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Jensen VF, Damborg P, Norström M, Nonnemann B, Slettemeås JS, Smistad M, Sølverød L, Turnidge J, Urdahl AM, Veldman K, van Essen-Zandbergen A, Astrup LB. Estimation of epidemiological cut-off values for eight antibiotics used for treatment of bovine mastitis caused by Streptococcus uberis and Streptococcus dysgalactiae subsp. dysgalactiae. Vet Microbiol 2024; 290:109994. [PMID: 38281323 DOI: 10.1016/j.vetmic.2024.109994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/30/2024]
Abstract
Interpretive criteria for antimicrobial susceptibility testing are lacking for most antimicrobials used for bovine streptococcal mastitis. The objectives of this study were to determine (tentative) epidemiological cut-off ((T)ECOFF) values for clinically relevant antibiotics used for treatment of bovine mastitis, and to estimate the proportion of acquired resistance (non-wild-types) in Streptococcus dysgalactiae subsp. dysgalactiae and Streptococcus uberis. A total of 255 S. uberis and 231 S. dysgalactiae subsp. dysgalactiae isolates were obtained in Denmark and Norway from bovine mastitis. The isolates were tested for susceptibility to 10 antibiotics using broth microdilution. In accordance with the European Committee on Antimicrobial Susceptibility Testing (EUCAST) standard operating procedure, additional published MIC distributions were included for the estimation of ECOFFs for cloxacillin, cephapirin, lincomycin and tylosin, and TECOFFs for amoxicillin, benzylpenicillin, cephapirin and oxytetracycline. The proportion of non-wild-type (NWT) isolates for the beta-lactams was significantly higher in the Danish S. uberis (45-55%) compared to the Norwegian isolates (10-13%). For oxytetracycline, the proportion of NWT was significantly higher in the Danish isolates, both for S. uberis (28% vs. 3%) and S. dysgalactiae (22% vs. 0%). A bridging study testing in parallel MICs in a subset of isolates (n = 83) with the CLSI-specified and the EUCAST-specified broths showed excellent correlation between the MICs obtained with the two methods. The new ECOFFs and TECOFFs proposed in this study can be used for surveillance of antimicrobial resistance, and - for antimicrobials licensed for streptococcal bovine mastitis - as surrogate clinical breakpoints for predicting their clinical efficacy for this indication.
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Affiliation(s)
- Vibeke Frøkjær Jensen
- SEGES Innovation P/S, Agro Food Park 15, 8200 Aarhus N, Denmark; Centre for Diagnostics, Technological University of Denmark, Anker Engelunds Vej 101, 2800 Kongens Lyngby, Denmark
| | - Peter Damborg
- Department of Veterinary and Animal Sciences, University of Copenhagen, Stigbøjlen 4, 1870 Frederiksberg C, Denmark.
| | - Madelaine Norström
- Norwegian Veterinary Institute, Research Food Safety and Animal Health, Elizabeth Stephansens vei 1, 1433 Ås, Norway
| | - Bettina Nonnemann
- Centre for Diagnostics, Technological University of Denmark, Anker Engelunds Vej 101, 2800 Kongens Lyngby, Denmark
| | - Jannice Schau Slettemeås
- Norwegian Veterinary Institute, Research Food Safety and Animal Health, Elizabeth Stephansens vei 1, 1433 Ås, Norway
| | - Marit Smistad
- Tine Mastitis Laboratory, Boks 2039, 6402 Molde, Norway
| | - Liv Sølverød
- Tine Mastitis Laboratory, Boks 2039, 6402 Molde, Norway
| | - John Turnidge
- School of Biological Sciences in the Faculty of Sciences, Engineering and Technology, University of Adelaide, North Terrace, Adelaide, South Australia 6062, Australia
| | - Anne Margrete Urdahl
- Norwegian Veterinary Institute, Research Food Safety and Animal Health, Elizabeth Stephansens vei 1, 1433 Ås, Norway
| | - Kees Veldman
- Department of Bacteriology, Host Pathogen Interaction & Diagnostics, Wageningen Bioveterinary Research part of Wageningen University & Research (WUR), Houtribweg 39, 8221 RA, Lelystad, the Netherlands
| | - Alieda van Essen-Zandbergen
- Department of Bacteriology, Host Pathogen Interaction & Diagnostics, Wageningen Bioveterinary Research part of Wageningen University & Research (WUR), Houtribweg 39, 8221 RA, Lelystad, the Netherlands
| | - Lærke Boye Astrup
- SEGES Innovation P/S, Agro Food Park 15, 8200 Aarhus N, Denmark; Centre for Diagnostics, Technological University of Denmark, Anker Engelunds Vej 101, 2800 Kongens Lyngby, Denmark
