结核分枝杆菌传统药敏试验方法.pptVIP

* This slide shows some of physicochemical factors affecting DST results. The amount of active drug in culture media may vary with drug dissolution, dilution, sterilization, and storage, and substantial amount of certain drugs added in the medium before inspissation or sterilization will be inactivated by heating and/or by protein binding or filtration. And some compounds in the media will antagonize activity of certain drugs. For example, phospholipids antagonize SM; D-alanine antagonize cycloserine; methionine antagonize PAS; polyamines or ions may antagonize EMB. Aminoglycisides and polypeptide antibiotics are fairly well sensitive to pH of medium. DST results are also influenced to a great extent by inoculum size, representativeness, dispersion and viability of bacilli in inoculum. So, if we fail control of those factors, we cannot obtain reliable and reproducible results. * * * * * * Objectives of this guideline is to assist TB control program managers and physicians in proper use of second-line drug susceptibility test data and to permit determination of true scope of second-line drug resistance for surveillance. The guideline also aim to recommend the laboratory to use standardized second-line DST methodologies and protocols; appropriate classes of drugs for DST; the scope of internal QC measures; and a framework for the evaluation of new drugs. * Objectives of this guideline is to assist TB control program managers and physicians in proper use of second-line drug susceptibility test data and to permit determination of true scope of second-line drug resistance for surveillance. The guideline also aim to recommend the laboratory to use standardized second-line DST methodologies and protocols; appropriate classes of drugs for DST; the scope of internal QC measures; and a framework for the evaluation of new drugs.  51个国家（或地区）参比实验室利福平和异烟肼药敏试验结果的一致性（世界卫生组织第四期全球耐药报告，2008） % Agreement一致性 Isoniazid异烟肼 Rifampicin利福平 100 38 (77.6) 37 (72.5) 95-99 6 (12.2) 9 (17.6) 90