Livermore D M, Winstanley T G, Shannon K P
Antibiotic Resistance Monitoring and Reference Laboratory, Central Public Health Laboratory, 61 Colindale Avenue, London NW9 5HT, UK.
J Antimicrob Chemother. 2001 Jul;48 Suppl 1:87-102. doi: 10.1093/jac/48.suppl_1.87.
If isolates are speciated and if a sufficient range of antibiotics is tested, underlying resistance mechanisms can often be inferred from the antibiogram data. This allows: (i) anomalous combinations of phenotype and organism to be reconsidered; (ii) prediction of further antibiotics that deserve testing; and (iii) the suppression of susceptibilities that are anomalous in the light of the inferred mechanism. This 'interpretative reading' is widely undertaken in France but is largely precluded in the UK by limited speciation and the testing of narrow ranges of antibiotics. Nevertheless, UK laboratories should be aware of: (i) grossly anomalous combinations of species and phenotype, demanding reference laboratory confirmation; (ii) useful indicator drugs, where resistance implies a mechanism conferring other resistances that may be less obvious in direct tests; and (iii) antibiotics that are prone to select resistant mutants of particular species during therapy. Details of these combinations of organism and resistance are presented. Relationships between antibiogram and mechanism are also presented to allow full interpretative reading for those testing wide panels of drugs versus speciated isolates.
如果对分离株进行了菌种鉴定，并且测试了足够广泛的抗生素，那么通常可以从抗菌谱数据推断出潜在的耐药机制。这使得：(i) 重新考虑表型与微生物的异常组合；(ii) 预测值得进一步测试的抗生素；以及 (iii) 根据推断出的机制抑制异常的药敏结果。这种“解释性解读”在法国广泛开展，但在英国，由于菌种鉴定有限以及抗生素测试范围狭窄，很大程度上无法进行。尽管如此，英国实验室应意识到：(i) 物种与表型的严重异常组合，需要参考实验室进行确认；(ii) 有用的指示药物，其耐药性意味着存在一种赋予其他耐药性的机制，而这些耐药性在直接测试中可能不太明显；以及 (iii) 在治疗过程中容易选择特定物种耐药突变体的抗生素。本文介绍了这些微生物与耐药性组合的详细信息。还介绍了抗菌谱与耐药机制之间的关系，以便对那些测试大量药物与已鉴定菌种分离株的人进行全面的解释性解读。
