2010年微生物药敏试验标准在肠杆菌科细菌药敏试验中的临床应用  

Clinical implementation of 2010 reference standards of the U.S. Clinical and Laboratory Standards Institute in antimicrobial susceptibility for Enterobacteriaceae

作　　者：马立艳[1] 苏建荣[1] 

机构地区：[1]首都医科大学附属北京友谊医院检验科,100050

出　　处：《中华全科医师杂志》2011年第7期468-471,共4页Chinese Journal of General Practitioners

基　　金：首都医学发展基金项目资助（2009-1031）

摘　　要：目的比较美国临床和实验室标准化研究所（CLSI）制定的微生物药敏试验2009年和2010年判读标准在肠杆菌科细菌药敏试验中的临床应用。方法分别应用CLSIM100-S19（2009）和M100-S20（2010）中头孢曲松、头孢他啶和氨曲南的判读标准对大肠埃希菌（308株）和肺炎克雷伯菌（194株）临床分离株的药敏试验结果进行比较分析。结果在2009年和2010年判读标准中，ESBLs（＋）大肠埃希菌对头孢他啶、头孢曲松、氨曲南的耐药率分别为84．2％和98．0％、84．2％和98．O％、84．9％和98．0％；ESBLs（-）大肠埃希菌对头孢他啶、头孢曲松、氨曲南的耐药率分别为4．2％和7．7％、4．2％和7．7％、5．6％和8．4％；ESBLs（＋）肺炎克雷伯菌对头孢他啶、头孢曲松、氨曲南的耐药率分别为67．2％和90．2％、67．2％和90．2％、67．2％和90．2％；ESBLs（-）肺炎克雷伯菌对头孢他啶、头孢曲松、氨曲南的耐药率分别为9．8％和10．6％、9．8％和10．6％、10．6％和10．6％。结论按照2010年CLSI新标准判读，头孢曲松、头孢他啶和氨曲南的耐药率较2009年旧版标准均有不同程度的升高；与ESBLs（-）菌株相比，ESBLs（＋）菌株受到新旧判读折点变化的影响更大；ESBLs（＋）菌株中，受头孢他啶和氨曲南折点变化影响的肺炎克雷伯菌的百分比要高于大肠埃希菌。Objective To compare the performance of 2009 and 2010 reference standards of the United States Clinical and Laboratory Standards Institute （CLSI） in antimicrobial susceptibility for Enterobacteriaceae. Methods The breakpoints of susceptibility for ceftriaxone, ceftazidime and aztreonam in CLSI M100-S19 （2009） were used to analyze results of antimicrobial susceptibility of Escherichia coli （308 isolates） and Klebsiella pneumoniae （194 isolates）, as well as those revised in M100-S20 （2010）. Results With both the breakpoints in CLSI M100-S19 （2009） and CLSI M100-S20 （2010）, proportions of antimicrobial resistance of ceftriaxone, ceflazidime and aztreonam for isolates of extended-spectrum β- laetamases （ESBLs）-producing E. coli were 84.2 percent vs. 98.0 percent and 84. 9 percent vs. 98.0 percent, respectively; those for isolates of ESBLs negative E. coli were 4. 2 percent vs. 7.7 percent and 5.6 percent vs. 8.4 percent, respectively ; those for isolates of ESBLs positive Klebsiella spp. were 67.2 percent vs. 90. 2 percent and 67.2 percent vs. 90. 2 percent, respectively; and those for isolates of ESBLs negative Klebsiella spp. were 9.8 percent vs. 10. 6 percent and 10. 6 percent vs. 10. 6 percent, respectively. Conclusions Proportions of antimicrobial resistance for ceftriaxone, ceflazidime and aztreonam with the reference breakpoints of CLSI M100-S20 （2010） increase to various extent, as compared to those with the old ones in 2009. Compared with ESBLs negative isolates, ESBLs positive isolates are affected much more by the breakpoints of CLSI M100-S20 （2010）. Proportion of affected Klebsiella spp. by the revised breakpoints of CLSI M100-S20 （2010） for ceftazidime and aztreonam is higher than that of E. coli with ESBLs positive.

关 键 词：肠杆菌科 微生物敏感性试验 参考标准 

分 类 号：R446.5[医药卫生—诊断学]