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Kahlmeter G, Turnidge J. Wild-type distributions of minimum inhibitory concentrations and epidemiological cut-off values-laboratory and clinical utility. Clin Microbiol Rev 2023; 36:e0010022. [PMID: 38038445 PMCID: PMC10732016 DOI: 10.1128/cmr.00100-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
The characterization of wild-type minimum inhibitory concentration (MIC) and zone diameter distributions with the setting of epidemiological cut-off values (ECOFFs or ECVs) provides a reference for the otherwise relative MIC values in the international system for antimicrobial susceptibility testing. Distributions of MIC values for a species and an agent follow a log-normal distribution, which in the absence of resistance mechanisms is monomodal and designated wild type (WT). The upper end of the WT distribution, the ECOFF, can be identified with statistical methods. In the presence of phenotypically detectable resistance, the distribution has at least one more mode (the non-WT), but despite this, the WT is most often identifiable using the same methods. The ECOFF provides the most sensitive measure of resistance development in a species against an agent. The WT and non-WT modes are independent of the organism´s response to treatment, but when the European Committee on Antimicrobial Susceptibility Testing (EUCAST) determines the clinical breakpoints, the committee avoids breakpoints that split WT distributions of target species. This is to avoid the poorer reproducibility of susceptibility categorization when breakpoints split major populations but also because the EUCAST has failed to identify different clinical outcomes for isolates with different MIC values inside the wild-type distribution. In laboratory practice, the ECOFF is used to screen for and exclude resistance and allows the comparison of resistance between systems with different breakpoints from different breakpoint organizations, breakpoints evolving over time, and different breakpoints between human and animal medicine. The EUCAST actively encourages colleagues to question MIC distributions as presented on the website (https://www.eucast.org/mic_and_zone_distributions_and_ecoffs) and to contribute MIC and inhibition zone diameter data.
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Affiliation(s)
- Gunnar Kahlmeter
- Technical Data Coordinator of the European Committee on Antimicrobial Susceptibility Testing (EUCAST), Växjö, Sweden
- Head of the Swedish Reference Laboratory for phenotypic susceptibility testing, Växjö, Sweden
- Head of the EUCAST Development Laboratory, Växjö, Sweden
| | - John Turnidge
- Document and Technical Support to the European Committee on Antimicrobial Susceptibility Testing (EUCAST), Växjö, Sweden
- School of Biological Sciences, University of Adelaide, Adelaide, Australia
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Sapula SA, Amsalu A, Whittall JJ, Hart BJ, Siderius NL, Nguyen L, Gerber C, Turnidge J, Venter H. The scope of antimicrobial resistance in residential aged care facilities determined through analysis of Escherichia coli and the total wastewater resistome. Microbiol Spectr 2023; 11:e0073123. [PMID: 37787536 PMCID: PMC10715142 DOI: 10.1128/spectrum.00731-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/07/2023] [Indexed: 10/04/2023] Open
Abstract
IMPORTANCE Antimicrobial resistance (AMR) is a global threat that imposes a heavy burden on our health and economy. Residential aged care facilities (RACFs), where frequent inappropriate antibiotic use creates a selective environment that promotes the development of bacterial resistance, significantly contribute to this problem. We used wastewater-based epidemiology to provide a holistic whole-facility assessment and comparison of antimicrobial resistance in two RACFs and a retirement village. Resistant Escherichia coli, a common and oftentimes problematic pathogen within RACFs, was isolated from the wastewater, and the phenotypic and genotypic AMR was determined for all isolates. We observed a high prevalence of an international high-risk clone, carrying an extended-spectrum beta-lactamase in one facility. Analysis of the entire resistome also revealed a greater number of mobile resistance genes in this facility. Finally, both facilities displayed high fluoroquinolone resistance rates-a worrying trend seen globally despite measures in place aimed at limiting their use.
