采用 VITEK2 AST-YS08 卡和肉汤微量稀释法比较 11 种真菌的六种抗真菌药敏性。
Comparison of Six Antifungal Susceptibilities of 11 Species Using the VITEK2 AST-YS08 Card and Broth Microdilution Method.
机构信息
Department of Laboratory Medicine, International St. Mary's Hospital, College of Medicine, Catholic Kwandong University, Incheon, Korea.
Department of Hematopoietic Stem Cell Transplantation Center, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
出版信息
Microbiol Spectr. 2022 Apr 27;10(2):e0125321. doi: 10.1128/spectrum.01253-21. Epub 2022 Apr 6.
We used a Vitek 2 AST-YS08 (YS08) system and the broth microdilution method (BMD) adopted by the Clinical and Laboratory Standards Institute (CLSI) to compare the susceptibility of 184 isolates of 11 species to fluconazole, voriconazole, micafungin, caspofungin, amphotericin B, and flucytosine. In Candida albicans, the categorical agreement (CA) was 79.2%, 91.7%, 95.8%, and 95.8% for fluconazole, voriconazole, micafungin, and caspofungin, respectively. About 12.5% and 4.2% of very major errors were detected for fluconazole and voriconazole, respectively. C. glabrata showed excellent essential agreements (EAs) (>90%) for azoles but different MIC distributions for fluconazole and caspofungin. The CA between BMD fluconazole MICs and YS08 voriconazole MICs by the method-specific clinical breakpoint (CBP) was 90% in C. glabrata. Over 80% of C. glabrata and C. krusei isolates identified as micafungin-susceptible were labeled intermediate or resistant to caspofungin in YS08. In C. parapsilosis, 5.3% of very major errors and 10.5% of minor errors were found, whereas 33.3% of minor errors were observed in C. tropicalis for fluconazole. For C. tropicalis, 13 (61.9%) non-wild type (WT) isolates of fluconazole and 7 (33.3%) non-WTs of voriconazole were classified in YS08 as WT. For C. auris, the EAs were 93.3%, 100%, 82.2%, 97.8%, and 97.8% for fluconazole, voriconazole, micafungin, caspofungin, and amphotericin B, respectively. YS08 showed comparable results to the BMD. However, considering the lower YS08 fluconazole MIC results compared with BMD in species and YS08 caspofungin results in C. glabrata and C. krusei, improvements are needed. The new Vitek 2 AST-YS08 (YS08) card has been updated to reflect the recently revised Clinical and Laboratory Standards Institute (CLSI) guideline. In this study, antifungal drug susceptibility tests were performed using the YS08 card and compared with the CLSI broth microdilution (BMD) method. In conclusion, YS08 showed similar results to BMD, including with C. auris. However, about 12.5% and 4.2% of major errors were detected for fluconazole and voriconazole, respectively, in C. albicans. More than 80% of C. glabrata and C. krusei isolates identified as susceptible to micafungin were labeled moderate or resistant to caspofungin in YS08. The categorical agreement between BMD fluconazole MICs and YS08 voriconazole MICs was 90% by the method-specific CBP of voriconazole, 80% by the current epidemiological cutoff value (ECV) (0.25 μg/mL) of voriconazole, and 85% by the previous ECV (0.5 μg/mL) of voriconazole. Further improvements in YS08 for the detection of fluconazole and echinocandin resistance are thus needed.
我们使用 Vitek 2 AST-YS08（YS08）系统和临床实验室标准化协会（CLSI）采用的肉汤微量稀释法（BMD）来比较 11 种 184 株菌对氟康唑、伏立康唑、米卡芬净、卡泊芬净、两性霉素 B 和氟胞嘧啶的敏感性。在白念珠菌中，氟康唑、伏立康唑、米卡芬净和卡泊芬净的分类一致性（CA）分别为 79.2%、91.7%、95.8%和 95.8%。氟康唑和伏立康唑分别检测到约 12.5%和 4.2%的重大误差。光滑念珠菌对唑类药物的基本一致率（EA）>90%，但氟康唑和卡泊芬净的 MIC 分布不同。BMD 氟康唑 MIC 与 YS08 伏立康唑 MIC 之间的 CA 通过特定方法的临床折点（CBP）为 90%，在光滑念珠菌中。超过 80%的氟康唑和卡泊芬净敏感的光滑念珠菌和克柔念珠菌被标记为中度或耐药。在近平滑念珠菌中，发现 5.3%的重大误差和 10.5%的次要误差，而在热带念珠菌中，氟康唑的次要误差为 33.3%。对于氟康唑，61.9%的非野生型（WT）氟康唑耐药株和 33.3%的非 WT 伏立康唑耐药株在 YS08 中被归类为 WT。对于耳念珠菌，氟康唑、伏立康唑、米卡芬净、卡泊芬净和两性霉素 B 的 EA 分别为 93.3%、100%、82.2%、97.8%和 97.8%。YS08 与 BMD 结果相似。然而，考虑到在一些种属中 YS08 氟康唑 MIC 结果与 BMD 相比较低，以及 YS08 卡泊芬净在光滑念珠菌和克柔念珠菌中的结果，需要进行改进。新的 Vitek 2 AST-YS08（YS08）卡已更新，以反映最近修订的临床实验室标准化协会（CLSI）指南。在这项研究中，使用 YS08 卡进行了抗真菌药物敏感性试验，并与 CLSI 肉汤微量稀释（BMD）方法进行了比较。总之，YS08 与 BMD 结果相似，包括对耳念珠菌。然而，在白念珠菌中，氟康唑和伏立康唑分别检测到约 12.5%和 4.2%的主要误差。超过 80%的氟康唑和卡泊芬净敏感的光滑念珠菌和克柔念珠菌被标记为中度或耐药。在 BMD 氟康唑 MIC 与 YS08 伏立康唑 MIC 之间，特定方法的 CBP 为 90%，当前的流行病学折点（ECV）（0.25μg/ml）为 80%，之前的 ECV（0.5μg/ml）为 85%。因此，需要进一步改进 YS08 以检测氟康唑和棘白菌素耐药性。
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