摘要
目的评估Vitek2 Compact AST-P639中国定制药敏卡(简称中国定制卡)测定金黄色葡萄球菌体外药敏、耐甲氧西林金黄色葡萄球菌(MRSA)、红霉素诱导克林霉素耐药试验及高级专家系统(AES)的修正能力。方法选取2020年5月至2021年9月绍兴市人民医院临床分离的非重复金黄色葡萄球菌100株,分别采用中国定制卡及微量肉汤稀释法测定万古霉素、替考拉宁、替加环素、利奈唑胺、达托霉素、苯唑西林、红霉素、克林霉素、左氧氟沙星、复方新诺明和利福平的敏感性。分别以微量肉汤稀释法、PCR和D试验为参考方法,评估中国定制卡的可靠性,并对AES修正能力进行评估。结果中国定制卡对金黄色葡萄球菌体外药敏分类一致性(CA)为95.38%,极大错误(VME)、大错误(ME)、小错误(MIE)分别为0.31%、3.77%、0.54%,其中万古霉素、替考拉宁、替加环素、利奈唑烷、达托霉素CA均为100.00%,苯唑西林、红霉素、克林霉素、左氧氟沙星、复方新诺明、利福平、MRSA、红霉素诱导克林霉素耐药试验的CA分别为95.00%、95.00%、66.00%、94.00%、98.00%、97.00%、98.00%、97.00%。左氧氟沙星、复方新诺明和利福平均出现了2.00%的ME,红霉素、MRSA、红霉素诱导克林霉素耐药试验出现了1.00%、2.00%、1.00%的VME。AES将4株苯唑西林敏感菌株和28株克林霉素敏感菌株修正为耐药,虽然均消除了1.00%的VME,但均增加了ME(分别为5.00%、34.00%)。PCR和D试验证实,被修正的4株苯唑西林敏感菌株均携带mecA基因,即与AES修正相符;被修正的28株克林霉素敏感菌株中26株D试验阳性,即AES存在7.14%(2/28)的错误修正率。结论中国定制卡对金黄色葡萄球菌体外药敏、MRSA表型、红霉素诱导克林霉素耐药试验的筛选有较高的准确性,AES对苯唑西林、克林霉素的修正结果可以有效的避免抗菌药物的错误选择,可靠性好,但也存在一定的错误率和局限性,应予以关�
Objective To evaluate the Vitek2 Compact AST-P639 China customized drug sensitivity card for drug susceptibility,erythromycin-induced clindamycin resistance phenotype and advanced expert system(AES)correction to methicillin-resistant Staphylococcus aureus(MRSA).Methods A total of 100 clinical isolates of Staphylococcus aureus were collected in Shaoxing People's Hospital from May 2020 to September 2021.The drug sensitivity of antibiotics to Staphylococcus aureus was tested by the AST-P639 China custom drug susceptibility card and broth microdilution method,respectively.The broth microdilution method,PCR and D test were used as the reference method for comparison.Results The categorical agreement(CA)of AST-P639 for Staphylococcus aureus was 95.38%,with 0.31%for VME,3.77%for ME and 0.54%for MIE.The CA for oxacillin,erythromycin,clinthromycin,levofloxacin,cotrimoxazole,rifampin,MRSA,and erythromycin was 95.00%,95.00%,66.00%,94.00%,98.00%,97.00%,98.00%,and 97.00%,respectively.The ME of levofloxacin,cotrimoxazole and rifampin was 2.00%.The VME of vancomycin,MRSA,erythromycin-induced clindamycin resistance tests was 1.00%,2.00%,and 1.00%,respectively.AES corrected for 4 oxacillin and 28 clindamycin-sensitive strains was eliminated as 1.00%of VME,but ME increased 5.00%and 34.00%.PCR and D tests confirmed that 4 modified benxacillin strains carried the mecA gene,which was consistent with AES correction.Twenty-six out of modified 28 clindamycin strains were positive for D test,the error correction rate was 7.14%for AES.Conclusion Vitek-2 Compact AST-P639 China custom susceptibility card has high accuracy in vitro susceptibility,MRSA phenotype and erythromycininduced clindamycin resistance.The correction results of AES for oxacillin and clindamycin can effectively avoid the wrong selection of antibiotics.However,attention should be paid to the error rate and limitations.
作者
梁美春
王萍
张小姣
何秋丽
吕黎
周宜庆
张海旺
茅国峰
王朵
LIANG Meichun;WANG Ping;ZHANG Xiaojiao;HE Qiuli;LYU Li;ZHOU Yiqing;ZHANG Haiwang;MAO Guofeng;WANG Duo(Department of Clinical Laboratory,Shaoxing People's Hospital,Shaoxing 312000,China;不详)
出处
《浙江医学》
CAS
2023年第13期1354-1358,1370,共6页
Zhejiang Medical Journal
基金
浙江省医药卫生科技计划项目(2021KY1136)
绍兴市公益性技术应用研究计划项目(2018C30100)。
