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Krüger A, Körber-Irrgang B, Flüh G, Gielen J, Scholz CJ, Wisplinghoff H, Jazmati N. Rapid Antimicrobial Susceptibility Testing Using the MicroScan System: Performance Evaluation of a 4-Hour Bacterial Cultivation From Positive Blood Cultures. Curr Microbiol 2024; 81:261. [PMID: 38981918 DOI: 10.1007/s00284-024-03768-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/04/2024] [Indexed: 07/11/2024]
Abstract
A reliable and above all, rapid antimicrobial susceptibility test (AST) is required for the diganostics of blood stream infections (BSI). In this study, resistance testing using DxM MicroScan WalkAway (MicroScan) from a 4-h subculture is compared with the standard overnight culture (18-24 h). Randomly selected positive blood cultures (PBC, n = 102) with gram-negative bacteria were included in the study. PBC were sub-cultured onto appropriate agar plates and AST by MicroScan was performed after 4 h of incubation and repeated after incubation for 18-24 h as standard. In a total of 1909 drug-strain pairs, the 4-h subculture approach showed a very high essential agreement (EA) (98.6%) and categorical agreement (CA) (97.1%) compared with the standard. The incidence of minor error (mE), major error (ME), very major error (VME), and adjusted very major error (aVME) was 1.1%, 0.4%, 12.9%, and 5.3%, respectively. In summary, the use of 4-h subcultures for resistance testing with the MicroScan offers a very reliable and easy to realize time saving when testing positive blood cultures with gram-negative bacteria.
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Affiliation(s)
- Alexander Krüger
- Wisplinghoff Laboratories, Horbeller Straße 18-20, 50858, Cologne, Germany.
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstr, 19-21, 50935, Cologne, Germany.
| | | | - Greta Flüh
- Wisplinghoff Laboratories, Horbeller Straße 18-20, 50858, Cologne, Germany
| | - Jörg Gielen
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstr, 19-21, 50935, Cologne, Germany
| | | | - Hilmar Wisplinghoff
- Wisplinghoff Laboratories, Horbeller Straße 18-20, 50858, Cologne, Germany
- Institute for Virology and Medical Microbiology, Witten/Herdecke University, Witten, Germany
| | - Nathalie Jazmati
- Wisplinghoff Laboratories, Horbeller Straße 18-20, 50858, Cologne, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstr, 19-21, 50935, Cologne, Germany
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2
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Klein Klouwenberg PMC, Altorf–van der Kuil W, van Griethuysen AJ, Hendriks M, Kuijper EJ, Notermans DW, Schoffelen AF. False aminoglycoside resistance in Enterobacterales and non-fermenters by an automated testing system: a descriptive study. Microbiol Spectr 2023; 11:e0309323. [PMID: 38194628 PMCID: PMC10790582 DOI: 10.1128/spectrum.03093-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/03/2023] [Indexed: 01/11/2024] Open
Abstract
IMPORTANCE Antimicrobial sensitivity data are important to guide antimicrobial therapy. In microbiological laboratories, routine sensitivity measurements are typically performed with automated testing systems such as VITEK2 and Phoenix. Using data from the Dutch national surveillance system for antimicrobial resistance over a 6-year period, we found that the measured minimum inhibitory concentrations for aminoglycosides in Enterobacterales and non-fermenters were too high for the Phoenix system. In addition, we observed a yearly increase in resistance for several species measured by Phoenix. These findings might have consequences for clinical treatment of patients with sepsis.
