Impact of minimal inhibitory concentration breakpoints on local cumulative bacterial susceptibility data and antibiotic consumption

BMC Research Notes

Gernot Geginat¹  Christina Grabau²  Stefanie Zibolka²  Ina Tammer¹  Sofia Stokkou¹ 

[1] Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Universitätsklinikum Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany;Zentralapotheke, Universitätsklinikum Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany

关键词: Antibiotic stewardship;    Antibiotic consumption;    EUCAST;    Clinical breakpoints;    Minimal inhibitory concentration;    Antibiotic susceptibility testing;   

Others  :  1129827
DOI  :  10.1186/1756-0500-7-603

 received in 2014-04-30, accepted in 2014-08-28,  发布年份 2014

【 摘 要 】

Background

The phenotypic antimicrobial susceptibility testing (AST) of bacteria depends on minimal inhibitory concentration breakpoints issued by national and international breakpoint committees. The current study was performed in order to test the influence of different AST standards on local cumulative AST data and on antibiotic consumption.

Methods

Automated AST was performed with clinical isolates of Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis,Staphylococcus aureus, coagulase-negative staphylococci, Enterococcus faecalis, and E. faecium. From each species 100 prospectively collected non-duplicate clinical isolates were tested and MIC data were interpreted according to the interpretation standards issued by DIN and EUCAST, respectively. In addition cumulative AST data from clinical isolates and antibiotic consumption were monitored before and after implementation of new EUCAST MIC breakpoints.

Results

The susceptibility rate of P. aeruginosa against piperacillin and gentamicin, and of C. freundii against piperacillin/tazobactam increased significantly, whereas the susceptibility rates of E. cloacae, S. marcescens, and M. morganii against ciprofloxacin decreased significantly after switching from DIN to EUCAST MIC breakpoints. These changes in the cumulative antibiotic resistance pattern were reflected by enhanced consumption of piperacillin/tazobactam after implementation of EUCAST MIC breakpoints.

Conclusions

These data show that changes of AST breakpoints have a significant influence on local cumulative AST data and on antibiotic consumption.

