External factors affecting imipenem performance in dried microdilution MIC plates

Copper complexation screen reveals compounds with potent antibiotic properties against methicillin-resistant Staphylococcus aureus

Macrophages take advantage of the antibacterial properties of copper ions in the killing of bacterial intruders. However, despite the importance of copper for innate immune functions, coordinated efforts to exploit copper ions for therapeutic interventions against bacterial infections are not yet in place. Here we report a novel high-throughput screening platform specifically developed for the discovery and characterization of compounds with copper-dependent antibacterial properties toward methicillin-resistant Staphylococcus aureus (MRSA). We detail how one of the identified compounds, glyoxal-bis(N4-methylthiosemicarbazone) (GTSM), exerts its potent strictly copper-dependent antibacterial properties on MRSA. Our data indicate that the activity of the GTSM-copper complex goes beyond the general antibacterial effects of accumulated copper ions and suggest that, in contrast to prevailing opinion, copper complexes can indeed exhibit species- and target-specific activities. Based on experimental evidence, we propose that copper ions impose structural changes upon binding to the otherwise inactive GTSM ligand and transfer antibacterial properties to the chelate. In turn, GTSM determines target specificity and utilizes a redox-sensitive release mechanism through which copper ions are deployed at or in close proximity to a putative target. According to our proof-of-concept screen, copper activation is not a rare event and even extends to already established drugs. Thus, copper-activated compounds could define a novel class of anti-MRSA agents that amplify copper-dependent innate immune functions of the host. To this end, we provide a blueprint for a high-throughput drug screening campaign which considers the antibacterial properties of copper ions at the host-pathogen interface.

Antimicrobial proficiency testing of National Nosocomial Infections Surveillance System hospital laboratories

OBJECTIVE

The National Nosocomial Infections Surveillance (NNIS) System personnel report trends in antimicrobial-resistant pathogens. To validate select antimicrobial susceptibility testing results and to identify test methods that tend to produce errors, we conducted proficiency testing among NNIS System hospital laboratories.

SETTING

NNIS System hospital laboratories in the United States.

METHODS

Each laboratory received five organisms (ie, an imipenem-resistant Serratia marcescens, an oxacillin-resistant Staphylococcus aureus, a vancomycin-resistant Enterococcus faecalis, a vancomycin-intermediate Staphylococcus epidermidis, and an extended-spectrum beta-lactamase (ESbetaL)-producing Klebsiella pneumoniae). Testing results were compared with reference testing results from the Centers for Disease Control and Prevention.

RESULTS

Of 138 laboratories testing imipenem against the Serratia marcescens strain, 110 (80%) correctly reported minimum inhibitory concentrations (MICs) or zone sizes in the resistant range. All 193 participating laboratories correctly reported the Staphylococcus aureus strain as oxacillin resistant Of the 193 laboratories, 169 (88%) reported correct MICs or zone sizes for the vancomycin-resistant Enterococcus faecalis. One hundred sixty-two (84%) of 193 laboratories demonstrated the ability to detect a vancomycin-intermediate strain of Staphylococcus epidermidis, however, disk diffusion performed poorly when testing both staphylococci and enterococci with vancomycin. Although laboratory personnel correctly reported nonsusceptible extended-spectrum cephalosporins and aztreonam results for K. pneumoniae, only 98 (51%) of 193 correctly reported this organism as an ESbetaL producer.

CONCLUSION

Overall, NNIS System hospital laboratory personnel detected most emerging resistance patterns. Disk diffusion continues to be unreliable for vancomycin testing of staphylococci and must be used cautiously for enterococci. Further education on the processing of ESbetaL-producing organisms is warranted.

Ability of laboratories to detect emerging antimicrobial resistance in nosocomial pathogens: a survey of project ICARE laboratories

A proficiency testing project was conducted among 48 microbiology laboratories participating in Project ICARE (Intensive Care Antimicrobial Resistance Epidemiology). All laboratories correctly identified the Staphylococcus aureus challenge strain as oxacillin- resistant and an Enterococcus faecium strain as vancomycin-resistant. Thirty-one (97%) of 32 laboratories correctly reported the Streptococcus pneumoniae strain as erythromycin-resistant. All laboratories testing the Pseudomonas aeruginosa strain against ciprofloxacin or ofloxacin correctly reported the organism as resistant. Of 40 laboratories, 30 (75%) correctly reported resistant MICs or zone sizes for the imipenem- and meropenem-resistant Serratia marcescens. For the extended-spectrum beta-lactamase (ESBL)-producing strain of Klebsiella pneumoniae, 18 (42%) of 43 laboratories testing ceftazidime correctly reported ceftazidime MICs in the resistant range. These results suggest that current testing generally produces accurate results, although some laboratories have difficulty detecting resistance to carbapenems and extended-spectrum cephalosporins. This highlights the need for monitoring how well susceptibility test systems in clinical laboratories detect emerging resistance.