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Affiliation(s)
| | - W. Altorf–van der Kuil
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | - M. Hendriks
- Department of Medical Microbiology, Gelderse Vallei Hospital, Ede, the Netherlands
| | - E. J. Kuijper
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - D. W. Notermans
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - A. F. Schoffelen
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - on behalf of the ISIS-AR study groupCohen StuartJ.W.T.1MellesD.C.2van DijkK.3AlzubaidyA.4ScholingM.5KuilS.D.6BlaauwG.J.7Altorf–van der KuilW.8BiermanS.M.8de GreeffS.C.8GroenendijkS.R.8HertroysR.8MarchalN.8MonenJ.C.M.8PolmanJ.8van den ReekW.J.8Schneeberger–van der LindenC.8SchoffelenA.F.8WieldersC.C.H.8de WitB.J.8ZoetigheidR.E.8van den BijllaardtW.9KraanE.M.10HaesekerM.B.11da SilvaJ.M.12de JongE.13MarahaB.14van GriethuysenA.J.15WintermansB.B.16van TrijpM.J.C.A.17MullerA.E.18WongM.19OttA.20BathoornE.21LokateM.21SinnigeJ.22MellesD.C.23RendersN.H.24Dorigo–ZetsmaJ.W.25BakkerL.J.25WaarK.26van der BeekM.T.27Leversteijn–van HallM.A.28van MensS.P.29SchaftenaarE.30Nabuurs–FranssenM.H.31MaatI.32SturmP.D.J.33DiederenB.M.W.34BodeL.G.M.35OngD.S.Y.36van RijnM.37PontesilliO.37DinantS.38van DamD.W.39de BrauwerE.I.G.B.39BentvelsenR.G.4041BuitingA.G.M.42VlekA.L.M.43de GraafM.44TroelstraA.45JanszA.R.46van MeerM.P.A.47de VriesJ.48MachielsJ.49Department of Medical Microbiology, Noordwest Ziekenhuisgroep, Alkmaar, the NetherlandsDepartment of Medical Microbiology, Meander Medical Center, Amersfoort, the NetherlandsDepartment of Medical Microbiology and Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam Infection and Immunity Institute, Amsterdam, the NetherlandsDepartment of Medical Microbiology, Atalmedial, Amsterdam, the NetherlandsDepartment of Medical Microbiology, OLVG Lab BV, Amsterdam, the NetherlandsPublic Health Service, Public Health Laboratory, Amsterdam, the NetherlandsDepartment of Medical Microbiology and Infection Prevention, Gelre Hospitals, Apeldoorn, the NetherlandsCentre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the NetherlandsMicrovida Amphia, Laboratory for Microbiology and Infection Control, Breda, the NetherlandsDepartment of Medical Microbiology, IJsselland Hospital, Capelle aan den IJssel, the NetherlandsDepartment of Medical Microbiology, Haeseker, Reinier de Graaf Group, Delft, the NetherlandsDepartment of Medical Microbiology, Deventer Hospital, Deventer, the NetherlandsDepartment of Medical Microbiology, Slingeland Hospital, Doetinchem, the NetherlandsDepartment of Medical Microbiology, Albert Schweitzer Hospital, Dordrecht, the NetherlandsDepartment of Medical Microbiology, Gelderse Vallei Hospital, Ede, the NetherlandsDepartment of Medical Microbiology, Admiraal De Ruyter Hospital, Goes, the NetherlandsDepartment of Medical Microbiology and Infection Prevention, Groene Hart Hospital, Gouda, the NetherlandsDepartment of Medical Microbiology, Haaglanden MC, 's-Gravenhage, the NetherlandsDepartment of Medical Microbiology, Haga Hospital, 's-Gravenhage, the NetherlandsCerte, Medical Microbiology Groningen|Drenthe, Groningen, the NetherlandsDepartment of Medical Microbiology, University of Groningen, University Medical Center, Groningen, the NetherlandsRegional Public Health Laboratory Haarlem, Haarlem, the NetherlandsDepartment of Medical Microbiology, St Jansdal Hospital, Harderwijk, the NetherlandsDepartment of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, 's-Hertogenbosch, the NetherlandsDepartment of Medical Microbiology, CBSL, Tergooi MC, Hilversum, the NetherlandsCerte, Medical Microbiology Friesland|NOP, Leeuwarden, the NetherlandsDepartment of Medical Microbiology, Leiden University Medical Center, Leiden, the NetherlandsDepartment of Medical Microbiology, Eurofins Clinical Diagnostics, Leiden-Leiderdorp, the NetherlandsDepartment of Medical Microbiology, Maastricht University Medical Centre, Maastricht, the NetherlandsDepartment of Medical Microbiology and Immunology, St Antonius Hospital, Nieuwegein, the NetherlandsDepartment of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, the NetherlandsDepartment of Medical Microbiology, Radboud University Medical Center, Nijmegen, the NetherlandsLaurentius Hospital, Roermond, the NetherlandsDepartment of Medical Microbiology, Bravis Hospital, Roosendaal, the NetherlandsDepartment of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, the NetherlandsDepartment of Medical Microbiology and Infection Control, Franciscus Gasthuis and Vlietland, Rotterdam, the NetherlandsDepartment of Medical Microbiology, Ikazia Hospital, Rotterdam, the NetherlandsStar-SHL, Rotterdam, the NetherlandsDepartment of Medical Microbiology and Infection Control, Zuyderland Medical Centre, Sittard-Geleen, the NetherlandsDepartment of Medical Microbiology, Microvida ZorgSaam, Terneuzen, the NetherlandsDepartment of Medical Microbiology, Microvida