Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, Children's and Women's Health Centre of British Columbia, 4480 Oak Street, Vancouver, British Columbia, V6H3V4 Canada.
Int J Antimicrob Agents. 2021 Mar;57(3):106258. doi: 10.1016/j.ijantimicag.2020.106258. Epub 2020 Dec 11.
There is considerable history and practice experience both with laboratory susceptibility testing for Bordetella pertussis and clinical treatment. This two-part narrative review provides a synthesis of the laboratory and clinical sciences as they apply to this bacterium and the clinical consequences of treating infection. It is generally held that antibiotic susceptibility testing for B. pertussis is not sufficiently standardised, but there has not been an urgent need to consolidate the same given the lack global experience with major resistance profiles. Experience in China, however, has provided concern for high-level macrolide resistance. The nature of and frequency of such resistance has raised the bar for reconsideration of susceptibility testing given that first-line treatment may be regionally compromised. Disk diffusion and Etest susceptibility testing can be recommended for screening resistance among individual isolates of B. pertussis and on an ad hoc manner. Disk diffusion, Etest and/or critical agar dilution testing can be recommended for large-scale studies. Standards for inoculum, growth atmosphere, timing of interpretation, preferred testing media and controls can be extrapolated from the publications to date. Such methods should be able to detect high-level resistance to several antibiotics, but especially macrolides. Concern for intermediate-susceptible categories requires consideration as well as the correlation with bacteriological and clinical outcomes. Provisional standards can be applied at this time, and modification or fine-tuning of any such standards are open to future investigation.
针对百日咳博德特氏菌的实验室药敏检测以及临床治疗都有着丰富的历史和实践经验。这篇由两部分组成的叙述性综述综合了适用于该细菌的实验室和临床科学，以及治疗感染的临床后果。通常认为，百日咳博德特氏菌的抗生素药敏检测尚未得到充分标准化，但由于缺乏对主要耐药谱的全球经验，因此没有迫切需要对其进行统一。然而，中国的经验令人担忧高水平大环内酯类耐药性。鉴于一线治疗可能在区域上受到影响，这种耐药性的性质和频率提高了重新考虑药敏检测的必要性。可以推荐纸片扩散法和 Etest 药敏检测用于筛选个别百日咳博德特氏菌分离株的耐药性，并可根据需要进行检测。可以推荐纸片扩散法、Etest 和/或临界琼脂稀释法进行大规模研究。可以从目前的出版物中推断出接种物、生长气氛、解释时间、首选测试介质和对照的标准。这些方法应该能够检测到几种抗生素的高水平耐药性，尤其是大环内酯类。需要考虑对中敏类别的关注，以及与细菌学和临床结果的相关性。目前可以应用临时标准，并且可以对任何此类标准进行修改或微调，以进行未来的研究。
