不同药敏试验方法检测耐碳青霉烯类革兰阴性杆菌对替加环素敏感性的效能评价  

Performance of different antibiotic susceptibility tests for testing susceptibility of carbapenem-resistant gram-negative bacteria to tigecycline

作　　者：谢国艳 周林艳 梁斌 裴凌燕 王禹婷 李凤娇 刘庆中 XIE Guoyan;ZHOU Linyan;LIANG Bin;PEI Lingyan;WANG Yuting;LI Fengjiao;LIU Qinzhong(Department of Laboratory Medicine,Shanghai Municipal Hospital of Traditional Chinese Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200071,China;Department of Pathology,Shanghai Municipal Hospital of Traditional Chinese Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200071,China)

机构地区：[1]上海中医药大学附属市中医医院检验科,上海200071 [2]上海中医药大学附属市中医医院病理科,上海200071

出　　处：《国际检验医学杂志》2023年第18期2187-2191,共5页International Journal of Laboratory Medicine

基　　金：国家自然科学基金项目(82172281)。

摘　　要：目的 评价4种药敏试验检测耐碳青霉烯类革兰阴性杆菌对替加环素敏感性的准确性,为临床微生物实验室探寻一种简便易行、结果可靠的替加环素敏感性检测方法。方法 收集2020年8月至2022年3月临床分离的非重复耐碳青霉烯类革兰阴性杆菌211株(肺炎克雷伯菌96株、大肠埃希菌48株、鲍曼不动杆菌62株和阴沟肠杆菌5株),采用仪器法、E-test法、纸片扩散(KB)1法(加复敏液)和KB2法(不加复敏液)检测细菌对替加环素的敏感性,分析其与肉汤微量稀释法(BMD法,参考方法)结果间的差异。结果 E-test法和KB1法分别检测4种细菌的药敏结果与BMD法比较差异无统计学意义(P>0.05),一致性好,基本一致率(EA)、分类一致率(CA)、微小误差(mE)和重大误差(ME)均在可接受范围,未发现非常重大误差(VME)。仪器法检测大肠埃希菌和阴沟肠杆菌的药敏结果与BMD法一致性较好,而检测肺炎克雷伯菌和鲍曼不动杆菌的药敏结果则一致性较差,ME超出可接受范围,尤其检测鲍曼不动杆菌的药敏结果还同时存在mE偏高(11.3%)。KB2法除大肠埃希菌外,检测其余菌种的药敏结果与BMD的一致性都不理想。结论 E-test和KB1法能够较可靠地检测所研究细菌对替加环素的敏感性。对于肺炎克雷伯菌和鲍曼不动杆菌,仪器法检测结果接近折点的菌株可推荐使用E-test法复查,这对于当地细菌感染治疗具有一定参考价值。Objective To evaluate the accuracy of 4 antimicrobial susceptibility tests in detecting the susceptibility of carbapenem-resistant gram-negative bacilli to tigecycline,and to explore a simple and reliable method for the testing of tigecycline sensitivity in clinical microbiology laboratory.Methods The tigecycline susceptibility of 211 non-repetitive clinical isolates of carbapenem-resistant gram-negative bacteria collected from August 2020 to March 2022,including Klebsiella pneumoniae(96 strains),Escherichia coli(48 strains),Acinetobacter baumannii(62 strains)and Enterobacter cloacae(5 strains),were detected by broth microdilution(BMD),instrument method,E-test,KB disk diffusion 1 with tigecycline buffer(KB1)and KB2(without tigecycline buffer)methods,respectively.The results of BMD were used as reference to evaluate the performance of other methods.Results There was no statistically significant difference in the drug sensitivity results of the E-test method and KB1 method for detecting four types of bacteria compared to the BMD method(P>0.05),with good consistency.The essential agreement(EA),classification agreement(CA),minor error(mE),and significant error(ME)were all within an acceptable range,and no significant error(VME)was found.The tigecycline sensitivity of the instrument method for Escherichia coli and Enterobacter cloacae was in good agreement with that of BMD,while the consistency was poor for Klebsiella pneumoniae and Acinetobacter baumannii with ME beyond the acceptable range,especially for Acinetobacter baumannii which was also with a high mE(11.3%).However,except Escherichia coli,the results of KB2 for other bacteria investigated had poor agreement with those of the BMD method.Conclusion E-test and KB1 methods could reliably test the sensitivity of the studied bacteria to tigecycline.For the isolates of Klebsiella pneumoniae and Acinetobacter baumannii with results close to breakpoint tested by instrument method,the tigecycline susceptibility could be reexaminated using E-test.This has some reference

关 键 词：替加环素 微量肉汤稀释法 E-TEST 纸片扩散法 耐碳青霉烯革兰阴性菌 药物敏感性试验 

分 类 号：R446.5[医药卫生—诊断学]