Frederico Brito flag Denunciar. CLSI breakpoints existed for oritavancin. Tedizolid January MS, 26th ed. No previous CLSI breakpoints existed for tedizolid. Telavancin January MS, 26th ed.
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This is prohibitive for clinical microbiology laboratories in resource poor settings. We set out to compare antibiotic susceptibility determined by the two guidelines to determine whether adoption of EUCAST guidelines would significantly affect our susceptibility patterns. We reviewed minimum inhibitory concentrations MIC of various antibiotics routinely reported for Escherichia coli E.
Susceptibility data from a total of E. The concordance rates of the two guidelines for E. The kappa statistics for E. For S. For P. Given that EUCAST guidelines are freely available, it makes it easier for laboratories in resource poor settings to have an updated and readily available reference for interpreting antibiotic susceptibilities.
Over the last two decades, there has been emergence and spread of antibiotic resistance in many bacterial clinical pathogens [ 1 ]. Categorization of minimum inhibitory concentrations MIC of various antibiotics in antimicrobial susceptibility testing AST depends on breakpoints set by various international agencies. These breakpoints affect clinical decision making by determining whether an antibiotic is reported as susceptible or not. One of the most popular guidelines used worldwide is from the Clinical and Laboratory Standards Institute CLSI whose interpretive cut offs for antibiotics is based on MIC distributions, pharmacokinetic—pharmacodynamic PK-PD properties and the mechanisms of resistance [ 1 ].
Polsfuss et al. They found no significant difference in the sensitivity of the two guidelines in the detection of ESBL-producing isolates [ 5 ]. A more recent study by Hombach et al.
This study recommended adjustments to the clinical breakpoints to further harmonize the two guidelines [ 6 ]. Since then and guidelines for both systems have been released in an effort to harmonize the clinical breakpoints [ 7 , 8 ]. CLSI guidelines have a number of disadvantages. Secondly, details on the decision making process are not accessible to the public. Thirdly, the FDA has a major influence in determining official clinical breakpoints before they are adopted by CLSI and this raises major concerns on the influence of pharmaceutical industries in establishing the guidelines.
CLSI has a voting committee comprising representatives of both the profession and the industry and hence the industry plays a role in the decision making process. As for EUCAST, the industry only plays a consultative role and is not allowed to finance or participate in decision making [ 3 ]. For resource poor settings like Africa, there is need for guidelines that are accessible and affordable while still maintaining quality of reported susceptibility. Given that antibiotic susceptibility is quite variable across different settings, we set out to compare the susceptibility rates of selected antibiotics based on CLSI and EUCAST AST guidelines and the level of agreement between the two guidelines.
This was a retrospective study reviewing the MICs of various antimicrobials on one commonly isolated gram positive organism, Staphylococcus aureus S.
MIC data for E. The concordance rate between the two guidelines in percentage was compared. The susceptibility rates for the various antimicrobial agents were also calculated in percentages for each organism. For all inferential statistics, a p value less than 0. A total of E. Of the E. The concordance between the two guidelines ranged from Susceptibilities of E.
The E. Analysis year by year did not show any difference in the trends and overall susceptibilities. Of the S. Susceptibilities of S. Year by year analysis did not show any differences in trends and susceptibility patterns. For the P. Antibiotics analyzed included amikacin, ceftazidime, ciprofloxacin, cefepime, gentamicin, meropenem and piperacillin—tazobactum.
Susceptibilities of P. The morbidity and mortality associated with communicable diseases including bacterial infections is quite significant in developing countries [ 10 ]. Antibiotics play a critical role in treating such infections especially when instituted in a timely fashion more so when the bacteria is susceptible to the antibiotic given. The determination of accurate antibiotic susceptibility is therefore an important cog in the clinical care of bacterial infections especially in organisms that possess acquired resistance mechanisms and careful consideration should be given when deciding how to interpret phenotypic susceptibility data [ 11 ].
These guidelines are updated annually and therefore require laboratories to keep on purchasing them at a cost that is prohibitive to most public laboratories. Failure to stay updated may result in misinterpretation of susceptibility. The MIC for the same was reduced from 1 to 0. In the same year new levofloxacin and ofloxacin breakpoints were introduced for Salmonella spp. These changes were motivated by an increased risk of treatment failure in patients with decreased ciprofloxacin susceptible Salmonella spp [ 15 ].
These examples highlight the importance of remaining up-to-date and emphasizes the need for an affordable, up-to-date and readily available guideline for the interpretation of antibiotic susceptibility. The major discrepancy was in the intermediate and susceptible categories as 8.
