Kansak N, Arıcı N, Adaleti R, Nakipoglu Y, Aksaray S
Istanbul, Haydarpasa Numune Training and Research Hospital, Clinical Research, Laboratory of Medical Microbiology, Istanbul, Turkey.
Istanbul, Haydarpasa Numune Training and Research Hospital, Clinical Research, Laboratory of Medical Microbiology, Istanbul, Turkey.
J Microbiol Methods. 2021 Sep;188:106296. doi: 10.1016/j.mimet.2021.106296. Epub 2021 Jul 30.
This study evaluates whether the rapid fosfomycin resistance (fosfomycin NP) method can be used for detecting fosfomycin resistance in routine laboratory work. Results from the disk diffusion and rapid fosfomycin NP methods were compared with the reference agar dilution method for Escherichia coli and Klebsiella spp. strains isolated from urinary tract infections. The study included 57 E. coli and 48 Klebsiella spp. isolates from urinary tract infections. The reference agar dilution and disk diffusion methods were performed in accordance with EUCAST recommendations, and the results were evaluated according to EUCAST V.10.0. The method developed by Nordmann et al. was used for rapid detection of fosfomycin resistance (Nordmann, P., Poirel, L., Mueller, L., 2019. Rapid Detection of Fosfomycin Resistance in Escherichia coli. J Clin Microbiol. 57(1), e01531-18. doi:https://doi.org/10.1128/JCM.01531-18). The acceptable categorical agreement (CA ≥ 90%) and the rates of major error (ME <3%) and very major error (VME < 3%) of the two methods were compared with the reference method according to the criteria of ISO 20776-1. Fosfomycin resistance was detected in 15.8% of E. coli and 75% of Klebsiella spp. isolates using the reference method. Disk diffusion method showed CA 89.5%, ME 12.5% in E. coli isolates, and CA 75%, ME 100% in Klebsiella spp. isolates. No VME was detected in both methods. The rapid fosfomycin NP method resulted in CA 96.4%, ME 0.0%, VME 22.2% in E. coli isolates, and CA 77.3%, ME 81.8%, and VME 3% in Klebsiella spp. isolates. We believe the results from both of disk diffusion assay and rapid fosfomycin NP for the E. coli and Klebsiella spp. isolates are incompatible with the reference method and should not be used as an alternative to the agar dilution method.
本研究评估快速磷霉素耐药性（磷霉素NP）检测方法是否可用于常规实验室工作中磷霉素耐药性的检测。将纸片扩散法和快速磷霉素NP法的结果与参考琼脂稀释法对从尿路感染分离出的大肠杆菌和克雷伯菌属菌株的检测结果进行比较。该研究纳入了57株来自尿路感染的大肠杆菌和48株克雷伯菌属分离株。参考琼脂稀释法和纸片扩散法按照欧洲抗菌药物敏感性试验委员会（EUCAST）的建议进行操作，结果根据EUCAST V.10.0进行评估。Nordmann等人开发的方法用于快速检测磷霉素耐药性（Nordmann, P., Poirel, L., Mueller, L., 2019. Rapid Detection of Fosfomycin Resistance in Escherichia coli. J Clin Microbiol. 57(1), e01531-18. doi:https://doi.org/10.1128/JCM.01531-18）。根据ISO 20776-1的标准，将两种方法的可接受分类一致性（CA≥90%）、主要误差率（ME<3%）和非常主要误差率（VME<3%）与参考方法进行比较。使用参考方法检测到15.8%的大肠杆菌分离株和75%的克雷伯菌属分离株对磷霉素耐药。纸片扩散法在大肠杆菌分离株中的CA为89.5%，ME为12.5%；在克雷伯菌属分离株中的CA为75%，ME为100%。两种方法均未检测到VME。快速磷霉素NP法在大肠杆菌分离株中的CA为96.4%，ME为0.0%，VME为22.2%；在克雷伯菌属分离株中的CA为77.3%，ME为81.8%，VME为3%。我们认为，对于大肠杆菌和克雷伯菌属分离株，纸片扩散试验和快速磷霉素NP法的结果与参考方法不一致，不应作为琼脂稀释法的替代方法。
