| Acinetobacter baumannii(Ab)is a kind of non-fermented,aerobicgram-negative bacilli without spores and flagella.It mainly obtains energy through the oxidative decomposition of sugars.It belongs to acinetobacter group.It exists widely in nature and hospital environment,and is one of the common opportunistic pathogens in human skin,open lumen mucosa throat and respiratory tract secretions.When the external conditions are mild,Ab is easy to multiply in large Numbers and destroy the normal bacterial community balance in the host,causing various primary or secondary infections[1].In the 1970s,Ab had low virulence and weak pathogenicity,and was sensitive to almost all antibacterial drugs.However,since the 1990s,Ab has shown strong tolerance,resistance to drug resistance and resistance gene ability to the harsh dry environment.Carbapenems have the advantages of high stability and low toxicity against-lactamase,and are recommended as the most effective drug for the clinical treatment of acinetobacter baumannii infection[2].Carbapenem-resistant acinetobacter baumannii CRAB was first detected in the blood of a patient at an Edinburgh hospital of England in 1985.In 1991,the first outbreak of hospital-acquired infection caused by CRAB in New York,USA[3],followed by the outbreak and epidemic in various countries in the world,Belgium,Argentina,Brazil,France,Hong Kong,Italy,Japan and Spain,etc.reported the infection of acinetobacter baumannii strain producing hydrolyzed carbapenilene.SHENG et al.[4-5]showed that the infection rate of acinetobacter baumannii resistant to carbapenems in hospitals was increasing,and the fatality rate was about 46%.Carbapenems are not the most effective drugs for the treatment of acinetobacter baumannii,so which antibacterial agents should be selected to solve the difficult problems and challenges.According to the surveillance data of bacterial resistance of CHINET in China,the drug resistance rate of acinetobacter baumannii to imipenem in China increased from 54.8%in 2009 to 62.4%in 2014.Meropenem increased from 57.2%to 66.7%[6-7].SENTRY antimicrobial monitoring data showed that the drug resistance rate of acinetobacter baumannii to meropenem in 2009-2012 was 66.1%(USA)and 71.6%(Europe and Mediterranean region)[8].In 2016,the monitoring report of the national bacterial drug resistance monitoring network(CARSS)indicated that the national average drug resistance rate of acinetobacter baumannii to carbapenems was 60.0%,which was 1%higher than that in 2015.The drug resistance rate of acinetobacter baumannii to carbapenems in different areas ranged from 24.8 to 81.2%.With the application of a large number of broad-spectrum antibacterial drugs,combination and repetition,the drug-resistant CRAB strain began to be widely popular in the hospital in the 1990s[9],Dut there were almost no available antibacterial drags,mainly myxins and tigaricyclines.Myxomycin has not been sold on the market in China.The situation of CRAB infection at home and abroad is increasingly grim,but there is a shortage of antibacterial drugs for clinical treatment.Through experimental research and exploration of the combined effect of traditional Chinese medicine,Chinese and western medicine to inhibit the growth of CRAB,which has clinical practical guiding value and research significance.Chinese medicine injection is a new dosage form developed on the basis of preparation and a modern product of Traditional Chinese medicine.Traditional Chinese medicine has obvious advantages such as antibacterial,anti-inflammatory,special efficacy and rapid onset[10].Many studies have reported that traditional Chinese medicine injection for the prevention and treatment of drug-resistant bacteria has achieved good results,and fewer side effects,worthy of wide application.Reduning is made three kinds of plants modern Chinese medicine injection,can effectively inhibit the virus and bacteria breeding disease,inhibit the pathogen to the target cell infection,with qinghao,antiviral,anti-inflammatory,enhance immunity and other effects.It is often used to treat headache,cough,fever and other symptoms caused by upper respiratory tract infection.The dosage is proportional to the efficacy,and the treatment effect is outstanding[11-12].Tanreqing injection is mainly composed of Scutellaria baicalensis,bear bile powder,goat horn,honeysuckle,forsythia.It has a variety of functions such as clearing heat and detoxifying,improving immune function,and has a good effect in treating respiratory tract infection and other diseases[13-16].Xiyanping injection was extracted from the fern andrographis paniculate and made into a water-soluble total lactone sulfonate of andrographis paniculata.With clearing heat,antibacterial anti-inflammatory,cough and other pharmacological effects.Compared