【 授权许可】

   
2014 Stokkou et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Normensausschuss Medizin im DIN: Teil 4: Bewertungsstufen für die Minimale Hemmkonzentration; MHK-Grenzwerte von Antibakteriellen Wirkstoffen. In Medizinische Mikrobiologie- Empfindlichkeitsprüfung von Mikrobiellen Krankheitserregern Gegen Chemotherapeutika. Edited by Normung DDIf. Berlin, Germany: Beuth Verlag GmbH; 2004.
• [2]Breakpoint tables for interpretation of MICs and zone diameters, version 2.0 http://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Breakpoint_tables/Breakpoint_table_v_2.0_120221.pdf webcite
• [3]Clinical and Laboratory Standards Institute: Performance Standards for Antimicrobial Susceptibility Testing: Twentieth Informational Supplement. M100-S20. Wayne, PA, USA: CLSI; 2010.
• [4]Dellit TH, Owens RC, McGowan JE Jr, Gerding DN, Weinstein RA, Burke JP, Huskins WC, Paterson DL, Fishman NO, Carpenter CF, Brennan PJ, Billeter M, Hooton TM: Infectious diseases society of America and the society for healthcare epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007, 44(2):159-177.
• [5]Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, Harbarth S, Hindler JF, Kahlmeter G, Olsson-Liljequist B, Paterson DL, Rice LB, Stelling J, Struelens MJ, Vatopoulos A, Weber JT, Monnet DL: Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012, 18(3):268-281.
• [6]Färber J, Moder KA, Layer F, Tammer I, König W, König B: Extended-spectrum beta-lactamase detection with different panels for automated susceptibility testing and with a chromogenic medium. J Clin Microbiol 2008, 46(11):3721-3727.
• [7]Collaborating center for drug statistics methodology. ATC/DDD index 2014 http://www.whocc.no/atcddd/ webcite
• [8]Jacoby GA: Mechanisms of resistance to quinolones. Clin Infect Dis 2005, 41(Suppl 2):S120-S126.
• [9]Hombach M, Bloemberg GV, Bottger EC: Effects of clinical breakpoint changes in CLSI guidelines 2010/2011 and EUCAST guidelines 2011 on antibiotic susceptibility test reporting of gram-negative bacilli. J Antimicrob Chemother 2012, 67(3):622-632.
• [10]Hombach M, Mouttet B, Bloemberg GV: Consequences of revised CLSI and EUCAST guidelines for antibiotic susceptibility patterns of ESBL- and AmpC beta-lactamase-producing clinical enterobacteriaceae isolates. J Antimicrob Chemother 2013, 68(9):2092-2098.
• [11]Hombach M, Wolfensberger A, Kuster SP, Bottger EC: Influence of clinical breakpoint changes from CLSI 2009 to EUCAST 2011 antimicrobial susceptibility testing guidelines on multidrug resistance rates of gram-negative rods. J Clin Microbiol 2013, 51(7):2385-2387.
• [12]Huang CC, Chen YS, Toh HS, Lee YL, Liu YM, Ho CM, Lu PL, Liu CE, Chen YH, Wang JH, Tang HJ, Yu KW, Liu YC, Chuang YC, Xu Y, Ni Y, Ko WC, Hsueh PR: Impact of revised CLSI breakpoints for susceptibility to third-generation cephalosporins and carbapenems among enterobacteriaceae isolates in the Asia-pacific region: results from the study for monitoring antimicrobial resistance trends (SMART), 2002–2010. Int J Antimicrob Agents 2012, 40(Suppl):S4-S10.
• [13]Liu PY, Shi ZY, Tung KC, Shyu CL, Chan KW, Liu JW, Wu ZY, Kao CC, Huang YC, Lin CF: Antimicrobial resistance to cefotaxime and ertapenem in enterobacteriaceae: the effects of altering clinical breakpoints. J Infect Dev Ctries 2014, 8(3):289-296.
• [14]van der Bij AK, van Dijk K, Muilwijk J, Thijsen SF, Notermans DW, de Greeff S, van de Sande-Bruinsma N: Clinical breakpoint changes and their impact on surveillance of antimicrobial resistance in Escherichia coli causing bacteraemia. Clin Microbiol Infect 2012, 18(11):E466-E472.
• [15]Livermore DM, Andrews JM, Hawkey PM, Ho PL, Keness Y, Doi Y, Paterson D, Woodford N: Are susceptibility tests enough, or should laboratories still seek ESBLs and carbapenemases directly? J Antimicrob Chemother 2012, 67(7):1569-1577.
• [16]Tamma PD, Powers JH: Do patient data really support the clinical and laboratory standards institute recommendation for lowering third-generation cephalosporin interpretive breakpoints? Clin Infect Dis 2013, 57(4):624-625.
• [17]Thomson KS: Lowering of Third Generation Cephalosporin Breakpoints. Clin Infect Dis 2013, 57(11):1663-1664.
• [18]Marchaim D, Sunkara B, Lephart PR, Gudur UM, Bhargava A, Mynatt RP, Zhao JJ, Bheemreddy S, Hayakawa K, Chopra T, Dhar S, Kaye KS: Extended-spectrum beta-lactamase producers reported as susceptible to piperacillin-tazobactam, cefepime, and cefuroxime in the era of lowered breakpoints and no confirmatory tests. Infect Control Hosp Epidemiol 2012, 33(8):853-855.
• [19]Hombach M, Bottger EC, Roos M: The critical influence of the intermediate category on interpretation errors in revised EUCAST and CLSI antimicrobial susceptibility testing guidelines. Clin Microbiol Infect 2013, 19(2):E59-E71.
• [20]Gagliotti C, Sarti M, Sabia C, Gargiulo R, Rossolini GM, Carillo C, Cassani C, Cipolloni AP, Pedna F, Rossi MR, Incerti SS, Testa G, Venturelli C, Moro ML: Accuracy of automated and manual systems for susceptibility testing of pseudomonas aeruginosa to piperacillin and piperacillin-tazobactam. New Microbiol 2011, 34(1):97-99.
• [21]Sader HS, Hsiung A, Fritsche TR, Jones RN: Comparative activities of cefepime and piperacillin/tazobactam tested against a global collection of escherichia coli and klebsiella spp. with an ESBL phenotype. Diagn Microbiol Infect Dis 2007, 57(3):341-344.