EUCAST guidelines eliminated the intermediate category for some antibiotics and this explains the reduced level of agreement for some of the antibiotics. For example, CLSI categorized From a clinical stand point, reclassifying amoxicillin-clavulanate from intermediate to resistant is unlikely to adversely affect the patient as it simply removes it from being a therapeutic consideration.
As for nitrofurantoin, its ability to concentrate in urine enables it to achieve significant concentrations and eliminate isolates that may have intermediate susceptibility. Therefore, the reclassification of isolates that are intermediate by CLSI to susceptible by EUCAST is unlikely to contribute to adverse outcomes for patients with urinary tract infections.
The EUCAST guidelines have slightly more stringent breakpoints for some antibiotics in an effort to curb the inappropriate use of antibiotics and control the rising rates of antibiotic resistance. The two guidelines performed equally in the detection of the rate of methicillin resistant Staphylococcus aureus MRSA of 7.
EUCAST eliminated the intermediate category for vancomycin in a bid to discourage the reporting of Glycopeptide-intermediate Staphylococcus aureus GISA due to poor response even to increased doses of vancomycin [ 8 , 16 ]. In view of the fact that no vancomycin resistant Staphylococcus aureus VRSA has been identified in our set up as yet, these changes are unlikely to influence interpretation of breakpoints.
The moderate level of agreement for gentamicin is due to the more stringent breakpoints by EUCAST leading to a much higher resistance rate of 8. The difference between the two susceptibility cut-offs is two dilutions and this may require further harmonization. Gentamicin is rarely used as monotherapy in treating gram positive bacteria and as such this difference in MIC cut off is unlikely to be clinically significant.
This accounts for the slightly reduced level of agreement. These accounted for the reduced level of agreement and may require further harmonization between the two breakpoints. In effect this has led to a slightly higher meropenem resistance of This is another aspect that will require harmonization.
Our study is limited by the fact that we only compared the susceptibility for three bacteria whose results may not necessarily be generalizable to all clinically relevant gram positive and negative bacteria. However, these three bacteria represent a significant proportion of common bacterial pathogens both in the community and healthcare settings namely Enterobacteriaceae, non-fermenting gram negative bacteria and Staphylococci.
The results obtained are also limited to MICs generated by an automated bacterial identification system which is not widely used in developing countries. In most laboratories in sub-Saharan Africa, disk diffusion is the preferred mode of antibiotic susceptibility testing. However, disk diffusion cut offs generally approximate MIC cut offs fairly well and we think a similar comparison based on disc diffusion cut offs would yield similar results.
With EUCAST guidelines being freely available it should be considered as an alternative especially in resource poor settings in order to maintain up-to-date antibiotic susceptibility interpretation.
AK and GO contributed equally in conceiving and designing the study, data collection, data analysis and drafting the manuscript. ZP and GR participated in study design, coordination and critical revision of the manuscript. All authors read and approved the final manuscript. Ali Kassim, Email: moc. Geoffrey Omuse, Email: moc. Zul Premji, Email: bude. Gunturu Revathi, Email: ude. National Center for Biotechnology Information , U.
Ann Clin Microbiol Antimicrob. Published online Apr Author information Article notes Copyright and License information Disclaimer. Box , Nairobi, Kenya. Corresponding author. Received Jan 22; Accepted Mar This article has been cited by other articles in PMC. Methods We reviewed minimum inhibitory concentrations MIC of various antibiotics routinely reported for Escherichia coli E. Results Susceptibility data from a total of E.
Background Over the last two decades, there has been emergence and spread of antibiotic resistance in many bacterial clinical pathogens [ 1 ]. Results A total of E. Open in a separate window. Discussion The morbidity and mortality associated with communicable diseases including bacterial infections is quite significant in developing countries [ 10 ]. Acknowledgements None. Competing interests The authors declare that they have no competing interests.
Contributor Information Ali Kassim, Email: moc. References 1.
CLSI 2017 M100 S27
This is prohibitive for clinical microbiology laboratories in resource poor settings. We set out to compare antibiotic susceptibility determined by the two guidelines to determine whether adoption of EUCAST guidelines would significantly affect our susceptibility patterns. We reviewed minimum inhibitory concentrations MIC of various antibiotics routinely reported for Escherichia coli E. Susceptibility data from a total of E.
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MS23 includes a dosage regimen for imipenem for Pseudomonas aeruginosa and new information for detection of inducible clindamycin resistance using the D-zone test or broth microdilution for Streptococcus pneumoniae. Expanded recommendations for testing fluoroquinolones and salmonella, and elimination breakpoints for beta-lactamase, other than oxacillin cefoxitin , penicillin, and ceftaroline for staphylococci are included. Jean B. Work more efficiently by providing the latest recommendations for detecting emerging resistance in an easy-to-use format.