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Coagulase-negative staphylococci in outpatient routines: the implications of switching from CLSI to BrCAST/EUCAST guidelines
Brazilian Journal of Microbiology ( IF 2.1 ) Pub Date : 2020-04-23 , DOI: 10.1007/s42770-020-00278-1
Vinícius Pietta Perez 1 , Jéssica Karoliny Baptista Porto Carvalho 2 , Marianne Schrader de Oliveira 3 , Adriana Medianeira Rossato 4 , Caroline Dani 2 , Gertrudes Corção 5 , Pedro Alves d'Azevedo 4
Affiliation  

Coagulase-negative staphylococci (CoNS) are frequently isolated in clinical specimens and are important reservoirs of resistance genes. In 2019, the Brazilian government set the BrCAST/EUCAST (Brazilian Committee on Antimicrobial Susceptibility Testing) guidelines as the national standard, resulting in changes in the interpretation of CoNS susceptibility tests. From outpatients, disk-diffusion susceptibility of 65 CoNS cultures were evaluated and compared using classification criteria from both CLSI and BrCAST/EUCAST. The isolates were identified using matrix assisted laser desorption ionization–time of flight (MALDI-TOF), and the presence of the mecA gene was determined. The most prevalent species were Staphylococcus saprophyticus (32.3%), S. haemolyticus (18.5%), and S. epidermidis (9.2%). Almost perfect agreement was seen between the guidelines, except concerning oxacillin and gentamicin, and the prevalence of multidrug resistant isolates increased with the use of BrCAST/EUCAST. Of all, 15 (23.1%) isolates, mainly S. epidermidis and S. haemolyticus , were positive for the mecA gene, and only three were detected when using CLSI or BrCAST/EUCAST disk-diffusion screening. This, using either guideline, could reveal the difficulty of determining oxacillin resistance. Using warning zones or molecular methods might well be indicated for CoNS. In conclusion, adoption of the BrCAST/EUCAST guidelines will result in certain artificial changes in epidemiological susceptibility profiles, and clinicians and institutions should be aware of the possible implications.

中文翻译:

门诊常规凝固酶阴性葡萄球菌:从 CLSI 转换为 BrCAST/EUCAST 指南的意义

凝固酶阴性葡萄球菌 (CoNS) 经常在临床标本中分离,并且是抗性基因的重要储存库。2019年,巴西政府将BrCAST/EUCAST(巴西抗菌药敏试验委员会)指南定为国家标准,导致对CoNS药敏试验的解释发生变化。从门诊患者中,使用 CLSI 和 BrCAST/EUCAST 的分类标准对 65 种 CoNS 培养物的椎间盘扩散敏感性进行了评估和比较。使用基质辅助激光解吸电离飞行时间 (MALDI-TOF) 鉴定分离株,并确定 mecA 基因的存在。最普遍的物种是腐生葡萄球菌 (32.3%)、溶血性葡萄球菌 (18.5%) 和表皮葡萄球菌 (9.2%)。指南之间几乎完全一致,除了苯唑西林和庆大霉素,多药耐药菌株的流行率随着 BrCAST/EUCAST 的使用而增加。其中,15 个(23.1%)分离株,主要是表皮葡萄球菌和溶血性葡萄球菌,mecA 基因呈阳性,在使用 CLSI 或 BrCAST/EUCAST 磁盘扩散筛查时仅检测到 3 个。使用任一指南,这都可以揭示确定苯唑西林耐药性的难度。使用警告区或分子方法很可能适用于 CoNS。总之,采用 BrCAST/EUCAST 指南将导致流行病学易感性的某些人为变化,临床医生和机构应该意识到可能的影响。其中,15 个(23.1%)分离株,主要是表皮葡萄球菌和溶血性葡萄球菌,mecA 基因呈阳性,在使用 CLSI 或 BrCAST/EUCAST 磁盘扩散筛查时仅检测到 3 个。使用任一指南,这都可以揭示确定苯唑西林耐药性的难度。使用警告区或分子方法很可能适用于 CoNS。总之,采用 BrCAST/EUCAST 指南将导致流行病学易感性的某些人为变化,临床医生和机构应该意识到可能的影响。其中,15 株(23.1%)分离株,主要是表皮葡萄球菌和溶血性葡萄球菌,mecA 基因呈阳性,在使用 CLSI 或 BrCAST/EUCAST 盘扩散筛查时仅检测到 3 株。使用任一指南,这都可以揭示确定苯唑西林耐药性的难度。使用警告区或分子方法很可能适用于 CoNS。总之,采用 BrCAST/EUCAST 指南将导致流行病学易感性的某些人为变化,临床医生和机构应该意识到可能的影响。可以揭示确定苯唑西林耐药性的困难。使用警告区或分子方法很可能适用于 CoNS。总之,采用 BrCAST/EUCAST 指南将导致流行病学易感性的某些人为变化,临床医生和机构应该意识到可能的影响。可以揭示确定苯唑西林耐药性的困难。使用警告区或分子方法很可能适用于 CoNS。总之,采用 BrCAST/EUCAST 指南将导致流行病学易感性的某些人为变化,临床医生和机构应该意识到可能的影响。
更新日期:2020-04-23
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