不同药敏方法检测替加环素对鲍曼不动杆菌敏感性的比较  

Evaluation of different tigecycline susceptibility testing methods for Acinetobacter baumannii

作　　者：杜小幸[1] 王海萍[1] 傅鹰[1] 陈衍[1] 俞云松[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院感染科,杭州310016

出　　处：《中华检验医学杂志》2013年第7期598-603,共6页Chinese Journal of Laboratory Medicine

基　　金：卫生行业公益性基金重大项目（201002021）;浙江省重大科技专项社会发展项目（2008C13029.1）;国家自然科学基金项目青年基金（81000757）

摘　　要：目的比较不同药敏方法检测替加环素对鲍曼不动杆菌的敏感性。方法回顾性选取2010年1至12月全国30家医院临床分离以及本实验室保存的碳青霉烯类抗生素敏感鲍曼不动杆菌（CSAB）和耐药鲍曼不动杆菌（CRAB）各30株，采用微量肉汤稀释法、Etest法、琼脂稀释法、MIC测试条（MTS）法、Vitek2仪器法和纸片扩散法测定替加环素对鲍曼不动杆菌的敏感性，并以微量肉汤稀释法结果为标准进行比较，同时比较M-H和ISO培养基对药敏结果的影响。结果CSAB微量肉汤稀释法、Etest法、琼脂稀释法、MTS法、Vitek2仪器法测定替加环素MIC。／MIC。分别为0．125／0．25mg／L、0．125／0．25mg／L、0．5／1mg／L、0．125／0．25mg／L、0．5／0．5mg／L，与微量肉汤稀释法比较，按照美国食品药品监督局（FDA）／欧洲药敏试验委员会（EUCAST）判断标准，所有药敏方法分类一致性（CA）≥90％，未出现非常严重误差（VME）。CRAB微量肉汤稀释法、Etest法、琼脂稀释法、MTS法、Vitek2仪器法测定替加环素MIC50／MIC90分别为2／4mg／L、4／4mg／L、4／4mg／L、1／2mg／L、2／4mg／L，按照FDA／EUCAST判断标准，MTS法产生3．3％（1／30）／6．7％（2／30）VME，没有一种药敏方法CA≥90％。按照Jones判断标准，纸片扩散法结果与微量肉汤稀释法结果分类一致性高于FDA标准，但对CRAB菌株CA仅为66．7％（20／30），未出现VME。采用M-H琼脂测得的替加环素MIC高于ISO琼脂。结论对CRAB菌株，琼脂稀释法、Etest法、Vitek2仪器法、纸片扩散法均不适合检测替加环素的敏感性，其检测中介或耐药菌株需用微量肉汤稀释法进一步确认，对MTS法测定结果也需要谨慎解释。Objective To evaluate different tigecycline susceptibility testing methods for A. baumannii. Methods Thirty carbapenem resistant A. baumannii （ CRAB ） and 30 carbapenem sensitive A. baumannii （CSAB） isolates were randomly collected from 30 hospitals during January to December in 2010 in China retrospectively. MIC and inhibitory zone diameters for tigecycline were determined by the susceptibility testing methods such as broth mierodilution （ BMD ） , agar dilution, E test, MIC Test Strip （MTS） , Vitek2. Data were analyzed by comparing the results from each method to those produced by the reference BMD method. The effects of two different susceptibility test media （ M-H and ISO-Sensitest Agar） on the MIC of tigecycline were also analyzed. Results For CSAB isolates, the MIC50/MIC50 of BMD, agar dilution, E test, MTS and Vitek2 were as follows：0. 125/0. 25 mg/L, 0. 125/0. 25 mg/L, 0. 5/1 mg/L, 0. 125/0. 25 mg/L and 0. 5/0. 5 mg/L. Compared with BMD method, the categorical agreement rates （CA） of each method were ≥90% , and produced no very major errors （VME）by Food and Drug Administration （FDA）/ European Committee on Antimicrobial Susceptibility Testing （EUCAST） breakpoints. For CRAB isolates, the MIC50/ MIC50 of BMD, agar dilution, E test, MTS and Vitek2 were as follows：2/4 mg/L, 4/ 4 mg/L, 4/4 mg/L,1/2 mg/L and 2/4 mg/L. Compared with BMD method, MTS produced 3.3% （ 1/30）/6. 7% （2/30） VME（FDA/EUCAST breakpoints）, and no method CA was ≥90%. The CA between disk diffusion and BMD results were higher by using the criteria of Jones than FDA breakpoints, but only 66. 7% （20/30） were observed in CRAB isolates, and produced no VME. The MIC of tigecycline determined using M-H agar were usually higher than those using ISO-sensitest Agar. Conclusions Agar dilution, E test, Vitek 2 and disk diffusion appear not to be a suitable method for routine susceptibility testing of tigecycline for CRAB strains. Tigecycline intermediate or resistant results determined by these me

关 键 词：鲍氏不动杆菌 微生物敏感性试验 替加环素 

分 类 号：R378[医药卫生—病原生物学]