CLSI、EUCAST和中国耐药判定标准概述

doi:10.13560/j.cnki.biotech.bull.1985.2022-0695

摘要/Abstract

摘要：

制定耐药判定标准的意义在于对药敏试验结果进行解释,以选择合适的药物和最佳的给药方案对动物进行治疗,是控制耐药性产生的重要手段。目前许多发达国家都成立了制定耐药判定标准的机构,其中最具影响力和权威的是美国临床和实验室标准协会以及欧盟药敏试验标准委员会两大机构。中国耐药性监测的研究起步较晚,主要借鉴美国临床和实验室标准协会所设立的耐药判定标准。2017年,在欧洲临床微生物和感染病学会和欧洲药敏试验委员会的支持下中国成立了华人药物敏感性试验委员会。近年来,在中国兽医药品监察所的带领下,各研究机构人员在耐药判定标准及耐药性监测方面也取得了突破性的进展,为控制中国抗菌药物耐药性的发展奠定了坚实的基础。本文首先介绍了耐药判定标准的定义和意义,为微生物研究者提供基本的理解;然后分别综述美国临床和实验室标准协会与欧盟药敏试验标准委员会的基本情况,并比较两者在兽用抗菌药物耐药判定标准制定上的差异;最后对中国兽用抗菌药物耐药性监测和耐药判定标准制定方面的成果进行分析总结。总体来说,中国在兽用抗菌药物耐药性控制方面处于稳步增长状态,已经制定的许多耐药判定标准对控制耐药性的发展具有重要意义。但仍有许多兽用抗菌药物缺乏相应的耐药判定标准,需要更多的研究者在未来找到更加快速、简便和准确的方法,不断填补、更新兽用抗菌药物的耐药判定标准。

关键词: 兽用抗菌药, CLSI, EUCAST, 折点, 差异

Abstract:

The significance of establishing susceptibility breakpoints is to interpret the results of drug susceptibility tests,and to select appropriate drugs and optimal dosing regimens in treating animals,which is an important means to control drug resistance. At present,institutions to establish susceptibility breakpoints have been established in many developed countries,among which the most influential and authoritative institutions are the Clinical and Laboratory Standards Institute（CLSI）and the European Committee on Antimicrobial Susceptibility Testing（EUCAST）. The research on drug resistance monitoring in China started relatively late,and mainly drew on the susceptibility breakpoints established by the CLSI. In 2017,with the support of the European Society for Clinical Microbiology and Infectious Diseases and EUCAST,the Chinese Committee on Antimicrobial Susceptibility Testing was established in China. Leading by the China Institute of Veterinary Drug Control（IVDC）in recent years,researchers from various research institutions have also made breakthroughs in susceptibility breakpoints and drug resistance monitoring,laying a solid foundation for controlling the development of antimicrobial resistance in China. This article first introduced the definition and significance of susceptibility breakpoints to provide a basic understanding for microbiological researchers. Then,it reviewed the basic situation of the CLSI and the EUCAST,and compared the differences in the establishment of susceptibility breakpoints between the two. Finally,this article analyzed and summarized the results of China's veterinary antimicrobial resistance monitoring and susceptibility breakpoints. In general,China is in a state of steady growth in the control of veterinary antimicrobial resistance,and many established standards for the determination of resistance are of great significance for controlling the development of resistance. However,there are still many veterinary antibiotics lacking corresponding susceptibility breakpoints,which requires more researchers to find more rapid,simple and accurate methods in the future,and fill and update the susceptibility breakpoints of veterinary antibiotics.

Key words: veterinary antimicrobials, CLSI, EUCAST, breakpoint, difference

阮紫涵, 黄安雄, 王秀娟, 黄玲利, 郝海红. CLSI、EUCAST和中国耐药判定标准概述[J]. 生物技术通报, 2022, 38(9): 47-58.

RUAN Zi-han, HUANG An-xiong, WANG Xiu-juan, HUANG Ling-li, HAO Hai-hong. Overview of CLSI,EUCAST,and Susceptibility Breakpoints in China[J]. Biotechnology Bulletin, 2022, 38(9): 47-58.

