Jones R N, Salazar J C, Pfaller M A, Doern G V
Department of Pathology, University of Iowa College of Medicine, Iowa City 52242, USA.
Diagn Microbiol Infect Dis. 1997 Dec;29(4):265-72. doi: 10.1016/s0732-8893(97)00157-0.
The need for comprehensive and quantitative accurate antimicrobial resistance surveillance systems has become acute as a guide to problem recognition and to focus local interventions. A multilaboratory (10 medical centers) Colombia surveillance project was initiated in early 1997 to monitor the potency and spectrum of six (cefepime, cefotaxime, ceftazidime, cefoperazone/sulbactam, aztreonam, and imipenem) broad-spectrum antimicrobial agents tested against 100 organisms per participant center (802 strains). Ten groups of organisms were tested by a reference-quality method (Etest; AB BIODISK, Solna, Sweden) with results validated by concurrent quality control and additional challenge strain analysis. Results from nine qualifying medical centers were tabulated, and 95.7 to 96.8% of quality assurance tests were within expected ranges. Only cefepime (90.1-100.0% susceptible) and imipenem (96.3-100.0%) were active against all Enterobacteriaceae at > 90% of susceptible isolates using the breakpoint concentrations recommended by the National Committee for Clinical Laboratory Standards. Among ceftazidime- (or cefotaxime- or aztreonam-) resistant Enterobacter spp. and Citrobacter freundii, cefepime remained active, but not cefoperazone with sulbactam. Escherichia coli and Klebsiella spp. strains having resistance phenotypes consistent with extended spectrum beta-lactamase production were discovered in approximately 5 to 10% of isolates. All tested drugs except ceftazidime (31.8-57.7% susceptible) were active against > 94% of oxacillin-susceptible staphylococci. Similar rates of resistance (9.1-14.8%) were observed in Pseudomonas aeruginosa for five of six drugs (not cefotaxime; 15.9% of strains were susceptible). Acinetobacter spp. isolates were most susceptible to imipenem (95.8%), cefepime (86.1%), and cefoperazone/sulbactam (83.3%). Overall for the 1997 order of antimicrobial spectrums for these tested compounds was: imipenem (96.6%) > cefepime (93.6%) > cefoperazone/sulbactam (90.5%) > cefotaxime (74.9%) > aztreonam (74.3% for Gram-negative bacilli only) > ceftazidime (73.2%). These data should be used to guide empiric regimens in Colombia, and additionally will provide a resistance statistical baseline to which future studies in this nation can be compared.
随着识别问题和聚焦本地干预措施的指南，对全面且定量准确的抗菌药物耐药性监测系统的需求变得极为迫切。1997年初启动了一个多实验室（10个医疗中心）的哥伦比亚监测项目，以监测六种（头孢吡肟、头孢噻肟、头孢他啶、头孢哌酮/舒巴坦、氨曲南和亚胺培南）广谱抗菌药物对每个参与中心100种生物体（802株菌株）的效力和抗菌谱。通过参考质量方法（Etest；AB BIODISK，瑞典索尔纳）对十组生物体进行检测，结果通过同步质量控制和额外的挑战菌株分析进行验证。汇总了九个合格医疗中心的结果，95.7%至96.8%的质量保证测试在预期范围内。按照美国国家临床实验室标准委员会推荐的断点浓度，仅头孢吡肟（90.1 - 100.0%敏感）和亚胺培南（96.3 - 100.0%）对所有肠杆菌科细菌的敏感分离株活性高于90%。在对头孢他啶（或头孢噻肟或氨曲南）耐药的肠杆菌属和弗氏柠檬酸杆菌中，头孢吡肟仍有活性，但头孢哌酮与舒巴坦则不然。在大约5%至10%的分离株中发现了具有与超广谱β - 内酰胺酶产生一致的耐药表型的大肠杆菌和克雷伯菌属菌株。除头孢他啶（31.8 - 57.7%敏感）外，所有测试药物对>94%的苯唑西林敏感葡萄球菌有活性。在铜绿假单胞菌中，六种药物中的五种（不包括头孢噻肟；15.9%的菌株敏感）观察到相似的耐药率（9.1 - 至14.8%）。不动杆菌属分离株对亚胺培南（95.8%）、头孢吡肟（86.1%）和头孢哌酮/舒巴坦（83.3%）最敏感。总体而言，1997年这些测试化合物的抗菌谱顺序为：亚胺培南（96.6%）>头孢吡肟（93.6%）>头孢哌酮/舒巴坦（90.5%）>头孢噻肟（74.9%）>氨曲南（仅对革兰氏阴性杆菌为74.3%）>头孢他啶（73.2%）。这些数据应用于指导哥伦比亚的经验性治疗方案，此外还将提供一个耐药性统计基线，以便与该国未来的研究进行比较。
