越南2009 - 2011年抗生素耐药性调查（SOAR）结果。
Results from the Survey of Antibiotic Resistance (SOAR) 2009-11 in Vietnam.
作者信息
Van P H, Binh P T, Minh N H L, Morrissey I, Torumkuney D
机构信息
University of Medicine and Pharmacy, 217 Hong Bang Street, Ward 11, District 5, Ho Chi Minh City, Vietnam.
GlaxoSmithKline Vietnam, Unit 701, 235 Dong Khoi, District 1, Ho Chi Minh City, Vietnam.
出版信息
J Antimicrob Chemother. 2016 May;71 Suppl 1(Suppl 1):i93-102. doi: 10.1093/jac/dkw069.
OBJECTIVES
To investigate the susceptibility of respiratory tract infection pathogens collected between 2009 and 2011 from the SOAR study in Vietnam.
METHODS
MICs were determined using Etest(®) and susceptibility was assessed using CLSI, EUCAST and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints.
RESULTS
Two hundred and eighty-nine Streptococcus pneumoniae and 195 Haemophilus influenzae were collected from 11 centres. Overall, 4.8% of S. pneumoniae were penicillin susceptible (CLSI oral and EUCAST breakpoints). Using CLSI intravenous breakpoints, 86.9% were penicillin susceptible. Susceptibility to high-dose amoxicillin/clavulanic acid (or amoxicillin) using PK/PD breakpoints, cefuroxime (using CLSI or PK/PD breakpoints), cefaclor (CLSI breakpoint) and azithromycin (CLSI breakpoint) was 96.9%, 18.7%, 8% and 4.2%, respectively. Ofloxacin susceptibility was 93.4% by CLSI but 0% by EUCAST. All S. pneumoniae were fully vancomycin susceptible. S. pneumoniae from children were significantly less susceptible to most antimicrobials than those from the elderly. For ofloxacin, however, the reverse was true.Among H. influenzae isolates, 40.5% produced β-lactamase and 13.8% were β-lactamase negative but ampicillin resistant (BLNAR) by CLSI. H. influenzae were highly susceptible (97.4%) in vitro to amoxicillin/clavulanic acid and also to ceftriaxone by CLSI and PK/PD breakpoints but not EUCAST breakpoints. However, BLNAR isolates should be considered clinically resistant, with susceptibility reduced to 84.1%. With EUCAST breakpoints, amoxicillin/clavulanic acid susceptibility was lower, at 63.1%. Azithromycin susceptibility was 79.5% (CLSI).
CONCLUSIONS
Resistance to antibacterials in Vietnam was high, with amoxicillin/clavulanic acid being the most active agent. Ceftriaxone was highly active against H. influenzae while ofloxacin appeared highly active against S. pneumoniae using CLSI but not by EUCAST breakpoints. Ongoing surveillance through SOAR will further assist in understanding susceptibility trends over time.
目的
调查2009年至2011年期间从越南SOAR研究中收集的呼吸道感染病原体的药敏情况。
方法
使用Etest(®)测定最低抑菌浓度（MIC），并使用美国临床和实验室标准协会（CLSI）、欧洲抗菌药物敏感性试验委员会（EUCAST）以及药代动力学/药效学（PK/PD）折点评估药敏情况。
结果
从11个中心收集了289株肺炎链球菌和195株流感嗜血杆菌。总体而言，4.8%的肺炎链球菌对青霉素敏感（CLSI口服和EUCAST折点）。使用CLSI静脉注射折点时，86.9%的菌株对青霉素敏感。使用PK/PD折点时，对高剂量阿莫西林/克拉维酸（或阿莫西林）、头孢呋辛（使用CLSI或PK/PD折点）、头孢克洛（CLSI折点）和阿奇霉素（CLSI折点）的药敏率分别为96.9%、18.7%、8%和4.2%。根据CLSI，氧氟沙星的药敏率为93.4%，但根据EUCAST则为0%。所有肺炎链球菌对万古霉素均完全敏感。儿童分离出的肺炎链球菌对大多数抗菌药物的敏感性明显低于老年人。然而，对于氧氟沙星，情况则相反。在流感嗜血杆菌分离株中，40.5%产生β-内酰胺酶，13.8%根据CLSI为β-内酰胺酶阴性但对氨苄西林耐药（BLNAR）。流感嗜血杆菌在体外对阿莫西林/克拉维酸高度敏感（97.4%），根据CLSI和PK/PD折点对头孢曲松也高度敏感，但根据EUCAST折点则不然。然而，BLNAR分离株在临床上应被视为耐药，药敏率降至84.1%。根据EUCAST折点，阿莫西林/克拉维酸的药敏率较低，为63.1%。阿奇霉素的药敏率为79.5%（CLSI）。
结论
越南的抗菌药物耐药性较高，阿莫西林/克拉维酸是最有效的药物。头孢曲松对流感嗜血杆菌高度有效，而根据CLSI，氧氟沙星对肺炎链球菌似乎高度有效，但根据EUCAST折点则不然。通过SOAR进行的持续监测将进一步有助于了解随时间变化的药敏趋势。
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