Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD, USA.
Department of Pharmacy, University of Maryland School of Pharmacy, Baltimore, MD, USA.
Diagn Microbiol Infect Dis. 2021 Oct;101(2):115483. doi: 10.1016/j.diagmicrobio.2021.115483. Epub 2021 Jul 9.
Revised breakpoints for cefazolin (CFZ) against Enterobacterales may be difficult to implement with current automated susceptibility testing platforms and could falsely report organisms as susceptible, leading to inappropriate treatment for bloodstream infections (BSI). This was a retrospective cohort of adult patients with Enterobacterales BSI reported CFZ susceptible per Vitek®2. The primary outcome was the percentage susceptible by minimum inhibitory concentration (MIC) Gradient Test Strips and disk diffusion. Secondary outcomes included clinical outcomes between CFZ and non-CFZ-treated patients. Among 195 isolates reported CFZ-susceptible per Vitek®2, 84 (43.1%) were CFZ susceptible by MIC Gradient Test Strips vs 119 (61%) by disk diffusion. No difference was noted in 30-day all-cause mortality, secondary complications, or 30-day readmissions. Treatment failure was less likely to occur with source control (adjusted OR 0.06) and infectious disease consult (adjusted OR 0.37). There was a large degree of discrepancy between automated testing and manual methods; the clinical impact of this discrepancy warrants further investigation.
头孢唑林（CFZ）对肠杆菌科的修订折点可能难以在当前的自动化药敏检测平台上实施，并且可能错误地报告对生物体敏感，从而导致血流感染（BSI）的治疗不当。这是一项回顾性队列研究，纳入了报告根据 Vitek®2 检测对头孢唑林敏感的成人肠杆菌科 BSI 患者。主要结局是通过最低抑菌浓度（MIC）梯度测试条和纸片扩散法评估的敏感率。次要结局包括头孢唑林和非头孢唑林治疗患者之间的临床结局。在根据 Vitek®2 报告头孢唑林敏感的 195 株分离株中，84 株（43.1%）通过 MIC 梯度测试条评估为头孢唑林敏感，而通过纸片扩散法评估为 119 株（61%）。30 天全因死亡率、次要并发症或 30 天再入院率无差异。有明确病因控制（校正比值比 0.06）和传染病会诊（校正比值比 0.37）的患者，治疗失败的可能性更小。自动检测与手动方法之间存在很大差异；这种差异的临床影响值得进一步研究。
