", pp.330~96 (1996)
- "In vitro activities of nontraditional antimicrobialsagainst multiresistant Acinetobacter baumanniistrains isolated in anintensive care unit outbreak", 44, pp.1035~40 (2000)
- "국내여러지역병원의임상검체에서분리된주요세균의항균제내성률", 6, pp.29~36 (2003)
- "In vitro selection of antibiotic resistance inPseudomonas aeruginosa", 7, pp.7~10 (2001)
- "Synergistic activity of colistin and ceftazidime againstmultiantibiotic-resistant Pseudomonas aeruginosain an in vitro phar-macodynamic model", 47, pp.905~9 (2003)
- "In vitro andin vivo activity of meropenem and sulbactam against a multidrug-resistant Acinetobacter baumanniistrain", 53, pp.393~5
- "In vitro investigationof the susceptibility of Acinetobacter baumanniistrains isolated fromclinical specimens to ampicillin", sulbactam alone and in combina-tion with amikacin, 2002, pp.20, 390~2
- "In vitro activities of beta-lactamantibiotics alone and in combination with sulbactam against Gram-negative bacteria", 23, pp.590~5 (2004)
- "alone and in combina-tionwith amikacin against acinetobacters as determined by checker-board and time-kill studies", pp.1073~6
- "Intravenous colistin as therapy for nosocomial infections causedby multidrug-resistant Pseudomonas aeruginosaand Acinetobacterbaumannii", 28, pp.1008~11 (1999)
- "Treatment of multidrug-resistant Acinetobacter baumanniiventilator-associated pneumonia", pp.1111~8
- "Colistin:the revival of polymyxinsfor the management of multidrug-resistant gram-negative bacterialinfections", 40, pp.1333~41 (2005)
- "In vitroactivity of colistin against non-fermentative Gram-negative bacilli" (2004)
- "In vitro activities of non-traditional antimicrobials againstmultiresistant strains of P"