Effect of zinc concentration in Mueller-Hinton agar on susceptibility of Pseudomonas aeruginosa to imipenem

The susceptibility of Pseudomonas aeruginosa to imipenem has been shown to vary according to zinc concentration in the media. MICs of imipenem for 68 unique clinical isolates of P. aeruginosa were determined in media supplemented with zinc at concentrations between 0.5 and 6.0 micrograms/ml. In agar containing up to 3 micrograms of zinc/ml, 75 to 82% of the strains were susceptible to imipenem at an MIC of < or = 4 micrograms/ml. In agar supplemented to contain 6 micrograms of zinc/ml, however, only 40% of the strains were susceptible to imipenem. Manufacturers should ensure that the concentration of zinc in commercial media is below 3 micrograms/ml to avoid false classification of isolates as resistant to imipenem.

Beta-lactam stability in frozen microdilution PASCO MIC panels using strains with known resistance mechanisms as biosensors

The stability of amoxicillin/clavulanate, piperacillin/tazobactam, cefepime, imipenem, and meropenem in PASCO (PASCO System, DIFCO Laboratories, Detroit, MI, USA) frozen microdilution susceptibility panels stored for 16 weeks at -20 degrees C and -70 degrees C was evaluated. The increase in MIC values for the five American-Type Culture Collection (ATCC) quality control strains for susceptibility testing recommended by the National Committee for Clinical Laboratory Standards (NCCLS) and for 13 strains with different well-characterized resistance mechanisms was indicative of bioactivity deterioration. The overall agreement (+/- 1 twofold dilution) at purchase between the MIC values of PASCO frozen microdilution susceptibility panels and the standard agar dilution method was 97.7%. Minimum inhibitory concentration values for the associations of amoxicillin/clavulanate and piperacillin/tazobactam remained unchanged for the study period at -70 degrees C. In contrast, a carbapenem bioactivity decrease was detected only with strains having well-characterized resistance mechanisms from the 12th week onwards. At -20 degrees C, antibiotic deterioration with these latter strains was observed earlier than with ATCC strains: the activity of meropenem and imipenem remained unchanged only for the first 2 weeks, while a loss of activity was detected for amoxicillin/clavulanate and piperacillin/tazobactam at the 7th and 10th week, respectively. Cefepime was highly stable both at -20 degrees C and -70 degrees C. Strains with well-characterized resistance mechanisms should be used in routine quality control studies of antibiotic stability for susceptibility testing panels during the storage period.

Discrepancies in susceptibility test results for imipenem employing different in vitro test methods and DIN 58,940 breakpoints

During the first half of 1993, bacteria that were isolated from clinical materials and found to have intermediate susceptibility by an agar dilution breakpoint method were collected in a large service laboratory in Germany. All of these isolates were gram-negative bacteria. They were re-tested employing full-scale agar dilution, broth microdilution, E-test and agar diffusion procedures. The results obtained indicated that 76.9% of the isolates were actually susceptible upon re-testing with a reference agar dilution technique. The reason for the discrepant results remained largely unclear. There was a high correlation between agar dilution and E-test results while the agreement with broth microdilution and agar diffusion was less satisfactory. It is suggested that the breakpoint between susceptible and intermediate categories currently recommended by DIN 58,940 (standard set by Deutsches Institut für Normung e.V.) be raised to reduce erroneous interpretations of minimum inhibitory concentrations.

Imipenem stability in a predried susceptibility panel

We performed a 15-month study using 11 clinical strains and 1 control strain (ATCC 27853) of Pseudomonas aeruginosa to determine whether changes in the manufacturing process of Sensititre predried panels result in a reliable test of susceptibility to imipenem. MIC and breakpoint susceptibility results remained stable during the manufacturer's recommended shelf life of 18 months and compared well with standard agar disk diffusion and broth macrodilution results. Imipenem concentrations measured by high-pressure liquid chromatography were acceptable through 15 months but declined in the breakpoint panels by approximately 50% at 18 months. Between 9 months and panel expiration, 13 of 141 (9%) of the MIC panel packages had moisture entry, as indicated by pink desiccants, with a resultant loss of imipenem activity of 32 to 100%. It appears that the new manufacturing process produces MIC panels that are reliable for imipenem susceptibility testing until the labeled expiration date, provided that packages containing pink desiccants are not used.

Comparison of sensititre broth microdilution and agar dilution susceptibility testing techniques for meropenem to determine accuracy, reproducibility, and predictive values

The stability, accuracy, reproducibility, and predictive value of Sensititre MIC panels containing meropenem (Merrem) were evaluated by using National Committee for Clinical Laboratory Standards (NCCLS)-recommended American Type Culture Collection (ATCC) strains and 110 selected strains of rapidly growing and fastidious aerobes and anaerobes with various degrees of susceptibility to meropenem. The NCCLS-recommended agar dilution method was used as a standard reference method. Meropenem-containing Sensititre MIC panels were monitored for their stabilities at room temperature and reproducibilities over 24 months by using six ATCC strains. Ninety-nine percent of the MICs of both meropenem and imipenem obtained for NCCLS-recommended ATCC strains were within the established ranges after 2 years. The overall agreement (+/- 1 twofold dilution) between the Sensititre and the agar dilution meropenem MICs was greater than 93%. The predictive value of meropenem MICs for indicating suspeptibility or resistance obtained by the Sensititre method was greater than 90%. No major or very major interpretive errors were observed, and only 5% of meropenem MICs were associated with minor interpretive errors. Problematic organisms were not observed. The Sensititre MIC panels containing meropenem offer a convenient and valid alternative to the NCCLS reference method for the susceptibility testing of potential pathogens likely to be recovered from mixed infections.