ZorgSaam, Terneuzen, the NetherlandsDepartment of Medical Microbiology, St. Elisabeth Hospital, Tilburg, the NetherlandsDepartment of Medical Microbiology and Immunology, Diakonessenhuis, Utrecht, the NetherlandsDepartment of Medical Microbiology, Saltro Diagnostic Centre, Utrecht, the NetherlandsDepartment of Medical Microbiology, University Medical Center Utrecht, Utrecht, the NetherlandsDepartment of Medical Microbiology, Eurofins-PAMM, Veldhoven, the NetherlandsRijnstate Hospital, Laboratory for Medical Microbiology and Immunology, Velp, the NetherlandsDepartment of Medical Microbiology, VieCuri Medical Center, Venlo, the NetherlandsIsala Hospital, Laboratory of Medical Microbiology and Infectious Diseases, Zwolle, the Netherlands
- Department of pharmacy, Fundashon Mariadal, Kralendijk, Bonaire, the Netherlands
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Department of Medical Microbiology, Gelderse Vallei Hospital, Ede, the Netherlands
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Abstract
Enterococci are major, recalcitrant nosocomial pathogens with a wide repertoire of intrinsic and acquired resistance determinants and the potential of developing resistance to all clinically available antimicrobials. As such, multidrug-resistant enterococci are considered a serious public health threat. Due to limited treatment options and rapid emergence of resistance to all novel agents, the clinical microbiology laboratory plays a critical role in deploying accurate, reproducible, and feasible antimicrobial susceptibility testing methods to guide appropriate treatment of patients with deep-seated enterococcal infections. In this review, we provide an overview of the advantages and disadvantages of existing manual and automated methods that test susceptibility of Enterococcus faecium and Enterococcus faecalis to β-lactams, aminoglycosides, vancomycin, lipoglycopeptides, oxazolidinones, novel tetracycline-derivatives, and daptomycin. We also identify unique problems and gaps with the performance and clinical utility of antimicrobial susceptibility testing for enterococci, provide recommendations for clinical laboratories to circumvent select problems, and address potential future innovations that can bridge major gaps in susceptibility testing.
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Celik M, Sunnetcioglu M, Guducuoglu H, Arslan Y, Akyuz S, Baran AI. Comparison of Carbapenem Resistance Detected by the BD Phoenix Automated System in Enterobacteriaceae Isolates with E-Test Method. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2022. [DOI: 10.29333/ejgm/11672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Barış A, Malkoçoğlu G, Büyükyanbolu E, Aslan FM, Bayraktar B, Aktaş E. Evaluation of Teicoplanin Resistance Detected by Automated System in Coagulase Negative Staphylococci: A Comparison with Gradient Test and Broth Microdilution Methods. Curr Microbiol 2020; 77:3355-3360. [PMID: 32754852 DOI: 10.1007/s00284-020-02144-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/22/2020] [Indexed: 11/28/2022]
Abstract
Upon the observation of an increase in teicoplanin resistance rates in coagulase negative staphylococci (CoNS) isolates determined by the automated system, we aimed to compare the automated system and gradient test methods with the gold standard broth microdilution method. In addition, the effect of standard antimicrobial susceptibility guidelines on teicoplanin susceptibility test results in CoNS was investigated. A total of 81 CoNS isolates, 52 resistant and 29 susceptible to teicoplanin determined by automated system (Phoenix, Becton Dickinson, USA), were tested. The minimum inhibitory concentration (MIC) values were determined by gradient test (M.I.C. Evaluators, OXOID, UK) and broth microdilution methods. Susceptibility categories were determined according to EUCAST and CLSI criteria and the results were compared. Among 29 isolates found to be susceptible by automated system, one isolate was found resistant by gradient and broth microdilution tests. Of the 52 resistant isolates determined by automated system, 12 (23%) were found to be resistant by gradient test and 22 (42.3%) were resistant by broth microdilution. According to CLSI criteria, no resistant isolates were detected by broth microdilution and six isolates were intermediately susceptible while, two isolates were detected to be resistant and five isolates were found to be intermediately susceptible by the gradient test. In conclusion, compared to microdilution, teicoplanin resistance was detected at a higher rate in CoNS isolates by the automated system used. On the other hand, the gradient test method which is frequently used for confirmation was not reliable in MIC values close to the EUCAST breakpoint values (4 μg/mL). In addition, lower resistance rates were observed when the CLSI breakpoints were used in gradient test and broth microdilution methods.
