报告葡萄球菌属的抗菌药物敏感性和耐药表型：一项全国性的能力验证研究。
Reporting antimicrobial susceptibilities and resistance phenotypes in Staphylococcus spp.: a nationwide proficiency study.
机构信息
Unidad Clínica de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain.
Instituto de Biomedicina de Sevilla (IBIs), Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain.
出版信息
J Antimicrob Chemother. 2021 Apr 13;76(5):1187-1196. doi: 10.1093/jac/dkab017.
OBJECTIVES
To evaluate the proficiency of microbiology laboratories in Spain in antimicrobial susceptibility testing (AST) of Staphylococcus spp.
MATERIALS AND METHODS
Eight Staphylococcus spp. with different resistance mechanisms were selected: six Staphylococcus aureus (CC-01/mecA, CC-02/mecC, CC-03/BORSA, CC-04/MLSBi, CC-06/blaZ and CC-07/linezolid resistant, cfr); one Staphylococcus epidermidis (CC-05/linezolid resistant, 23S rRNA mutation); and one Staphylococcus capitis (CC-08/daptomycin non-susceptible). Fifty-one laboratories were asked to report: (i) AST system used; (ii) antimicrobial MICs; (iii) breakpoints used (CLSI or EUCAST); and (iv) clinical category. Minor, major and very major errors (mEs, MEs and VMEs, respectively) were determined.
RESULTS
The greatest MIC discrepancies found were: (i) by AST method: 19.4% (gradient diffusion); (ii) by antimicrobial agent: daptomycin (21.3%) and oxacillin (20.6%); and (iii) by isolate: CC-07/cfr (48.0%). The greatest error rates were: (i) by AST method: gradient diffusion (4.3% and 5.1% VMEs, using EUCAST and CLSI, respectively); (ii) by breakpoint: 3.8% EUCAST and 2.3% CLSI; (iii) by error type: mEs (0.8% EUCAST and 1.0% CLSI), MEs (1.8% EUCAST and 0.7% CLSI) and VMEs (1.2% EUCAST and 0.6% CLSI); (iii) by antimicrobial agent: VMEs (4.7% linezolid and 4.3% oxacillin using EUCAST); MEs (14.3% fosfomycin, 9.1% tobramycin and 5.7% gentamicin using EUCAST); and mEs (22.6% amikacin using EUCAST).
CONCLUSIONS
Clinical microbiology laboratories should improve their ability to determine the susceptibility of Staphylococcus spp. to some antimicrobial agents to avoid reporting false-susceptible or false-resistant results. The greatest discrepancies and errors were associated with gradient diffusion, EUCAST breakpoints and some antimicrobials (mEs for aminoglycosides; MEs for fosfomycin, aminoglycosides and oxacillin; and VMEs for linezolid and oxacillin).
目的
评估西班牙微生物学实验室在检测耐甲氧西林金黄色葡萄球菌（MRSA）的药敏试验（AST）方面的能力。
材料与方法
选择了 8 株具有不同耐药机制的金黄色葡萄球菌：6 株金黄色葡萄球菌（CC-01/mecA、CC-02/mecC、CC-03/BORSA、CC-04/MLSBi、CC-06/blaZ 和 CC-07/利奈唑胺耐药，cfr）；1 株表皮葡萄球菌（CC-05/利奈唑胺耐药，23S rRNA 突变）；1 株头状葡萄球菌（CC-08/达托霉素不敏感）。要求 51 个实验室报告：（i）使用的 AST 系统；（ii）抗菌 MIC；（iii）使用的断点（CLSI 或 EUCAST）；和（iv）临床类别。确定了小、大、非常大误差（mEs、MEs 和 VMEs，分别）。
结果
发现最大的 MIC 差异为：（i）AST 方法：19.4%（梯度扩散）；（ii）抗菌剂：达托霉素（21.3%）和苯唑西林（20.6%）；和（iii）分离株：CC-07/cfr（48.0%）。最大的误差率为：（i）AST 方法：梯度扩散（分别使用 EUCAST 和 CLSI 时，4.3%和 5.1%的 VMEs）；（ii）断点：3.8%EUCAST 和 2.3%CLSI；（iii）误差类型：mEs（0.8%EUCAST 和 1.0%CLSI）、MEs（1.8%EUCAST 和 0.7%CLSI）和 VMEs（1.2%EUCAST 和 0.6%CLSI）；（iii）抗菌剂：VMEs（EUCAST 中分别为 4.7%利奈唑胺和 4.3%苯唑西林）；MEs（EUCAST 中分别为 14.3%磷霉素、9.1%妥布霉素和 5.7%庆大霉素）和 mEs（EUCAST 中分别为 22.6%阿米卡星）。
结论
临床微生物学实验室应提高其确定某些抗菌药物对金黄色葡萄球菌敏感性的能力，以避免报告假敏感或假耐药结果。最大的差异和误差与梯度扩散、EUCAST 断点和一些抗菌药物有关（氨基糖苷类药物的 mEs；磷霉素、氨基糖苷类和苯唑西林的 MEs；利奈唑胺和苯唑西林的 VMEs）。
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