CAJ | 학술논문

目的研究替加环素体外药敏检测的影响因素,并对检测方法进行评估.方法回顾性收集2010年1至12月中国13家教学医院临床分离的116株鲍曼不动杆菌和肺炎克雷伯菌,评价隔夜培养基、培养基品牌和批号对替加环素药敏检测的影响.按照2010年和2012年临床标本中替加环素的MIC分布比例随机选择鲍曼不动杆菌56株,肺炎克雷伯菌47株,以微量肉汤稀释法为参考方法,评估琼脂稀释法、纸片扩散法、MIC检测试纸条(MTS)和Vitek GN16板的一致性和错误率.结果琼脂稀释法分别使用隔夜培养基和新鲜配制培养基检测替加环素对鲍曼不动杆菌和肺炎克雷伯菌基本一致率分别为89.7％ (52/58)和87.9％ (51/58)；不同培养基品牌(BBL和Oxoid)和批号检测替加环素对两种细菌的基本一致率和分类一致率均为100％；按照美国食品药品监督局的折点判定标准:琼脂稀释法、MTS法、Vitek GN16板与微量肉汤稀释法检测结果的分类一致率/基本一致率分别为77.7％(80/103)/99.0％(102/103),87.4％ (90/103)/98.1％(101/103),64.1％ (66/103)/76.7％ (79/103)；纸片扩散法与微量肉汤稀释法(FDA折点判定标准)的分类一致性分别为:79.6％(82/103,敏感≥14mm,耐药≤10 mm),69.9％(72/103,敏感≥16 mm,耐药≤12 mm),34.0％ (35/103,敏感≥19 mm,耐药≤14 mm).结论替加环素的体外药敏检测应使用新鲜配制的培养基,不同培养基的品牌(BBL和Oxoid)和批号检测替加环素对鲍曼不动杆菌和肺炎克雷伯菌体外药敏结果无影响.琼脂稀释法和MTS法与微量肉汤稀释法相关性较好,而纸片扩散法、Vitek GN16板一致性较低.通过调整纸片扩散法折点有望提高一致性.
목적 연구체가배소체외약민검측적영향인소,병대검측방법진행평고.방법 회고성수집2010년1지12월중국13가교학의원림상분리적116주포만불동간균화폐염극뢰백균,평개격야배양기、배양기품패화비호대체가배소약민검측적영향.안조2010년화2012년림상표본중체가배소적MIC분포비례수궤선택포만불동간균56주,폐염극뢰백균47주,이미량육탕희석법위삼고방법,평고경지희석법、지편확산법、MIC검측시지조(MTS)화Vitek GN16판적일치성화착오솔.결과 경지희석법분별사용격야배양기화신선배제배양기검측체가배소대포만불동간균화폐염극뢰백균기본일치솔분별위89.7％ (52/58)화87.9％ (51/58)；불동배양기품패(BBL화Oxoid)화비호검측체가배소대량충세균적기본일치솔화분류일치솔균위100％；안조미국식품약품감독국적절점판정표준:경지희석법、MTS법、Vitek GN16판여미량육탕희석법검측결과적분류일치솔/기본일치솔분별위77.7％(80/103)/99.0％(102/103),87.4％ (90/103)/98.1％(101/103),64.1％ (66/103)/76.7％ (79/103)；지편확산법여미량육탕희석법(FDA절점판정표준)적분류일치성분별위:79.6％(82/103,민감≥14mm,내약≤10 mm),69.9％(72/103,민감≥16 mm,내약≤12 mm),34.0％ (35/103,민감≥19 mm,내약≤14 mm).결론 체가배소적체외약민검측응사용신선배제적배양기,불동배양기적품패(BBL화Oxoid)화비호검측체가배소대포만불동간균화폐염극뢰백균체외약민결과무영향.경지희석법화MTS법여미량육탕희석법상관성교호,이지편확산법、Vitek GN16판일치성교저.통과조정지편확산법절점유망제고일치성.
Objective To investigate the factors affecting the susceptibility of tigecycline and assess the testing methods.Methods The 116 isolates of Acinetobacter baumanaii and Klebsiella pneumoniae were collected in 13 hospitals from January to December,2010,to evaluate the effects on the tigecycline susceptibility of the overnight medium,medium brand and lot number,respectively.The 56 isolates of Acinetobacter baumannii and the 47 isolates of Klebsiella pneumoniae were selected randomly according to the MIC distribution proportion in 2010 and 2012.The broth microdilution was taken as the reference method to evaluate the effects of the agar dilution,disk diffusion,MIC Test Strip (MTS) and Vitek2 (GN16) on the susceptibility of tigecycline.Results The essential agreement (EA) of Acinetobacter baumannii and Klebsiella pneumoniae is 89.7％ (52/58)and 87.9％ (51/58) using overnight medium and fresh medium respectively.Both EA and categorical agreement (CA) of the different brands (BBL and Oxoid) and lot numbers are 100％ using agar dilution.According to the FDA break point criteria,the CA/EA is 77.7％ (80/103)/99.0％ (102/103),87.4％ (90/103)/98.1％ (101/103),64.1％ (66/103)/76.7％ (79/103) using agar dilution,MTS,Vitek (GN16) with respect to broth microdilution.The CA is 79.6％ (82/ 103,S≥14 mm,R≤10 mm),69.9％ (72/103,S≥ 16 mm,R≤ 12 mm),34.0％ (35/103,S≥19 mm,R≤14 mm)using disk diffusion method compared with broth microdilution (FDA break point criteria).Conclusions The susceptibility of tigecycline must be tested using fresh medium.The medium brands and lot numbers used in this test have no effects on the tigecycline susceptibility to Acinetobacter baumannii and Klebsiella pneumoniae.There exist the better correlations on MIC using agar dilution and MTS than the disk diffusion and Vitek(GN16) compared with broth microdilution.It is expected that the consistency can be improved by adjusting the break point of disk diffusion.