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Affiliation(s)
- Sylvia A. Sapula
- Health and Biomedical Innovation, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Anteneh Amsalu
- Health and Biomedical Innovation, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
- Department of Medical Microbiology, University of Gondar, Gondar, Ethiopia
| | - Jon J. Whittall
- Health and Biomedical Innovation, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Bradley J. Hart
- Health and Biomedical Innovation, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Naomi L. Siderius
- Health and Biomedical Innovation, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Lynn Nguyen
- Health and Biomedical Innovation, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Cobus Gerber
- Health and Biomedical Innovation, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - John Turnidge
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Henrietta Venter
- Health and Biomedical Innovation, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Kahlmeter G, Turnidge J. The determination of epidemiological cut-off values requires a systematic and joint approach based on quality controlled, non-truncated minimum inhibitory concentration series. Eur Respir J 2023; 61:61/5/2202259. [PMID: 37147008 DOI: 10.1183/13993003.02259-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/26/2023] [Indexed: 05/07/2023]
Affiliation(s)
- Gunnar Kahlmeter
- Department of Clinical Microbiology, Central Hospital, and EUCAST Development Laboratory, Växjö, Sweden
| | - John Turnidge
- School of Biological Sciences and Adelaide Medical School, University of Adelaide, Adelaide, Australia
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Fröberg G, Maurer FP, Chryssanthou E, Fernström L, Benmansour H, Boarbi S, Mengshoel AT, Keller PM, Viveiros M, Machado D, Fitzgibbon MM, Mok S, Werngren J, Cirillo DM, Alcaide F, Hyyryläinen HL, Aubry A, Andres S, Nadarajan D, Svensson E, Turnidge J, Giske CG, Kahlmeter G, Cambau E, van Ingen J, Schön T. Towards clinical breakpoints for non-tuberculous mycobacteria - Determination of epidemiological cut off values for the Mycobacterium avium complex and Mycobacterium abscessus using broth microdilution. Clin Microbiol Infect 2023:S1198-743X(23)00060-5. [PMID: 36813087 DOI: 10.1016/j.cmi.2023.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVE For non-tuberculous mycobacteria (NTM), minimum inhibitory concentration (MIC) distributions of wild-type isolates have not been systematically evaluated despite their importance for establishing antimicrobial susceptibility testing (AST) breakpoints. METHODS We gathered MIC distributions for drugs used against the Mycobacterium avium complex (MAC) and Mycobacterium abscessus (MAB) obtained by commercial broth microdilution (SLOMYCOI and RAPMYCOI) from 12 laboratories. Epidemiological cut-off values (ECOFFs) and tentative ECOFFs (TECOFFs) were determined by EUCAST methodology including quality control (QC) strains. RESULTS The clarithromycin ECOFF was 16 mg/L for M. avium (n = 1271) whereas TECOFFs were 8 mg/L for M. intracellulare (n = 415) and 1 mg/L for MAB (n = 1014) confirmed by analysing MAB subspecies without inducible macrolide resistance (n = 235). For amikacin, the ECOFFs were 64 mg/L for MAC and MAB. For moxifloxacin, the WT spanned >8 mg/L for both MAC and MAB. For linezolid, the ECOFF and TECOFF were 64 mg/L for M. avium and M. intracellulare, respectively. Current CLSI breakpoints for amikacin (16 mg/L), moxifloxacin (1 mg/L) and linezolid (8 mg/L) divided the corresponding WT distributions. For QC M. avium and M. peregrinum, ≥95% of MIC values were well within recommended QC ranges. CONCLUSION As a first step towards clinical breakpoints for NTM, (T)ECOFFs were defined for several antimicrobials against MAC and MAB. Broad wild-type MIC distributions indicate a need for further method refinement which is now under development within the EUCAST subcommittee for anti-mycobacterial drug susceptibility testing. In addition, we showed that several CLSI NTM breakpoints are not consistent in relation to the (T)ECOFFs.
