Kolistin Duyarlılık Testlerinin Karşılaştırılması

Year 2024, , 38 - 45, 31.03.2024

Nurullah Çiftçi , Prof. Dr. Uğur Arslan , Hatice Türk Dağı

https://doi.org/10.25279/sak.1274681

An Erratum to this article was published on August 31, 2024. https://dergipark.org.tr/en/pub/sak/issue/82482/1507448

Abstract

Giriş: Polimiksinler, Gram negatif bakterilerin neden olduğu enfeksiyonların tedavisinde kullanılan önemli bir antimikrobiyal ajandır. Bu antibiyotiklerin çalışıldığı duyarlılık testlerinin performans, tekrar edilebilirlik ve doğru yöntemin uygulanmasındaki zorluklar nedeniyle klinik laboratuvarlar için problem oluşturmaktadır. Otomatize edilmiş antimikrobiyal duyarlılık testlerinin doğruluğu halen belirsizdir. Amaç: Bu çalışmada, kolistin duyarlılık testi çalışılan otomatize sistem ve gradient testin altın standart olan sıvı mikrodilüsyon testi ile karşılaştırılması amaçlanmaktadır. Gereç ve yöntem: Çoklu ilaç direncine sahip 102 A. baumannii, 40 K. pneumoniae ve 11 P. aeruginosa suşu çalışmaya dahil edildi. VITEK 2 ve gradient test firma önerileri doğrultusunda çalışıldı. Sıvı mikrodilüsyon testi ise EUCAST kriterlerine göre değerlendirildi. Bu çalışmada ticari testler ile sıvı mikrodilüsyon testi karşılaştırıldı. Bulgular: Sıvı mikrodilüsyon testi ile VITEK 2 ve gradient test arasındaki temel uyum oranı sırasıyla %96.1 ve %79.7 olarak hesaplandı. VITEK 2 ve gradient test ile sıvı mikrodilüsyon yöntemi arasında %95.4 ve %94.8 kategorik uyum saptandı. Çok büyük hata oranı VITEK 2 ile %3.2, gradient test ile %5.2 olarak tespit edildi. Büyük hata oranı VITEK 2 ile %1.3 olarak hesaplandı ve gradient test ile büyük hata tespit edilmedi. Sonuç ve Öneriler: Çalışmamızda çok büyük hata oranı gradient testte VITEK 2’ye göre daha yüksek oranda saptandı. VITEK 2 yönteminde çok büyük hata oranı düşük olsa bile bu yöntemle elde edilen duyarlılık ve direnç sonuçları sıvı mikrodilüsyon yöntemi ile doğrulanmalıdır. Farklı testler ile elde edilen MIK sonuçları arasında uyumu gösteren daha fazla çalışmaya ihtiyaç duyulmaktadır.

Keywords

Kolistin, Minimum inhibisyon konsantrasyonu, Antimikrobiyal ilaç direnci, Mikrobiyal duyarlılık testleri, En düşük engelleyici yoğunluk

Comparison of Colistin Susceptibility Tests

An Erratum to this article was published on August 31, 2024. https://dergipark.org.tr/en/pub/sak/issue/82482/1507448

Abstract

Introduction: Polymyxins are important antimicrobial agents for the treatment of infections caused by Gram-negative bacteria. The susceptibility testing for polymyxins is a challenge for clinical laboratories due to the difficulty of performance, reproducibility, and accuracy of available methods. Aim: To compare the performance of the colistin susceptibility test of an automated system and a gradient test with the gold standard broth microdilution method (BMD). Materials and Methods: Multidrug-resistant isolates of Acinetobacter baumannii (n=102), Klebsiella pneumoniae (n=40), and Pseudomonas aeruginosa(n=11) were included. The VITEK 2 systems and gradient test were studied according to the manufacturer’s instructions. Broth microdilution tests were performed according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST). Commercial susceptibility testing methods were compared to BMD. Results: Rates of essential agreement of colistin test results between BMD, VITEK 2, and gradient test were 96.1% and 79.7%, respectively. The VITEK 2 and gradient test showed 95.4% and 94.8% of categorial agreement. The very major error rate of VITEK 2 was 3.2%, and the gradient test was 5.2%. The major error rate of VITEK 2 was 1.3%, and there was no major error for the gradient test. Conclusion and Suggestions: The very major error rate was higher in the gradient test (5.2%) than VITEK 2 (3.2%). Even if the very major error rate of VITEK 2 was lower, both resistance and susceptility results of VITEK 2 should be confirmed with the BMD test. Further studies for susceptibility testing are needed with a focus on the correlation of MIC’s results of different tests.

Keywords

Colistin, Minimum inhibitory concentration, Antimicrobial drug resistance, Microbial sensitivity tests

