结核分枝杆菌传统药敏试验方法课件.pptVIP

 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) 90-94 4 (8.2) 5 (9.8) 90 1 (2.0) 0 Total number of labs 合计 49 (100.0) 51 (100.0) Test Drug 药物 敏感性 (%) 特异性 (%) 患病情况下的耐药结果预测值(%) 1%1 5%1 10%1 30%1 KM2 100 90 9.2 34.5 52.6 81.1 CPM2 100 96 20.0 56.8 73.5 91.5 OFX2 100 97 25.0 64.1 78.7 93.5 ETH2 79 91 8.2 32.0 49.4 79.0 二线抗结核药物耐药预测值 1 Prevalence rates 2 Results of SLDST proficiency tests done once in 2004 (coordinated by Dr. Nuria Martine Casabona) (participated SRL=9) 3 Based on sensitivity/ specificity of 9 rounds proficiency tests of SRLs, 1994-2002 利福平敏感性试验耐药预测值基于跨国参比实验室网络第14轮熟练度测试数据（来源于Armand Van Deun） Resistance predictive values (%) Resistance prevalence 敏感性= 99.6% 特异性= 97.9% 小结和结论 1. 传统的药敏试验方法需要很长时间-耗时长，直接的药敏试验过去常常被应用-应用于临床。 2. 除异烟肼及利福平外，其他药物的技术可靠性仍不是很让人满意 3. 卡那霉素/氧氟沙星的重复性较好，但是大量的可能耐药的分离菌株在其临界浓度时是敏感的 小结和结论 4.因为试验材料，这些药物的临界浓度与可能敏感株的MIC非常接近，微小的操作变化会导致结果的改变 5. 在严格的内部/外部质量保证下进行好的标化药敏试验，对是持续工作的有力保障 * Greeting. I have been asked to speak on susceptibility testing to secondline drugs, which is tough issue to deal. * * * * * * * Reliability of DST results largely depend on two major factors, one is how well the criteria of resistance of the given test method correlate with clinical response in patients and the other one is how well physicochemical test environment is controlled to obtain reproducible test results. Many existing DST methods suffer very much from irrelevance of clinical response due to these two factors. * * * This is an example of calibration of susceptibility tests to isoniazid. We have done this study many years ago to find out first reasonable criteria of INH resistance in absolute concentration method using L-J medium with 99 PS strains and 117 IHN PR strains. Figures shows cumulative percentage of susceptibility to the wide range of IINH concentrations, blue line indicates cumulative distribution of susceptibility of PS strains and ora