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Affiliation(s)
- Ayşe Barış
- Department of Medical Microbiology, University of Health Sciences, Sisli Hamidiye Etfal Research and Training Hospital, Halaskargazi, Etfal Street, 34371, Sisli/İstanbul, Turkey. .,Department of Medical Microbiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
| | | | - Ecem Büyükyanbolu
- Department of Medical Microbiology, University of Health Sciences, Sisli Hamidiye Etfal Research and Training Hospital, Halaskargazi, Etfal Street, 34371, Sisli/İstanbul, Turkey
| | - Feride Merve Aslan
- Department of Medical Microbiology, University of Health Sciences, Sisli Hamidiye Etfal Research and Training Hospital, Halaskargazi, Etfal Street, 34371, Sisli/İstanbul, Turkey
| | - Banu Bayraktar
- Department of Medical Microbiology, University of Health Sciences, Sisli Hamidiye Etfal Research and Training Hospital, Halaskargazi, Etfal Street, 34371, Sisli/İstanbul, Turkey
| | - Elif Aktaş
- Department of Medical Microbiology, University of Health Sciences, Sisli Hamidiye Etfal Research and Training Hospital, Halaskargazi, Etfal Street, 34371, Sisli/İstanbul, Turkey
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6
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Soares A, Pestel-Caron M, Leysour de Rohello F, Bourgoin G, Boyer S, Caron F. Area of technical uncertainty for susceptibility testing of amoxicillin/clavulanate against Escherichia coli: analysis of automated system, Etest and disk diffusion methods compared to the broth microdilution reference. Clin Microbiol Infect 2020; 26:1685.e1-1685.e6. [PMID: 32151599 DOI: 10.1016/j.cmi.2020.02.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 02/18/2020] [Accepted: 02/27/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The European Committee on Antimicrobial Susceptibility Testing (EUCAST) recently warned about an area of technical uncertainty (ATU) of amoxicillin/clavulanate (AMX/C) disk susceptibility testing against members of the Enterobacterales. Thus, we aimed to compare the reliability of three routine methods and to evaluate the impact of the ATU. METHODS 286 Escherichia coli strains (including 159 AMX-resistant strains) were categorized for the two EUCAST AMX/C breakpoints by disk diffusion (Bio-Rad), the Phoenix automated system (Becton Dickinson) and the Etest (AES) compared to the broth microdilution reference method. RESULTS By microdilution, 84.2% of strains were AMX/C-susceptible using the urinary breakpoint (MIC ≤32 mg/L) and 62.2% using the systemic breakpoint (MIC ≤8 mg/L), with 63.6% of MICs between 4 and 16 mg/L. For the systemic breakpoint, category agreement (CA) and very major error (VME) were unacceptable for the Etest (71.7% and 27.3%), disk (73.1% and 23.4% at 19-mm cut-off) and to a lesser extent for the Phoenix system (83.6% and 10.5%). For disks, an unacceptable VME rate was observed for diameters up to 22 mm, probably due to overcharged disks. For the Etest, VMEs were high at 6 mg/L (46/63) and 8 mg/L (22/29). For the urinary breakpoint, CA was more acceptable for disk (88.9%) and Etest (84.3%) but was unevaluable for Phoenix. CONCLUSION AMX/C susceptibility testing of E. coli for systemic breakpoint was unreliable with the three routine methods, explained mainly by the high prevalence (~60%) of strains with microdilution MICs around the breakpoint (8 mg/L). Our data confirmed the EUCAST 19-20-mm ATU for disk and suggest introducing ATU for Etest MIC values of 6 and 8 mg/L.
