临床和实验室标准协会（CLSI）及欧洲抗菌药物敏感性试验委员会（EUCAST）头孢吡肟折点变化对肠杆菌科细菌药敏报告的影响
Impact of CLSI and EUCAST Cefepime breakpoint changes on the susceptibility reporting for Enterobacteriaceae.
作者信息
Bork Jacqueline T, Heil Emily L, Leekha Surbhi, Fowler Randal C, Hanson Nancy D, Majumdar Anjali, Johnson J Kristie
机构信息
University of Maryland School of Medicine, Department of Medicine, Division of Infectious Diseases, Baltimore, MD.
University of Maryland School of Pharmacy, Baltimore, MD.
出版信息
Diagn Microbiol Infect Dis. 2017 Dec;89(4):328-333. doi: 10.1016/j.diagmicrobio.2017.08.020. Epub 2017 Oct 12.
OBJECTIVE
We analyzed the effects of different cefepime MIC breakpoints on Enterobacteriaceae cefepime susceptibility and the presence of AmpC and extended-spectrum β-lactamase (ESBL) genes within the cefepime MIC interpretative categories.
METHODS
Using Enterobacteriaceae susceptibility data from 2013 comparisons of MIC breakpoints were performed using Pearson's chi-squared test. Molecular testing on a subset of isolates was done.
RESULTS
Among 3784 non-duplicate clinical isolates, cefepime susceptibility decreased from 97.6% to 96.1% to 93.7% for CLSI 2013, CLSI 2014, and EUCAST 2011, respectively. In ceftriaxone non-susceptible isolates, cefepime susceptibility decreased from 79% to 66% (P<0.0001) using CLSI 2013 and 2014, respectively, which was greater and statistically significant for Escherichia coli and Klebsiella spp. but not for Enterobacter spp. (P=0.06). Isolates with MIC ≤1μg/mL more often harbored AmpC (77%) than ESBL (18%) genes.
CONCLUSIONS
Lower cefepime MIC breakpoints decrease cefepime susceptibility for isolates harboring ESBLs, while sparing the majority of those with AmpCs.
目的
我们分析了不同头孢吡肟MIC折点对肠杆菌科细菌头孢吡肟敏感性的影响，以及在头孢吡肟MIC解释类别中AmpC和超广谱β-内酰胺酶（ESBL）基因的存在情况。
方法
利用2013年肠杆菌科细菌的药敏数据，采用Pearson卡方检验对MIC折点进行比较。对一部分分离株进行了分子检测。
结果
在3784株非重复临床分离株中，对于CLSI 2013、CLSI 2014和EUCAST 2011，头孢吡肟敏感性分别从97.6%降至96.1%再降至93.7%。在对头孢曲松不敏感的分离株中，分别使用CLSI 2013和2014时，头孢吡肟敏感性从79%降至66%（P<0.0001），这在大肠埃希菌和克雷伯菌属中变化更大且具有统计学意义，但在肠杆菌属中无此变化（P=0.06）。MIC≤1μg/mL的分离株携带AmpC基因（77%）的频率高于携带ESBL基因（18%）的频率。
结论
较低的头孢吡肟MIC折点会降低携带ESBLs分离株的头孢吡肟敏感性，而对大多数携带AmpC的分离株影响较小。
Zotero 插件