解读铜绿假单胞菌的碳青霉烯类药物敏感性测试结果。
Interpreting carbapenem susceptibility testing results for Pseudomonas aeruginosa.
机构信息
Laboratoire de bactériologie-hygiène, hôpital Pitié-Salpêtrière, Assistance publique - Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
Laboratoire de bactériologie-hygiène, hôpital Pitié-Salpêtrière, Assistance publique - Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Service de réanimation médicale, groupe hospitalier Pitié-Salpêtrière, Assistance publique - Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Service de réanimation polyvalente, département d'anesthésie-réanimation, groupe hospitalier Pitié-Salpêtrière, Assistance publique - Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Sorbonne Universités, UPMC Université Paris 06, CR7, Centre d'immunologie et des maladies infectieuses, CIMI, équipe E13 (Bactériologie), 91, boulevard de l'Hôpital, 75013 Paris, France; Inserm U1135, Centre d'immunologie et des maladies infectieuses, CIMI, team E13 (Bactériologie), 91, boulevard de l'Hôpital, 75013 Paris, France.
出版信息
Med Mal Infect. 2018 Aug;48(5):365-371. doi: 10.1016/j.medmal.2018.03.003. Epub 2018 Apr 5.
OBJECTIVES
Carbapenems are among the most powerful antipseudomonal agents. Limited data is available on drug susceptibility testing by routine methods (disc diffusion and Etest) for meropenem and doripenem. We aimed to compare the in vitro activity of imipenem, meropenem, and doripenem against Pseudomonas aeruginosa.
METHODS
A total of 311 P. aeruginosa strains isolated from respiratory specimens in 170 patients who developed ventilator-associated pneumonia in two intensive care units were collected over a period of 31 months. The susceptibility of these isolates to imipenem, meropenem, and doripenem were determined by Etest and disc diffusion method.
RESULTS
Considering either all isolates or only the first isolates recovered per patient (311 and 170 respectively), the susceptibility rate for doripenem was higher than that for meropenem and imipenem. When MICs determined by Etest were converted into interpretative categories (S, I, R) using French (CA-SFM) guidelines, a poor correlation was observed for meropenem and doripenem. The percentages of correlation with the disc diffusion method were 90.6% and 89.7% for imipenem, 80.5% and 82.6% for meropenem, and 80.5% and 73.3% for doripenem, for the first isolates and all isolates, respectively. The rate of minor errors was as high as 17.7% and 16.1% for meropenem and 17.7% and 25.7% for doripenem for the first isolates and all isolates, respectively.
CONCLUSION
The accuracy of disc diffusion using CA-SFM guidelines appears unsatisfactory for all three carbapenems justifying guideline update for P. aeruginosa and carbapenems.
目的
碳青霉烯类抗生素是最有效的抗假单胞菌药物之一。目前关于美罗培南和多利培南的常规药敏检测方法（纸片扩散法和 Etest）的药物敏感性数据有限。本研究旨在比较亚胺培南、美罗培南和多利培南对铜绿假单胞菌的体外活性。
方法
收集了在两个重症监护病房发生呼吸机相关性肺炎的 170 名患者的 311 株呼吸道标本中分离的铜绿假单胞菌。采用 Etest 和纸片扩散法测定这些分离株对亚胺培南、美罗培南和多利培南的敏感性。
结果
考虑所有分离株或每位患者首次分离株（分别为 311 株和 170 株），多利培南的敏感性率高于美罗培南和亚胺培南。当使用法国（CA-SFM）指南将 Etest 测定的 MIC 值转换为解释类别（S、I、R）时，美罗培南和多利培南的相关性较差。与纸片扩散法的相关性百分比分别为 90.6%和 89.7%的亚胺培南，80.5%和 82.6%的美罗培南，80.5%和 73.3%的多利培南，用于首次分离株和所有分离株。对于美罗培南和多利培南，首次分离株和所有分离株的次要错误率分别高达 17.7%和 16.1%和 17.7%和 25.7%。
结论
使用 CA-SFM 指南的纸片扩散法的准确性对于所有三种碳青霉烯类抗生素都不够令人满意，这证明需要更新铜绿假单胞菌和碳青霉烯类抗生素的指南。
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