系统评价药敏谱：密歇根州改善抗菌药物敏感性检测实践的国家实验室系统方法。
Systematic review of antibiograms: A National Laboratory System approach for improving antimicrobial susceptibility testing practices in Michigan.
机构信息
Bureau of Laboratories, Michigan Department of Community Health, Lansing, MI 48909, USA.
出版信息
Public Health Rep. 2010 May-Jun;125 Suppl 2(Suppl 2):63-72. doi: 10.1177/00333549101250S208.
OBJECTIVES
Public health surveillance is often dependent on sentinel testing performed in clinical microbiology laboratories, and recognition of emerging/ unusual antimicrobial resistance is especially challenging. We obtained cumulative antibiograms from hospitals to determine whether clinical laboratories recognized unusual resistance or reported antimicrobials inappropriate for various bacterial species, as measured before and after public health laboratory (PHL) educational and technical-support interventions.
METHODS
We compared cumulative antibiogram data from 81 clinical laboratories servicing 86 hospitals in Michigan from 2000 through 2005 with a standardized checklist derived from Clinical and Laboratory Standards Institute (CLSI) antimicrobial susceptibility testing (AST) documents. We considered the reporting of unlikely percent-susceptible results and/or inappropriate antimicrobials serious errors, and we calculated error rates for each data year. We used CLSI-recommendation compliance as a measure to determine whether laboratories were implementing changes.
RESULTS
Ninety-five of 239 (28%) cumulative antibiograms examined had one or more serious errors. The annual number of cumulative antibiograms with serious errors did not change radically (range: 10-13); however, when expressed as a percentage of cumulative antibiograms received, the occurrence of these errors declined from 59% in 2000 to 19% in 2005. The reporting of misleading or dangerous antimicrobial-organism combinations occurred less frequently than the reporting of unlikely percent-susceptible results. Compliance with new CLSI recommendations did not improve significantly.
CONCLUSIONS
AST is complex and nuanced. PHL programs can provide resources, guidance, and technical support to help clinical microbiologists differentiate questionable AST results from true emerging antimicrobial resistance.
目的
公共卫生监测通常依赖于临床微生物学实验室进行的哨点检测，而识别新出现/不常见的抗菌药物耐药性尤其具有挑战性。我们从医院获得累积抗生素谱，以确定临床实验室是否识别出不常见的耐药性，或报告不适合各种细菌的抗菌药物，这是在公共卫生实验室（PHL）教育和技术支持干预前后进行的测量。
方法
我们比较了 2000 年至 2005 年密歇根州 86 家医院的 81 家临床实验室的累积抗生素谱数据与从临床和实验室标准协会（CLSI）抗菌药物敏感性测试（AST）文件中得出的标准化检查表。我们认为报告不太可能的敏感百分比结果和/或不适当的抗菌药物是严重错误，并计算了每个数据年度的错误率。我们使用 CLSI 建议的合规性作为衡量标准，以确定实验室是否在实施更改。
结果
在检查的 239 份累积抗生素谱中有 95 份（28%）存在一个或多个严重错误。累积抗生素谱中严重错误的年度数量没有发生巨大变化（范围：10-13）；但是，当以收到的累积抗生素谱的百分比表示时，这些错误的发生频率从 2000 年的 59%下降到 2005 年的 19%。报告误导性或危险的抗菌药物-生物体组合的频率低于报告不太可能的敏感百分比结果的频率。新 CLSI 建议的合规性没有显著提高。
结论
AST 很复杂且微妙。PHL 计划可以提供资源、指导和技术支持，帮助临床微生物学家将可疑的 AST 结果与真正的新出现的抗菌药物耐药性区分开来。
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