结核分枝杆菌传统药敏试验方法.pptVIP

* 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 orange line, cumulative distribution of susceptibility of PR strains. If you look at cumulative susceptibility at the different concentrations of INH, you can easily notice 0.2 mcg/ml discriminate these two populations of clinical samples. However, this concentration did not discriminate with 100% power because the various reasons discrimination power was only 75.8%. 13.1% of PS were classified as Resistance mainly due to technical variation and inclusion of PR strains and 11.1% of PR strains as susceptible strains again mainly due to technical errors and inclusion of rapid acetylators, the patients with poor adherence to treatment, and many other factors will cause it. Right hand figure shows cumulative distribution of susceptibility to a wide range of critical resistant proportions at 2 mcg/ml of isoniazid. Although difference is small, but still 1.0% critical proportion can discriminate these two samples of clinical isolates most widely. * * * * * * * 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 po