哌拉西林/他唑巴坦对三种非发酵菌体外敏感性检测方法的比较

Comparison of three methods of piperacillin/tazobactam susceptibility test for non-enterbacteriaceae

目的评价不同方法检测无CLSI解释标准的3种非发酵菌———嗜麦芽窄食单胞菌、洋葱伯克霍尔德菌、脑膜脓毒性黄杆菌对哌拉西林/他唑巴坦的耐药性情况,以利于检测方法的选择应用。方法同时用标准K-B法、VITEK-32配套的药敏检测卡GNS-143法、E-test试条法检测临床分离的139株无CLSI解释标准的非发酵菌对哌拉西林/他唑巴坦的敏感性,并对3种方法相互间的符合情况进行比较。结果3种方法检测80株嗜麦芽窄食单胞菌,36株洋葱伯克霍尔德菌,23株脑膜脓毒性黄杆菌对哌拉西林/他唑巴坦的敏感率分别为:46.3%、82.5%、45.0%,77.8%、44.4%、52.8%,69.6%、52.2%、56.5%;耐药率分别为:32.5%、10.0%、48.8%,19.4%、38.9%、38.9%,17.4%、39.1%、21.7%。139株细菌3种方法间的符合情况:K-B法与VITEK法比较,完全符合率为51.1%、部分符合率为22.3%、完全不符合率为26.6%;K-B法与E-test试条法比较,三者分别为61.9%、15.8%、22.3%;VITEK法与E-test试条法比较,三者分别为56.1%、16.6%、27.3%。结论不同的方法检测同一种细菌对哌拉西林/他唑巴坦的药敏结果有较大不同,各方法间的可比性较差。嗜麦芽窄食单胞菌K-B法与E-test试条法符合性好于VITEK法,而其他2种细菌VITEK法好于K-B法。建议临床实验室对此类细菌的药敏检测仅报告实验检测结果,而不报药敏检测解释结果。

Objective To evaluate the resistance to piperacillin/tazobactam of non-enterobacteriaceae with non- CLSI interpretive standards to help to choose the method in clinic. Methods The disk diffusion and GNS-143 card in VITEK 32 system and E-test were used determine the susceptibility of piperacillin/tazobactam of 139 strains of non-enter- obacteriaceae with non-CLSI interpretive standards. And, to compare the match rate of results of the three methods. Results We determind the resistance to piperacillin/tazobactam of 80 strains of Stenotrophomonas mahophilia and 36 strains of Burkholderia cepacia and 23 strains of Flavbacterium meningosepticum, the susceptibility were 46.3 % , 82.5% , 45.0% （by the disk diffusion） ,respectively,77.8% , 44.4% , 52.8% （by GNS-143 card in VITEK 32 system） , respectively, 69.6% , 52.2% , 56.5 % （by E-test）, respectively. For the 139 strains that were tested,the match rate between the disk diffusion and VITEK system was 51.1% ,and between the disk diffusion and E-test was 61.9% ,and between VITEK system and E-test was 56.1%. Conclusions Different methods to determine the resistance to piperacillin/tazobactam of same bacteria had different results. The match rate was poor between the different methods, but,it was better between the disk diffusion and E- test than that of VITEK system in Stenotrophmonas mahophilia. The others, the match rate of vitek system and E-test was better than of the disffusion. So ,we propose that everyone do not report the CLSI interpretive results of non-enterobacteriaceae with non-CLSI interpretive standards to piperacillin/tazobactam, but, report the test results.