Metan G, Zarakolu P, Unal S
Section of Infectious Diseases, Department of Medicine, Hacettepe University School of Medicine, 06100 Ankara, Turkey.
J Hosp Infect. 2005 Oct;61(2):93-9. doi: 10.1016/j.jhin.2005.02.020.
Effective infection control efforts obviously depend on the performance of the laboratory to detect emerging resistant pathogens accurately and confirm resistance patterns by additional methods to conventional or automated systems. Conventional methods still remain the predominant approaches for detection and identification of bacteria and resistance patterns. However, the estimated time for conventional tests to detect resistance is at least 24-48 h for methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci and other epidemiologically important pathogens. Most of the tests used for rapid detection require bacterial growth in culture. There is an important clinical need for rapid detection of bacteria directly from patient samples. Rapid methods based on immunological or molecular technologies have contributed significantly. Molecular assays for several resistance markers are reliable, such as for mecA in staphylococci and vanA in enterococci. However, for other resistance markers, there is a lack of field testing. Cost-effectiveness of rapid detection of antibacterial resistance is another concern. Molecular assays would be useful for tertiary hospitals considering the investment costs and requirement of expert laboratory staff. For smaller centres, rapid tests based on immunological techniques may be a better choice.
有效的感染控制措施显然取决于实验室的表现，即准确检测新出现的耐药病原体，并通过传统或自动化系统以外的其他方法确认耐药模式。传统方法仍然是检测和鉴定细菌及其耐药模式的主要方法。然而，对于耐甲氧西林金黄色葡萄球菌、耐万古霉素肠球菌和其他具有重要流行病学意义的病原体，传统检测方法检测耐药性的估计时间至少为24 - 48小时。大多数用于快速检测的方法都需要细菌在培养物中生长。临床上迫切需要直接从患者样本中快速检测细菌。基于免疫或分子技术的快速方法做出了重大贡献。针对几种耐药标志物的分子检测是可靠的，例如葡萄球菌中的mecA和肠球菌中的vanA。然而，对于其他耐药标志物，缺乏现场测试。抗菌药物耐药性快速检测的成本效益是另一个问题。考虑到投资成本和对专业实验室人员的要求，分子检测对三级医院会很有用。对于较小的中心，基于免疫技术的快速检测可能是更好的选择。
