评估纸片扩散法与Vitek-2 Compact仪器法检测洋葱伯克霍尔德菌体外药物敏感性

doi:10.3877/cma.j.issn.1674-1358.2018.06.010

目的

评估纸片扩散法与Vitek-2 Compact仪器法检测洋葱伯克霍尔德菌体外药敏试验的可靠性。

方法

收集2017年1月至2017年12月绍兴市人民医院临床分离到的34株洋葱伯克霍尔德菌，分别采用纸片扩散法、Vitek-2 Compact仪器法和微量肉汤稀释法检测其对头孢他啶、复方磺胺甲噁唑、左氧氟沙星、哌拉西林/他唑巴坦、替加环素、美罗培南、氯霉素、米诺环素和头孢哌酮/舒巴坦共9种抗菌药物的体外敏感性。以微量肉汤稀释法为参考方法，分别评估纸片扩散法、Vitek-2 Compact仪器法与参考方法的分类一致率（CA%）。

结果

微量肉汤稀释法检测头孢他啶、复方磺胺甲噁唑、左氧氟沙星、美罗培南和氯霉素5种抗菌药物95%可信区间（95%CI）分别为6.2～13.2、0.5～0.8、3.8～6.3、3.7～7.3和5.0～10.0；纸片扩散法检测头孢他啶、复方磺胺甲噁唑、替加环素、氯霉素和米诺环素的体外敏感性结果与参考方法一致率均> 90%；Vitek-2 Compact检测头孢他啶、复方磺胺甲噁唑和左氧氟沙星的体外敏感性结果与参考方法的一致率均> 90%；纸片扩散法和Vitek-2 Compact仪器法检测哌拉西林/他唑巴坦体外敏感性与参考方法一致率最低，均< 80%；Vitek-2 Compact检测替加环素的大错误（ME）为50%；以微量肉汤稀释法为标准，体外敏感性最好的抗菌药物为复方磺胺甲噁唑和米诺环素（均为100%），敏感性最差的抗菌药物为左氧氟沙星（38.2%）。

结论

纸片扩散法和Vitek-2 Compact仪器法检测洋葱伯克霍尔德菌体外药物敏感性，对头孢他啶和复方磺胺甲噁唑均具有较好的可靠性；应用纸片扩散法检测哌拉西林/他唑巴坦和头孢哌酮/舒巴坦的药物敏感性时，应注意可能出现极大错误（VME）及ME。

关键词: 洋葱伯克霍尔德菌, 纸片扩散法, Vitek-2, 微量肉汤稀释法, 一致率

Objective

To evaluate the capabilities of disc diffusion and Vitek-2 Compact methods for testing antimicrobial susceptibility of Burkholderia cepacia.

Methods

Total of 34 isolates of Burkholderia cepacia were collected from January 2017 to December 2017 in Shaoxing People’s Hospital, the vitro minimum inhibition concentration (MIC) values of ceftazidime, compound sulfamethoxazole, levofloxacin, piperacillin/tazobactam, tetracycline, meropenem, chloramphenicol, minocycline and cefperidone/sulbactam were detected by disc diffusion method, Vitek-2 Compact method and broth microdilution method, respectively. Categorical agreement (CA) rates of disc diffusion and Vitek-2 Compact methods were determined, taking broth microdilution method as the reference method.

Results

The 95% confidence intervals (95%CI) of ceftazidime, compound sulfamethoxazole, levofloxacin, meropenem and chloramphenicol were 6.2-13.2, 0.5-0.8, 3.8-6.3, 3.7-7.3 and 5.0-10.0, respectively, detected by broth microdilution method. The CA values of disc diffusion for ceftazidime, compound sulfamethoxazole, tigocycline, chloramphenicol and minocycline antibiotics were all > 90%, compared with broth microdilution method, Disc diffusion method and Vitek-2 Compact method were taken to detect the sensitivity of piperacillin/tazobactam in vitro, and the rate of agreement with reference method was the lowest, all < 80%. The major error (ME) of Vitek-2 Compact for detection of Tegafycline was 50%. Taken the broth microdilution method as the standard, the best antimicrobial agent in vitro was compound sulfamethoxazole and minocycline (all 100%), and the most sensitive antibacterials were levofloxacin (38.2%).

Conclusions

The drug sensitivity of Burkholderia cepacia detected by disk diffusion method and Vitek-2 Compact instrument method both had good reliability to ceftazidime and compound sulfamethoxazole. Ateention should be paid to the possible occurrence of very major error (VME) and ME, when antimicrobial susceptibility of piperacillin/tazobactam and cefoperazone/sulbactam were detected by disk diffusion method.