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Affiliation(s)
- A Soares
- GRAM, EA 2656, Normandie University, Unirouen, Rouen, France; Microbiology Department, Rouen University Hospital, Rouen, France.
| | - M Pestel-Caron
- GRAM, EA 2656, Normandie University, Unirouen, Rouen, France; Microbiology Department, Rouen University Hospital, Rouen, France
| | | | - G Bourgoin
- Microbiology Department, Rouen University Hospital, Rouen, France
| | - S Boyer
- GRAM, EA 2656, Normandie University, Unirouen, Rouen, France; Microbiology Department, Rouen University Hospital, Rouen, France
| | - F Caron
- GRAM, EA 2656, Normandie University, Unirouen, Rouen, France; Infectious Diseases Department, Rouen University Hospital, Rouen, France
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Javed M, Ueltzhoeffer V, Heinrich M, Siegrist HJ, Wildermuth R, Lorenz FR, Neher RA, Willmann M. Colistin susceptibility test evaluation of multiple-resistance-level Pseudomonas aeruginosa isolates generated in a morbidostat device. J Antimicrob Chemother 2019; 73:3368-3374. [PMID: 30137346 DOI: 10.1093/jac/dky337] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 07/25/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives Colistin is a last-resort antibiotic against the critical-status pathogen Pseudomonas aeruginosa. There is still uncertainty regarding how to accurately measure colistin susceptibility in P. aeruginosa. Evaluation of antimicrobial susceptibility testing (AST) methods is largely hampered by the lack of resistant isolates and those around the susceptibility breakpoint. The aim of this study was to generate such strains in a morbidostat device for use in AST method evaluation. Methods A morbidostat device was used to cultivate susceptible clinical strains into isolates with a wide range of colistin MICs. Subsequently, five commercial AST methods were compared against the gold standard broth microdilution (BMD) method: MICRONAUT-S, SensiTest, Sensititre, Rapid Polymyxin Pseudomonas and Etest. Results A total of 131 P. aeruginosa isolates were used for colistin susceptibility test evaluation (100 colistin susceptible and 31 colistin resistant). The 31 colistin-resistant isolates evolved resistance in the morbidostat to different MIC ranges (4-512 mg/L, 100% resistance generation efficacy). The categorical agreement (CA) rates for MICRONAUT-S, SensiTest and Rapid Polymyxin Pseudomonas were 94.7%, 93.9% and 92.4%, respectively. The Sensititre achieved the highest CA score (96.9%), whereas the Etests had the lowest CA score (84%). The very major discrepancy (VMD) rates for all tests were between 3.2% and 67.7%. Conclusions The morbidostat device can efficiently provide laboratories with colistin-resistant strains for test evaluation. Although CA rates were high for commercial AST methods except for Etests, none met the ≤1.5% CLSI limit for VMD rates. Performance was generally inferior when using isolates with low-level resistance.
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Affiliation(s)
- Mumina Javed
- Interfaculty Institute of Microbiology and Infection Medicine Tübingen, Institute of Medical Microbiology and Hygiene, Tübingen, Germany.,German Center for Infection Research (DZIF), partner site Tübingen, Tübingen, Germany
| | - Viola Ueltzhoeffer
- Interfaculty Institute of Microbiology and Infection Medicine Tübingen, Institute of Medical Microbiology and Hygiene, Tübingen, Germany
| | - Maximilian Heinrich
- Interfaculty Institute of Microbiology and Infection Medicine Tübingen, Institute of Medical Microbiology and Hygiene, Tübingen, Germany.,German Center for Infection Research (DZIF), partner site Tübingen, Tübingen, Germany
| | - Hans Justus Siegrist
- Interfaculty Institute of Microbiology and Infection Medicine Tübingen, Institute of Medical Microbiology and Hygiene, Tübingen, Germany
| | - Ronja Wildermuth
- Interfaculty Institute of Microbiology and Infection Medicine Tübingen, Institute of Medical Microbiology and Hygiene, Tübingen, Germany
| | - Freia-Raphaella Lorenz
- Interfaculty Institute of Microbiology and Infection Medicine Tübingen, Institute of Medical Microbiology and Hygiene, Tübingen, Germany
| | | | - Matthias Willmann
- Interfaculty Institute of Microbiology and Infection Medicine Tübingen, Institute of Medical Microbiology and Hygiene, Tübingen, Germany.,German Center for Infection Research (DZIF), partner site Tübingen, Tübingen, Germany
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Bardet L, Rolain JM. Development of New Tools to Detect Colistin-Resistance among Enterobacteriaceae Strains. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2018; 2018:3095249. [PMID: 30631384 PMCID: PMC6305056 DOI: 10.1155/2018/3095249] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/11/2018] [Indexed: 12/27/2022]
Abstract
