CAJ | 학술논문

目的：比较四种不同药敏方法检测替加环素对鲍曼不动杆菌和肠杆菌科细菌药敏结果的不同。方法将临床分离的鲍曼不动杆菌（158株）和肠杆菌科细菌（339株）用纸片扩散法检测替加环素敏感性，对非敏感的124株细菌再分别采用微量肉汤稀释法、MTS法、琼脂稀释法检测替加环素最小抑菌浓度（ MIC），分析四种不同药敏检测方法间的差异性。结果替加环素对纸片扩散法非敏感的两种细菌均有较好的抗菌活性，MIC50大部分在敏感范围内（0．5～2 mg／L），MIC90均为4 mg／L。微量肉汤稀释法表明，替加环素对鲍曼不动杆菌和肠杆菌科细菌均有较好的抗菌活性，MIC50为1 mg／L， MIC90为4 mg／L。参照美国食品药品监督局（ FDA）和欧洲药敏试验委员会（ EUCAST）判读标准，敏感率分别为87．1％和70．2％。琼脂稀释法显示多数鲍曼不动杆菌和肠杆菌科细菌测得的替加环素MIC结果比微量肉汤稀释法高2个稀释度[基本一致性（ EA）为56．5％]，按照FDA判读标准，非常重大误差（ VME）和重大误差（ME）均为0，分类一致性（CA）为46．8％；按照EUCAST判读标准，VME为0．8％，CA为24．2％。MTS法相比于琼脂稀释法，测定替加环素对鲍曼不动杆菌和肠杆菌科细菌的药敏结果更好，MIC50为1．5 mg／L，MIC90为4 mg／L，与微量肉汤稀释法较接近，按照FDA／EUCAST判读标准，敏感率分别为83．1％／21．0％，CA分别为81．5％／29．8％，EA为71．8％，但多数细菌结果比微量肉汤稀释法高1个稀释度。FDA判读标准的相关性比EUCAST判读标准好。纸片扩散法结果表明，按照FDA判断标准， ME 为19．4％，小误差（mE）为71．8％。本研究未出现VME菌株，但CA仅为8．9％。结论纸片法、MTS法、琼脂稀释法与微量肉汤稀释法均存在差异，其中以MTS法与微量肉汤稀释法相关性最好，且FDA判读标准相比于EUCAST判读标准相关性更好。建议临床检测替加环素体外药敏试验，可参照美国FDA判读标准，通过纸片法常规检查，对于纸片法中介或耐药的菌株再进行MTS法进行确认，必要时可进行微量肉汤稀释法做进一步确证试验。目的：比較四種不同藥敏方法檢測替加環素對鮑曼不動桿菌和腸桿菌科細菌藥敏結果的不同。方法將臨床分離的鮑曼不動桿菌（158株）和腸桿菌科細菌（339株）用紙片擴散法檢測替加環素敏感性，對非敏感的124株細菌再分彆採用微量肉湯稀釋法、MTS法、瓊脂稀釋法檢測替加環素最小抑菌濃度（ MIC），分析四種不同藥敏檢測方法間的差異性。結果替加環素對紙片擴散法非敏感的兩種細菌均有較好的抗菌活性，MIC50大部分在敏感範圍內（0．5～2 mg／L），MIC90均為4 mg／L。微量肉湯稀釋法錶明，替加環素對鮑曼不動桿菌和腸桿菌科細菌均有較好的抗菌活性，MIC50為1 mg／L， MIC90為4 mg／L。參照美國食品藥品鑑督跼（ FDA）和歐洲藥敏試驗委員會（ EUCAST）判讀標準，敏感率分彆為87．1％和70．2％。瓊脂稀釋法顯示多數鮑曼不動桿菌和腸桿菌科細菌測得的替加環素MIC結果比微量肉湯稀釋法高2箇稀釋度[基本一緻性（ EA）為56．5％]，按照FDA判讀標準，非常重大誤差（ VME）和重大誤差（ME）均為0，分類一緻性（CA）為46．8％；按照EUCAST判讀標準，VME為0．8％，CA為24．2％。MTS法相比于瓊脂稀釋法，測定替加環素對鮑曼不動桿菌和腸桿菌科細菌的藥敏結果更好，MIC50為1．5 mg／L，MIC90為4 mg／L，與微量肉湯稀釋法較接近，按照FDA／EUCAST判讀標準，敏感率分彆為83．1％／21．0％，CA分彆為81．5％／29．8％，EA為71．8％，但多數細菌結果比微量肉湯稀釋法高1箇稀釋度。FDA判讀標準的相關性比EUCAST判讀標準好。紙片擴散法結果錶明，按照FDA判斷標準， ME 為19．4％，小誤差（mE）為71．8％。本研究未齣現VME菌株，但CA僅為8．9％。結論紙片法、MTS法、瓊脂稀釋法與微量肉湯稀釋法均存在差異，其中以MTS法與微量肉湯稀釋法相關性最好，且FDA判讀標準相比于EUCAST判讀標準相關性更好。建議臨床檢測替加環素體外藥敏試驗，可參照美國FDA判讀標準，通過紙片法常規檢查，對于紙片法中介或耐藥的菌株再進行MTS法進行確認，必要時可進行微量肉湯稀釋法做進一步確證試驗。
목적：비교사충불동약민방법검측체가배소대포만불동간균화장간균과세균약민결과적불동。방법장림상분리적포만불동간균（158주）화장간균과세균（339주）용지편확산법검측체가배소민감성，대비민감적124주세균재분별채용미량육탕희석법、MTS법、경지희석법검측체가배소최소억균농도（ MIC），분석사충불동약민검측방법간적차이성。결과체가배소대지편확산법비민감적량충세균균유교호적항균활성，MIC50대부분재민감범위내（0．5～2 mg／L），MIC90균위4 mg／L。미량육탕희석법표명，체가배소대포만불동간균화장간균과세균균유교호적항균활성，MIC50위1 mg／L， MIC90위4 mg／L。삼조미국식품약품감독국（ FDA）화구주약민시험위원회（ EUCAST）판독표준，민감솔분별위87．1％화70．2％。경지희석법현시다수포만불동간균화장간균과세균측득적체가배소MIC결과비미량육탕희석법고2개희석도[기본일치성（ EA）위56．5％]，안조FDA판독표준，비상중대오차（ VME）화중대오차（ME）균위0，분류일치성（CA）위46．8％；안조EUCAST판독표준，VME위0．8％，CA위24．2％。MTS법상비우경지희석법，측정체가배소대포만불동간균화장간균과세균적약민결과경호，MIC50위1．5 mg／L，MIC90위4 mg／L，여미량육탕희석법교접근，안조FDA／EUCAST판독표준，민감솔분별위83．1％／21．0％，CA분별위81．5％／29．8％，EA위71．8％，단다수세균결과비미량육탕희석법고1개희석도。FDA판독표준적상관성비EUCAST판독표준호。지편확산법결과표명，안조FDA판단표준， ME 위19．4％，소오차（mE）위71．8％。본연구미출현VME균주，단CA부위8．9％。결론지편법、MTS법、경지희석법여미량육탕희석법균존재차이，기중이MTS법여미량육탕희석법상관성최호，차FDA판독표준상비우EUCAST판독표준상관성경호。건의림상검측체가배소체외약민시험，가삼조미국FDA판독표준，통과지편법상규검사，대우지편법중개혹내약적균주재진행MTS법진행학인，필요시가진행미량육탕희석법주진일보학증시험。