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Affiliation(s)
- Gabrielle Fröberg
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Florian P Maurer
- National Reference Center for Mycobacteria, Research Center Borstel, Borstel, Germany; Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Erja Chryssanthou
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Louise Fernström
- Department of Internal Medicine, Lycksele Hospital, Lycksele, Sweden
| | - Hanaa Benmansour
- AP-HP, GHU Nord, Service de Mycobactériologie Spécialisée et de référence, laboratoire associé au Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Université Paris Cité, Paris, France
| | - Samira Boarbi
- National Reference Center for Tuberculosis and Mycobacteria, Sciensano, Brussels, Belgium
| | - Anne Torunn Mengshoel
- Department of Bacteriology, Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Miguel Viveiros
- Unit of Medical Microbiology, Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Diana Machado
- Unit of Medical Microbiology, Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Margaret M Fitzgibbon
- Irish Mycobacteria Reference Laboratory, St James's Hospital, Dublin, Ireland; Department of Clinical Microbiology, School of Medicine, Trinity College, Dublin, Ireland
| | - Simone Mok
- Irish Mycobacteria Reference Laboratory, St James's Hospital, Dublin, Ireland; Department of Clinical Microbiology, School of Medicine, Trinity College, Dublin, Ireland
| | - Jim Werngren
- Department of Microbiology, Unit for Laboratory Surveillance of Bacterial Pathogens, Public Health Agency of Sweden, Solna, Sweden
| | | | - Fernando Alcaide
- Department of Clinical Microbiology, Bellvitge University Hospital-IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Alexandra Aubry
- Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Centre d'Immunologie et des Maladies Infectieuses, Sorbonne Université, Paris, France
| | - Sönke Andres
- National Reference Center for Mycobacteria, Research Center Borstel, Borstel, Germany
| | - Darshaalini Nadarajan
- National Reference Center for Mycobacteria, Research Center Borstel, Borstel, Germany
| | - Erik Svensson
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - John Turnidge
- School of Biological Sciences and Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Christian G Giske
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Kahlmeter
- The EUCAST Development Laboratory, Clinical Microbiology, Central Hospital, Växjö, Sweden
| | - Emmanuelle Cambau
- AP-HP, GHU Nord, Service de Mycobactériologie Spécialisée et de référence, laboratoire associé au Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Université Paris Cité, Paris, France
| | - Jakko van Ingen
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Thomas Schön
- Department of Infectious Diseases, Kalmar County Hospital, Kalmar, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Infectious Diseases in Östergötland, Linköping University, Linköping, Sweden.
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Hillock N, Chen G, Turnidge J, Louise J, Merlin T, Karnon J. 56: IS IT WORTH THE MONEY? HEALTHCARE PRACTITIONERS’ WILLINGNESS TO PAY FOR NARROW SPECTRUM AND OTHER ATTRIBUTES OF ANTIMICROBIALS. J Glob Antimicrob Resist 2022. [DOI: 10.1016/s2213-7165(22)00335-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Graham M, Graves D, Cooley L, Elvy J, Kelley P, Maley M, Porter M, Robson J, Turnidge J. Establishment of RCPA national guidelines for selective reporting of antimicrobials: processes, challenges and measuring the impact. J Antimicrob Chemother 2022; 77:3064-3068. [PMID: 35972404 DOI: 10.1093/jac/dkac279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES In 2016, The Royal College of Pathologists of Australasia (RCPA) initiated the formation of a working group comprising medical microbiologists to establish guidelines to assist Australian laboratories to implement selective and cascade reporting of antimicrobials-the first guidelines of this type in the world. METHODS A 2017 audit of antimicrobial reporting in Australian and New Zealand laboratories identified significant opportunities for improvement and standardization of selective reporting. RESULTS The first draft of the RCPA Selective Reporting Guidelines was circulated to all RCPA Microbiology fellows for feedback in August 2018 and the first version was published in February 2019. Subsequently, version two of the guidelines has recently been published in Australia, and New Zealand adapted these guidelines for formulation of their own national guidelines to accommodate local needs. CONCLUSIONS Here we describe the processes, acceptance and challenges associated with the establishment of these guidelines and measurement of their impact.
