犬猫皮肤、耳部和尿液感染的门诊集中式直接培养及抗菌药物敏感性检测工作流程的临床评估

文献信息

中文摘要

背景/目的： 小动物临床中快速抗菌决策受限于传统实验室培养和抗菌药物敏感性检测（AST）的周转时间（≥2天）。现有的即时检测和门诊检测可提供更快结果，但其性能往往取决于使用者经验。本研究评估了VetBac，这是一种混合工作流程，检测在门诊进行，而由专家集中判读平板上的细菌生长。
方法： 我们分析了来自犬猫皮肤、耳部和尿液感染的60个可判读平板。在门诊，将样本接种到显色Mueller-Hinton琼脂平板上，然后放置抗生素纸片。平板孵育16-20小时，拍照，并由专家集中判读。作为比较，样本同时送至标准微生物学实验室。
结果： 临床样本中主要细菌群体的鉴定与实验室结果在种水平上显示高度一致（83.9%），当葡萄球菌属物种合并时增至100.0%。次要细菌一致性较低（16.7%），原因是无法识别及被优势细菌过度生长。总体AST一致性为93.6%（262/280），检测耐药性的敏感性为91.9%，检测敏感性的特异性为94.0%。VetBac敏感不一致出现在5/62个实验室耐药比较中（8.1%），VetBac耐药不一致出现在13/218个实验室敏感比较中（6.0%）。
结论： 在可判读的皮肤、耳部和尿液样本中，VetBac工作流程在主要细菌鉴定和AST方面与实验室结果显示高度一致。这些发现支持门诊/集中式混合模型作为更早抗菌决策支持的辅助来源，但有待实验室确认。然而，该研究未估计所有临床样本中适合直接培养和AST的比例。

英文摘要

BACKGROUND/OBJECTIVES: Rapid antimicrobial decision-making in small-animal practice is limited by the turnaround time (≥2 days) of conventional laboratory-based culture and antimicrobial susceptibility testing (AST). Existing point-of-care and in-clinic tests can provide faster results, but their performance often depends on user experience. This study evaluated VetBac, a hybrid workflow in which the test is conducted in the clinic, while experts centrally interpret bacterial growth on plates.
METHODS: We analyzed 60 interpretable plates from canine and feline skin, ear, and urine infections. In the clinic, samples were inoculated onto chromogenic Mueller-Hinton agar plates, after which antibiotic discs were applied. Plates were incubated for 16-20 h, photographed, and interpreted centrally by an expert. For comparison, samples were submitted in parallel to standard microbiology laboratories.
RESULTS: Identification of primary bacterial populations in clinical samples showed high species-level agreement with laboratory results (83.9%), increasing to 100.0% when staphylococci species were grouped. Secondary bacteria agreement (16.7%) was lower due to unrecognizability and overgrowth by dominant bacteria. Overall AST agreement was 93.6% (262/280), with 91.9% sensitivity for detecting resistance and 94.0% specificity for detecting susceptibility. VetBac-susceptible discrepancies occurred in 5/62 laboratory-resistant comparisons (8.1%), and VetBac-resistant discrepancies occurred in 13/218 laboratory-susceptible comparisons (6.0%).
CONCLUSIONS: In interpretable skin, ear, and urine samples, the VetBac workflow showed high agreement with laboratory results for primary bacterial identification and AST. These findings support the hybrid in-clinic/centralized model as an adjunctive source of earlier antimicrobial decision support, pending laboratory confirmation. However, the study did not estimate the proportion of all clinical samples suitable for direct culture and AST.