Objective To evaluate the capability of four tests for identification of the in vitro suscepti-bility of tigecycline against Acinetobacter and Enterobacteriaceae isolates.Methods Disk diffusion test was per-formed to detect the sensitivity of 158 Acinetobacter and 339 Enterobacteriaceae isolates to tigecycline.The mini-mum inhibitory concentrations ( MICs) of tigecycline for non-sensitive isolates were detected by using broth dilu-tion method ( BDM) , MIC Test Strip ( MTS) and agar dilution method.The differences with antimicrobial sus-ceptibility among the four different methods were evaluated.Results Tigecycline showed good antibacterial ac-tivity against both non-sensitive Acinetobacter and Enterobacteriaceae isolates with most of the MIC50 values in the sensitivity range of (0.5-2) mg/L and all of the MIC90 values of 4 mg/L.The MIC50 and MIC90 values measured by BDM were respectively 1 mg/L and 4 mg/L.The sensitivity rates presented by the results of BDM were re-spectively 87.1%and 70.2%based on the standards made by Food and Drug Administration (FDA) and Euro-pean Committee on Antimicrobial Susceptibility Testing ( EUCAST) .Agar dilution method indicated that most of the MICs of tigecycline to Acinetobacter and Enterobacteriaceae isolates were two dilutions higher than those de-tected by BDM with essential agreement (EA) rate of 56.5%.Both the very major error (VME) and the major error (ME) values were 0 and the categorical agreement (CA) rate was 46.8%according to the FDA standard.The VME and CA values were 0.8% and 24.2% based on EUCAST standard.Compared with agar dilution method, MTS showed better results in determining the susceptibility of Acinetobacter and Enterobacteriaceae iso-lates to tigecycline with MIC50 and MIC90 values of 1.5 mg/L and 4 mg/L, which was similar to the capability of BDM.Referring to the FDA and EUCAST standards, the sensitivity rates were 83.1% and 21.0%, the CA rates was 81.5%and 29.8%, and the EA rate was 71.8%.Most of the results tested by MTS were one dilution higher than those by BDM.FDA standard showed better correlation than EUCAST standard.Disk diffusion method showed the ME, mE, VME and CA values were respectively 19.4%, 71.8%, 0 and 8.9%according to FDA standard.Conclusion Disk diffusion method, MTS and agar dilution method all showed differences with BDM in susceptibility testing.The capability of MTS was similar to that of BDM.The results evaluated by FDA standard were better than those by EUCAST standard.The in vitro susceptibility of bacteria to tigecycline could be tested by disk diffusion method using FDA standard for evaluation, and confirmed with MTS if isolates were resistance or intermediate strains.The BDM could be performed for further confirmation if necessary.