Key words: Burkholderia cepacia, Disc diffusion method, Vitek-2, Broth microdilution method, Categorical agreement

表1 纸片扩散法、Vitek-2 Compact仪器法、E-test法与微量肉汤稀释法结果

抗菌药物	样本编号	KB法		VITEK-2法		微量肉汤稀释法
抗菌药物	样本编号	结果判读	解释	结果判读	解释	结果判读
头孢他啶	9	S	MIE	R	MIE	I
?	10	S	MIE	R	MIE	I
?	13	I	—	R	MIE	I
?	17	S	MIE	I	—	I
?	21	S	MIE	I	—	I
?	24	S	—	S	—	S
?	25	S	—	S	—	S
左氧氟沙星	8	R	—	I	MIE	R
?	10	S	MIE	I	—	I
?	15	S	VME	S	VME	R
?	25	R	—	R	—	R
?	28	S	MIE	I	—	I
?	31	I	MIE	I	MIE	S
哌拉西林/他唑巴坦	1	S	VME	R	—	R
?	3	I	MIE	R	—	R
?	5	S	—	R	ME	S
?	7	S	VME	R	—	R
?	9	S	VME	R	—	R
?	10	S	VME	R	—	R
?	11	S	—	R	ME	S
?	14	R	ME	R	ME	S
?	15	S	—	R	ME	S
?	16	S	—	R	ME	S
?	17	S	VME	R	—	R
?	18	S	—	R	ME	S
?	19	S	VME	R	—	R
?	20	S	—	R	ME	S
?	21	S	—	R	ME	S
?	22	S	—	R	ME	S
?	23	S	—	R	ME	S
?	24	S	VME	R	—	R
?	25	S	VME	R	—	R
?	26	S	VME	R	—	R
?	27	S	VME	R	—	R
?	31	I	MIE	R	—	R
替加环素	8	I	—	R	MIE	I
?	21	I	MIE	R	ME	S
?	22	S	—	I	MIE	S
?	26	I	MIE	R	ME	S
?	27	S	—	R	ME	S
?	28	I	MIE	S	—	S
?	30	S	—	R	ME	S
?	33	I	—	R	MIE	I
?	34	I	—	R	MIE	I
美罗培南	2	I	MIE	—	—	R
?	8	R	ME	—	—	S
?	10	S	MIE	—	—	I
?	15	S	MIE	—	—	I
?	22	S	MIE	—	—	I
?	24	S	—	—	—	S
?	25	S	MIE	—	—	I
?	31	S	—	—	—	S
?	33	S	—	—	—	S
氯霉素	5	S	—	—	—	S
?	12	S	—	—	—	S
?	19	S	—	—	—	S
?	23	I	MIE	—	—	R
?	28	I	MIE	—	—	R
米诺环素	8	I	MIE	—	—	S
?	15	S	—	—	—	S
头孢哌酮/舒巴坦	7	S	MIE	—	—	I
?	14	I	—	—	—	I
?	21	R	ME	—	—	S
?	24	S	MIE	—	—	I
?	25	S	—	—	—	S
?	26	S	VME	—	—	R
?	28	S	MIE	—	—	I