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Affiliation(s)
- Maryza Graham
- Department of Microbiology and Infectious Diseases, Monash Health, Clayton, Victoria, Australia.,Faculty of Medicine Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia.,Microbiological Diagnostic Unit Public Health Laboratory, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Debra Graves
- The Royal College of Pathologists of Australasia
| | - Louise Cooley
- Department of Microbiology and Infectious Diseases, Royal Hobart Hospital & Department of Pathology, University of Tasmania, Hobart, Tasmania, Australia
| | - Juliet Elvy
- New Zealand Microbiology Network & New Zealand National Antimicrobial Susceptibility Testing Committee.,Southern Community Laboratories, Dunedin, New Zealand
| | - Peter Kelley
- Dorevitch Pathology and Peninsula Health, Victoria, Australia.,Eastern Health Pathology, Victoria, Australia
| | - Michael Maley
- Department of Microbiology and Infectious Diseases, NSW Health Pathology, Liverpool, New South Wales, Australia
| | | | | | - John Turnidge
- European Committee on Antimicrobial Susceptibility Testing.,Australian Commission on Safety and Quality in Health Care
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Hillock NT, Merlin TL, Turnidge J, Karnon J. Modelling the Future Clinical and Economic Burden of Antimicrobial Resistance: The Feasibility and Value of Models to Inform Policy. Appl Health Econ Health Policy 2022; 20:479-486. [PMID: 35368230 PMCID: PMC8977126 DOI: 10.1007/s40258-022-00728-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 05/31/2023]
Abstract
Due to the increasing threat to public health and the economy, governments internationally are interested in models to estimate the future clinical and economic burden of antimicrobial resistance (AMR) and to evaluate the cost-effectiveness of interventions to prevent or control resistance and to inform resource-allocation decision making. A widely cited UK report estimated that 10 million additional deaths will occur globally per annum due to AMR by 2050; however, the utility and accuracy of this prediction has been challenged. The precision of models predicting the future economic burden of AMR is dependent upon the accuracy of predicting future resistance rates. This paper reviews the feasibility and value of modelling to inform policy and resource allocation to manage and curb AMR. Here we describe methods used to estimate future resistance in published burden-of-disease models; the sources of uncertainty are highlighted, which could potentially mislead policy decision-making. While broad assumptions can be made regarding some predictable factors contributing to future resistance rates, the unexpected emergence, establishment and spread of new resistance genes introduces substantial uncertainty into estimates of future economic burden, and in models evaluating the effectiveness of interventions or policies to address AMR. Existing reporting standards for best practice in modelling should be adapted to guide the reporting of AMR economic models, to ensure model transparency and validation for interpretation by policymakers.
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Affiliation(s)
- Nadine T. Hillock
- School of Public Health, University of Adelaide, North Terrace, Adelaide, SA 5000 Australia
| | - Tracy L. Merlin
- School of Public Health, University of Adelaide, North Terrace, Adelaide, SA 5000 Australia
| | - John Turnidge
- University of Adelaide, North Terrace, Adelaide, SA 5000 Australia
| | - Jonathan Karnon
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042 Australia
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Gatermann S, Das S, Dubreuil L, Giske CG, Kahlmeter G, Lina G, Lindemann C, MacGowan A, Meletiadis J, Rossolini GM, Turnidge J, Cantón R. Expected phenotypes and expert rules are important complements to antimicrobial susceptibility testing. Clin Microbiol Infect 2022; 28:764-767. [PMID: 35306191 DOI: 10.1016/j.cmi.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/04/2022] [Accepted: 03/06/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Sören Gatermann
- Abteilung für Medizinische Mikrobiologie, Ruhr-Universität Bochum, Bochum, Germany.
