无CLSI解释标准非发酵菌对哌拉西林/他唑巴坦敏感性三种检测方法的比较

Comparison of three methods of piperacillin/tazobactam susceptibility testing for non-fermentative bacilli with non-CLSI interpretive standards

目的评价不同方法检测无CLSI解释标准的非发酵菌对哌拉西林/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,并对三种方法相互间的符合情况进行比较。结果三种方法检测80株嗜麦芽窄食单胞菌,36株洋葱伯克霍尔德菌,23株脑膜败血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%和56.5%;耐药率分别为:32.5%、10.0%、48.8%、19.4%、38.9%、38.9%、17.4%、39.1%和21.7%。139株细菌三种方法间的符合情况:K-B法与VITEK法比较,完全符合率51.1%、部分符合率22.3%和完全不符合率26.6%;K-B法与E-test试条法比较,三者分别为61.9%、15.8%和22.3%;VITEK法与E-test试条法比较,三者分别为56.1%、16.6%和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试条符合性好于VITEK法,而其他二种细菌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-fermentative bacilli with non-CLSI interpretive standards to help to choose the methhod in clinic.Methods Using the disk diffusion, GNS-143 card in VITEK 32 system and E-test to determine the susceptibility to piperacillin/tazobactam of 139 strains of non-fermentative bacilli with non-CLSI interpretive standards. And, to compare the match rate of results of the three methods.Results We determined the resistance to piperacillin/tazobactam of 80 strains of Stenotrophomonas maltophilia and 36 strains of Burkholderia cepacia and 23 strains of Flavobacterium meningosepticum, the susceptibilities 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. The drug-resistantrates were 32.5%, 10.0%, 48.8%(by the disk diffusion), respectively; 19.4%, 38.9%, 38.9%(by GNS-143 card in VITEK 32 system), respectively;17.4%, 39.1%, 21.7%(by E-test), respectively. For the 139 strains tested, the match rate between the disk diffusion and VITEK system was 51.1%, between the disk diffusion and E-test was 61.9%, and between VITEK system and E-test was 56.1%. Conclusion Different methods to determine the resistance to piperacillin/tazobactam of same bacterium 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 Stenotrophomonas maltophilia. The others ,the match rate of VITEK system and E-test was better than that of the diffusion. So, we propose that everyone do not report the CLSI interpretive results of non-fermentative bacilli with non-CLSI interpretive standards to piperacillin/tazobactam, but, report the test results.