PDF(Pubmed)
Abstract：
There are increasing reports of carbapenem-resistant Enterobacterales (CRE) that test as cefepime-susceptible (S) or susceptible-dose dependent (SDD). However, there are no data to compare the cefepime testing performance of BD Phoenix automated susceptibility system (BD Phoenix) and disk diffusion (DD) relative to reference broth microdilution (BMD) against carbapenemase-producing (CPblaKPC-CRE) and non-producing (non-CP CRE) isolates. Cefepime susceptibility results were interpreted according to CLSI M100Ed32. Essential agreement (EA), categorical agreement (CA), minor errors (miEs), major errors (MEs), and very major errors (VMEs) were calculated for BD Phoenix (NMIC-306 Gram-negative panel) and DD relative to BMD. Correlates were also analyzed by the error rate-bounded method. EA and CA for CPblaKPC-CRE isolates (n = 64) were <90% with BD Phoenix while among non-CP CRE isolates (n = 58), EA and CA were 96.6%, and 79.3%, respectively. CA was <90% with DD for both cohorts. No ME or VME was observed for either isolate cohort; however, miEs were >10% for CPblaKPC-CRE and non-CP CRE with BD Phoenix and DD tests. For error rate-bounded method, miEs were <40% for IHigh + 1 to ILow - 1 ranges for CPblaKPC-CRE and non-CP CRE with BD Phoenix. Regarding disk diffusion, miEs were unacceptable for all MIC ranges among CPblaKPC-CRE. For non-CP CRE isolates, only IHigh + 1 to ILow - 1 range was acceptable at 37.2%. Using this challenge set of genotypic-phenotypic discordant CRE, the BD Phoenix MICs and DD susceptibility results trended higher (toward SDD and resistant phenotypes) relative to reference BMD results yielding lower CA. These results were more prominent among CPblaKPC-CRE than non-CP CRE.
摘要：
越来越多的碳青霉烯类耐药肠杆菌（CRE）的报道被测试为头孢吡肟敏感（S）或易感剂量依赖性（SDD）。然而,没有数据可以比较BDPhoenix自动药敏系统(BDPhoenix)和圆盘扩散(DD)相对于参考肉汤微量稀释(BMD)对产碳青霉烯酶(CPblaKPC-CRE)和非产(非CPCRE)分离株的头孢吡肟检测性能.根据CLSIM100Ed32解释头孢吡肟敏感性结果。基本协议(EA)，绝对协议(CA)，小错误(MIE)，主要错误(ME)，计算BDPhoenix（NMIC-306革兰氏阴性图）和DD相对于BMD的非常大的误差（VME）。还通过错误率有界方法分析了相关性。对于BDPhoenix，CPblaKPC-CRE分离株（n=64）的EA和CA<90％，而在非CPCRE分离株（n=58）中，EA和CA为96.6%，和79.3%，分别。两个队列的CA均<90%,DD。任一分离组均未观察到ME或VME；然而，通过BDPhoenix和DD测试，CPblaKPC-CRE和非CPCRE的miE>10%。对于错误率有界方法，对于具有BDPhoenix的CPblaKPC-CRE和非CPCRE，IHigh+1至IILow-1范围的miE<40%。关于磁盘扩散，对于CPblaKPC-CRE中的所有MIC范围，miE都是不可接受的。对于非CPCRE分离株，只有IHigh+1到ILow-1范围是可以接受的，为37.2%。使用这个挑战组的基因型-表型不一致的CRE，相对于参考BMD结果，BDPhoenixMIC和DD易感性结果呈较高趋势（朝向SDD和抗性表型），从而产生较低的CA。这些结果在CPblaKPC-CRE中比非CPCRE更为突出。