图/表 5

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委员会 Committee	职责 Responsibility	主要文件 Main documents
抗菌药物敏感性试验（AST）小组委员会Antimicrobial Susceptibility Testing（AST）Subcommittee	为实验室提供信息,使其为临床医生选择适当的抗菌治疗提供建议Provide the laboratory with information to advise the clinician on the choice of appropriate antimicrobial therapy	M100、M23、M11、M07、M02
抗真菌药物敏感性试验委员会Antifungal Susceptibility Testing Subcommittee	制定标准和指南,促进准确的抗真菌药物敏感性试验和适当的报告Develop standards and guidelines to facilitate accurate antifungal susceptibility testing and appropriate reporting	M54、M59、M60、M61
兽用抗菌药物敏感性试验（VAST）委员会Veterinary Antimicrobial Susceptibility Testing（VAST）	VAST小组委员会合作制定标准和指南,确保准确的抗菌药物敏感性试验和适当的报告The VAST subcommittee collaborated to develop standards and guidelines to ensure accurate antimicrobial susceptibility testing and appropriate reporting	VET01、VET01S、VET03

委员会 Committee	职责 Responsibility	主要文件 Main documents
抗菌药物敏感性试验（AST）小组委员会Antimicrobial Susceptibility Testing（AST）Subcommittee	为实验室提供信息,使其为临床医生选择适当的抗菌治疗提供建议Provide the laboratory with information to advise the clinician on the choice of appropriate antimicrobial therapy	M100、M23、M11、M07、M02
抗真菌药物敏感性试验委员会Antifungal Susceptibility Testing Subcommittee	制定标准和指南,促进准确的抗真菌药物敏感性试验和适当的报告Develop standards and guidelines to facilitate accurate antifungal susceptibility testing and appropriate reporting	M54、M59、M60、M61
兽用抗菌药物敏感性试验（VAST）委员会Veterinary Antimicrobial Susceptibility Testing（VAST）	VAST小组委员会合作制定标准和指南,确保准确的抗菌药物敏感性试验和适当的报告The VAST subcommittee collaborated to develop standards and guidelines to ensure accurate antimicrobial susceptibility testing and appropriate reporting	VET01、VET01S、VET03

抗菌药物类别 Class of antibiotics	抗菌药物 Antibiotic
氨基糖苷类Aminoglycosides	卡那霉素,阿米卡星,链霉素Kanamycin,Amikacin,Streptomycin
大环内酯类Macrolides	红霉素Erythromycin
叶酸途径抑制剂Folic acid pathway inhibitor	磺胺类药物、甲氧苄氨Sulfonamides,Trimethoprim
糖肽类Glycopeptides	万古霉素、替考拉宁Vancomycin,Teicoplanin
其他Others	氟苯尼考,呋喃妥因、黏菌素、夫西地酸、利福平、甲硝唑Flufenicol,Nitrofurantoin,Colistin,Fusidic Acid,Rifampicin,Metronidazole

抗菌药物类别 Class of antibiotics	抗菌药物 Antibiotic
氨基糖苷类Aminoglycosides	卡那霉素,阿米卡星,链霉素Kanamycin,Amikacin,Streptomycin
大环内酯类Macrolides	红霉素Erythromycin
叶酸途径抑制剂Folic acid pathway inhibitor	磺胺类药物、甲氧苄氨Sulfonamides,Trimethoprim
糖肽类Glycopeptides	万古霉素、替考拉宁Vancomycin,Teicoplanin
其他Others	氟苯尼考,呋喃妥因、黏菌素、夫西地酸、利福平、甲硝唑Flufenicol,Nitrofurantoin,Colistin,Fusidic Acid,Rifampicin,Metronidazole

微生物Microorganism	抗菌药物Antibacterial agent	MIC折点 MIC breakpoints/（μg·mL^-1）					抑菌圈直径折点Zone diameter breakpoints /mm
		CLSI			EUCAST		CLSI			EUCAST
		S≤	I	R≥	S≤	R>	S≥	I	R≤	S≥	R<
肠杆菌Enterobacterium	哌拉西林Iperacillin	16	32-64	128	8	8	17	14-16	16	20	20
	强力霉素Oxycycline	4	8	16	-	-	14	11-13	10	-	-
	左氧氟沙星Levofloxacin	0.12	0.25-1	2	0.5	1	-	-	-	23	19
葡萄球菌 Staphylococcus spp.	氧氟沙星Ofloxacin	1^a	2^a	4^a	0.001^b/0.001^c	1^b/1^c	21^a	16-20^a	21^a	50^b/50^c	21^b/24^c
葡萄球菌 Staphylococcus spp.	左氧氟沙星Levofloxacin	1^a	2^a	4^a	0.001 ^b/0.001^c	1^b/1^c	19^a	16-18^a	15^a	50^b/50^c	22^b/24^c
肺炎链球菌 Streptococcus neumoniae	左氧氟沙星Levofloxacin	2	4	8	0.001	2	17	14-16	13	50	16
肺炎链球菌 Streptococcus neumoniae	万古霉素Ancomycin	1	-	-	2	2	17	-	-	16	16
厌氧菌 Anaerobic bacteria	美罗培南Eropenem	4^d	8^d	16^d	1^e	1^e	NF	NF	NF	28^e	28^e
厌氧菌 Anaerobic bacteria	克林霉Clindamycin	2^d	4^d	8^d	4^e	4^e	NF	NF	NF	10^e	10^e