中华临床感染病杂志
中華臨床感染病雜誌
중화림상감염병잡지
CHINESE JOURNAL OF CLINICAL INFECTIOUS DISEASES
2013年
5期
282-286
,共5页
何翠娥%李妍淳%田彬%杨华%胡志东
何翠娥%李妍淳%田彬%楊華%鬍誌東
하취아%리연순%전빈%양화%호지동
鲍氏不动杆菌%肺炎克雷伯菌%替加环素%微生物敏感性试验
鮑氏不動桿菌%肺炎剋雷伯菌%替加環素%微生物敏感性試驗
포씨불동간균%폐염극뢰백균%체가배소%미생물민감성시험
Acinetobacter baumannii%Klebsiella pneumoniae%Tigecycline%Microbial sensitivity tests
目的 评估不同药敏试验方法检测鲍曼不动杆菌和肺炎克雷伯菌对替加环素的体外药敏结果.方法 连续收集2012年1月至3月临床感染患者分离的50株耐碳青霉烯类鲍曼不动杆菌(CRAB)和49株肺炎克雷伯菌,采用微量肉汤稀释法、Vitek-2法、MIC Test Strip(MTS)法及纸片扩散法分别测定替加环素对两种细菌的敏感性,并以微量肉汤稀释法为参考方法,评估Vitek-2法、MTS法及纸片扩散法与参考方法的一致性.结果 按照美国食品药品监督局(FDA)的判断标准,微量肉汤稀释法、Vitek-2法和MTS法检测替加环素对CRAB和肺炎克雷伯菌的敏感性分别为94.0％/91.8％,68.0％/91.8％和90.0％/91.8％.对于CRAB,Vitek-2法和MTS法与参考方法的基本一致率/分类一致率(EA/CA)分别为94.0％/72.0％和92.0％/90.0％,66.0％ (33/50)的菌株Vitek-2法检测的MIC值比参考方法高1～2个稀释度,MTS法检测的MIC值存在32.0％ (16/50)偏高及22.0％ (11/50)偏低;对于肺炎克雷伯菌,Vitek-2法和MTS法与参考方法的EA/CA分别为95.9％/98.0％和83.7％/91.8％,36.7％ (18/49)的菌株Vitek-2法检测的MIC值比参考方法低1～3个稀释度,79.6％(39/49)的菌株MTS检测的MIC值比参考方法低1～3个稀释度.Vitek-2法和MTS法检测两种细菌均未出现重大误差(VME)和大误差(ME).纸片扩散法与参考方法相比,对于CRAB,采用敏感/耐药(≥14 mm/≤10 mm)折点,CA为94.0％,高于Jones等推荐的折点(≥16 mm/≤12 mm,CA为82.0％);对肺炎克雷伯菌,采用敏感/耐药(≥14 mm/≤10 mm)折点,CA为93.9％,高于FDA中肠杆菌的折点(≥19 mm/≤14 mm,CA为67.3％).结论 对于CRAB菌株,MTS法与微量肉汤稀释法的一致性较高,MIC结果存在一定程度的偏差;对于肺炎克雷伯菌,Vitek-2法与微量肉汤稀释法的一致性较高,MIC结果存在一定程度的偏低;纸片扩散法与微量肉汤稀释法一致性较低,针对不同细菌其判定折点需进一步研究.
目的 評估不同藥敏試驗方法檢測鮑曼不動桿菌和肺炎剋雷伯菌對替加環素的體外藥敏結果.方法 連續收集2012年1月至3月臨床感染患者分離的50株耐碳青黴烯類鮑曼不動桿菌(CRAB)和49株肺炎剋雷伯菌,採用微量肉湯稀釋法、Vitek-2法、MIC Test Strip(MTS)法及紙片擴散法分彆測定替加環素對兩種細菌的敏感性,併以微量肉湯稀釋法為參攷方法,評估Vitek-2法、MTS法及紙片擴散法與參攷方法的一緻性.結果 按照美國食品藥品鑑督跼(FDA)的判斷標準,微量肉湯稀釋法、Vitek-2法和MTS法檢測替加環素對CRAB和肺炎剋雷伯菌的敏感性分彆為94.0％/91.8％,68.0％/91.8％和90.0％/91.8％.對于CRAB,Vitek-2法和MTS法與參攷方法的基本一緻率/分類一緻率(EA/CA)分彆為94.0％/72.0％和92.0％/90.0％,66.0％ (33/50)的菌株Vitek-2法檢測的MIC值比參攷方法高1～2箇稀釋度,MTS法檢測的MIC值存在32.0％ (16/50)偏高及22.0％ (11/50)偏低;對于肺炎剋雷伯菌,Vitek-2法和MTS法與參攷方法的EA/CA分彆為95.9％/98.0％和83.7％/91.8％,36.7％ (18/49)的菌株Vitek-2法檢測的MIC值比參攷方法低1～3箇稀釋度,79.6％(39/49)的菌株MTS檢測的MIC值比參攷方法低1～3箇稀釋度.Vitek-2法和MTS法檢測兩種細菌均未齣現重大誤差(VME)和大誤差(ME).紙片擴散法與參攷方法相比,對于CRAB,採用敏感/耐藥(≥14 mm/≤10 mm)摺點,CA為94.0％,高于Jones等推薦的摺點(≥16 mm/≤12 mm,CA為82.0％);對肺炎剋雷伯菌,採用敏感/耐藥(≥14 mm/≤10 mm)摺點,CA為93.9％,高于FDA中腸桿菌的摺點(≥19 mm/≤14 mm,CA為67.3％).結論 對于CRAB菌株,MTS法與微量肉湯稀釋法的一緻性較高,MIC結果存在一定程度的偏差;對于肺炎剋雷伯菌,Vitek-2法與微量肉湯稀釋法的一緻性較高,MIC結果存在一定程度的偏低;紙片擴散法與微量肉湯稀釋法一緻性較低,針對不同細菌其判定摺點需進一步研究.
