Experimental Study On The Inhibitory Effect Of Tanreqing Injection On KPC-producing Klebsiella Pneumoniae Resistance

Klebsiella pneumoniae is gram negative bacilli,which was founded and purified by Friedlander in 1882 from a lobar pneumonia patient’s sputum.Klebsiella pneumoniae has periphery capsule and this character enhance its adaptability to adopt environment.Klebsiella pneumoniae often lives in the human gut or respiratory tract and other parts.It is a clinical infectious disease caused by one of the most common pathogens.Klebsiella pneumoniae is a very important conditional pathogen.Klebsiella pneumoniae infection can cause sepsis,severe pneumonia,urinary tract,respiratory system and intracranial,skin and soft tissue infections,and the rate of incidence is rising during these years[1-4]These years,there has been widespread concern in the medical community that Klebsiella pneumoniae continues to cause fatal community problems.In healthy people,Klebsiella pneumonia caused by the incidence of infectious diseases continue to rise,including[5-6]pneumonia,meningitis,endophthalmitis and Klebsiella pneumoniae liver abscess and other related diseases.Many studies show that[7-9]Klebsiella pneumoniae from sputum specimens,suggesting pneumonia Cray bacilli diseases caused respiratory diseases.According to 2005-2014 CHINET of Klebsiella bacterial resistance monitoring showed clinical[12]:10 years Klebsiella pneumoniae detection rate is rising,rising from 10.1%in 2014 to 14.3%in 2005,which were the main source of the respiratory tract,accounting for nearly 60%.2005-2014 monitoring showed antimicrobial resistance of Klebsiella pneumoniae to carbapenem increased meropenem resistant rate rose from 2.8%in 2005 to 13.4%in 2014.There are different pathogenic factors in Klebsiella pneumoniae,which cause the damage of human organs and systems.The pathogenic factors of Klebsiella pneumoniae mainly capsule,pili,endotoxin,iron stick cells and carrier,serum bactericidal,antibacterial peptides,outer membrane protein.Tanreqing has five Chinese medicinal components and they are:Huangqin,Xiongdanfen,Shanyangjiao,Jinyinhua,Lianqiao.The main clinical efficacy of Tanreqing for detoxification,clearing heat and resolving phlegm.Clinically,it is mainly used for wind Fengwenfeire syndrome.The common clinical symptoms include cough,fever,cough,thirsty,red tongue,yellow moss;which was mainly used for acute bronchitis,acute pneumonia(early)of these symptoms,.And clinical using of Tanreqing is very extensive.Tanreqing has pharmacological action of phlegm,antibacterial,antiviral,antipyretic and immune regulation etc..Convert it into injection after application of Tanreqing in clinical practice is becoming more and more widely.There are a lot of Tanreqing value n clinic has not been discovered.And the efffection should be of our further mining,to bring more convenience to clinical work.Objective:Through the observation of Tanreqing Injection in vitro KPC producing Klebsiella pneumoniae strains antibacterial effect,the effect of Tanreqing Injection on KPC producing Klebsiella pneumoniae strains,to investigate the inhibitory effects of traditional Chinese medicine and combination of traditional Chinese medicine and Western Medicine on KPC producing Klebsiella pneumoniae strains,Chinese medicine clinical on the production of KPC enzyme Klebsiella pneumoniae strains were resistant to the intervention,in order to reduce and delay the bacterial resistance,and lay the foundation for further study of traditional Chinese medicine in vivo antibacterial mechanism.Methods:By using automated microbial identification and drug susceptibility analysis system(Phenix-100)we can identifi and screen bacterial phenotypes.According to Clinical and Laboratory Standard Institute(CLSI),recommended by the disk diffusion method for screening resistant strains were identified according to the suspicious experiment in vitro of KPC producing Klebsiella pneumoniae pneumoniae he recommended sodium CLSI broth dilution method of Tanreqing injection,Tanreqing injection combined with Tanreqing injection combined with meloxicam ampicillin,mezlocillin sulbactam and Tanreqing combined with imipenem and inhibited by our.Results:Tanreqing injection drug of KPC producing Klebsiella pneumoniae minimum inhibitory concentration MIC of 500μl/ml;mezlocillin drugs on KPC producing Klebsiella pneumoniae minimum inhibitory concentration MIC of 4096 μg/ml;mezlocillin and sulbactam against KPC producing enzyme Klebsiella pneumoniae minimum inhibitory drug the concentration of MIC is 1024 μg/ml.Results:when Tanreqing and mezlocillin were applied simultaneously to the KPC enzyme produced by Klebsiella pneumoniae,Tanreqing solution with high concentration can make the mezlocillin MIC increase,suggesting that the clinical mezlocillin injection and Tanreqing Injection in a short time cannot use at the same time.If the combined application of Tanreqing and mezlocillin not only to reduce the MIC of mezlocillin did not help or even have a side effect.When the concentration of Tanreqing for 350μl/ml～500μl/ml,can make the mezlocillin MIC increased by 2 times to 8192μg/ml.When Tanreqing and mezlocillin and sulbactam simultaneously in KPC producing Klebsiella pneumoniae,Tanreqing solution and mezlocillin sulbactam combined with no help to reduce mezlocillin sulbactam MIC,suggesting that clinical mezlocillin and sulbactam with Tanreqing injection should not be used at the same time.There was no synergistic effect between the two combinations in a short period of time.When Tanreqing and imipenem cilastatin sodium and effect on KPC enzyme produced by Klebsiella pneumoniae,Tanreqing when the solution concentration was 250-300μl/ml,to imipenem and cilastatin sodium MIC decreased 2 times,reached 32μg/ml can inhibit KPC enzyme producing Klebsiella pneumoniae the growth and reproduction of bacteria;when Tanreqing solution concentration was 350-500μl/ml,to imipenem and cilastatin sodium MIC decreased 4 times,up to 16μg/ml can inhibit KPC enzyme producing Klebsiella pneumoniae growth.Conclusion:the KPC producing Klebsiella pneumoniae was highly toxic,and the MIC of different antibiotics were higher than those of other common antibiotic which are resistant bacterias,and the MIC was higher.Enzyme inhibitors on KPC producing Klebsiella pneumoniae growth were inhibited,so the mezlocillin sulbactam MIC value is low mezlocillin.Tanreqing injection has a good inhibitory effect on KPC enzyme produced by Klebsiella pneumoniae used alone,clinical can be used between different kinds of antibiotics;due to the chemical structure and antibacterial mechanism of the difference between the effect of combined application of Tanreqing injection with different antibiotics are not the same.The effect of combination of Tanreqing and imipenem and division between his ideal of butyl sodium,Tanreqing solution with high concentration can make the imipenem cilastatin sodium MIC value decreased obviously,the highest to imipenem and cilastatin sodium MIC decreased 4 times,slightly low concentration of Tanreqing injection solution the imipenem cilastatin sodium MIC value decreased by 2 times,the value of clinical application;however,the effect of combined application of Tanreqing injection and mezlocillin is poor,even the two will have a certain antagonism,high concentrations of phlegm heat and even make clear solution of mezlocillin KPC producing Klebsiella pneumoniae pneumoniae was the MIC value increased 2 times;Tanreqing solution and mezlocillin sulbactam and application did not decrease and mezlocillin sulbactam dosage,mezlocillin sulbactam MIC remaines the same,so the two drugs should not be combined in clinical application.