CAJ | 학술논문

目的：评价临床常用的3种药敏方法对产IMP酶肺炎克雷伯菌耐药性的检出率，比较FDA与CLSI折点对判定结果的影响。方法：选取2010年6月~2013年6月临床分离的42株经PCR证实产IMP酶的肺炎克雷伯菌，以纸片扩散法、Etest法及VITEK 2系统检测各菌株对碳青霉烯类抗菌药物的耐药率，比较FDA与CLSI M100-S22折点对耐药率的影响，FDA折点判读结合改良Hodge试验(MHT)分析。结果：依照FDA折点，纸片扩散法、Etest法及VITEK 2系统检测厄他培南耐药率分别为95.2%(40株)、100%(42株)和100%(42株)，亚胺培南耐药率分别为76.2%(32株)、83.3%(35株)和90.5%(38株)，纸片扩散法和Etest法检测美罗培南耐药率分别为73.8%(31株)和83.3%(35株)；依照CLSI M100-S22折点，纸片扩散法、Etest法及VITEK 2系统检测厄他培南耐药率分别为90.5%(38株)、100%(42株)和100%(42株)，亚胺培南耐药率分别为54.8%(23株)、59.5%(25株)和61.9%(26株)，纸片扩散法和Etest法检测美罗培南耐药率分别为57.1%(24株)和61.9%(26株)。结论：厄他培南作为筛选产IMP酶肺炎克雷伯菌的指示药物优于其他药物，FDA标准结合MHT比CLSI标准更能检出菌株产IMP酶情况，VITEK 2系统能更好地检出IMP酶介导的碳青霉烯类抗菌药物的耐药性。
목적：평개림상상용적3충약민방법대산IMP매폐염극뢰백균내약성적검출솔，비교FDA여CLSI절점대판정결과적영향。방법：선취2010년6월~2013년6월림상분리적42주경PCR증실산IMP매적폐염극뢰백균，이지편확산법、Etest법급VITEK 2계통검측각균주대탄청매희류항균약물적내약솔，비교FDA여CLSI M100-S22절점대내약솔적영향，FDA절점판독결합개량Hodge시험(MHT)분석。결과：의조FDA절점，지편확산법、Etest법급VITEK 2계통검측액타배남내약솔분별위95.2%(40주)、100%(42주)화100%(42주)，아알배남내약솔분별위76.2%(32주)、83.3%(35주)화90.5%(38주)，지편확산법화Etest법검측미라배남내약솔분별위73.8%(31주)화83.3%(35주)；의조CLSI M100-S22절점，지편확산법、Etest법급VITEK 2계통검측액타배남내약솔분별위90.5%(38주)、100%(42주)화100%(42주)，아알배남내약솔분별위54.8%(23주)、59.5%(25주)화61.9%(26주)，지편확산법화Etest법검측미라배남내약솔분별위57.1%(24주)화61.9%(26주)。결론：액타배남작위사선산IMP매폐염극뢰백균적지시약물우우기타약물，FDA표준결합MHT비CLSI표준경능검출균주산IMP매정황，VITEK 2계통능경호지검출IMP매개도적탄청매희류항균약물적내약성。
Objective:To evaluate three susceptibility methods on detecting of carbapenem resistance in IMP-producing Klebsiella pneumonia, and compared FDA and CLSI breakpoints for determining outcomes. Methods:Forty-two Klebsiella pneumoniae producing IMP carbapenemase were isolated from June 2010 to June 2013 which were confirmed by PCR, carbapenem resistance in IMP-producing Klebsiella pneumoniae were detected by the disk diffusion method, Etest method and VITEK 2 system, then comparaed FDA and CLSI M100-S22 breakpoint on the impact of drug resistance, FDA breakpoint interpretation was analysised by combining modified Hodge test (MHT).Results:According to FDA breakpoints, the resistance rates of ertapenem detected by disk diffusion method, Etest method and the VITEK 2 system were 95.2%(40 isolates), 100%(42 isolates) and 100%(42 isolates), the resistance rates of imipenem were 76.2% (32 isolates), 83.3% (35 isolates) and 90.5% (38 isolates), the resistance rates of meropenem detected by disk diffusion method and Etest method were 73.8%(31 isolates) and 83.3%(35 isolates). According to CLSI M100-S22 breakpoints, the resistance rates of ertapenem detected by disk diffusion method, Etest method and the VITEK 2 system were 90.5%(38 isolates), 100% (42 isolates) and 100% (42 isolates), the resistance rates of imipenem were 54.8% (23 isolates), 59.5% (25 isolates) and 61.9%(26 isolates), the resistance rates of meropenem detected by disk diffusion method and Etest method were 57.1%(24 isolates) and 61.9%(26 isolates). Conclusions:Ertapenem was a more sensitive indicator than meropenem and imipenem as screening IMP-possessing isolates. Combined with FDA standards and MHT was better than the CLSI standard to detect Klebsiella pneumoniae producing IMP carbapenemase of sensitivity of VITEK 2 system was higher than other methods in identification of IMP-mediated carbapenem resistance.