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首页> 外文期刊>Journal of Clinical Microbiology >In Vitro Activity of Amikacin against Isolates of Mycobacterium avium Complex with Proposed MIC Breakpoints and Finding of a 16S rRNA Gene Mutation in Treated Isolates
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In Vitro Activity of Amikacin against Isolates of Mycobacterium avium Complex with Proposed MIC Breakpoints and Finding of a 16S rRNA Gene Mutation in Treated Isolates

机译：阿米卡星对具有建议的MIC断裂点的鸟分枝杆菌复合物分离物的体外活性和治疗分离物的16S rRNA基因突变的发现

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Amikacin is a major drug used for the treatment of Mycobacterium avium complex (MAC) disease, but standard laboratory guidelines for susceptibility testing are not available. This study presents in vitro amikacin MICs for 462 consecutive clinical isolates of the MAC using a broth microdilution assay. Approximately 50% of isolates had amikacin MICs of 8 μg/ml, and 86% had MICs of ≤16 μg/ml. Of the eight isolates (1.7%) with MICs of 64 μg/ml, five had an MIC of 32 μg/ml on repeat testing. Ten isolates (2.1%) had an initial amikacin MIC of >64 μg/ml, of which seven (1.5%) had MICs of >64 μg/ml on repeat testing. These seven isolates had a 16S rRNA gene A1408G mutation and included M. avium, Mycobacterium intracellulare, and Mycobacterium chimaera. Clinical data were available for five of these seven isolates, all of which had received prolonged (>6 months) prior therapy, with four that were known to be treated with amikacin. The 16S mutation was not detected in isolates with MICs of ≤64 μg/ml. We recommend primary testing of amikacin against isolates of the MAC and propose MIC guidelines for breakpoints that are identical to the CLSI guidelines for Mycobacterium abscessus: ≤16 μg/ml for susceptible, 32 μg/ml for intermediate, and ≥64 μg/ml for resistant. If considered and approved by the CLSI, this will be only the second drug recommended for primary susceptibility testing against the MAC and should facilitate its use for both intravenous and inhaled drug therapies.
机译：阿米卡星是用于治疗鸟分枝杆菌复合物（MAC）疾病的主要药物，但尚无用于敏感性测试的标准实验室指南。本研究使用肉汤微量稀释法对462个连续的MAC临床分离株提供了体外阿米卡星MIC。分离株中约50％的阿米卡星MIC值为8μg/ ml，86％的MIC≤16μg/ ml。 MIC均为64μg/ ml的8个分离株（1.7％）中，有5个在重复测试中的MIC为32μg/ ml。十个分离株（2.1％）的初始阿米卡星MIC大于64μg/ ml，其中七个（1.5％）重复测试的MIC大于64μg/ ml。这七个分离株具有16S rRNA基因A1408G突变，包括鸟分枝杆菌，胞内分枝杆菌和嵌合分枝杆菌。这七个分离株中有五个的临床数据均可用，所有这些分离株在治疗前均已接受了长时间（> 6个月）的治疗，其中四个已知已用丁胺卡那霉素治疗。在MIC≤64μg/ ml的分离物中未检测到16S突变。我们建议对阿米卡星进行MAC分离株的初步测试，并针对与脓肿分枝杆菌的CLSI指南相同的断点提出MIC指南：敏感菌≤16μg/ ml，中间体≤32μg/ ml，≥64μg/ ml耐。如果得到CLSI的考虑和批准，这将仅是推荐用于针对MAC的主要药敏试验的第二种药物，并且应有助于将其用于静脉和吸入药物治疗。

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