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首页> 美国卫生研究院文献>Pathogens >Assessing the Surrogate Susceptibility of Oxacillin and Cefoxitin for Commonly Utilized Parenteral Agents against Methicillin-Susceptible Staphylococcus aureus: Focus on Ceftriaxone Discordance between Predictive Susceptibility and in Vivo Exposures
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Assessing the Surrogate Susceptibility of Oxacillin and Cefoxitin for Commonly Utilized Parenteral Agents against Methicillin-Susceptible Staphylococcus aureus: Focus on Ceftriaxone Discordance between Predictive Susceptibility and in Vivo Exposures

机译：评估奥沙西林和头孢西丁对常用的胃肠外药物对甲氧西林敏感的金黄色葡萄球菌的替代药敏性：集中于头孢曲松在预测药敏性和体内暴露之间的差异

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Susceptibility testing with the use of surrogate agents is common among clinical microbiology laboratories. One such example is oxacillin and cefoxitin for β-lactams against methicillin-susceptible Staphylococcus aureus (MSSA). This study aimed to assess the surrogate predictive value (SPV) of oxacillin and cefoxitin for the susceptibility of commonly utilized parenteral β-lactams against MSSA as well as to evaluate the concordance between predictive susceptibility testing and the in vivo exposures for ceftriaxone. Broth microdilution MICs were determined for cefazolin, cefoxitin, ceftaroline, ceftriaxone, nafcillin, and oxacillin against a national collection of 1238 MSSA from US hospitals. Pharmacodynamic profiling was utilized to establish a clinical breakpoint for commonly utilized doses of ceftriaxone. Oxacillin had good SPVs for all the β-lactams tested, whereas cefoxitin produced unacceptable major errors for all four agents and thus appears to be an unacceptable susceptibility surrogate. While oxacillin is an adequate surrogate based on the currently defined laboratory criteria, our data also suggest that caution should be exercised when incorporating this testing approach in the clinical setting in view of the fact that the MIC distribution of MSSA coupled with the commonly utilized low doses of ceftriaxone may result in inadequate in vivo exposures against this pathogen.
机译：在临床微生物学实验室中，通常使用替代药物进行药敏试验。一种这样的例子是用于抗甲氧西林的金黄色葡萄球菌（MSSA）的β-内酰胺的奥沙西林和头孢西丁。本研究旨在评估奥沙西林和头孢西丁对常用肠胃外β-内酰胺类药物对MSSA敏感性的替代预测值（SPV），并评估预测敏感性试验与头孢曲松钠体内暴露之间的一致性。相对于美国医院收集的全国1238种MSSA，测定了肉汤微稀释MICs中的头孢唑林，头孢西丁，头孢太林，头孢曲松，纳夫西林和奥沙西林。利用药效学概况分析来建立常用头孢曲松剂量的临床断点。奥沙西林对所有测试的β-内酰胺均具有良好的SPV，而头孢西丁对所有四种药物均产生不可接受的主要误差，因此似乎是不可接受的药敏性替代指标。尽管根据目前确定的实验室标准，奥沙西林是适当的替代品，但我们的数据还表明，考虑到MSSA的MIC分布以及常用的低剂量，将这种测试方法纳入临床时应谨慎行事头孢曲松钠的使用可能会导致体内对该病原体的暴露不足。

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