CAJ | 학술논문

目的比较不同药敏方法检测替加环素对鲍曼不动杆菌的敏感性.方法回顾性选取2010年1至12月全国30家医院临床分离以及本实验室保存的碳青霉烯类抗生素敏感鲍曼不动杆菌(CSAB)和耐药鲍曼不动杆菌(CRAB)各30株,采用微量肉汤稀释法、Etest法、琼脂稀释法、MIC测试条(MTS)法、Vitek 2仪器法和纸片扩散法测定替加环素对鲍曼不动杆菌的敏感性,并以微量肉汤稀释法结果为标准进行比较,同时比较M-H和ISO培养基对药敏结果的影响.结果 CSAB微量肉汤稀释法、Etest法、琼脂稀释法、MTS法、Vitek 2仪器法测定替加环素MIC50/MIC90分别为0.125/0.25 mg/L、0.125/0.25 mg/L、0.5/1 mg/L、0.125/0.25 mg/L、0.5/0.5 mg/L,与微量肉汤稀释法比较,按照美国食品药品监督局(FDA)/欧洲药敏试验委员会(EUCAST)判断标准,所有药敏方法分类一致性(CA) ≥90％,未出现非常严重误差(VME).CRAB微量肉汤稀释法、Etest法、琼脂稀释法、MTS法、Vitek 2仪器法测定替加环素MIC50/MIC90分别为2/4 mg/L、4/4 mg/L、4/4 mg/L、1/2 mg/L、2/4mg/L,按照FDA/EUCAST判断标准,MTS法产生3.3％(1/30)/6.7％ (2/30) VME,没有一种药敏方法CA≥90％.按照Jones判断标准,纸片扩散法结果与微量肉汤稀释法结果分类一致性高于FDA标准,但对CRAB菌株CA仅为66.7％ (20/30),未出现VME.采用M-H琼脂测得的替加环素MIC高于ISO琼脂.结论对CRAB菌株,琼脂稀释法、Etest法、Vitek 2仪器法、纸片扩散法均不适合检测替加环素的敏感性,其检测中介或耐药菌株需用微量肉汤稀释法进一步确认,对MTS法测定结果也需要谨慎解释.
목적 비교불동약민방법검측체가배소대포만불동간균적민감성.방법 회고성선취2010년1지12월전국30가의원림상분리이급본실험실보존적탄청매희류항생소민감포만불동간균(CSAB)화내약포만불동간균(CRAB)각30주,채용미량육탕희석법、Etest법、경지희석법、MIC측시조(MTS)법、Vitek 2의기법화지편확산법측정체가배소대포만불동간균적민감성,병이미량육탕희석법결과위표준진행비교,동시비교M-H화ISO배양기대약민결과적영향.결과 CSAB미량육탕희석법、Etest법、경지희석법、MTS법、Vitek 2의기법측정체가배소MIC50/MIC90분별위0.125/0.25 mg/L、0.125/0.25 mg/L、0.5/1 mg/L、0.125/0.25 mg/L、0.5/0.5 mg/L,여미량육탕희석법비교,안조미국식품약품감독국(FDA)/구주약민시험위원회(EUCAST)판단표준,소유약민방법분류일치성(CA) ≥90％,미출현비상엄중오차(VME).CRAB미량육탕희석법、Etest법、경지희석법、MTS법、Vitek 2의기법측정체가배소MIC50/MIC90분별위2/4 mg/L、4/4 mg/L、4/4 mg/L、1/2 mg/L、2/4mg/L,안조FDA/EUCAST판단표준,MTS법산생3.3％(1/30)/6.7％ (2/30) VME,몰유일충약민방법CA≥90％.안조Jones판단표준,지편확산법결과여미량육탕희석법결과분류일치성고우FDA표준,단대CRAB균주CA부위66.7％ (20/30),미출현VME.채용M-H경지측득적체가배소MIC고우ISO경지.결론 대CRAB균주,경지희석법、Etest법、Vitek 2의기법、지편확산법균불괄합검측체가배소적민감성,기검측중개혹내약균주수용미량육탕희석법진일보학인,대MTS법측정결과야수요근신해석.
Objective To evaluate different tigecycline susceptibility testing methods for A.baumannii.Methods Thirty carbapenem resistant A.baumannii (CRAB) and 30 carbapenem sensitive A.baumannii (CSAB) isolates were randomly collected from 30 hospitals during January to December in 2010 in China retrospectively.MIC and inhibitory zone diameters for tigecyclinc were determined by the susceptibility testing methods such as broth microdilution (BMD),agar dilution,E test,MIC Test Strip (MTS),Vitek2.Data were analyzed by comparing the results from each method to those produced by the reference BMD method.The effects of two different susceptibility test media (M-H and ISO-Sensitest Agar) on the MIC of tigecycline were also analyzed.Results For CSAB isolates,the MIC50/MIC90 of BMD,agar dilution,E test,MTS and Vitek2 were as follows:0.125/0.25 mg/L,0.125/0.25 mg/L,0.5/1 mg/L,0.125/0.25 mg/L and 0.5/0.5 mg/L.Compared with BMD method,the categorical agreement rates (CA) of each method were ≥90％,and produced no very major errors (VME) by Food and Drug Administration (FDA)/ European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints.For CRAB isolates,the MIC50/MIC90 of BMD,agar dilution,E test,MTS and Vitek2 were as follows:2/4 mg/L,4/4 mg/L,4/4 mg/L,1/2 mg/L and 2/4 mg/L.Compared with BMD method,MTS produced 3.3％ (1/30)/6.7％ (2/30) VME(FDA/EUCAST breakpoints),and no method CA was ≥90％.The CA between disk diffusion and BMD results were higher by using the criteria of Jones than FDA breakpoints,but only 66.7％ (20/30) were observed in CRAB isolates,and produced no VME.The MIC of tigecycline determined using M-H agar were usually higher than those using ISO-sensitest Agar.Conclusions Agar dilution,E test,Vitek 2 and disk diffusion appear not to be a suitable method for routine susceptibility testing of tigecycline for CRAB strains.Tigecycline intermediate or resistant results determined by these methods require confirmation by BMD,and MTS results also need to be interpreted with caution.