Kowalski Regis P, Yates Kathleen A, Romanowski Eric G, Karenchak Lisa M, Mah Francis S, Gordon Y Jerold
Charles T. Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh Medical Center Eye Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Ophthalmology. 2005 Nov;112(11):1987. doi: 10.1016/j.ophtha.2005.06.025. Epub 2005 Sep 23.
To address the need to establish appropriate evaluation criteria for analyzing in vitro antibiotic susceptibility based on original data.
In vitro laboratory investigation.
Bacterial isolates from patients with conjunctivitis.
Minimum inhibitory concentrations (MICs), descriptive statistics, antibiotic susceptibility, potency, and statistical analysis.
Minimum inhibitory concentrations were determined for 80 bacterial conjunctivitis isolates to moxifloxacin, gatifloxacin, levofloxacin, ciprofloxacin, and ofloxacin. Using the MIC values, descriptive statistics (median, MIC50, MIC90, mode, range), antibiotic susceptibility, and potency of each antibiotic were calculated for each bacterial group. The data were analyzed statistically using appropriate randomization and nonparametric tests.
The descriptive statistics of gram-positive bacteria (Staphylococcus aureus, Streptococcus pneumoniae) followed a consistent trend where the median, MIC50, MIC90, and mode demonstrated the lowest values, in all instances, for moxifloxacin, gatifloxacin, levofloxacin, ciprofloxacin, and ofloxacin. The descriptive statistics for Haemophilus species (the predominant gram-negative bacteria implicated in conjunctivitis) did not describe any consistent trend. In contrast, antibiotic susceptibility testing did not demonstrate any advantage among the 5 fluorquinolones tested, except for moxifloxacin in the S. aureus fluoroquinolone-resistant group. Potency studies indicated that moxifloxacin and gatifloxacin were the most potent for gram-positive bacteria, whereas gatifloxacin and ciprofloxacin were the most potent for Haemophilus species.
In the absence of human clinical trial data to guide care, in vitro susceptibility data should be analyzed with a set of descriptive statistics along with a nonparametric statistical analysis. No single parameter or test should be relied upon in all instances to demonstrate the in vitro superiority of one antibiotic over another. In this study, fourth-generation fluoroquinolones did have some potency advantages over second-generation fluoroquinolones against gram-positive conjunctival bacterial isolates, but not for Haemophilus isolates.
满足基于原始数据建立体外抗生素敏感性分析的适当评估标准的需求。
体外实验室研究。
结膜炎患者的细菌分离株。
最低抑菌浓度（MIC）、描述性统计、抗生素敏感性、效力及统计分析。
测定80株细菌性结膜炎分离株对莫西沙星、加替沙星、左氧氟沙星、环丙沙星和氧氟沙星的最低抑菌浓度。利用MIC值，计算每个细菌组每种抗生素的描述性统计量（中位数、MIC50、MIC90、众数、范围）、抗生素敏感性和效力。使用适当的随机化和非参数检验对数据进行统计分析。
革兰氏阳性菌（金黄色葡萄球菌、肺炎链球菌）的描述性统计呈现一致趋势，在所有情况下，莫西沙星、加替沙星、左氧氟沙星、环丙沙星和氧氟沙星的中位数、MIC50、MIC90和众数均显示出最低值。嗜血杆菌属（结膜炎中主要的革兰氏阴性菌）的描述性统计未呈现任何一致趋势。相比之下，除了金黄色葡萄球菌氟喹诺酮耐药组中的莫西沙星外，抗生素敏感性测试在测试的5种氟喹诺酮类药物中未显示出任何优势。效力研究表明，莫西沙星和加替沙星对革兰氏阳性菌最有效，而加替沙星和环丙沙星对嗜血杆菌属最有效。
在缺乏指导治疗的人体临床试验数据的情况下，体外敏感性数据应通过一组描述性统计量以及非参数统计分析进行分析。在所有情况下，不应仅依赖单一参数或测试来证明一种抗生素在体外优于另一种抗生素。在本研究中，第四代氟喹诺酮类药物在抗革兰氏阳性结膜细菌分离株方面确实比第二代氟喹诺酮类药物具有一些效力优势，但对嗜血杆菌分离株则不然。
