不同方法检测黏液型铜绿假单胞菌药物敏感性结果比较

摘要

Objective To compare the difference of three methods testing the antibiotic susceptibility of mucoid Pseudomonas aeruginosa in order to provide accurate and reliable antibiotic susceptibility result for clinic.Methods A total of 630 mucoid Pseudomonas aeruginosa were collected from Linyi People′s Hospital during January 2015 to December 2016.They mainly come from respiratory medicine and the most common specimen source was sputum.All specimens were examined in 2 h.The strains isolated from the same patient were discarded.Antibiotic susceptibility was tested by the automatic microorganism analyzer VITEK2 compact, E-test, which was reference method, and K-B disk.The results of three methods were analyzed and compared by χ2 test.Results The result of E-test showed that antibiotic sensitivity of 630 mucoid Pseudomonas aeruginosa was above 52.7% except for Cefepime (39.2%).The result of K-B disk was compared with E-test, the antibiotic sensitivity of mucoid Pseudomonas aeruginosa to imipenem (72.4% vs 52.7%) and amikacin (48.6% vs 71.1%)had significant difference (χ2=8.283 7 and 10.533 8, P<0.05).The result of VITEK2 compact showed that the antibiotic susceptibility of mucoid Pseudomonas aeruginosa to imipenem(70.8% vs 52.7%), cefepime(60.8% vs 39.2%), gentamicin (87.6% vs 74.1%)and levofloxacin(81.3% vs 65.4%) was significant higher than the result of E-test (χ2=6.935 2,9.331 2,5.885 6 and 6.466 5, P<0.05).For tobramycin, piperacillin/tazobactam and ciprofloxacin, the result of three methods is more consistent.Compared to VITEK2 compact, the consistency between K-B disk and E-test was higher.The rate of very major error and major error were between 0.0%-4.8% (Amikacin 12.2%) and minor error was 4.6%-20.3%.Conclusions The drug sensitivity of mucoid Pseudomonas aeruginosa is different between various methods.The result of K-B disk and E-test using blood MH is more reliable than VITEK2 compact.%目的 比较不同方法检测黏液型铜绿假单胞菌药物敏感性结果是否有差异, 为临床提供准确可靠的药物敏感性检测结果.方法 收集2015年1月至2016年12月临沂市人民医院分离的黏液型铜绿假单胞菌630株,科室来源主要是呼吸内科,标本来源主要是痰液.所有标本均在2 h内送检,同一患者多次分离到的菌株不重复计入.分别采用VITEK2 compact全自动细菌鉴定及药敏分析系统、K-B纸片法和E-test法对黏液型铜绿假单胞菌进行药物敏感性检测,以E-test法为参考方法,用χ2检验对3种方法的药物敏感性结果进行统计分析.结果 E-test法药敏结果显示黏液型铜绿假单胞菌对大部分抗菌药物敏感率都较高,除对头孢吡肟敏感率为39.2%外,其余药物敏感率均≥52.7%.K-B法检测结果与E-test法比较,对亚胺培南(72.4% vs 52.7%)和阿米卡星(48.6% vs 71.1%)的敏感率差异有统计学意义(χ2=8.283 7和10.533 8,P<0.05);仪器法检测结果显示黏液型铜绿假单胞菌对亚胺培南(70.8% vs 52.7%)、头孢吡肟(60.8% vs 39.2%)、庆大霉素(87.6% vs 74.1%)和左氧氟沙星(81.3% vs 65.4%)的敏感率均高于E-test法(χ2=6.935 2、9.331 2、5.885 6和6.466 5,P<0.05).对于妥布霉素、哌拉西林/他唑巴坦和环丙沙星,3种方法的检测结果较一致.K-B法与E-test法敏感率解释一致性较高,非常严重错误(VME)和重大错误(ME)的出现几率在0.0%~4.8%之间 (阿米卡星为12.2%),一般错误(MIE)的几率为4.6%~20.3%.结论 不同方法检测黏液型铜绿假单胞菌药物敏感性结果有所差异,黏液型铜绿假单胞菌使用血MH琼脂平板采用K-B法或E-test法结果较可靠.