头孢哌酮-舒巴坦药敏纸片中舒巴坦量对药敏结果的影响  

Influence of sulbactam content on susceptibility testing results of cefoperazone/sulbactam combination disks

作　　者：胡继红[1] 张楠[1] 高振祥[1] 高屹[1] 张然[1] 艾效曼[2] 许宏涛[2] 陶凤荣[2] 宣天芝[2] 胡云建[2] 

机构地区：[1]卫生部北京医院卫生部临床检验中心,100730 [2]卫生部北京医院检验科

出　　处：《中华检验医学杂志》2010年第3期231-235,共5页Chinese Journal of Laboratory Medicine

摘　　要：目的探讨头孢哌酮-舒巴坦药敏纸片中舒巴坦量对药敏结果的影响。方法用琼脂稀释法检测头孢哌酮、头孢哌酮-舒巴坦（2：1）和头孢哌酮-舒巴坦（1：1）3组药对临床分离的534株革兰阴性杆菌的MIC值；用纸片扩散法检测头孢哌酮、头孢哌酮-舒巴坦75／30μg和75／75μg3种纸片对此534株菌的抑菌环直径；分析MIC结果之间、纸片扩散法之间，以及2种药敏方法之间的结果是否有差异。结果经琼脂稀释法检测头孢哌酮、头孢哌酮-舒巴坦（2：1）和（1：1）MIC90别为：32、16、16μg/ml，MIC90分别为≥256，128，64μg/ml，Wilcoxon秩和检验两种药量配比MIC结果无统计学差异（Z=-0．248，P=0．804）；头孢哌酮-舒巴坦75／30μg药敏纸片（75／30纸片）检测的敏感率（S％）、耐药率（R％）和中介率（1％）分别为55．3％、24．5％和20．2％，与琼脂稀释法结果相似。头孢哌酮．舒巴坦75／75μg（75／75纸片）敏感率、耐药率和中介率分别为72．5％、12．4％和15．1％，比75／30纸片检测的总敏感率高17．2％，对75／30纸片及75／75纸片测所有菌株的2组抑菌环直径进行配对t检验（t=21．613，P〈0．01），但这种差异只来自于CLSI规定检测出的产ESBL菌株、鲍曼不动杆菌和未经ESBL检测的其他肠杆菌科菌株；而对铜绿假单胞菌、嗜麦芽窄食单胞菌和ESBL阴性菌株的敏感率或耐药率差异无统计学意义。结论头孢哌酮一舒巴坦（2：1）和（1：1）琼脂稀释法药敏结果及75／30μg纸片法药敏结果无差异。当使用75／75Ixg药敏纸片报告产ESBL菌株、鲍曼不动杆菌和其他肠杆菌科菌株的药敏结果时，应注明舒巴坦的含量。Objective To study the discrepancy influence of the sulbactam content on susceptibility testing results of cefoperazone/sulbactam combination disks. Methods Agar dilution method was used to determine MICs of cefoperazone, cefoperazone/sulbactam （2：1 and 1 ： 1 ）, and disk diffusion was used to detect the zone diameters of cefoperazone, cefoperazone/sulbactam （75/30 and 75/75μg/disk） disks against 534 clinical gram-negative isolates. The discrepancy within the results of MICs, zone diameters, the method of agar dilution and disk diffusion was analyzed. Results By standard agar dilution method, MIC90 of cefoperazone, cefoperazone/sulbactam （2：1 and 1：1 ） were 32, 16, 16μg/ml, and MIC90 of those were I〉256,128,64μg/ml respectively. No statistic discrepancy was found for MICs between the ratios of 2：1 and 1：1 combination by Wilcoxon ranks test （Z = -0. 248, P = 0. 804 ）. Susceptibility rate, resistance rate, and intermediate rate with 75/30 μg disk were 55.3% , 24. 5% and 20. 2% respectively, which were similar to those determined by agar dilution method. Susceptibility rate, resistance rate, and intermediate rate （ 1% ） with 75/75μg disk were 72. 5%, 12. 4% and 15. 1% respectively, compared with the susceptibility rate from 75/30 μg disk was 17. 2% higher. Statistic discrepancy were tested by paired t-test （t =21. 613, P 〈 0. 01 ） with two groups of whole strains＇ zone diameters from 75/30μg and 75/75μg disks, and resulting in the difference of susceptibility or resistance rates for ESBL-producing strains, Acinetobacter bauamnnii and Enterobacteriaceae without ESBL tested isolates. On the contrary, for Pseudomonas aeruginosa, Stenotrophomonas maltophilia and ESBL negative isolates, the zone diameters discrepancy was not statistically significant between the results from 75/30 μg and 75/75μg disks. Conclusions There is no statistic discrepancy between the susceptibility results from cefoperazone/salbactam （2： 1 or 1：1 ratios） in dilution method and in diffusi

关 键 词：头孢哌酮 舒巴坦 纸片扩散抗菌试验 微生物敏感性试验 

分 类 号：R446.5[医药卫生—诊断学]