对囊性纤维化患者铜绿假单胞菌的药敏试验和最小抑菌浓度的当代分析。
Contemporary analysis of ETEST for antibiotic susceptibility and minimum inhibitory concentration agreement against Pseudomonas aeruginosa from patients with cystic fibrosis.
机构信息
Center for Anti-Infective Research and Development, Hartford Hospital, 80 Seymour Street, Hartford, 06102, CT, USA.
Department of Clinical Microbiology, Huntington Hospital, Pasadena, CA, USA.
出版信息
Ann Clin Microbiol Antimicrob. 2021 Jan 19;20(1):9. doi: 10.1186/s12941-021-00415-0.
OBJECTIVES
Cystic fibrosis (CF) acute pulmonary exacerbations are often caused by Pseudomonas aeruginosa, including multi-drug resistant strains. Optimal antibiotic therapy is required to return lung function and should be guided by in vitro susceptibility results. There are sparse data describing ETEST performance for CF isolates using contemporary isolates, methods and interpretation, as well as novel antibiotics, such as ceftazidime-avibactam and ceftolozane-tazobactam.
METHODS
Pseudomonas aeruginosa (n = 105) isolated during pulmonary exacerbation from patients with CF were acquired from 3 US hospitals. Minimum inhibitory concentrations (MICs) were assessed by reference broth microdilution (BMD) and ETEST for aztreonam, cefepime, ceftazidime, ceftazidime-avibactam, ceftolozane-tazobactam, ciprofloxacin, levofloxacin, meropenem, piperacillin-tazobactam, and tobramycin. Broth microdilution was conducted in concordance with the Clinical and Laboratory Standards Institute M100. ETEST methodology reflected package insert recommendations. Performance of ETEST strips was evaluated using the Food and Drug Administration (FDA) and Susceptibility Testing Manufacturers Association (STMA) guidance.
RESULTS
Of the 105 P. aeruginosa included, 46% had a mucoid phenotype. ETEST MICs typically read 0-1 dilution higher than BMD for all drugs. Categorical agreement and essential agreement ranged from 64 to 93% and 63 to 86%, respectively. The majority of observed errors were minor. A single very major error occurred with ceftazidime (4.2%). For ceftazidime-vibactam, 2 very major errors were observed and both were within essential agreement. Major errors occurred for aztreonam (3.3%), cefepime (9.4%), ceftazidime-avibactam (5.3%, adjusted 2.1%), ceftolozane-tazobactam (1%), meropenem (3.3%), piperacillin-tazobactam (2.9%), and tobramycin (1.5%).
CONCLUSIONS
ETEST methods performed conservatively for most antibiotics against this challenging collection of P. aeruginosa from patients with CF.
目的
囊性纤维化（CF）急性肺部恶化通常由铜绿假单胞菌引起，包括多药耐药株。为了恢复肺功能，需要进行最佳的抗生素治疗，并且应该根据体外药敏结果进行指导。目前有关使用当代分离株、方法和解释以及新型抗生素（如头孢他啶-阿维巴坦和头孢洛扎南-他唑巴坦）描述 CF 分离株的 ETEST 性能的数据很少。
方法
从 3 家美国医院的 CF 患者肺部恶化期间获得了 105 株铜绿假单胞菌。使用参考肉汤微量稀释（BMD）和 ETEST 评估氨曲南、头孢吡肟、头孢他啶、头孢他啶-阿维巴坦、头孢洛扎南-他唑巴坦、环丙沙星、左氧氟沙星、美罗培南、哌拉西林-他唑巴坦和妥布霉素的最小抑菌浓度（MIC）。BMD 按照临床和实验室标准协会 M100 进行。ETEST 方法学反映了包装说明书的建议。使用食品和药物管理局（FDA）和药敏试验制造商协会（STMA）指南评估 ETEST 条带的性能。
结果
在纳入的 105 株铜绿假单胞菌中，46%表现为粘液表型。对于所有药物，ETEST MIC 通常比 BMD 高 0-1 个稀释度。分类一致性和主要一致性分别为 64%至 93%和 63%至 86%。观察到的大多数错误都是次要的。只有一个头孢他啶（4.2%）出现非常大的错误。对于头孢他啶-阿维巴坦，观察到 2 个非常大的错误，并且均符合主要一致性。氨曲南（3.3%）、头孢吡肟（9.4%）、头孢他啶-阿维巴坦（5.3%，调整后为 2.1%）、头孢洛扎南-他唑巴坦（1%）、美罗培南（3.3%）、哌拉西林-他唑巴坦（2.9%）和妥布霉素（1.5%）发生主要错误。
结论
针对来自 CF 患者的具有挑战性的铜绿假单胞菌分离株，ETEST 方法对大多数抗生素的表现都较为保守。
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