耐碳青霉烯类肠杆菌(CRE)已成为全球主要的公共卫生问题。这项研究的目的是研究头孢他啶/阿维巴坦和plazomicin对碳青霉烯类耐药的肺炎克雷伯菌和大肠埃希菌的疗效。亚胺培南的敏感性,美罗培南,厄他培南,采用肉汤微量稀释法研究头孢他啶/阿维巴坦和普拉佐米星。主要碳青霉烯酶NDM,VIM,IMP,KPC,OXA-48以及其他β-内酰胺酶,TEM,SHV,OXA-1样,CTX-M,ACC,福克斯,MOX,DHA,CIT,EBC,VEB,GES,通过PCR研究PER。共有120个碳青霉烯类耐药菌株(60个大肠杆菌和60个肺炎克雷伯菌)被纳入本研究,发现blaOXA-48样菌株占78.33%,blaNDM占26.66%,blaKPC在7.5%,blaIMP在5.83%,和blaVIM在5%。在94个具有blaOXA-48样基因的分离株中,22.3%对头孢他啶/阿维巴坦耐药,51.1%对普拉佐米星耐药。在32个blaNDM分离株中,31例(96.9%)对头孢他啶/阿维巴坦耐药,30例(93.75%)对普拉佐米星耐药,两种抗生素对blaNDM携带者的作用有限(P<0.001)。在blaNDM+OXA-48组合的12个分离株中,11例(91.7%)对头孢他啶/阿维巴坦和普拉佐米星耐药。在blaNDM+OXA-48组合的菌株中,两种抗生素的效果均显著降低(P<0.005)。本研究中最常见的碳青霉烯酶基因是blaOXA-48样和blaNDM。头孢他啶/阿维巴坦在产OXA-48肺炎克雷伯菌和大肠杆菌中表现出良好的疗效,然而,在我们的研究中,plazomicin的抗菌作用明显较低。通过评估通过区域和全球分子数据在CRE感染治疗中获得的联合易感性结果和基因模式,应将两种抗微生物剂视为一种选择。
Carbapenem-resistant Enterobacterales (CRE) have become a major public health problem worldwide. The aim of this study was to investigate efficacy of ceftazidime/avibactam and plazomicin on carbapenem-resistant Klebsiella pneumoniae and Escherichia coli isolates. Susceptibility of imipenem, meropenem, ertapenem, ceftazidime/avibactam and plazomicin was investigated by broth-microdilution method. Major carbapenemases NDM, VIM, IMP, KPC, OXA-48 as well as other β-lactamases namely, TEM, SHV, OXA-1-like, CTX-M, ACC, FOX, MOX, DHA, CIT, EBC, VEB, GES, PER were investigated by PCR. A total of 120 carbapenem-resistant isolates (60 E. coli and 60 K. pneumoniae) were included in this study and blaOXA-48-like was found in 78.33%, blaNDM in 26.66%, blaKPC in 7.5%, blaIMP in 5.83%, and blaVIM in 5%. Among 94 isolates with the blaOXA-48-like gene, 22.3% were resistant to ceftazidime/avibactam and 51.1% were resistant to plazomicin. Of 32 isolates with blaNDM, 31 (96.9%) were resistant to ceftazidime/avibactam and 30 (93.75%) were resistant to plazomicin, and both antibiotics had limited effects against blaNDM carriers (P < 0.001). Of the 12 isolates with blaNDM+OXA-48 combination, 11 (91.7%) were resistant to ceftazidime/avibactam and plazomicin. The effect of both antibiotics was significantly lower in strains with blaNDM+OXA-48 combination (P < 0.005).The most common carbapenemase genes in this study were blaOXA-48-like and blaNDM. Ceftazidime/avibactam demonstrated a good efficacy among OXA-48 producing K. pneumoniae and E. coli, however, plazomicin had a significantly lower antibacterial effect in our study. Both antimicrobial agents should be considered as an option by evaluating combined susceptibility results and gene patterns obtained by regional and global molecular data in the treatment of CRE infections.