053.革兰氏阳性细菌抗生素耐药检测概览.ppt

标本：尿 诊断：急性膀胱炎105 CFU/ml 腐生葡萄球菌 “腐生葡萄球菌对治疗急性非复杂尿路感染的药物（如呋喃妥因，复方磺胺或氟喹诺酮类）能达到的尿液浓度有反应“ Final Report终报告 CLSI M100-S19. Table 2C. CLSI说不必要检测 葡萄球菌-总结（1） Cefoxitin disk diffusion and cefoxitin MIC tests are more sensitive in detecting mecA-mediated resistance in staphylococci than tests using oxacillin.头孢西丁纸片扩散法和头孢西丁MIC法在检测mecA介导的葡萄球菌耐药上优于苯唑西林。 Borderline oxacillin resistance in S. aureus may be missed with cefoxitin tests; borderline oxacillin resistance is rare in S. aureus and has not been reported in CoNS. 用头孢西丁试验可能会漏检苯唑西林边介耐药金葡菌；苯唑西林边介耐药在金葡菌中很少见，在凝固酶阴性葡萄球菌中还未报道。 Borderline oxacillin resistant S. aureus may not be clinically significant. 苯唑西林边介耐药的金葡菌可能没有临床意义。 VISA are often slow growing, may have colonies with morphology inconsistent with S. aureus and may therefore be easily missed. VISA常生长缓慢且菌落形态与金葡菌不一致，易被漏检。 Staphylococcus - Summary (2)葡萄球菌-总结（2） VRSA are uncommon (9 to date in USA) and are likely to be detected with most AST systems.VRSA不常见（美国至今报道9例），大多数药敏系统均可检测出。 There are currently no CLSI or other standard recommendations for testing for hVISA.目前没有CLSI或其他标准推荐来检测hVISA。 Infections due to MRSA with vancomycin susceptible MICs of 2 μg/ml may require higher doses of vancomycin or use of alternative agents.由万古霉素MIC为2 μg/ml 的MRSA引起的感染可能需要更高剂量的万古霉素进行治疗或使用其他药物。 Vancomycin disk diffusion test should only be used to rule out VRSA; it cannot distinguish VISA from VSSA.万古霉素纸片扩散法试验只能用于筛除VRSA；它不能区分VISA和VSSA。 Staphylococcus - Summary (3)葡萄球菌-总结（3） Erythromycin-R and clindamycin-S staphylococci should NOT be reported as clindamycin-S without performance of a test for inducible clindamycin resistance (e.g., D zone test).对于红霉素耐药且克林霉素敏感的葡萄球菌，若未进行诱导性克林霉素耐药试验（如D试验），不能报告克林霉素敏感。 Oxacillin disk diffusion test was eliminated for CoNS in 2009. 在2009年中，苯唑西林纸片扩散法试验不能用于检测凝固酶阴性葡萄球菌。 Oxacillin MIC tests work well for S. epidermidis but can overcall oxacillin-R in other CoNS that lack mecA. The cefoxitin disk diffusion test is better. 苯唑西林MIC试验适用于表皮葡萄球菌但可能高估了其他mecA阴性凝固酶阴性葡萄球菌的苯唑西林耐药性。比较而言