목적 평고불동약민시험방법검측포만불동간균화폐염극뢰백균대체가배소적체외약민결과.방법 련속수집2012년1월지3월림상감염환자분리적50주내탄청매희류포만불동간균(CRAB)화49주폐염극뢰백균,채용미량육탕희석법、Vitek-2법、MIC Test Strip(MTS)법급지편확산법분별측정체가배소대량충세균적민감성,병이미량육탕희석법위삼고방법,평고Vitek-2법、MTS법급지편확산법여삼고방법적일치성.결과 안조미국식품약품감독국(FDA)적판단표준,미량육탕희석법、Vitek-2법화MTS법검측체가배소대CRAB화폐염극뢰백균적민감성분별위94.0％/91.8％,68.0％/91.8％화90.0％/91.8％.대우CRAB,Vitek-2법화MTS법여삼고방법적기본일치솔/분류일치솔(EA/CA)분별위94.0％/72.0％화92.0％/90.0％,66.0％ (33/50)적균주Vitek-2법검측적MIC치비삼고방법고1～2개희석도,MTS법검측적MIC치존재32.0％ (16/50)편고급22.0％ (11/50)편저;대우폐염극뢰백균,Vitek-2법화MTS법여삼고방법적EA/CA분별위95.9％/98.0％화83.7％/91.8％,36.7％ (18/49)적균주Vitek-2법검측적MIC치비삼고방법저1～3개희석도,79.6％(39/49)적균주MTS검측적MIC치비삼고방법저1～3개희석도.Vitek-2법화MTS법검측량충세균균미출현중대오차(VME)화대오차(ME).지편확산법여삼고방법상비,대우CRAB,채용민감/내약(≥14 mm/≤10 mm)절점,CA위94.0％,고우Jones등추천적절점(≥16 mm/≤12 mm,CA위82.0％);대폐염극뢰백균,채용민감/내약(≥14 mm/≤10 mm)절점,CA위93.9％,고우FDA중장간균적절점(≥19 mm/≤14 mm,CA위67.3％).결론 대우CRAB균주,MTS법여미량육탕희석법적일치성교고,MIC결과존재일정정도적편차;대우폐염극뢰백균,Vitek-2법여미량육탕희석법적일치성교고,MIC결과존재일정정도적편저;지편확산법여미량육탕희석법일치성교저,침대불동세균기판정절점수진일보연구.
Objective To compare different susceptibility testing methods of tigecycline against Acinetobacter baumannii and Klebsiella pneumoniae.Methods Fifty carbapenem-resietant A.baumannii (CRAB) strains and 49 K.pneumoniae strains were collected from Tianjin Medical University General Hospital during January and March 2012.Minimum inhibitory concentration (MIC) and inhibitory zone diameters for tigecycline were determined by broth microdilution,Vitek-2,MTS and disk diffusion methods.The results of Vitek-2,MTS and disk diffusion methods were compared with those of broth microdilution method.Results According to FDA standards,the susceptibilities of CRAB and K.pneumoniae to tigecycline determined by broth microdilution,Vitek-2 and MTS were 94.0％/91.8％,68.0％/91.8％ and 90.0％/91.8％,respectively.For CRAB isolates,the essential agreement (EA) and categorical agreement (CA) produced by Vitek-2 and MTS were 94.0％/72.0％ and 92.0％/90.0％.MICs determined by Vitek-2 were 1-2 dilutions higher than the reference method in 33 (66.0％) strains,and those determined by MTS were higher in 16 (32.0％) strains and lower in 11 (22.0％) strains.For K.pneumoniae isolates,the EA/CA produced by Vitek-2 and MTS were 95.9％/98.0％ and 83.7％/91.8％,respectively.MICs determined by Vitek-2 were 1-3 dilutions lower than the reference method in 17 (34.7％) strains,and those determined by MTS were 1-3 dilutions lower than the reference method in 39 (79.6％) strains.None of thetwo methods produced very major error (VME) and major error (ME) against two kinds of isolates.The results were determined by disk diffusion method using different breakpoints according different isolates.For CRAB,using ≥14 mm/≤ 10 mm as breakpoint,CA was 94.0％,which was higher than the breakpoint recommended by Jones et al (≥16 mm/≤12 mm,CA was 82.0％) ; and for K.pneumoniae,using the ≥ 14 mm/≤ 10 mm as breakpoint,CA was 93.9％,higher than the FDA Enterobacteriaceae breakpoint (≥ 19 mm/≤ 14 mm,CA was 67.3％).Conclusion For CRAB strains,MTS produces better consistence with broth microdilution,with several higher or lower MIC results.For K.pneumoniae strains,Vitek-2 has better correlation with reference method,with several lower MIC results.The consistence between disk diffusion method and broth microdilution is comparatively lower,and the breakpoint should be adjusted according to different bacteria.
