在中国临床实践中，纸片扩散法检测并非用于筛选耐头孢菌素淋病奈瑟菌菌株的合适工具。
Disk-Diffusion Testing Is an Inappropriate Screening Tool for Cephalosporin-Resistant Gonorrhoea Strains in Clinical Practice in China.
作者信息
Han Yan, Yin Yue-Ping, Xu Wen-Qi, Zhu Xiao-Yu, Chen Shao-Chun, Dai Xiu-Qin, Yang Li-Gang, Zhu Bang-Yong, Zhong Na, Cao Wen-Ling, Zhang Xiao-Hui, Wu Zhi-Zhou, Yuan Liu-Feng, Zheng Zhong-Jie, Liu Jun, Chen Xiang-Sheng
机构信息
Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, People's Republic of China.
National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, Jiangsu, People's Republic of China.
出版信息
Infect Drug Resist. 2020 Jul 20;13:2417-2423. doi: 10.2147/IDR.S248030. eCollection 2020.
PURPOSE
Injectable ceftriaxone and oral cefixime are the last agents effective against . In vitro antimicrobial-susceptibility testing (AST) is done to identify the most efficacious antibiotic needed to combat the infection in that particular individual. The objective of this study was to evaluate whether Kirby-Bauer (KB) disk-diffusion tests can detect isolates that have decreased susceptibility to ceftriaxone and cefixime for appropriate clinical management.
METHODS
A total of 1,633 consecutive clinical isolates of were collected from January 1, 2013 to December 31, 2017 from seven dermatology clinics located in five provinces in China. Consistency between KB disk-diffusion tests and the agar-dilution method, as well as sensitivity of the KB test for detecting isolates with decreased susceptibility to ceftriaxone and cefixime, were determined using 1,306 clinical isolates that had been recovered to complete agar-dilution AST.
RESULTS
The prevalence of isolates with decreased susceptibility to ceftriaxone and cefixime was 12.1% (198 of 1,633) and 12.7% (208 of 1,633), respectively, using KB disk-diffusion tests. The prevalence of isolates with decreased susceptibility was 9.9% (129 of 1,306) for ceftriaxone and 9.9% (129 of 1,305) for cefixime using agar-dilution AST. The categorical agreement of these two methods was 80.9% for both ceftriaxone and cefixime. Compared to agar-dilution AST, the sensitivity of the KB test for detecting isolates with decreased susceptibility was 22.5% (29 of 129) for ceftriaxone and 29.5% (38 of 129) for cefixime, and its specificity 87.3% (1,028 of 1,177) for ceftriaxone and 86.7% (1,018 of 1,176) for cefixime.
CONCLUSION
Although KB tests are easy to carry out in clinical practice, their ability to detect cephalosporin-resistant gonorrhoea strains is limited. This method is not an appropriate selection for screening cephalosporin-resistant gonorrhoea strains in clinical practice in China.
目的
注射用头孢曲松和口服头孢克肟是针对……的最后有效药物。进行体外抗菌药敏试验（AST）以确定对抗该特定个体感染所需的最有效抗生素。本研究的目的是评估 Kirby-Bauer（KB）纸片扩散试验能否检测出对头孢曲松和头孢克肟敏感性降低的分离株，以进行适当的临床管理。
方法
2013年1月1日至2017年12月31日期间，从中国五个省份的七家皮肤科诊所连续收集了总共1633株……临床分离株。使用已完成琼脂稀释AST的1306株临床分离株，确定KB纸片扩散试验与琼脂稀释法之间的一致性，以及KB试验检测对头孢曲松和头孢克肟敏感性降低的分离株的敏感性。
结果
使用KB纸片扩散试验，对头孢曲松和头孢克肟敏感性降低的分离株患病率分别为12.1%（1633株中的198株）和12.7%（1633株中的208株）。使用琼脂稀释AST，头孢曲松敏感性降低的分离株患病率为9.9%（1306株中的129株），头孢克肟为9.9%（1305株中的129株）。这两种方法对头孢曲松和头孢克肟的分类一致性均为80.9%。与琼脂稀释AST相比，KB试验检测敏感性降低的分离株的敏感性，头孢曲松为22.5%（129株中的29株），头孢克肟为29.5%（129株中的38株），其特异性，头孢曲松为87.3%（1177株中的1028株），头孢克肟为86.7%（1176株中的1018株）。
结论
虽然KB试验在临床实践中易于开展，但其检测耐头孢菌素淋病菌株的能力有限。在中国临床实践中，该方法不是筛查耐头孢菌素淋病菌株的合适选择。
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