表1 纸片扩散法、Vitek-2 Compact仪器法、E-test法与微量肉汤稀释法结果

抗菌药物	样本编号	KB法		VITEK-2法		微量肉汤稀释法
抗菌药物	样本编号	结果判读	解释	结果判读	解释	结果判读
头孢他啶	9	S	MIE	R	MIE	I
?	10	S	MIE	R	MIE	I
?	13	I	—	R	MIE	I
?	17	S	MIE	I	—	I
?	21	S	MIE	I	—	I
?	24	S	—	S	—	S
?	25	S	—	S	—	S
左氧氟沙星	8	R	—	I	MIE	R
?	10	S	MIE	I	—	I
?	15	S	VME	S	VME	R
?	25	R	—	R	—	R
?	28	S	MIE	I	—	I
?	31	I	MIE	I	MIE	S
哌拉西林/他唑巴坦	1	S	VME	R	—	R
?	3	I	MIE	R	—	R
?	5	S	—	R	ME	S
?	7	S	VME	R	—	R
?	9	S	VME	R	—	R
?	10	S	VME	R	—	R
?	11	S	—	R	ME	S
?	14	R	ME	R	ME	S
?	15	S	—	R	ME	S
?	16	S	—	R	ME	S
?	17	S	VME	R	—	R
?	18	S	—	R	ME	S
?	19	S	VME	R	—	R
?	20	S	—	R	ME	S
?	21	S	—	R	ME	S
?	22	S	—	R	ME	S
?	23	S	—	R	ME	S
?	24	S	VME	R	—	R
?	25	S	VME	R	—	R
?	26	S	VME	R	—	R
?	27	S	VME	R	—	R
?	31	I	MIE	R	—	R
替加环素	8	I	—	R	MIE	I
?	21	I	MIE	R	ME	S
?	22	S	—	I	MIE	S
?	26	I	MIE	R	ME	S
?	27	S	—	R	ME	S
?	28	I	MIE	S	—	S
?	30	S	—	R	ME	S
?	33	I	—	R	MIE	I
?	34	I	—	R	MIE	I
美罗培南	2	I	MIE	—	—	R
?	8	R	ME	—	—	S
?	10	S	MIE	—	—	I
?	15	S	MIE	—	—	I
?	22	S	MIE	—	—	I
?	24	S	—	—	—	S
?	25	S	MIE	—	—	I
?	31	S	—	—	—	S
?	33	S	—	—	—	S
氯霉素	5	S	—	—	—	S
?	12	S	—	—	—	S
?	19	S	—	—	—	S
?	23	I	MIE	—	—	R
?	28	I	MIE	—	—	R
米诺环素	8	I	MIE	—	—	S
?	15	S	—	—	—	S
头孢哌酮/舒巴坦	7	S	MIE	—	—	I
?	14	I	—	—	—	I
?	21	R	ME	—	—	S
?	24	S	MIE	—	—	I
?	25	S	—	—	—	S
?	26	S	VME	—	—	R
?	28	S	MIE	—	—	I

表2 洋葱伯克霍尔德菌KB法和MIC法判定折点

抗菌药物	纸片含量（μg）	纸片扩散法（mm）			MIC法（μg/ml）
抗菌药物	纸片含量（μg）	S	I	R	S	I	R
头孢他啶	30	≥ 21	18～20	≤ 17	≤ 8	16	≥ 32
美罗培南	10	≥ 20	16～19	≤ 15	≤ 4	8	≥ 16
米诺环素	30	≥ 19	15～18	≤ 14	≤ 4	8	≥ 16
左氧氟沙星	5	≥ 17	14～16	≤ 13	≤ 2	4	≥ 8
复方磺胺甲噁唑	25	≥ 16	11～15	≤ 10	≤ 2/38	…	≥ 4/76
氯霉素	30	≥ 18	13～17	≤ 12	≤ 8	16	≥ 32
头孢哌酮舒巴坦	105	≥ 21	16～20	≤ 15	≤ 16/4	32/4	≥ 64/4
哌拉西林他唑巴坦	110	≥ 21	18～20	≤ 17	≤ 16/4	32/4～64/4	≥ 128/4
替加环素	15	≥ 16	13～15	≤ 12	≤ 2	4	≥ 8

表2 洋葱伯克霍尔德菌KB法和MIC法判定折点

抗菌药物	纸片含量（μg）	纸片扩散法（mm）			MIC法（μg/ml）
抗菌药物	纸片含量（μg）	S	I	R	S	I	R
头孢他啶	30	≥ 21	18～20	≤ 17	≤ 8	16	≥ 32
美罗培南	10	≥ 20	16～19	≤ 15	≤ 4	8	≥ 16
米诺环素	30	≥ 19	15～18	≤ 14	≤ 4	8	≥ 16
左氧氟沙星	5	≥ 17	14～16	≤ 13	≤ 2	4	≥ 8
复方磺胺甲噁唑	25	≥ 16	11～15	≤ 10	≤ 2/38	…	≥ 4/76
氯霉素	30	≥ 18	13～17	≤ 12	≤ 8	16	≥ 32
头孢哌酮舒巴坦	105	≥ 21	16～20	≤ 15	≤ 16/4	32/4	≥ 64/4
哌拉西林他唑巴坦	110	≥ 21	18～20	≤ 17	≤ 16/4	32/4～64/4	≥ 128/4
替加环素	15	≥ 16	13～15	≤ 12	≤ 2	4	≥ 8

