评价EUCAST血培养阳性瓶直接快速药敏试验的应用价值  

Evaluation of the Application Value of Direct Rapid Drug Sensitivity Testing in EUCAST Blood Culture Positive Bottles

作　　者：巫益坷 谢桂扬 张慧珊 彭方 张珏 WU Yike;XIE Guiyang;ZHANG Huishan(Medical Laboratory Department of Meizhou Traditional Chinese Medicine Hospital,Meizhou City,Guangdong Province 514000)

机构地区：[1]广东省梅州市中医医院医学检验科,514000

出　　处：《医学理论与实践》2024年第22期3803-3807,共5页The Journal of Medical Theory and Practice

基　　金：2022年度梅州市医药卫生科研课题(2022-B-55)。

摘　　要：目的:评估欧洲抗菌药物敏感性试验委员会(EUCAST)血培养阳性瓶快速药敏试验(RAST)在临床上的适用性。方法:对2022年我院血培养阳性样本进行收集,按照2022年EUCAST发布的RAST version 5.1指南,对大肠埃希菌、肺炎克雷伯菌及金黄色葡萄球菌共115株进行快速药敏试验。在4h、6h、8h及16~20h时刻分别读取药敏结果,并与Vitek 2 Compact全自动微生物鉴定及药敏系统的结果进行对比。结果:RAST在不同时间点(4h、6h、8h及16~20h)的抑菌圈量取比例分别为91.3%、99.1%、100.0%以及100.0%。金黄色葡萄球菌在4h读取能力差。判读细菌药敏结果可得,所有抗菌药物在4h、6h、8h、16~20h时的RAST结果平均CA比例上升,ATU下降。其中16~20h细菌药敏结果的符合率最优,4h最差,6h和8h较为接近。4h、6h、8h、16~20h判读CA比例最高的药物分别为NOR、MEM和NOR、MEM和NOR、MEM和NOR,CA最低的为DA、DA、LEV、DA。4h、6h、8h大肠埃希菌CA比例上升,ATU比例下降;4h、6h、8h、16~20h肺炎克雷伯菌CA比例和ATU比例下降;4h、6h、8h、16~20h金黄色葡萄球菌ATU比例均上升,CA比例在6h最低;组间比较基本无统计学差异(P>0.05)。大肠埃希菌、肺炎克雷伯菌4h、6h、8h、16~20h的VME、ME、mE的误差率均分别符合≤1.5%、≤3.0%、<10%的要求;而金黄色葡萄球菌各时间段VME、ME均不符合要求,mE均符合要求。CTX在4h、6h、8h筛查ESBL阳性大肠埃希菌的符合率均为100.0%,而CAZ符合率分别为75.0%、76.9%、74.1%;CTX在4h、6h、8h筛查ESBL阳性肺炎克雷伯菌符合率均为75.0%,而CAZ符合率分别为50.0%、25.0%、25.0%。结论:EUCAST血培养阳性瓶RAST具有较高的临床准确性,能为临床医生提供快速而准确的治疗建议,对于改进感染病例的临床管理具有潜在价值。EUCAST血培养RAST方法,大肠埃希菌、肺炎克雷伯菌血培养标本快速药敏结果与常规结果一致性好,4h可作为RAST药敏判读的时间点。金黄色葡Objective:To evaluate the clinical applicability of the rapid antibacterial susceptibility test(RAST)in blood culture positive bottles by the European Commission on Antibiotic Susceptibility Testing(EUCAST).Methods:A total of 115 strains of Escherichia coli,Klebsiella pneumoniae,and Staphylococcus aureus were subjected to rapid drug sensitivity testing in accordance with the RAST version 5.1 guidelines released by EUCAST in 2022,after collecting blood culture positive samples from our hospital in 2022.Read the drug sensitivity results at 4 hours,6 hours,8 hours,and 16~20 hours,and compare them with the results of the Vitek 2 Compact fully automatic microbial identification and drug sensitivity system.Results:At different time points of 4 hours,6 hours,8 hours,and 16~20 hours,the proportion of RAST’s inhibition zone was 91.3%,99.1%,100.0%,and 100.0%,respectively.Staphylococcus aureus has poor reading ability at 4 hours.Judging the bacterial drug sensitivity results,it can be concluded that the average CA ratio of RAST results for all antibacterial drugs increases and ATU decreases at 4 hours,6 hours,8 hours,and 16~20 hours.The consistency rate of bacterial drug sensitivity results from 16~20 hours is the best,the worst is at 4 hours,and the results are relatively close at 6 hours and 8 hours.The drugs with the highest CA ratio at 4 hours,6 hours,8 hours,and 16~20 hours were NOR,MEM and NOR,MEM and NOR,MEM and NOR,respectively,and the drugs with the lowest CA were DA,DA,LEV,and DA.The proportion of Escherichia coli CA increased at 4 hours,6 hours,and 8 hours,while the proportion of ATU decreased;the proportion of Klebsiella pneumoniae CA and ATU decreased at 4 hours,6 hours,8 hours,and 16~20 hours;the ATU ratio of Staphylococcus aureus increased at 4 hours,6 hours,8 hours,and 16~20 hours,while the CA ratio was the lowest at 6 hours;there was no significant statistical difference between groups(P>0.05).The error rates of VME,ME,and mE for Escherichia coli and Klebsiella pneumoniae at 4 hours,6 hours,8 hours,and 16

关 键 词：抗菌药物 敏感性试验 血培养 快速药敏试验 EUCAST 

分 类 号：R446[医药卫生—诊断学]