最小抑制浓度和流行病学临界值的野生型分布-实验室和临床应用。

IF 19 1区 医学 Q1 MICROBIOLOGY
Clinical Microbiology Reviews Pub Date : 2023-12-20 Epub Date: 2023-12-01 DOI:10.1128/cmr.00100-22
Gunnar Kahlmeter, John Turnidge
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引用次数: 0

摘要

摘要通过设定流行病学临界值(ecoff或ECVs)对野生型最小抑菌浓度(MIC)和区径分布进行表征,为国际药敏试验体系中相对MIC值提供参考。一个物种和一种病原体的MIC值的分布遵循对数正态分布,在缺乏抗性机制的情况下,这种分布是单峰的,被称为野生型(WT)。WT分布的上端,即ECOFF,可以用统计方法识别。在存在表型可检测的抗性时,分布至少有一种模式(非WT),但尽管如此,WT通常使用相同的方法来识别。ECOFF提供了一个物种对一种药剂产生耐药性的最灵敏的测量方法。WT和非WT模式独立于生物体对治疗的反应,但当欧洲抗微生物药敏试验委员会(EUCAST)确定临床断点时,委员会避免了分裂目标物种WT分布的断点。这是为了避免当断点分裂主要种群时敏感性分类的可重复性较差,也是因为EUCAST未能识别野生型分布中具有不同MIC值的分离株的不同临床结果。在实验室实践中,ECOFF用于筛选和排除耐药性,并允许比较来自不同断点组织的具有不同断点的系统之间的耐药性,断点随着时间的推移而变化,以及人类和动物药物之间的不同断点。EUCAST积极鼓励同事们对网站(https://www.eucast.org/mic_and_zone_distributions_and_ecoffs)上的MIC分布提出质疑,并提供MIC和抑制带直径数据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Wild-type distributions of minimum inhibitory concentrations and epidemiological cut-off values-laboratory and clinical utility.

The characterization of wild-type minimum inhibitory concentration (MIC) and zone diameter distributions with the setting of epidemiological cut-off values (ECOFFs or ECVs) provides a reference for the otherwise relative MIC values in the international system for antimicrobial susceptibility testing. Distributions of MIC values for a species and an agent follow a log-normal distribution, which in the absence of resistance mechanisms is monomodal and designated wild type (WT). The upper end of the WT distribution, the ECOFF, can be identified with statistical methods. In the presence of phenotypically detectable resistance, the distribution has at least one more mode (the non-WT), but despite this, the WT is most often identifiable using the same methods. The ECOFF provides the most sensitive measure of resistance development in a species against an agent. The WT and non-WT modes are independent of the organism´s response to treatment, but when the European Committee on Antimicrobial Susceptibility Testing (EUCAST) determines the clinical breakpoints, the committee avoids breakpoints that split WT distributions of target species. This is to avoid the poorer reproducibility of susceptibility categorization when breakpoints split major populations but also because the EUCAST has failed to identify different clinical outcomes for isolates with different MIC values inside the wild-type distribution. In laboratory practice, the ECOFF is used to screen for and exclude resistance and allows the comparison of resistance between systems with different breakpoints from different breakpoint organizations, breakpoints evolving over time, and different breakpoints between human and animal medicine. The EUCAST actively encourages colleagues to question MIC distributions as presented on the website (https://www.eucast.org/mic_and_zone_distributions_and_ecoffs) and to contribute MIC and inhibition zone diameter data.

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来源期刊
Clinical Microbiology Reviews
Clinical Microbiology Reviews 医学-微生物学
CiteScore
54.20
自引率
0.50%
发文量
38
期刊介绍: Clinical Microbiology Reviews (CMR) is a journal that primarily focuses on clinical microbiology and immunology.It aims to provide readers with up-to-date information on the latest developments in these fields.CMR also presents the current state of knowledge in clinical microbiology and immunology.Additionally, the journal offers balanced and thought-provoking perspectives on controversial issues in these areas.
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