CMI:碳青霉烯类耐药肠杆菌对抗菌药物敏感性半自动检测系统的严重的临床后果

2022-04-09 从医路漫漫 MedSci原创

ME和VME是比较常见的半自动药敏试验系统。VME与抗生素的不当使用和较差的预后有关。

背景:耐碳青霉烯类肠杆菌(CRE)被认为是一种全球卫生紧急情况。由CRE引起的感染与高死亡率、复发率和微生物学失败有关。半自动系统对几种常用于治疗CRE的药物进行的抗菌药物敏感性试验(AST)的可靠性存在差异。临床和实验室标准研究所(CLSI)和欧洲抗菌药物敏感性试验委员会(EUCAST)都建议使用参考微量稀释法(BMD)对一些最后手段的抗生素进行敏感性试验,如粘菌素和替加环素,或磷霉素琼脂稀释法,以避免这一问题。此外,与半自动系统相比,由于需要额外的工作量,参考方法并不总是用于诊断实验室的常规药敏试验。

目的:在本研究中,调查了半自动系统和参考系统对CRE的药敏试验差异率,以及半自动系统所谓的错误对指导CRE血流感染(BSI)靶向治疗的影响。

方法:多中心回顾性研究,纳入2013年1月至2016年12月由CRE引起的单一微生物BSI患者。在转诊实验室集中使用半自动系统对索引血培养中的非重复分离物进行本地检测,并通过参考肉汤微量稀释或琼脂稀释法进行重新检测。

结果:我们纳入了366例CRE-BSI患者;220人(60%)为男性,中位年龄(IQR)为67岁(54-76岁)。当与参考方法的结果相比较时,半自动系统的结果表现出非常大的误差(VME,即假磁化率)和大的误差可变比率(ME,即假电阻)。磷霉素(14%)和粘菌素(13.9%)的VME发生率最高,而庆大霉素(21%)、磷霉素(7.7%)和替加环素(34%)的ME发生率最高。总的来说,VME和ME带领临床医生对341例患者中的25例(7%)进行了无效治疗。根据Kaplan-Meier生存曲线,与接受积极治疗相比,接受误导性药物敏感性试验支持的无效治疗与较高的30天死亡率相关[56%比26% (p=0.002)],在校正COX回归模型中的混杂因素后证实了这一差异[aHR 2.91(95%1.62-5.22) p<0.001]。

表1 根据美罗培南、磷霉素、阿米卡星、庆大霉素、粘菌素和替加环素的EUCAST断点*对从3家大型三级教学医院收集的366株耐碳青霉烯类肠杆菌进行最小抑菌分布(MIC)、MIC50、MIC90

图1 Kaplan-Meier曲线分析了由于自动化测试的误导性结果而导致的不适当靶向治疗的影响,并与根据对相同菌株进行的回顾性参考测试进行的积极治疗进行了比较。用对数秩检验进行比较

结论:ME和VME是比较常见的半自动药敏试验系统。VME与抗生素的不当使用和较差的预后有关。

原文出处:Bartoletti M,  Antonelli A,  Bussini L,et al.Clinical consequences of very major and errors with semi-automated testing systems for antimicrobial susceptibility of carbapenem-resistant enterobacterales.Clin Microbiol Infect 2022 Mar 17

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    2022-04-08 lhlxtx
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