欧盟CAST和CLSI M27 - A2肉汤微量稀释法检测念珠菌属对氟康唑、伊曲康唑、泊沙康唑和伏立康唑药敏的国际多中心比较
International and multicenter comparison of EUCAST and CLSI M27-A2 broth microdilution methods for testing susceptibilities of Candida spp. to fluconazole, itraconazole, posaconazole, and voriconazole.
作者信息
Espinel-Ingroff A, Barchiesi F, Cuenca-Estrella M, Pfaller M A, Rinaldi M, Rodriguez-Tudela J L, Verweij P E
机构信息
VCU Medical Center, Medical Mycology Research Laboratory, 1101 E. Marshall St., Sanger Hall Room 7049, P.O. Box 980049, Richmond, VA 23298-0049, USA.
出版信息
J Clin Microbiol. 2005 Aug;43(8):3884-9. doi: 10.1128/JCM.43.8.3884-3889.2005.
The aim of this study was to compare MICs of fluconazole, itraconazole, posaconazole, and voriconazole obtained by the European Committee on Antibiotic Susceptibility Testing (EUCAST) and CLSI (formerly NCCLS) methods in each of six centers for 15 Candida albicans (5 fluconazole-resistant and 4 susceptible-dose-dependent [S-DD] isolates), 10 C. dubliniensis, 7 C. glabrata (2 fluconazole-resistant isolates), 5 C. guilliermondii (2 fluconazole-resistant isolates), 10 C. krusei, 9 C. lusitaniae, 10 C. parapsilosis, and 5 C. tropicalis (1 fluconazole-resistant isolate) isolates. CLSI MICs were obtained visually at 24 and 48 h and spectrophotometric EUCAST MICs at 24 h. The agreement (within a 3-dilution range) between the methods was species, drug, and incubation time dependent and due to lower EUCAST than CLSI MICs: overall, 94 to 95% with fluconazole and voriconazole and 90 to 91% with posaconazole and itraconazole when EUCAST MICs were compared against 24-h CLSI results. The agreement was lower (85 to 94%) against 48-h CLSI endpoints. The overall interlaboratory reproducibility by each method was > or =92%. When the comparison was based on CLSI breakpoint categorization, the agreement was 68 to 76% for three of the four species that included fluconazole-resistant and S-DD isolates; 9% very major discrepancies (< or =8 microg/ml versus > or =64 microg/ml) were observed among fluconazole-resistant isolates and 50% with voriconazole (< or =1 microg/ml versus > or =4 microg/ml). Similar results were observed with itraconazole for seven of the eight species evaluated (28 to 77% categorical agreement). Posaconazole EUCAST MICs were also substantially lower than CLSI MIC modes (0.008 to 1 microg/ml versus 1 to > or =8 microg/ml) for some of these isolates. Therefore, the CLSI breakpoints should not be used to interpret EUCAST MIC data.
本研究的目的是比较欧洲抗生素敏感性试验委员会（EUCAST）和美国临床和实验室标准协会（CLSI，前身为NCCLS）方法所测得的氟康唑、伊曲康唑、泊沙康唑和伏立康唑对6个中心的15株白色念珠菌（5株耐氟康唑和4株剂量依赖性敏感[S-DD]菌株）、10株都柏林念珠菌、7株光滑念珠菌（2株耐氟康唑菌株）、5株季也蒙念珠菌（2株耐氟康唑菌株）、10株克柔念珠菌、9株葡萄牙念珠菌、10株近平滑念珠菌和5株热带念珠菌（1株耐氟康唑菌株）的最低抑菌浓度（MIC）。CLSI的MIC在24小时和48小时通过肉眼读取，EUCAST的MIC在24小时通过分光光度法测定。两种方法之间的一致性（在3倍稀释范围内）取决于菌种、药物和孵育时间，且由于EUCAST的MIC低于CLSI的MIC：总体而言，将EUCAST的MIC与CLSI 24小时结果相比较时，氟康唑和伏立康唑的一致性为94%至95%，泊沙康唑和伊曲康唑的一致性为90%至91%。与CLSI 48小时的终点结果相比，一致性较低（85%至94%）。每种方法的总体实验室间重复性≥92%。当基于CLSI的断点分类进行比较时，对于包含耐氟康唑和S-DD菌株的4种菌种中的3种，一致性为68%至76%；在耐氟康唑菌株中观察到9%的重大差异（≤8μg/ml对≥64μg/ml），伏立康唑为50%（≤1μg/ml对≥4μg/ml）。在所评估的8种菌种中的7种中，伊曲康唑也观察到类似结果（分类一致性为28%至77%）。对于其中一些菌株，泊沙康唑的EUCAST MIC也显著低于CLSI的MIC模式（0.008至1μg/ml对1至≥8μg/ml）。因此，CLSI的断点不应被用于解释EUCAST的MIC数据。
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