2010年CLSI三代头孢菌素折点改变对我国大肠埃希菌和肺炎克雷伯菌及奇异变形杆菌药物敏感性结果解释的评估  

Evaluation of the susceptibility interpretation on Escherichia coli, Klebsiella pneumonia, Proteus mirabilis in China by agar dilution method according to the changes of cephalosporin breakpoints in CLSI 2010

作　　者：刘文静[1] 杨启文[1] 徐英春[1] 王辉[1] 谢秀丽[1] 王瑶[1] 赵旺盛[2] 何林 王晶[4] 季萍[5] 刘蓬蓬[6] 张利侠[7] 胡云建[8] 刘勇[9] 叶惠芬[10] 孙自镛[11] 段琼[12] 倪语星[13] 俞云松[14] 朱莲娜[15] 

机构地区：[1]中国医学科学院北京协和医院检验科,100730 [2]江苏省人民医院临床检验中心 [3]深圳市人民医院检验医学部 [4]大连医科大学附属第一医院检验科 [5]新疆医学院附属医院细菌室 [6]青岛市立医院检验科 [7]陕西省人民医院检验科 [8]北京医院检验科 [9]中国医科大学附属第二医院检验科 [10]广州市第一人民医院检验科 [11]华中科技大学同济医学院附属同济医院检验科 [12]吉林省人民医院检验科 [13]上海交通大学医学院附属瑞金医院微生物科 [14]浙江大学附属第一医院检验科 [15]广西医科大学第一附属医院细菌室

出　　处：《中华检验医学杂志》2010年第10期942-947,共6页Chinese Journal of Laboratory Medicine

摘　　要：目的评估2010年CLSI M100-S20（S20）及2009年CLSI M100-S19（S19）文件中CAZ、CTX、CRO新旧折点变化对我国如何解释产ESBL大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌体外药物敏感性试验结果的影响.方法收集2005-2007年中国15家医院SEANIR监测项目中3种细菌琼脂稀释法药敏结果,用PCR-基因序列分析法和（或）药敏表型分析法去除产AmpC酶的菌株.用CLSI琼脂稀释法确定ESBL表型.3种抗菌药物对2 733株大肠埃希菌、肺炎克雷伯菌、奇异变形杆菌的敏感性用WHONET5.4软件分别按S19和S20折点进行回顾性分析.对北京协和医院同时有琼脂稀释法和纸片扩散法药敏结果的207株3种肠杆菌科细菌用WHONET5.4软件进行散点图和回归性分析,观察S19和S20折点下3种抗菌药物两种方法的相关性.结果产ESBL的大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌对CTX的耐药率分别由S19折点（64μg/m1）下的65.2%、55.5%和14.6%上升为S20折点（4 μg/ml）下的99.7%、96.2%和93.8%,敏感率则由S19折点（8 μg/ml）下的6.0%、11.5%和33.3%下降至S20折点（1μg/ml）下的0%、0.2%和0%.CRO的结果与CTX相近.虽然在我国产ESBL的大肠埃希菌和肺炎克雷伯菌对CAZ的敏感率比CTX和CRO高,它们的耐药率也由S19折点（32μg/ml）下的30.3%和43.2%升为S20折点（16μg/ml）下的41.9%和55.9%,敏感率则由S19折点（8μg/ml）下的58.1%和44.1%降至S20折点（4 μg/m1）下的44.7%和28.0%.不产ESBL的大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌在CTX、CRO和CAZ新旧折点下的敏感率为99.2%～100.0%,耐药率为0%～0.4%.琼脂稀释法CTX和CRO S20折点与ESBL表型分布具有良好的对应关系;琼脂稀释法和纸片扩散法回归性分析得CAZ、CTX和CRO的r值分别为0.67、0.79和0.77,P均＜0.01,S20与S19相比,纸片扩散法药敏正确分类均在可接受范围内.结论应用S20 CTX和CRO的新折点,药敏结果与ESBL检测结果一致性大大提高,临床医生可�Objective To evaluate the influences of susceptibility interpretation of Escherichia coli,Klebsiella pneumonia and Proteus mirabilis in China mainland according to the old and new ceftazidime,cefotaxime and ceftriaxone breakpoints in CLSI M100-S20 and CLSI M100-S19. Methods First, We analyzed the antibacterial susceptibility results of the three bacteria by agar dilution method in the SEANIR surveillance item, which were collected from 15 national hospitals between the year of 2005 and 2007 and excluded the AmpC enzyme positive isolates according to the PGR-DNA sequencing method and/or the antibacterial susceptibility phenotype. ESBL phenotype was confirmed by the CLSI phenotypic confirmatory test. Antibacterial susceptibility of the total 2733 Escherichia coli, Klebsiella pneumonia, Proteus mirabilis isolates was retrospectively analyzed by WHONET 5. 4 software according to the breakpoints of the CLSI M100-S19 （S19） and CLSI M100-S20 （S20）. Second, 207 isolates of Peking Union Medical College Hospital with the results of both agar dilution method and disk diffusion method were performed by recurrent analysis. Then we observed the inter-method agreement through the scatter diagram according to the breakpoints of S19 and S20. Results First, as to the ESBL positive Escherichia coli, Klebsiella pneumonia and Proteus mirabili.s, the resistant rate of cefotaxime increased from 65.2% , 55.5%, 14. 6% under S19 （64 μg/ml） to 99. 7%, 96. 2% , 93. 8% under S20 （4 μg/ml）. The susceptibility rates decreased from 6. 0%, 11.5%, 33.3% under S19 （8 μg/ml） to 0%, 0. 2%, 0% under S20 （ 1 μg/ml）. Ceftriaxone had the same trend as cefotaxime. Though ceftazidime was more active than cefotaxime and ceftriaxone, as to the ESBL positive Escherichia coli and Klebsiella pneumonia, the resistant rates slightly increased from 30. 3%,43. 2% under S19 （32 μg/ml） to42.0%, 56. 0% under S20 （16 μg/ml）. The susceptibility rates slightly decreased from 58. 1%, 44. 1% under S19 （8 μg/ml） to 44. 7%, 28.0% u

关 键 词：大肠杆菌 克雷伯菌 肺炎 变形杆菌 奇异 Β内酰胺酶类 头孢菌素类 微生物敏感性试验 评价研究 

分 类 号：R686[医药卫生—骨科学]