References

• Akın, Ö.F.E., Bayram, A., Balcı, İ.(2010). Çoğul dirençli Acinetobacter baumannii izolatlarında kolistin, polimiksin B ve tigesiklin direncinin saptanmasında disk difüzyon, E-test ve buyyon mikrodilüsyon yöntemlerinin karşılaştırılması. Mikrobiyol Bul, 44(2), 203-10.
• Altınkanat Gelmez, G., Sayın, E., Hasdemir Gökboğa, M., Söyledir, G.(2021). Kolistin Duyarlılık Testi İçin Diagnostics Colistin MIC-Strip Testinin Değerlendirilmesi. Ankem Derg, 35(1), 9-13. doi: 10.5222/ankem.2021.009
• Chew, K.L., La, M.V., Lin, R.T., Teo, J.W. (2017) Colistin and polymyxin B susceptibility testing for carbapenem-resistant and mcr-positive Enterobacteriaceae: comparison of Sensititre, MicroScan, Vitek 2, and Etest with broth microdilution. J clin microbiol, 55(9), 2609-16. https://doi.org/10.1128/jcm.00268-17
• Dafopoulou, K., Zarkotou, O., Dimitroulia, E., Hadjichristodoulou, C., Gennimata, V., Pournaras S, et al.(2015) Comparative evaluation of colistin susceptibility testing methods among carbapenem-nonsusceptible Klebsiella pneumoniae and Acinetobacter baumannii clinical isolates. Antimicrob agents and chemother, 59(8), 4625-30. https://doi.org/10.1128/aac.00868-15
• EUCAST (2016). Recommendations for MIC determination of colistin (polymyxin E) as recommended by the joint CLSI-EUCAST Polymyxin Breakpoints Working Group. EUCAST: Växjö, Sweden. 2016.
• EUCAST (2021). European Committee on Antimicrobial Susceptibility Testing 2021 [Availablefrom:https://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Breakpoint_tables/v_11.0_Breakpoint_Tables.pdf.
• Girardello, R., Cury, A.P., Franco, M.R.G., Di Gióia, T.R., de Almeida, Jr J.N., de Araújo, M.R.E., et al. (2018). Colistin susceptibility testing and Vitek-2TM: is it really useless? Diagn Microbiol Infect Dis, 91(4), 309-311. https://doi.org/10.1016/j.diagmicrobio.2018.03.019
• ISO (2019). Clinical Laboratory Testing and in Vitro Diagnostic Test Systems-Susceptibility Testing of Infectious Agents and Evaluation of Performance of Antimicrobial Susceptibility Test Devices: Reference Method for Testing the in Vitro Activity of Antimicrobial Agents Against Rapidly Growing Aerobic Bacteria Involved in Infectious Diseases: ISO; 2019. https://www.iso.org/standard/70464.html
• Karaiskos, I., Giamarellou, H. (2014). Multidrug-resistant and extensively drug-resistant Gram-negative pathogens: current and emerging therapeutic approaches. Expert opin pharmacother, 15(10), 1351-70. https://doi.org/10.1517/14656566.2014.914172
• Lee, S.Y., Shin, J.H., Lee, K., Joo, M.Y., Park, K.H., Shin, M.G., et al. (2013). Comparison of the Vitek 2, MicroScan, and Etest methods with the agar dilution method in assessing colistin susceptibility of bloodstream isolates of Acinetobacter species from a Korean university hospital. J clin microbiol, 51(6), 1924-6. https://doi.org/10.1128/jcm.00427-13
• Li, J., Nation, R.L., Milne, R.W., Turnidge, J.D., Coulthard, K. (2005). Evaluation of colistin as an agent against multi-resistant Gram-negative bacteria. Int j antimicrob agents, 25(1), 11-25. https://doi.org/10.1016/j.ijantimicag.2004.10.001
• Li, J., Nation, R.L., Turnidge, J.D., Milne, R.W., Coulthard, K., Rayner, C.R., et al. (2006). Colistin: the re-emerging antibiotic for multidrug-resistant Gram-negative bacterial infections. The Lancet infect dis, 6(9), 589-601. https://doi.org/10.1016/S1473-3099(06)70580-1
• Lo-Ten-Foe, J.R., de Smet, A.M.G., Diederen, B.M., Kluytmans, J.A., van Keulen, P.H. (2007) Comparative evaluation of the VITEK 2, disk diffusion, Etest, broth microdilution, and agar dilution susceptibility testing methods for colistin in clinical isolates, including heteroresistant Enterobacter cloacae and Acinetobacter baumannii strains. Antimicrob agents chemother, 51(10), 3726-30. https://doi.org/10.1128/aac.01406-06
• Maalej, S., Meziou, M., Rhimi, F., Hammami, A. (2011) Comparison of disc diffusion, E test and agar dilution for susceptibility testing of colistin against Enterobacteriaceae. Lett appl microbiol, 53(5), 546-51. https://doi.org/10.1111/j.1472-765X.2011.03145.x
• Matuschek, E., Åhman, J., Webster, C., Kahlmeter, G. (2018). Antimicrobial susceptibility testing of colistin–evaluation of seven commercial MIC products against standard broth microdilution for Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter spp. Clin Microbiol and Infect,24(8), 865-70. https://doi.org/10.1016/j.cmi.2017.11.020
• Paköz, N.İ.E., Kaya, E., Orhan, Z., Kayış, A., Aral, M. (2018). Farklı klinik örneklerden izole edilen çoğul dirençli Acinetobacter baumannii izolatlarında tigesiklin, kolistin direncinin disk difüzyon, E-test ve otomatize sistem yöntemleri ile karşılaştırılması. Turk Hij Den Biyol Derg, 75(2), 109-16. https://doi.org/10.5505/TurkHijyen.2018.13334
• Storm, D.R, Rosenthal, K.S, Swanson, P.E. (1977) Polymyxin and related peptide antibiotics. Annu rev biochem, 46(1):,723-63.
• Vourli, S., Dafopoulou, K., Vrioni, G., Tsakris, A., Pournaras, S. (2017). Evaluation of two automated systems for colistin susceptibility testing of carbapenem-resistant Acinetobacter baumannii clinical isolates. J Antimicrob Chemother, 72(9), 2528-30. https://doi.org/10.1093/jac/dkx186