在囊性纤维化微生物学中,分离的细菌病原体的抗生素敏感性结果与临床结果之间通常不匹配,当患者使用相同的抗生素治疗时。这方面的推理在很大程度上仍然难以捉摸。抗生素对四种抗生素的敏感性(头孢他啶,美罗培南,在成年囊性纤维化患者的连续分离株(n=11)中确定了米诺环素和甲氧苄啶-磺胺甲恶唑),超过63个月。每种分离物显示其自己独特的抗性型。第一个分离株对所有四种抗生素都敏感,根据临床和实验室标准研究所的方法和解释标准。四个月时首次检测到耐药性,对头孢他啶和美罗宁具有抗性,对米诺环素和甲氧苄啶-磺胺甲恶唑具有中等抗性。Pan抗性在18个月时首次检测到(抗性IV型),具有三种抗性型(I,II和III)在该完全抗性型之前。在接下来的45个月中,该细菌继续显示出进一步的抗生素敏感性异质性,并描述了另外7种抗性型(抗性型V-XI)。该细菌在63个月期间的相对抗性指数显示抗生素抗性的发展与时间之间没有关系。采用多项分布的数学模型表明,大量的个体菌落采摘(>40/痰),将需要78%的信心捕获存在的所有11个抗性型。对大量菌落的需求与与抗生素敏感性相关的方法学问题相结合,在生物医学科学实践中产生了一个难题。在提供一个强大的检测,将捕获抗生素易感性的变化,务实且具有成本效益的提供病理服务,但具有帮助临床医生为患者选择合适的抗生素的可靠性。这项研究代表了生物医学科学的进步,因为它证明了伯克霍尔德氏菌对ciocepacia的抗生素敏感性测试的潜在变异性。呼吸科医生和儿科医生需要让生物医学科学家意识到这种变化,以便临床医生可以将报告的易感性结果的重要性置于上下文中,当为囊性纤维化患者选择合适的抗生素时。此外,需要考虑在实验室报告中提供额外的指导,以强调这种异质性,从而强调易感性结果和临床结局之间可能存在不一致.
Within cystic fibrosis microbiology, there is often mismatch between the antibiotic susceptibility result of an isolated bacterial pathogen and the clinical outcome, when the patient is treated with the same antibiotic. The reasoning for this remains largely elusive. Antibiotic susceptibility to four antibiotics (ceftazidime, meropenem, minocycline and trimethoprim-sulfamethoxazole) was determined in consecutive isolates (n = 11) from an adult cystic fibrosis patient, over a 63 month period. Each isolate displayed its own unique resistotype. The first isolate was sensitive to all four antibiotics, in accordance with Clinical and Laboratory Standards Institute methodology and interpretative criteria. Resistance was first detected at four months, showing resistance to ceftazidime and meropenen and intermediate resistance to minocycline and trimethoprim-sulfamethoxazole. Pan resistance was first detected at 18 months (resistotype IV), with three resistotypes (I, II and III) preceding this complete resistotype. The bacterium continued to display further antibiotic susceptibility heterogeneity for the next 45 months, with the description of an additional seven resistotypes (resistotypes V-XI). The Relative Resistance Index of this bacterium over the 63 month period showed no relationship between the development of antibiotic resistance and time. Adoption of mathematical modelling employing multinomial distribution demonstrated that large numbers of individual colony picks (>40/sputum), would be required to be 78% confident of capturing all 11 resistotypes present. Such a requirement for large numbers of colony picks combined with antibiotic susceptibility-related methodological problems creates a conundrum in biomedical science practice, in providing a robust assay that will capture antibiotic susceptibility variation, be pragmatic and cost-effective to deliver as a pathology service, but have the reliability to help clinicians select appropriate antibiotics for their patients. This study represents an advance in biomedical science as it demonstrates potential variability in antibiotic susceptibility testing with Burkholderia cenocepacia. Respiratory physicians and paediatricians need to be made aware of such variation by biomedical scientists at the bench, so that clinicians can contextualise the significance of the reported susceptibility result, when selecting appropriate antibiotics for their cystic fibrosis patient. Furthermore, consideration needs to be given in providing additional guidance on the laboratory report to highlight this heterogeneity to emphasise the potential for misalignment between susceptibility result and clinical outcome.