表3 三种药敏方法检测9种抗菌药物95%CI

检测方法	头孢他啶	美罗培南	复方磺胺甲噁唑	左氧氟沙星	氯霉素
纸片扩散法（mm）	26.4～35.1	23.3～32.1	26.4～33.7	12.3～21.8	25.8～32.2
仪器法（μg/ml）	8.8～23.8	ND	1.1～1.5	3.6～6.0	ND
微量肉汤稀释法（μg/ml）	6.2～13.2	3.7～7.3	0.5～0.8	3.8～6.3	5.0～10.0
检测方法	米诺环素	头孢哌酮舒巴坦	哌拉西林他唑巴坦	替加环素
纸片扩散法（mm）	25.8～32.5	18.3～30.8	25.2～36.3	16.1～17.8
仪器法（μg/ml）	ND	ND	39.4～82.3	5.0～6.0
微量肉汤稀释法（μg/ml）	1.1～2.1	38.9～101.3	61.9～128.3	1.0～2.1

表3 三种药敏方法检测9种抗菌药物95%CI

检测方法	头孢他啶	美罗培南	复方磺胺甲噁唑	左氧氟沙星	氯霉素
纸片扩散法（mm）	26.4～35.1	23.3～32.1	26.4～33.7	12.3～21.8	25.8～32.2
仪器法（μg/ml）	8.8～23.8	ND	1.1～1.5	3.6～6.0	ND
微量肉汤稀释法（μg/ml）	6.2～13.2	3.7～7.3	0.5～0.8	3.8～6.3	5.0～10.0
检测方法	米诺环素	头孢哌酮舒巴坦	哌拉西林他唑巴坦	替加环素
纸片扩散法（mm）	25.8～32.5	18.3～30.8	25.2～36.3	16.1～17.8
仪器法（μg/ml）	ND	ND	39.4～82.3	5.0～6.0
微量肉汤稀释法（μg/ml）	1.1～2.1	38.9～101.3	61.9～128.3	1.0～2.1

表4 以微量肉汤法为参考纸片扩散法和VITEK-2仪器法的一致率和错误率（%）

抗菌药物	纸片扩散法				VITEK-2仪器法
抗菌药物	CA	VME	ME	MIE	CA	VME	ME	MIE
头孢他啶	91.2	0.0	0.0	8.8	91.2	0.0	0.0	8.8
复方磺胺甲噁唑	100.0	0.0	0.0	0.0	100.0	0.0	0.0	0.0
左氧氟沙星	88.2	2.9	0.0	8.8	91.2	2.9	0.0	5.9
哌拉西林/他唑巴坦	61.8	29.4	2.9	5.9	70.6	0.0	29.4	0.0
替加环素	91.2	0.0	0.0	8.8	32.4	0.0	50.0	17.6
美罗培南	82.4	0.0	2.9	14.7	ND	ND	ND	ND
氯霉素	94.1	0.0	0.0	5.9	ND	ND	ND	ND
米诺环素	97.1	0.0	0.0	2.9	ND	ND	ND	ND
头孢哌酮/舒巴坦	85.3	2.9	2.9	8.8	ND	ND	ND	ND

表4 以微量肉汤法为参考纸片扩散法和VITEK-2仪器法的一致率和错误率（%）

抗菌药物	纸片扩散法				VITEK-2仪器法
抗菌药物	CA	VME	ME	MIE	CA	VME	ME	MIE
头孢他啶	91.2	0.0	0.0	8.8	91.2	0.0	0.0	8.8
复方磺胺甲噁唑	100.0	0.0	0.0	0.0	100.0	0.0	0.0	0.0
左氧氟沙星	88.2	2.9	0.0	8.8	91.2	2.9	0.0	5.9
哌拉西林/他唑巴坦	61.8	29.4	2.9	5.9	70.6	0.0	29.4	0.0
替加环素	91.2	0.0	0.0	8.8	32.4	0.0	50.0	17.6
美罗培南	82.4	0.0	2.9	14.7	ND	ND	ND	ND
氯霉素	94.1	0.0	0.0	5.9	ND	ND	ND	ND
米诺环素	97.1	0.0	0.0	2.9	ND	ND	ND	ND
头孢哌酮/舒巴坦	85.3	2.9	2.9	8.8	ND	ND	ND	ND

