[1]张冬萍,李 凯,蒋瑞鑫,等.临床分离碳青霉烯类耐药大肠埃希菌的基因型分析及体外联合抗菌作用研究[J].现代检验医学杂志,2026,41(03):87-91+97.[doi:10.3969/j.issn.1671-7414.2026.03.016]
　ZHANG Dongping,LI Kai,JIANG Ruixin,et al.Genotypic Analysis and in Vitro Study of Combined Antibacterial Effects of Carbapenem-Resistant Escherichia coli Isolated from Clinical Settings[J].Journal of Modern Laboratory Medicine,2026,41(03):87-91+97.[doi:10.3969/j.issn.1671-7414.2026.03.016]
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临床分离碳青霉烯类耐药大肠埃希菌的基因型分析及体外联合抗菌作用研究()

《现代检验医学杂志》[ISSN:/CN:]

卷:
第41卷
期数:
2026年03期
页码:
87-91+97
栏目:
论著
出版日期:
2026-05-13

文章信息/Info

Title:
Genotypic Analysis and in Vitro Study of Combined Antibacterial Effects of Carbapenem-Resistant Escherichia coli Isolated from Clinical Settings
文章编号:
1671-7414（2026）03-087-06
作者:
张冬萍1，李 凯2，蒋瑞鑫1，李 娜1，张雨婷1，白 冰1，沈 璇1
1.新疆四七四医院检验科，乌鲁木齐833013;2.新疆军区总医院检验科，乌鲁木齐833099
Author(s):
ZHANG Dongping1，LI Kai2，JIANG Ruixin1，LI Na1，ZHANG Yuting1，BAI Bing1，SHEN Xuan1
1.Department of Clinical Laboratory, Xinjiang 474 Hospital, Urumqi 833013, China;2.Department of Clinical Laboratory, Xinjiang Military Region General Hospital, Urumqi 833099, China
关键词:
碳青霉烯类耐药大肠埃希菌; 碳青霉烯酶基因型; 联合药敏试验; 部分抑菌浓度指数
分类号:
R378.21；R446.5
DOI:
10.3969/j.issn.1671-7414.2026.03.016
文献标志码:
A
摘要:
目的?探究碳青霉烯类耐药大肠埃希菌（CR-Eco）碳青霉烯酶基因型分布特征，并系统评估以多黏菌素B（PMB）为基础分别联合多种抗生素对CR-Eco的体外联合抗菌效应，为临床治疗方案提供理论依据。方法收集2021～2024年新疆四七四医院临床分离的20株非重复CR-Eco菌株，采用胶体金免疫层析法（GICA）进行碳青霉烯酶基因型测定，肉汤微量稀释棋盘法测定各单药及以PMB为基础分别联合亚胺培南（IPM）、美罗培南（MEM）、阿米卡星（AK）、环丙沙星（CIP）、磷霉素（FOS）、替加环素（TGC）及氨曲南（ATM）联合头孢他啶/阿维巴坦（CZA）的最低抑菌浓度（MIC），计算部分抑菌浓度（FIC）指数判定联合效果。结果20株CR-Eco中，18株产NDM型金属酶，2株产KPC型丝氨酸酶。联合用药显著降低单药MIC值，差异具有统计学意义（均P<0.05）。ATM+CZA组合呈现最优协同效应（协同率80%，协同/相加率合计90%）；PMB+CIP组合抗菌效应最弱（协同/相加率合计40%）；PMB+IPM、PMB+MEM联合协同/相加率合计分别达90%、95%；PMB与FOS、AMK、TGC联合协同/相加率合计均为50%。结论CR-Eco主要携带NDM型碳青霉烯酶，联合用药能够显著降低单药的MIC值及耐药率。建议临床优先采用ATM+CZA或PMB+IPM、PMB+MEM联合方案作为CR-Eco感染的治疗。
Abstract:
Objective To investigate the distribution characteristics of carbapenemase genotypes in carbapenem-resistant Esch-erichia coli (CR-Eco), and to systematically evaluate the in vitro combined antibacterial effects of polymyxin B (PMB)-based combinations with various antibiotics against CR-Eco, so as to provide theoretical basis for clinical treatment regimens. Methods A total of 20 non-repetitive CR-Eco strains clinically isolated from Xinjiang 474 Hospital between 2021 and 2024 were col-lected. The gold immunochromatography assay (GICA) was used to determine the carbapenemase genotype. The broth micro-dilution checkerboard method was employed to measure the minimum inhibitory concentration (MIC) of each single agent and PMB-based combinations with imipenem (IPM), meropenem (MEM), amikacin (AK), ciprofloxacin (CIP), fosfomycin (FOS), tigecycline (TGC), aztreonam (ATM) plus ceftazidime/avibactam (CZA). The fractional inhibitory concentration (FIC) index was calculated to evaluate the combined effects. Results Among the 20 CR-Eco strains, 18 strains produced NDM-type metal-lo-β-lactamases and 2 strains produced KPC-type serine carbapenemases. Combination therapy significantly reduced the MIC values of single agents, with statistically significant differences (all P < 0.05). The ATM + CZA combination showed the optimal synergistic effect (synergism rate 80%, total synergistic/additive rate 90%). The PMB + CIP combination exhibited the weakest antibacterial effect (total synergism/additive rate 40%). The total synergism/additive rates of PMB + IPM and PMB + MEM com-binations reached 90% and 95%, respectively. The total synergism/additive rates of PMB combined with FOS, AMK and TGC were all 50%. Conclusions CR-Eco mainly carries NDM-type carbapenemase, and combination therapy can significantly reduce the MIC value and resistance rate of single agents. It is recommended that AZT+CZA or PMB+IPM, PMB+MEM combined regi-mens be preferentially used in clinical practice for the treatment of CR-Eco infections.

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备注/Memo

备注/Memo:
基金项目：乌鲁木齐市卫生健康委员会科技计划项目（202459）。
作者简介：张冬萍（1982-），女，学士，副主任技师，研究方向：临床微生物检验和细菌耐药机制，E-mail:782400422@qq.com。
通讯作者：李凯（1984-），男，博士，副主任技师，研究方向：临床微生物实验室诊断和感染性疾病，E-mail：958813693@qq.com。
更新日期/Last Update: 2026-05-15