2007 年台湾地区多重抗药性监测计划（SMART）：从加护病房临床重要肠杆菌科分离菌检测超广谱β内醯胺酶产生与头孢吡肟最低抑菌浓度分布之关系。
Relationship between the distribution of cefepime minimum inhibitory concentrations and detection of extended-spectrum β-lactamase production among clinically important Enterobacteriaceae isolates obtained from patients in intensive care units in Taiwan: results from the Surveillance of Multicenter Antimicrobial Resistance in Taiwan (SMART) in 2007.
机构信息
Department of Emergency Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Division of Infectious Diseases, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
出版信息
J Microbiol Immunol Infect. 2015 Feb;48(1):85-91. doi: 10.1016/j.jmii.2013.07.002. Epub 2013 Aug 22.
BACKGROUND
The data on susceptibility of important cephalosporins against four Enterobacteriaceae members producing potential extended-spectrum β-lactamase (ESBL) collected from Taiwanese intensive care units are lacking.
METHODS
Minimum inhibitory concentrations (MICs) of cefotaxime, ceftazidime, and cefepime were determined using agar dilution method, against Escherichia coli (n = 344), Klebsiella pneumoniae (n = 359), Enterobacter cloacae (n = 103), and Proteus mirabilis (n = 78). Susceptibilities of these isolates to three cephalosporins were assessed according to MIC breakpoints recommended by the Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) in 2013. The double-disk synergy test using disks containing cefepime (30 μg) with or without clavulanate (10 μg) was applied to confirm production of ESBL for isolates with cephalosporin MIC ≥ 2 μg/mL.
RESULTS
A total of 175 isolates were verified as ESBL producers. The rates of cefepime susceptibility among the ESBL-producing isolates, according to CLSI (EUCAST) criteria, were 56.7% (22.4%) for E. coli, 61.3% (12.0%) for K. pneumoniae, 57.9% (31.6%) for E. cloacae, and 71.4% (7.1%) for P. mirabilis. Using different cefepime MIC breakpoints (MICs ≥ 16 μg/mL recommended by CLSI criteria and ≥ 2 μg/mL by EUCAST criteria) to define nonsusceptibility, we found that both criteria were poorer at predicting ESBL producers among K. pneumoniae and E. cloacae than among the other two species. In addition, we also found that the cefepime MIC level of 1.0 μg/mL best distinguished non-ESBL- from ESBL-producing K. pneumoniae and E. cloacae.
CONCLUSION
To detect ESBLs, CLSI should revise the cefepime MIC breakpoint against Enterobacteriaceae.
背景
缺乏来自台湾重症监护病房的四种产生潜在超广谱β-内酰胺酶（ESBL）的肠杆菌科成员对重要头孢菌素的敏感性数据。
方法
使用琼脂稀释法测定头孢噻肟、头孢他啶和头孢吡肟的最小抑菌浓度（MIC），针对大肠杆菌（n = 344）、肺炎克雷伯菌（n = 359）、阴沟肠杆菌（n = 103）和奇异变形杆菌（n = 78）。根据 2013 年临床和实验室标准协会（CLSI）和欧洲抗菌药物敏感性试验委员会（EUCAST）推荐的 MIC 折点，评估这些分离物对三种头孢菌素的敏感性。对于头孢菌素 MIC ≥ 2 μg/mL 的分离物，应用含头孢吡肟（30 μg）和克拉维酸（10 μg）的双碟协同试验来确认 ESBL 的产生。
结果
共有 175 株分离物被确认为 ESBL 产生者。根据 CLSI（EUCAST）标准，头孢吡肟药敏试验中 ESBL 产生分离株的头孢吡肟敏感性率分别为大肠杆菌 56.7%（22.4%）、肺炎克雷伯菌 61.3%（12.0%）、阴沟肠杆菌 57.9%（31.6%）和奇异变形杆菌 71.4%（7.1%）。使用不同的头孢吡肟 MIC 折点（CLSI 标准推荐的 MIC ≥ 16 μg/mL 和 EUCAST 标准的 MIC ≥ 2 μg/mL）来定义不敏感，我们发现这两个标准在预测肺炎克雷伯菌和阴沟肠杆菌中的 ESBL 产生者方面都不如其他两种。此外，我们还发现头孢吡肟 MIC 水平为 1.0 μg/mL 可最佳区分非 ESBL-和 ESBL-肺炎克雷伯菌和阴沟肠杆菌。
结论
为了检测 ESBLs，CLSI 应该修订针对肠杆菌科的头孢吡肟 MIC 折点。
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