表5 洋葱伯克霍尔德菌体外药敏试验

抗菌药物	敏感率（%）	中介率（%）	耐药率（%）	MIC₅₀（μg/ml）	MIC₉₀（μg/ml）	MIC范围（μg/ml）
头孢他啶	64.7	23.5	11.8	8	32	0.25～32
复方磺胺甲噁唑	100.0	0.0	0.0	0.5	1	0.016～2
左氧氟沙星	38.2	5.9	55.9	8	32	0.25～> 32
哌拉西林他唑巴坦	41.2	0.0	58.8	128	256	< 0.125～> 256
替加环素	85.3	11.8	2.9	1	4	0.125～32
美罗培南	61.8	23.5	14.7	4	16	0.125～32
氯霉素	91.2	2.9	5.9	8	8	< 0.064～>256
米诺环素	100.0	0.0	0.0	1	4	0.064～4
头孢哌酮舒巴坦	47.0	11.8	41.2	32	256	< 0.125～256

表5 洋葱伯克霍尔德菌体外药敏试验

抗菌药物	敏感率（%）	中介率（%）	耐药率（%）	MIC₅₀（μg/ml）	MIC₉₀（μg/ml）	MIC范围（μg/ml）
头孢他啶	64.7	23.5	11.8	8	32	0.25～32
复方磺胺甲噁唑	100.0	0.0	0.0	0.5	1	0.016～2
左氧氟沙星	38.2	5.9	55.9	8	32	0.25～> 32
哌拉西林他唑巴坦	41.2	0.0	58.8	128	256	< 0.125～> 256
替加环素	85.3	11.8	2.9	1	4	0.125～32
美罗培南	61.8	23.5	14.7	4	16	0.125～32
氯霉素	91.2	2.9	5.9	8	8	< 0.064～>256
米诺环素	100.0	0.0	0.0	1	4	0.064～4
头孢哌酮舒巴坦	47.0	11.8	41.2	32	256	< 0.125～256

