Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.
Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Diagn Microbiol Infect Dis. 2022 Dec;104(4):115799. doi: 10.1016/j.diagmicrobio.2022.115799. Epub 2022 Aug 25.
In 2019, the CLSI lowered the susceptible levofloxacin breakpoints for Enterobacterales from a MIC of ≤2 μg/mL to ≤0.5 μg/mL. The study evaluated the correlation between the susceptibility profiles obtained by the Vitek 2 and agar dilution (AD) methods in levofloxacin MIC ≤2 μg/mL isolates and its clinical impacts. Two hundred fifty-three Enterobacterales isolates and 222 patients treated with levofloxacin for Enterobacterales bacteremia were enrolled for analysis. There was 86.2% categorical agreement, 5 very major errors, and 30 minor errors based on the 2019 CLSI breakpoints. Higher levofloxacin MICs (1 or 2 μg/mL) determined using Vitek 2 or AD predicted early clinical failure (P < 0.001 for Vitek 2 and P = 0.001 for AD). In conclusion, Vitek 2 performance for levofloxacin susceptibility testing of Enterobacterales declined according to the 2019 CLSI criteria compared with the pre-2019 criteria. Although discrepant results were obtained, the MICs measured by Vitek 2 could still predict treatment outcomes.
2019 年，CLSI 将肠杆菌科的左氧氟沙星敏感折点从 MIC≤2μg/mL 降低至 MIC≤0.5μg/mL。本研究评估了 Vitek 2 与琼脂稀释（AD）方法在左氧氟沙星 MIC≤2μg/mL 分离株中获得的药敏谱之间的相关性及其临床影响。共纳入 253 株肠杆菌科分离株和 222 例接受左氧氟沙星治疗的肠杆菌科菌血症患者进行分析。根据 2019 年 CLSI 折点，有 86.2%的分类一致性、5 个非常大的错误和 30 个小错误。使用 Vitek 2 或 AD 确定的左氧氟沙星 MIC 值较高（1 或 2μg/mL）预测早期临床失败（Vitek 2 为 P<0.001，AD 为 P=0.001）。总之，与 2019 年之前的标准相比，Vitek 2 对肠杆菌科左氧氟沙星药敏试验的性能根据 2019 年 CLSI 标准下降。尽管得到了不一致的结果，但 Vitek 2 测量的 MIC 值仍可预测治疗结果。
