Klebsiella pneumoniae and Colistin Susceptibility Testing: Performance Evaluation for Broth Microdilution, Agar Dilution and Minimum Inhibitory Concentration Test Strips and Impact of the "Skipped Well" Phenomenon.
Klebsiella pneumoniae and Colistin Susceptibility Testing: Performance Evaluation for Broth Microdilution, Agar Dilution and Minimum Inhibitory Concentration Test Strips and Impact of the "Skipped Well" Phenomenon.
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DOI：
10.3390/diagnostics11122352
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发表时间：
2021-12-14
期刊：
影响因子：
--
通讯作者：
Perdigão J
中科院分区：
文献类型：
--
作者：
Elias R;Melo-Cristino J;Lito L;Pinto M;Gonçalves L;Campino S;Clark TG;Duarte A;Perdigão J
多重耐药革兰氏阴性病原体的出现，特别是碳青霉烯酶产生者，迫使临床医生使用最后一线抗生素，例如粘菌素。由于粘菌素药敏试验存在一些挑战，本研究旨在评估肺炎克雷伯菌的两种替代药敏方法的性能，即琼脂稀释法 (AD) 和 MIC 试纸 (MTS)。这些方法与参考方法肉汤微量稀释 (BMD) 进行了比较，并为“跳井”(SW) 现象提供了定量描述。使用 141 个肺炎克雷伯菌临床分离株，通过 BMD 和 AD 平行评估粘菌素敏感性，并一式三份，而 MTS 性能仅针对一个子集（n = 121）进行评估。最低抑菌浓度分析显示，由于以下原因，初始分离株的很大一部分（n = 26/141；18.4%）被认为未通过 BMD 确定： 重复之间的不一致（1.4%）；存在多个软件（7.8%）；以及这两个事件的组合（9.2%）。 AD 和 MTS 均显示大量假敏感菌株（“非常重大的错误”），分别为 37.5% 和 68.8%。然而，AD 一致性指数相当高（EA = 71.3%，CA = 94.8%）。对于 MTS，这些指数较低，特别是 EA（EA = 41.7% 和 CA = 89.6），但该方法能够检测四个分离株的不同亚群。总之，本研究提供了关于 AD 和 MTS 在肺炎克雷伯菌粘菌素药敏试验中的性能的最全面的研究，强调了其局限性，并强调了样本量和组成的重要性。此外，本研究强调了与 BMD 方法相关的 SW 现象对肺炎克雷伯菌的影响。
The emergence of multidrug resistant Gram-negative pathogens, particularly carbapenemase producers, has forced clinicians to use last line antibiotics, such as colistin. Since colistin susceptibility testing presents several challenges, this study aimed at evaluating the performance of two alternative susceptibility methods for Klebsiella pneumoniae, namely, agar dilution (AD) and MIC test strips (MTS). These approaches were compared with the reference method, broth microdilution (BMD), and provide a quantitative description for the “skipped well” (SW) phenomenon. Colistin susceptibility was evaluated by BMD and AD in parallel and triplicate, using 141 K. pneumoniae clinical isolates while MTS performance was evaluated only for a subset (n = 121). Minimum inhibitory concentration analysis revealed that a substantial part (n = 26/141; 18.4%) of the initial isolates was deemed undetermined by BMD due to the following: discordance between replicates (1.4%); presence of multiple SWs (7.8%); and the combination of both events (9.2%). Both AD and MTS revealed a high number of false-susceptible strains (“very major errors”), 37.5% and 68.8%, respectively. However, AD agreement indices were reasonably high (EA = 71.3% and CA = 94.8%). For MTS these indices were lower, in particular EA (EA = 41.7% and CA = 89.6), but the approach enabled the detection of distinct sub-populations for four isolates. In conclusion, this study provides the most comprehensive study on the performance of AD and MTS for colistin susceptibility testing in K. pneumoniae, highlighting its limitations, and stressing the importance of sample size and composition. Further, this study highlights the impact of the SW phenomenon associated with the BMD method for K. pneumoniae.
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DOI：
10.3390/diagnostics11071165
发表时间：
2021-06-25
期刊：
Diagnostics (Basel, Switzerland)
影响因子：
--
作者：
Elias R;Duarte A;Perdigão J
通讯作者：
Perdigão J
影响因子：
9.4
作者：
Lat, Asma;Clock, Sarah A.;Kubin, Christine J.
通讯作者：
Kubin, Christine J.
影响因子：
4.9
作者：
Jayol, Aurelie;Nordmann, Patrice;Poirel, Laurent
通讯作者：
Poirel, Laurent
影响因子：
9.4
作者：
Chew, Ka Lip;La, My-Van;Teo, Jeanette W. P.
通讯作者：
Teo, Jeanette W. P.
影响因子：
56.3
作者：
Liu, Yi-Yun;Wang, Yang;Shen, Jianzhong
通讯作者：
Shen, Jianzhong