耐碳青霉烯类药物肺炎克雷伯菌和鲍曼不动杆菌对替加环素的敏感性及药物敏感性试验的临床应用  

Susceptibility of tigecycline against carbapenems-resistant Klebsiella pneumoniae and Acinetobacter baumannii and susceptibility test

作　　者：刘妍[1] 袁应华[1] 

机构地区：[1]同济大学附属第十人民医院检验科,上海200072

出　　处：《检验医学》2018年第2期147-151,共5页Laboratory Medicine

摘　　要：目的分析耐碳青霉烯类药物肺炎克雷伯菌和鲍曼不动杆菌对替加环素的敏感性,探索适合临床实验室的用于替加环素体外敏感性检测的方法。方法收集2013年11月—2014年2月同济大学附属第十人民医院临床分离的肺炎克雷伯菌和鲍曼不动杆菌,经Vitek 2 compact全自动微生物分析系统(简称Vitek 2)、纸片扩散法确认为耐碳青霉烯类药物的菌株,其中肺炎克雷伯菌20株、鲍曼不动杆菌41株。采用微量肉汤稀释法、最低抑菌浓度(MIC)法、纸片扩散法分别检测菌株对替加环素的敏感性。结果对耐碳青霉烯类药物鲍曼不动杆菌,微量肉汤稀释法检测替加环素的MIC50和MIC90分别为2和4 mg/L,按照美国食品与药品监督管理局(FDA)的判断标准,耐药率为7.3%、中介率为29.3%、敏感率为63.4%;与微量肉汤稀释法比较,MIC法的基本一致性(EA)和分类一致性(CA)分别为97.6%和87.8%,未出现非常重大误差(VME)和重大误差(ME),小误差(mE)为12.2%;纸片扩散法的CA为24.4%,未出现VME,ME为7.3%,mE为68.3%。对耐碳青霉烯类药物肺炎克雷伯菌,微量肉汤稀释法检测替加环素的MIC50和MIC90分别为1和2 mg/L,按照FDA的判断标准,耐药率为5.0%、中介率为0.0%、敏感率为95.0%;与微量肉汤稀释法相比较,MIC法的EA和CA均为95.0%,未出现VME和ME,mE为5.0%;纸片扩散法的CA为30.0%,未出现VME和ME,mE为70.0%。结论替加环素对耐碳青霉烯类药物肺炎克雷伯菌有较好的抗菌活性,而对耐碳青霉烯类药物鲍曼不动杆菌的抗菌活性下降;对于耐碳青霉烯类药物肺炎克雷伯菌,MIC法可用于替加环素敏感性的临床常规检测或复核确认,而对于耐碳青霉烯类药物鲍曼不动杆菌,MIC法检测结果需谨慎对待,必要时用微量肉汤稀释法确认;各项评价指标不支持使用纸片扩散法进行替加环素敏感性分析。Objective To analyze the susceptibility of tigecycline against carbapenems-resistant Klebsiella pneumoniae and Acinetobacter baumannii and the methods for in vitro susceptibility test. Methods A total of 61 isolates,including 41 isolates of Acinetobacter baumannii and 20 isolates of Klebsiella pneumoniae,were collected in the Tenth People＇s Hospital of Tongji University from November 2013 to February 2014. The isolates were con？rmed as carbapenems-resistant isolates by Vitek 2 compact automatic microbiological analysis system and disk diffusion method. The broth microdilution method,minimum inhibitory concentration（MIC） method and disk diffusion method were used to determine the susceptibility of tigecycline. Results For carbapenems-resistant Acinetobacter baumannii,the MIC50 and MIC90 of tigecycline by broth microdilution method were 2 and 4 mg/ L. According to the U. S. Food and Drug Administration（FDA） criterion,the resistance rate,intermediary rate and sensitivity rate were 7.3%,29.3% and 63.4%,respectively. Compared with broth microdilution method,the essential agreement（EA） and categorical agreement（CA） of MIC method were 97.6% and 87.8%,and there was no very major error（VME） and major error（ME）,and the minor error（mE） accounted for 12.2%. The CA of disk diffusion method was 24.4%,and there was no VME,the ME accounted for 7.3%,and the mE accounted for68.3%. For carbapenems-resistant Klebsiella pneumoniae,the MIC50 and MIC90 of tigecycline by broth microdilution method were 1 and 2 mg/L. According to the FDA criterion,the resistance rate,intermediary rate and sensitivity rate were 5.0%,0.0% and 95.0%,respectively. Compared with broth microdilution method,the EA and CA of MIC method accounted for 95.0%. There was no VME and ME,and the mE accounted for 5.0%. The CA of disk diffusion method was 30.0%,VME and ME did not appear,and mE accounted for 70.0%. Conclusions Tigecycline against carbapenems-resistant Klebsiella pneumoniae has good antibacter

关 键 词：替加环素 耐碳青霉烯类药物肺炎克雷伯菌 耐碳青霉烯类药物鲍曼不动杆菌 药物敏感性试验 

分 类 号：R446.5[医药卫生—诊断学]