Institut für Medizinische Mikrobiologie, Universität Zürich, Zürich, Switzerland.
J Antimicrob Chemother. 2012 Mar;67(3):622-32. doi: 10.1093/jac/dkr524. Epub 2011 Dec 13.
The aim of this study was to analyse the effects of clinical breakpoint changes in CLSI 2010 and 2011 guidelines and EUCAST 2011 guidelines on antibiotic susceptibility testing (AST) reports.
In total, 3713 non-duplicate clinical isolates of Enterobacteriaceae, Pseudomonas aeruginosa, Stenotrophomonas maltophilia and Acinetobacter baumannii were analysed. Inhibition zone diameters were determined for β-lactams, carbapenems, fluoroquinolones, aminoglycosides and trimethoprim/sulfamethoxazole. CLSI 2009-11 and EUCAST 2011 clinical breakpoints were applied.
Changes in resistance as defined per the guidelines affected individual species and drug classes differently. The cefepime resistance rate in Escherichia coli and Enterobacter cloacae increased from 2.1% and 1.3% to 8.2% and 6.9%, respectively, applying CLSI 2009-11 versus EUCAST 2011 guidelines. Ertapenem resistance rates in E. cloacae increased from 2.6% with CLSI 2009 to 7.2% for CLSI 2010 and 2011, and to 10.1% when applying EUCAST 2011. Cefepime and meropenem resistance rates in P. aeruginosa increased from 12.2% and 20.6% to 19.8% and 27.7%, respectively, comparing CLSI 2009-11 with EUCAST 2011. Tobramycin and gentamicin resistance rates in A. baumannii increased from 15.9% and 25.4% to 34.9% and 44.4% applying CLSI 2009-11 versus EUCAST 2011.
Higher resistance rates reported due to breakpoint changes in CLSI and EUCAST guidelines will result in increasing numbers of Gram-negative bacilli reported as multidrug resistant. AST reports classifying amoxicillin/clavulanic acid, cefepime or carbapenem resistance will lead clinicians to use alternative agents. Upon implementation of the EUCAST guidelines, laboratories should be aware of the implications of modified drug susceptibility testing reports on antibiotic prescription policies.
本研究旨在分析 CLSI 2010 年和 2011 年指南以及 EUCAST 2011 年指南中临床折点变化对抗生素药敏试验（AST）报告的影响。
共分析了 3713 例非重复临床分离的肠杆菌科、铜绿假单胞菌、嗜麦芽窄食单胞菌和鲍曼不动杆菌。β-内酰胺类、碳青霉烯类、氟喹诺酮类、氨基糖苷类和复方磺胺甲噁唑的抑菌环直径进行了测定。应用 CLSI 2009-11 年和 EUCAST 2011 年临床折点。
按指南定义的耐药性变化对不同的种属和药物类别有不同的影响。应用 CLSI 2009-11 年和 EUCAST 2011 年指南时，大肠埃希菌和阴沟肠杆菌的头孢吡肟耐药率分别从 2.1%和 1.3%增加到 8.2%和 6.9%。CLSI 2009 年时，阴沟肠杆菌厄他培南耐药率为 2.6%，CLSI 2010 年和 2011 年为 7.2%，而 EUCAST 2011 年为 10.1%。铜绿假单胞菌的头孢吡肟和美罗培南耐药率分别从 12.2%和 20.6%增加到 19.8%和 27.7%，CLSI 2009-11 年和 EUCAST 2011 年相比。鲍曼不动杆菌的妥布霉素和庆大霉素耐药率分别从 15.9%和 25.4%增加到 34.9%和 44.4%，CLSI 2009-11 年和 EUCAST 2011 年相比。
由于 CLSI 和 EUCAST 指南中折点变化导致报告的耐药率增加，将导致越来越多的革兰氏阴性杆菌被报告为多药耐药菌。AST 报告分类为阿莫西林/克拉维酸、头孢吡肟或碳青霉烯类耐药将导致临床医生使用替代药物。在实施 EUCAST 指南时，实验室应意识到药物敏感性试验报告的修改对抗生素处方政策的影响。
