Antimicrobial susceptibility tests: testing methods and interpretive problems

Diagnostic microbiology in veterinary dermatology: present and future

BACKGROUND

The microbiology laboratory can be perceived as a service provider rather than an integral part of the healthcare team.

OBJECTIVES

The aim of this review is to discuss the current challenges of providing a state-of-the-art diagnostic veterinary microbiology service including the identification (ID) and antimicrobial susceptibility testing (AST) of key pathogens in veterinary dermatology.

METHODS

The Study Group for Veterinary Microbiology (ESGVM) of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) identified scientific, technological, educational and regulatory issues impacting the predictive value of AST and the quality of the service offered by microbiology laboratories.

RESULTS

The advent of mass spectrometry has significantly reduced the time required for ID of key pathogens such as Staphylococcus pseudintermedius. However, the turnaround time for validated AST methods has remained unchanged for many years. Beyond scientific and technological constraints, AST methods are not harmonized and clinical breakpoints for some antimicrobial drugs are either missing or inadequate. Small laboratories, including in-clinic laboratories, are usually not adequately equipped to run up-to-date clinical microbiologic diagnostic tests.

CONCLUSIONS AND CLINICAL IMPORTANCE

ESGVM recommends the use of laboratories employing mass spectrometry for ID and broth micro-dilution for AST, and offering assistance by expert microbiologists on pre- and post-analytical issues. Setting general standards for veterinary clinical microbiology, promoting antimicrobial stewardship, and the development of new, validated and rapid diagnostic methods, especially for AST, are among the missions of ESGVM.

Antibiotic resistance in human peri-implantitis microbiota

OBJECTIVES

Because antimicrobial therapy is often employed in the treatment of infectious dental implant complications, this study determined the occurrence of in vitro antibiotic resistance among putative peri-implantitis bacterial pathogens.

METHODS

Submucosal biofilm specimens were cultured from 160 dental implants with peri-implantitis in 120 adults, with isolated putative pathogens identified to species level, and tested in vitro for susceptibility to 4 mg/l of doxycycline, 8 mg/l of amoxicillin, 16 mg/l of metronidazole, and 4 mg/l of clindamycin. Findings for amoxicillin and metronidazole were combined post-hoc to identify peri-implantitis species resistant to both antibiotics. Gram-negative enteric rods/pseudomonads were subjected to ciprofloxacin disk diffusion testing.

RESULTS

One or more cultivable submucosal bacterial pathogens, most often Prevotella intermedia/nigrescens or Streptococcus constellatus, were resistant in vitro to clindamycin, amoxicillin, doxycycline, or metronidazole in 46.7%, 39.2%, 25%, and 21.7% of the peri-implantitis subjects, respectively. Only 6.7% subjects revealed submucosal test species resistant in vitro to both amoxicillin and metronidazole, which were either S. constellatus (one subject) or ciprofloxacin-susceptible strains of gram-negative enteric rods/pseudomonads (seven subjects). Overall, 71.7% of the 120 peri-implantitis subjects exhibited submucosal bacterial pathogens resistant in vitro to one or more of the tested antibiotics.

CONCLUSIONS

Peri-implantitis patients frequently yielded submucosal bacterial pathogens resistant in vitro to individual therapeutic concentrations of clindamycin, amoxicillin, doxycycline, or metronidazole, but only rarely to both amoxicillin and metronidazole. Due to the wide variation in observed drug resistance patterns, antibiotic susceptibility testing of cultivable submucosal bacterial pathogens may aid in the selection of antimicrobial therapy for peri-implantitis patients.

In vitro antibacterial activity of different endodontic irrigants

AIM

The objective of this study was to compare in vitro the antibacterial activity of Tetraclean (mixture of doxycycline, citric acid and polypropylene glycol), Niclor 5 (5.25% sodium hypochlorite solution), Cloreximid (0.2% chlorhexidine and 0.2% cetrimide solution) and hydrogen peroxide 12 volumes on three endodontic pathogens associated with primary endodontic infections. Enterococcus faecalis, Streptococcus mutans and Staphylococcus aureus strains were selected to evaluate the antibacterial activity of endodontic irrigants by the agar disc-diffusion test.

MATERIAL AND METHODS

Paper discs were saturated with each one of the test solutions (at room temperature and preheating at 50°C) and placed onto culture agar-plates preadsorbed with bacterial cells and further incubated for 24 h at 37°C. The growth inhibition zones around each irrigant were recorded and compared for each bacterial strain. Kruskal-Wallis and Mann-Whitney tests were applied to compare the various groups.

RESULTS

At room temperature, Tetraclean showed significantly higher inhibition of bacteria growth than all other irrigants tested. Preheating at 50°C significantly increased growth inhibition for all the groups tested. At 50°C, hydrogen peroxide 12 volumes and Tetraclean showed significantly higher efficacy than all other irrigants tested.

CONCLUSIONS

50°C-preheated hydrogen peroxide 12 volumes and Tetraclean showed highest inhibition of the bacterial growth.

Has antifungal susceptibility testing come of age?

The in vitro susceptibility of an infecting organism to the antimicrobial agent selected for therapy is one of several factors that influence the likelihood that therapy for an infection will be successful. To appreciate the value of antifungal susceptibility testing, it is helpful to review the overall predictive utility of antibacterial susceptibility testing. After >30 years of study, in vitro susceptibility can be said to predict the response of bacterial infections with an accuracy that is well summarized as the "90-60 rule": infections due to susceptible isolates respond to therapy approximately 90% of the time, whereas infections due to resistant isolates respond approximately 60% of the time. On the basis of a growing body of knowledge, standardized susceptibility testing for selected organism-drug combinations (most notably, Candida species and the azole antifungal agents) has been shown to have similar predictive utility. Antifungal susceptibility testing is now increasingly and appropriately used as a routine adjunct to the treatment of fungal infections.

Cefoperazone: an analysis of results in the pediatric population from a post-marketing surveillance study in hospitalized patients. The Cefoperazone Collaborative Post-marketing Surveillance Study Group

The injectable third-generation cephalosporin, cefoperazone, was introduced in India in early 1994. A post-marketing surveillance study was conducted in 1994-95 to collect local data on efficacy and safety, evaluate the native pattern of bacterial susceptibility, and assess the relationship of in vitro susceptibility tests to clinical efficacy. Hospitalized patients with features suggestive of infections that are approved indications for cefoperazone were eligible for the study. This report presents an analysis of the results among patients in the pediatric age group. The recommended dose range for children was 50-200 mg/kg/day. At analysis, 95 patients aged 6 days to 14 years were evaluable for efficacy. About a third of these (31%) were judged to have hospital acquired infections, and 22 (23%) had failed prophylaxis or previous treatment. A successful clinical outcome was observed in 91% of 75 non-neutropenic patients. Eighteen (95%) of 19 patients with pneumonia and 8 (89%) of 9 patients with pyogenic meningitis responded to cefoperazone. Five of 6 patients with complicated or hospital-acquired upper urinary tract infections, 2 of 3 patients with peritonitis, and all patients with skin or soft tissue infections, intra-abdominal abscess, osteomyelitis, and brain abscess also responded. Four of 5 non-neutropenic patients with septicemia recovered with cefoperazone monotherapy. The response rate was 70% among 20 neutropenic patients, 16 of whom were deemed septicemic. Antibiotic disc susceptibility data among pediatric patients was available for 63 isolates and 13% were reported resistant to cefoperazone. Microbiologic eradication was reported with 94% of initial isolates. Mild to moderate adverse events of study, drug-related or uncertain causation occurred in 4 (3.7%) of patients.