The recent discovery of the plasmid-mediated mcr-1 gene conferring resistance to colistin is of clinical concern. The worldwide screening of this resistance mechanism among samples of different origins has highlighted the urgent need to improve the detection of colistin-resistant isolates in clinical microbiology laboratories. Currently, phenotypic methods used to detect colistin resistance are not necessarily suitable as the main characteristic of the mcr genes is the low level of resistance that they confer, close to the clinical breakpoint recommended jointly by the CLSI and EUCAST expert systems (S ≤ 2 mg/L and R > 2 mg/L). In this context, susceptibility testing recommendations for polymyxins have evolved and are becoming difficult to implement in routine laboratory work. The large number of mechanisms and genes involved in colistin resistance limits the access to rapid detection by molecular biology. It is therefore necessary to implement well-defined protocols using specific tools to detect all colistin-resistant bacteria. This review aims to summarize the current clinical microbiology diagnosis techniques and their ability to detect all colistin resistance mechanisms and describe new tools specifically developed to assess plasmid-mediated colistin resistance. Phenotyping, susceptibility testing, and genotyping methods are presented, including an update on recent studies related to the development of specific techniques.
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Affiliation(s)
- Lucie Bardet
- Aix-Marseille Université, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Jean-Marc Rolain
- Aix-Marseille Université, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, Marseille, France
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9
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Susceptibility testing and detection of β-lactam resistance mechanisms in Enterobacteriaceae: a multicentre national proficiency study. Int J Antimicrob Agents 2018; 51:612-619. [DOI: 10.1016/j.ijantimicag.2017.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 12/13/2017] [Accepted: 12/16/2017] [Indexed: 11/23/2022]
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10
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Susceptibility Testing for the Polymyxins: Two Steps Back, Three Steps Forward? J Clin Microbiol 2017; 55:2573-2582. [PMID: 28724555 DOI: 10.1128/jcm.00888-17] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Optimizing and standardizing susceptibility testing for the polymyxins have become pressing issues, given the rise in multidrug-resistant Gram-negative bacilli. Recently, both the CLSI and EUCAST have recommended broth microdilution (BMD) (without polysorbate) as the reference method for polymyxin susceptibility testing. In this issue, K. L. Chew et al. (J Clin Microbiol 55:2609-2616, 2017, https://doi.org/10.1128/JCM.00268-17) compare the performances of three commercial BMD panels and the Etest to the reference, BMD, for polymyxin B and colistin, using 76 Enterobacteriaceae isolates (21 of which were mcr-1 positive). Although none of the commercial BMD panels strictly met FDA performance standards in this evaluation, possibly because of the small number isolates tested, the Sensititre panel achieved >90% categorical agreement for both polymyxin compounds. These results also reaffirm CLSI and EUCAST guidance that gradient diffusion testing, which had unacceptable error rates, should be abandoned. In a simulated analysis with lowered breakpoints (susceptible, ≤1 mg/liter; intermediate, 2 mg/liter; resistant, ≥4 mg/liter), error rates and agreement were improved across the various methods and the rate of detection of mcr-1-positive isolates improved. These observations, taken together with recent pharmacokinetic data on optimizing target attainment for the polymyxins, suggest that more-stringent (lower) breakpoints may be reasonable, although such an approach may be limited by the inherent reliability of current testing methodologies and a lack of robust clinical correlative data, which are sorely needed.
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María DA, María-Isabel M, María-Carmen C, Álvaro P, Jorge C, Luis MM, Francesc M, Jordi V, Adriana O, Jesús O, Rafael C. Establishing the validity of different susceptibility testing methods to evaluate the in vitro activity of amoxicillin-clavulanate against Escherichia coli. Diagn Microbiol Infect Dis 2015; 84:334-6. [PMID: 26830054 DOI: 10.1016/j.diagmicrobio.2015.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 12/11/2015] [Accepted: 12/14/2015] [Indexed: 10/22/2022]
Abstract
Amoxicillin-clavulanate MICs of 160 Escherichia coli isolates with characterized resistance mechanisms were obtained by 2 MIC gradient strip brands, 3 automated systems, and reference ISO microdilution method using EUCAST (fixed 2μg/mL clavulanate) and CLSI (2:1 ratio) criteria. Discrepancies, mainly obtained with gradient strips, lead to an essential agreement range of 76.2-92.5.