[6]	Papaleo MC, Perrin E, Maida I, et al. Identification of species of the Burkholderia cepacia complex by sequence analysis of the hisA gene[J]. J Med Microbiol,2010,59(Pt 10):1163-1170.
[7]	Tatman-Otkun M, Gtircan S, Ozer B, et al. The antimicrobial susceptibility of Stenotrophomonas maltophilia isolates using three different methods and their genetic relatedness[J]. BMC Microbiol, 2005,12(5):24-29.
[8]	Kuper KM, Boles DM, Mohr JF, et al. Antim icrobial susceptibility testing: a primer for clinicians[J]. Phannaeotherapy,2009,29(11):1326- 1343.
[9]	Justesen US, Acar Z, Olsson K, et al. Comparison of Rosco Neo-Sensitabs with Oxoid paper disks in EUCAST disk diffusion antimicrobial susceptibility testing on Mueller-Hinton agar[J]. Eur J Clin Microbiol Infect Dis,2013,32(5):621-625.
[10]	覃琼英，车汉荣. 浅淡微生物药敏试验报告解读[J]. 检验医学与临床,2017,17(增刊Ⅰ):402-403.
[11]	Clinical and Laboratory Standard Institute. Pefrormance standards for antimicorbial disk susceptibility tests: approved standard-eleventhedition[S]. CLSI document. M02-A11. Wayne, PA: CLSI,2012:12-13
[12]	Clinical and Laboratory Standard Institute. Methods for Dilution antimicrobial susceptibility tests for bacteria that grow aerobically: approved standrad-ninth edition[S]. CLSI document. M07-A9. Wayne, PA: CLSI,2012:16-19.
[13]	Andrea S, Angela M, Elizabeth T, et al. Spontaneous and evolutionary changes in the antibiotic resistance of Burkholderia cenocepacia observed by global gene expression analysis[J]. BMC Genomics,2011,12(2):373-390.
[14]	Clinicla and Laboratory Standard Institute. M100-S27. Performance Standards for antimicrobial susceptibility testing: twenty-third informational supplement[S]. CLSI document M100-S27. Wayne, PA: CLSI,2017:46.
[15]	Lorena F, Corrêa C, Nianinni NA, et al. In vitro susceptibility of Burkholderia cepacia complex isolates: Comparison of disk diffusion, Etest, agar dilution, and broth microdilution methods[J]. Diagn Microb Inf Dis,2016,15(8):422-427.
[16]	Oderiz S, Palau MJ, Del Palacio P, et al. Evaluation of commercial systems VITEK 2 and API 20NE for identification of Burkholderia cepacia complex bacteria from clinical samples[J]. Rev Argent Microbiol,2011,43(3):168-175.
[17]	Kiratisin P, Santanirand P, Chantratita N, et al. Accuracy of commercial systems for identification of Burkholderia pseudomallei versus Burkholderia cepacia[J]. Diagn Microbiol Infect Dis, 2007,59(3):277-281.
[18]	Tekintaş Y, Çilli F, Eraç B et al. Comparison of phenotypic methods and polymerase chain reaction for the detection of carbapenemase production in clinical Klebsiella pneumoniae isolates[J]. Mikrobiyol Bul,2017,51(3):269-276.
[19]	康凤凤，黄钰竹，王薇, 等. 美国CLSI M52商品化微生物鉴定和药敏试验系统的验证后质量保证[J]. 临床检验杂志,2017,35(11):866-867.
[20]	Nath R, Bora R, Borkakoty B, et al. Clinically relevant yeast species identified by sequencing the internal transcribed spacer region of r-RNA gene and Vitek 2 compact (YST card) commercial identification system: Experience in a Tertiary Care Hospital in Assam, Northeast India[J]. Indian J Med Microbiol,2017,35(4):588-592.
[21]	Stefaniuk E, Baraniak A, Fortuna M, et al. Usefulness of CHROMagar Candida Medium, biochemical methods--API ID32C and VITEK 2 Compact and two MALDI-TOF MS systems for Candida spp. identification[J]. Pol J Microbiol,2016,65(1):111-114.
[22]	Bemer P, Juvin ME, Le Gargasson G, et al. Correlation between the VITEK-2 system and cefoxitin disk diffusion for the daily detection of oxacillin resistance in a large number of clinicla Staphylococcus aureus isolates[J]. Eur J Clin Microbila Infect Dis,2010,29(6):745-747.
[23]	刘亚丽，张戈，徐英春, 等. 5种国产与进口E-test药敏条的一致性比较[J]. 临床检验杂志,2016,34(11):827-830.
[24]	Abbott Felicity K, Milne Kathleen EN, Stead David A, et al. Combination antimicrobial susceptibility testing of Burkholderia cepacia complex: significance of species[J]. Int J Antimicrob Agents,2016,20(7):35-40.
[25]	Flamm RK, Castanheira M, Streit JM, et al. Minocycline activity tested against Acinetobacter baumannii complex, Stenotrophomonas maltophilia and Burkholderia cepacia species complex isolates from a global surveillance program (2013) [J]. Diagn Microbiol Infect Dis, 2016,85(3):352-355.
[1]	Orhan B. An opportunistic pathogen frequently isolated from immunocompromised patients: Burkholderia cepacia complex[J]. Mikrobiyol Bul,2012,46(2):304-318.
[2]	Fazli M, Almblad H, Rybtke ML, et al. Regulation of biofilm formation in Pseudomonas and Burkholderia species[J]. Environ Microbiol,2014,16(7):1961-1981.
[3]	Kuzumoto K, Kubota N, Ishii K, et al. Successful cessation of transmitting healthcare--associated infections due to Burkholderia cepacia complex in a neonatal intensive care unit in a Japanese children’s hospital[J]. Eur J Med Res,2011,16(2):537-542.
[4]	Liao CH, Chang HT, Lai CC, et al. Clinical characteristics and outcomes of patients with Burkholderia cepacia bacteremia in an intensive care unit[J]. Diagn Microbiol Infect Dis,2011,70(2):260-266.
[5]	胡付品，郭燕，朱德妹, 等. 2016年中国CHINET细菌耐药性监测[J]. 中国感染与化疗杂志,2017,17(5):481-491.

[1]	孙国先, 单清, 林涛, 徐德宇, 侯红玲. 洋葱伯克霍尔德菌耐药及用药合理性分析[J]. 中华实验和临床感染病杂志(电子版), 2018, 12(03): 278-281.
[2]	茅国峰, 梁美春, 陈建东, 周洁. 洋葱伯克霍尔德菌血流感染危险因素及其同源性[J]. 中华实验和临床感染病杂志(电子版), 2018, 12(02): 128-133.
[3]	茅国峰, 王瑶琴. 硝酸镓联合抗菌药物抑制洋葱伯克霍尔德菌生物膜形成的研究[J]. 中华临床实验室管理电子杂志, 2019, 07(01): 35-39.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

The capabilities of disc diffusion and Vitek-2 Compact methods for testing antimicrobial susceptibility of Burkholderia cepacia

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

The capabilities of disc diffusion and Vitek-2 Compact methods for testing antimicrobial susceptibility of Burkholderia cepacia