Bookstaver David A, Bland Christopher M, Arroyo Miguel A
Department of Pharmacy, Eisenhower Army Medical Center, 300 Hospital Road, Fort Gordon, GA 30905, USA.
Department of Pathology, Eisenhower Army Medical Center, 300 Hospital Road, Fort Gordon, GA 30905, USA.
J Med Microbiol. 2015 Oct;64(10):1170-1173. doi: 10.1099/jmm.0.000142. Epub 2015 Jul 23.
Of the cephalosporins, cefpodoxime has the most published clinical data for the treatment of urinary tract infections. In 2014, the Clinical and Laboratory Standards Institute (CLSI) guidelines recommended that cefazolin should be used as the surrogate marker for cefpodoxime among urinary tract isolates, replacing cephalothin. This study attempted to determine how well cefazolin serves as the surrogate marker. Additionally, it investigated how cefuroxime compared with cefazolin as a surrogate marker. The MicroScan Walkaway Plus system was used to determine susceptibility for cefazolin and cefuroxime on consecutive urine cultures with a colony count of ≥ 50 000 organisms. Only Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis isolates were included, following CLSI guidelines. Simultaneously, an Etest for cefpodoxime was conducted. The cefpodoxime interpretation was compared with that of the other two agents, and the categorical agreement was calculated, defined as the percentage of identical susceptibility interpretations. Cefazolin (92 %) had a significantly higher categorical agreement than cefuroxime (85 %) among 284 isolates (P = 0.011). The major error rate was 4.4 % for cefazolin and 1.1 % for cefuroxime. The very major error rate was 64 % for cefazolin and 18 % for cefuroxime among the 11 cefpodoxime-resistant isolates. Cefazolin was a better predictor of cefpodoxime susceptibility than the previously recommended agent, cephalothin. However, cefuroxime had better major and very major error rates than cefazolin.
在头孢菌素类药物中，头孢泊肟在治疗尿路感染方面有最多已发表的临床数据。2014年，临床和实验室标准协会（CLSI）指南建议，在尿路分离菌株中，头孢唑林应作为头孢泊肟的替代标志物，取代头孢噻吩。本研究试图确定头孢唑林作为替代标志物的效果如何。此外，还研究了头孢呋辛与头孢唑林作为替代标志物的比较情况。使用MicroScan Walkaway Plus系统对菌落计数≥50000个菌落形成单位的连续尿培养物中的头孢唑林和头孢呋辛进行药敏试验。按照CLSI指南，仅纳入大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌分离株。同时，进行头孢泊肟的Etest试验。将头孢泊肟的药敏结果与其他两种药物的结果进行比较，并计算分类一致性，定义为药敏结果相同的百分比。在284株分离株中，头孢唑林（92%）的分类一致性显著高于头孢呋辛（85%）（P = 0.011）。头孢唑林的主要错误率为4.4%，头孢呋辛为1.1%。在11株对头孢泊肟耐药的分离株中，头孢唑林的极主要错误率为64%，头孢呋辛为18%。与先前推荐的药物头孢噻吩相比，头孢唑林是头孢泊肟药敏性更好的预测指标。然而，头孢呋辛的主要和极主要错误率比头孢唑林更低。
