Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain.
Clin Microbiol Infect. 2012 Sep;18(9):894-900. doi: 10.1111/j.1469-0691.2011.03673.x. Epub 2011 Oct 10.
The impact of recent changes in and discrepancies between the breakpoints for cephalosporins and other antimicrobials, as determined by CLSI and European Committee on Antimicrobial Susceptibility Testing (EUCAST), was analysed in patients with bloodstream infections caused by extended-spectrum β-lactamase (ESBL) producing Escherichia coli in Spain, was analysed. We studied a cohort of 191 episodes of bloodstream infection caused by ESBL-producing E. coli in 13 Spanish hospitals; the susceptibility of isolates to different antimicrobials was investigated by microdilution and interpreted according to recommendations established in 2009 and 2010 by CLSI, and in 2011 by EUCAST. Overall, 58.6% and 14.7% of isolates were susceptible to ceftazidime, and 35.1% and 14.7% to cefepime using the CLSI-2010 and EUCAST-2009/2011 recommendations, respectively (all isolates would have been considered resistant using the previous guidelines). Discrepancies between the CLSI-2010 and the EUCAST-2011 recommendations were statistically significant for other antimicrobials only in the case of amikacin (98.4% versus 75.9% of susceptible isolates; p <0.01). The results varied depending on the ESBL produced. No significant differences were found in the percentage of patients classified as receiving appropriate therapy, following the different recommendations. Four out of 11 patients treated with active cephalosporins according to CLSI-2010 guidelines died (all had severe sepsis or shock); these cases would have been considered resistant according to EUCAST-2011. In conclusion, by using current breakpoints, extended-spectrum cephalosporins would be regarded as active agents for treating a significant proportion of patients with bloodstream infections caused by ESBL-producing E. coli.
最近 CLSI 和欧洲抗菌药物敏感性试验委员会 (EUCAST) 对头孢菌素和其他抗菌药物折点的变化和差异进行了分析，本研究旨在分析西班牙产超广谱β-内酰胺酶（ESBL）大肠埃希菌血流感染患者的这些变化和差异的影响。我们研究了西班牙 13 家医院 191 例产 ESBL 大肠埃希菌血流感染的病例，采用微量稀释法检测分离株对不同抗菌药物的敏感性，并根据 2009 年和 2010 年 CLSI 以及 2011 年 EUCAST 制定的标准进行解释。总体而言，根据 CLSI-2010 和 EUCAST-2009/2011 指南，分别有 58.6%和 14.7%的分离株对头孢他啶敏感，分别有 35.1%和 14.7%对头孢吡肟敏感（所有分离株均被认为是根据以前的指南耐药）。只有在用氨基糖苷类药物时，CLSI-2010 与 EUCAST-2011 建议之间的差异具有统计学意义（分别为 98.4%和 75.9%敏感分离株；p<0.01）。根据不同的建议，不同的 ESBL 产生的结果也不同。根据不同的指南，接受适当治疗的患者比例没有显著差异。根据 CLSI-2010 指南，用活性头孢菌素治疗的 11 例患者中有 4 例死亡（均为严重败血症或休克）；根据 EUCAST-2011，这些病例将被认为是耐药的。总之，根据目前的折点，头孢菌素类药物被认为是治疗产 ESBL 大肠埃希菌血流感染的患者的重要药物。