with antibacterial drugs,traditional Chinese medicine injection has special chemical structure and efficacy,convenient application,low price,strong antibacterial activity and fewer adverse reactions.Therefore,the above three Chinese medicine injections combined with CRAB were selected to study the bacteriostatic effect in vitro.Objective:to study the in vitro antibacterial effect of reduning,tanreqing and xiyanping on carbapenem resistant acinetobacter baumannii and evaluate the antibacterial effect alone.Reduning,tanreqing and xiyanping injections were combined with imipenem sodium and ceftazidime respectively to analyze the bacteriostasis effect of carbapenem resistant acinetobacter baumannii in vitro.Through the test of three kinds of Chinese medicine injections on acinetobacter baumannii resistant to carbapenem,this paper studied the inhibitory effect of Chinese medicine injections alone on drug-resistant bacteria and delayed bacterial drug resistance,so as to further understand the bacteriostatic components of Chinese medicine and the mechanism of action.To investigate the antibacterial effect of three traditional Chinese medicine injections combined with imipenem,ceftazidime and cefaladine respectively on carbapenem resistant acinetobacter baumannii,and to provide experimental basis for future clinical combined treatment with Chinese and western medicine.Methods:sputum specimens from the intensive care unit were selected and cultured,and then the bacteria were identified and tested by the automatic microbial identification and drug sensitivity analysis system(VITEK2 Compact).The 2018 Clinical and Laboratory StandardInstitute(CLSI)will screen carbapenems resistant acinetobacter baumannii.The inhibition effect of reduning,tanreqing and xiyanping injection combined with imipenem,statin sodium and ceftazidime on carbapenem-resistant acinetobacter baumannii in vitro was studied by broth dilution method.Results:the minimum inhibitory concentration(MIC)of reduning injection against acinetobacter baumannii was 400?l/ml.The MIC of tanreqing injection against acinetobacter baumannii was 1000?l/ml.The MIC of xiyanping injection against acinetobacter baumannii was 1000?l/ml.Reduning injection has the best antibacterial effect.The minimum inhibitory concentration(MIC)of imipenem sodium statin against carbapenem resistant acinetobacter baumannii was 1281,g/ml.The MIC of ceftazidime against acinetobacter baumannii was 128,g/ml.When Reduning and imipenecsistatin group were used for acinetobacter baumannii resistant to carbapenem,the concentration of reduning injection was 200?l/ml,and the concentration of imipenecsistatin sodium was 8?g/ml,which could inhibit the growth of acinetobacter baumannii resistant to carbapenem.The growth of carbapenem-resistant acinetobacter baumannii was inhibited at 250?l/ml and 4?g/ml of imipenem-statin sodium.The MIC values of the lowest inhibitory concentration of imipenem and statin sodium were decreased by 16 times and 32 times when the concentrations of thermonin solution were 200?l/ml and 250?l/ml,respectively.The lowest drug concentration of reduning combined with imipenem was 200?l/ml,which was twice lower than that of single application.When Reduning and ceftazidime were used in combination for acinetobacter baumannii resistant to carbapenem,the concentration of reduning injection was 150?l/ml and ceftazidime 16?g/ml,which inhibited the growth of acinetobacter baumannii resistant to carbapenem.When the concentration of redoxine injection was 300?l/ml and ceftazidime 4?g/ml,the growth of acinetobacter baumannii resistant to carbapenem was inhibited.When the concentration of retoxanine injection was 150?l and 300?l/ml,the MIC value of ceftazidine was decreased by 8 times and 32 times.When combined with ceftazidime,the minimum concentration was 150?l/ml,2.6 times less than that when applied alone.Conclusion:the study conclusion for reduning,tanreqing and xiyanping injection on in vitro resistance to carbon penicillium ene acinetobacter baumannii all have certain bacteriostatic action,including redunig better bacteriostatic effect is most obvious,but tanreqingt and xiyanpingin influent concentration can inhibit the alone,so don't recommend clinical choice these two injection as a separate or joint antibacterial pharmacological inhibition of the resistance to carbon alkene acinetobacter baumannii.The combined application of reduning injection with imipenecitabine sodium and ceftazidime was more effective than that of single drug use,and the drug concentration was significantly reduced to effectively reduce and delay the drug resistance of bacteria,laying a foundation for further study on the pharmacological effects of redoxine antibacterial components. |
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