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Affiliation(s)
- Díez-Aguilar María
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain
| | - Morosini María-Isabel
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain
| | - Conejo María-Carmen
- Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain; Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain
| | - Pascual Álvaro
- Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain; Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain; Unidad Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Calvo Jorge
- Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain; Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Martínez-Martínez Luis
- Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain; Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain; Departamento de Biología Molecular, Universidad de Cantabria, Santander, Spain
| | - Marco Francesc
- Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain; Servei de Microbiologia, Centre Diagnòstic Biomèdic (CDB), ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Vila Jordi
- Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain; Servei de Microbiologia, Centre Diagnòstic Biomèdic (CDB), ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Ortega Adriana
- Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain; Laboratorio de Antibióticos, Bacteriología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Oteo Jesús
- Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain; Laboratorio de Antibióticos, Bacteriología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Cantón Rafael
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain.
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Chen WT, Shen SM, Shu CM. Application of ethylene diamine tetra acetic acid degrading bacterium Burkholderia cepacia on biotreatment process. BIORESOURCE TECHNOLOGY 2015; 193:357-362. [PMID: 26143003 DOI: 10.1016/j.biortech.2015.06.099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/18/2015] [Accepted: 06/19/2015] [Indexed: 06/04/2023]
Abstract
Ethylene diamine tetra acetic acid (EDTA), the effluent of secondary biotreatment units, can be properly biodegraded by Burkholderia cepacia. Through batch degradation of EDTA, the raw wastewater of EDTA was controlled at 50 mg/L, and then nutrients was added in diluted wastewater to cultivate activated sludge, which the ratio of composition is depicted as "COD:N:P:Fe = 100:5:1:0.5". After 27 days, the removal efficiency of Fe-EDTA and COD was 100% and 92.0%, correspondingly. At the continuous process, the raw wastewater of EDTA was dictated at 166 mg/L before adding nutrients to cultivate activated sludge, in which the ratio of composition did also follow with batch process. After 22 days, the removal efficiency of Fe-EDTA and COD for experimental group was 71.46% and 62.58%, correspondingly. The results showed that the batch process was more suited for EDTA biodegradation.
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Affiliation(s)
- Wei-Ting Chen
- Department of Cosmetic Application & Management, St. Mary's Junior College of Medicine, Nursing and Management, Yilan 26644, Taiwan, ROC.
| | - Shu-Min Shen
- Department of Safety, Health, and Environmental Engineering, National Yunlin University of Science and Technology, Yunlin 64002, Taiwan, ROC
| | - Chi-Min Shu
- Department of Safety, Health, and Environmental Engineering, National Yunlin University of Science and Technology, Yunlin 64002, Taiwan, ROC
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Leverstein-van Hall MA, Waar K, Muilwijk J, Cohen Stuart J, Sabbe LJM, Frenay HME, Maraha B, van Keulen PHJ, Kluytmans JAJW, de Jongh BM, Vlaminckx BJM, de Brauwer EIGB, Stals FS, Bakker LJ, Dorigo-Zetsma JW, Sebens FW, Mattsson EE, Kaan JA, Thijsen SFT, Buiting AGM, Wintermans RGF, van Hees BC, Brimicombe RW, Ruijs GJHM, Wolfhagen MJHM, van Zeijl JH, Waar K, Renders NHM, Bernards AT, Wintermans RGF, Heilmann FGC, Halaby T, Overbeek BP, Schellekens JFP, Jansen CL, Vlaspolder F, Alblas J, van der Bij AK, Leenstra T, Leversteijn-van Hall MA, Monen J, Muilwijk J, Tjhie HT, Sturm PDJ, Diederen BMW, van Zwet AA, Deege MPD, Boel CHE, Cohen Stuart J, Hendrickx BGA. Consequences of switching from a fixed 2 : 1 ratio of amoxicillin/clavulanate (CLSI) to a fixed concentration of clavulanate (EUCAST) for susceptibility testing of Escherichia coli. J Antimicrob Chemother 2013; 68:2636-40. [DOI: 10.1093/jac/dkt218] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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