评估零售肉类和人类中分离的耐药沙门氏菌的表型耐药性以预测多重耐药性沙门氏菌
Evaluation of antimicrobial resistance phenotypes for predicting multidrug-resistant Salmonella recovered from retail meats and humans in the United States.
机构信息
Division of Foodborne, Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
出版信息
J Food Prot. 2010 Mar;73(3):445-51. doi: 10.4315/0362-028x-73.3.445.
Although multidrug-resistant (MDR) non-Typhi Salmonella (NTS) strains are a concern in food production, determining resistance to multiple antimicrobial agents at slaughter or processing may be impractical. Single antimicrobial resistance results for predicting multidrug resistance are desirable. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value were used to determine each antimicrobial agent's ability to predict MDR phenotypes of human health significance: ACSSuT (resistance to at least ampicillin, chloramphenicol, streptomycin, sulfamethoxazole, tetracycline) in NTS isolates, and MDR-AmpC-SN (resistance to ACSSuT, additional resistance to amoxicillin-clavulanate and to ceftiofur, and decreased susceptibility [MIC >= 2 microg/ml] to ceftriaxone) in NTS serotype Newport. The U.S. National Antimicrobial Resistance Monitoring System determined MICs to 15 or more antimicrobial agents for 9,955 NTS isolates from humans from 1999 to 2004 and 689 NTS isolates from retail meat from 2002 to 2004. A total of 847 (8.5%) human and 26 (3.8%) retail NTS isolates were ACSSuT; 995 (10.0%) human and 16 (2.3%) retail isolates were serotype Newport. Among Salmonella Newport, 204 (20.5%) human and 9 (56.3%) retail isolates were MDR-AmpC-SN. Chloramphenicol resistance provided the highest PPVs for ACSSuT among human (90.5%; 95% confidence interval, 88.4 to 92.3) and retail NTS isolates (96.3%; 95% confidence interval, 81.0 to 99.9). Resistance to ceftiofur and to amoxicillin-clavulanate and decreased susceptibility to ceftriaxone provided the highest PPVs (97.1, 98.1, and 98.6%, respectively) for MDR-AmpC-SN from humans. High PPVs for these agents applied to retail meat MDR-AmpC-SN, but isolate numbers were lower. Variations in MIC results may complicate ceftriaxone's predictive utility. Selecting specific antimicrobial resistance offers practical alternatives for predicting MDR phenotypes. Chloramphenicol resistance works best for ACSSuT-NTS, and resistance to ceftiofur, amoxicillin-clavulanate, or chloramphenicol works best for MDR-AmpC-SN.
尽管多药耐药（MDR）非伤寒沙门氏菌（NTS）菌株在食品生产中令人担忧，但在屠宰或加工时确定对多种抗菌药物的耐药性可能并不实际。因此，人们希望通过单次抗菌药物耐药性来预测多药耐药性。本研究使用敏感性、特异性、阳性预测值（PPV）和阴性预测值来评估每个抗菌药物预测对人类健康有重要意义的多药耐药表型的能力：NTS 分离株中 ACSSuT（对至少氨苄西林、氯霉素、链霉素、磺胺甲恶唑、四环素耐药），以及 NTS 纽波特血清型中 MDR-AmpC-SN（对 ACSSuT 耐药，对阿莫西林-克拉维酸和头孢噻肟耐药，头孢曲松敏感性降低[MIC>=2μg/ml]）。1999 年至 2004 年，美国国家抗菌药物耐药性监测系统（National Antimicrobial Resistance Monitoring System）测定了 9955 例来自人类的 NTS 分离株和 2002 年至 2004 年来自零售肉类的 689 例 NTS 分离株的 15 种或更多种抗菌药物的 MIC 值。共有 847 例（8.5%）人类和 26 例（3.8%）零售 NTS 分离株为 ACSSuT；995 例（10.0%）人类和 16 例（2.3%）零售分离株为纽波特血清型。在沙门氏菌纽波特中，204 例（20.5%）人类和 9 例（56.3%）零售分离株为 MDR-AmpC-SN。氯霉素耐药性对人类（90.5%；95%置信区间，88.4 至 92.3）和零售 NTS 分离株（96.3%；95%置信区间，81.0 至 99.9）的 ACSSuT 具有最高的 PPV。头孢噻肟耐药性、对阿莫西林-克拉维酸的耐药性和对头孢曲松的敏感性降低对人类 MDR-AmpC-SN 具有最高的 PPV（分别为 97.1%、98.1%和 98.6%）。这些药物对零售肉品 MDR-AmpC-SN 的高 PPV 也适用，但分离株数量较低。微量肉汤稀释法 MIC 结果的变化可能会使头孢曲松的预测实用性复杂化。选择特定的抗菌药物耐药性为预测 MDR 表型提供了实用的替代方法。氯霉素耐药性对 ACSSuT-NTS 最有效，而头孢噻肟、阿莫西林-克拉维酸或氯霉素耐药性对 MDR-AmpC-SN 最有效。
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