| | - Shampa Das
- Centre for Antimicrobial Pharmacodynamics, University of Liverpool, Liverpool, United Kingdom
| | | | - Christian G Giske
- Department of Clinical Microbiology L2:02, Karolinska University Hospital, Solna, and Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | | | - Gerard Lina
- Institut des Agents Infectieux, Hôpital de la Croix-Rousse, Hospices Civils de Lyon and Equipe Pathogénie des Staphylocoques, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS, UMR 5308, ENS de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | | | - Alasdair MacGowan
- Department of Medical Microbiology, Southmead Hospital, Westbury on Trym, Bristol, United Kingdom
| | - Joseph Meletiadis
- Clinical Microbiology Laboratory, Attikon University General Hospital, Haidari, Athens, Greece
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence and Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - John Turnidge
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Rafael Cantón
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investiagación Sanitaria (IRYCIS), Madrid, Spain
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10
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Aguilera-Alonso D, Cantón R, Giske CG, Kahlmeter G, Kohns Vasconcelos M, Papan C, Turnidge J. Searching High and Low: Call for a Joint European Society for Paediatric Infectious Diseases-European Committee on Antimicrobial Susceptibility Testing Survey on Dosage of Antibacterial Agents in Children-Part One. Pediatr Infect Dis J 2022; 41:e182-e185. [PMID: 35153290 DOI: 10.1097/inf.0000000000003457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- David Aguilera-Alonso
- Pediatric Infectious Diseases Unit, Gregorio Marañón Hospital, Instituto de Investigación Gregorio Marañón, Unidad de Investigación Materno-Infantil Fundación Familia Alonso, Madrid, Spain, CIBER en Enfermedades Infecciosas, Madrid, Spain
| | - Rafael Cantón
- CIBER en Enfermedades Infecciosas, Madrid, Spain, Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain, EUCAST Clinical Data Coordinator
| | - Christian G Giske
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden, Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Gunnar Kahlmeter
- EUCAST Technical Data Coordinator, EUCAST Development Laboratory, Växjö, Sweden
| | - Malte Kohns Vasconcelos
- Department for Infectious Diseases and Vaccinology and Department for Paediatric Pharmacolgy, University of Basel Children's Hospital, Basel, Switzerland, Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, United Kingdom
| | - Cihan Papan
- Centre for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - John Turnidge
- EUCAST Scientific Secretary, University of Adelaide, ESPID-EUCAST Joint Task Force
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Kahlmeter G, Turnidge J. How To: ECOFFs - the why, the how and the don´ts of EUCAST epidemiological cutoff values. Clin Microbiol Infect 2022; 28:952-954. [PMID: 35218980 DOI: 10.1016/j.cmi.2022.02.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Identifying the MIC wild type distribution and its delineation of species targeted for receiving antimicrobial agent breakpoints is an important first step for determining clinical breakpoints. Having the main responsibility in EUCAST for characterizing the wild-type distributions and the setting of epidemiological cutoff values (ECOFFs), we explain the why, the how and frequent misconceptions of wild-type MIC distributions and ECOFFs. OBJECTIVES To clarify how wild type MIC distributions and ECOFFs for agents and important target organisms are defined and determined and why these are important tools in microbiology, as well as to point to common misunderstandings and inappropriate use. SOURCES The EUCAST database of >40 000 MIC distributions, publications addressing the definition of wild-type MIC distributions and ECOFFs in bacteria and fungi. The EUCAST Standard Operating Procedure 10. Documents published by the European Centre for Disease Control and the European Food Safety Agency. CONTENT The rationale for defining wild-type distributions and ECOFFs is explained. Setting breakpoints that bisect wild-type MIC distributions lead to poor methodological reproducibility and poor correlation between clinical outcome and susceptibility testing results. The methods applied by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) to selecting distributions for aggregation and website display are described, highlighting the importance of incorporation of data from multiple sources and methods. The methods used by EUCAST to estimate ECOFFs are outlined. Finally, the common misunderstandings of these processes are addressed. IMPLICATIONS The international community needs to agree on the phenotypic definitions of wild-type distributions. Systematic methods for developing and applying ECOFFs are essential to the conduct of phenotypic antimicrobial susceptibility testing and interpretation, which will remain the dominant laboratory method for the foreseeable future.
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Affiliation(s)
- Gunnar Kahlmeter
- Klinisk mikrobiologi, Centrallasarettet, SE-351 85 Växjö, Sweden.
| | - John Turnidge
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia
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Schug AR, Scholtzek AD, Turnidge J, Meurer M, Schwarz S, Feßler AT. Development of Quality Control Ranges for Biocide Susceptibility Testing. Pathogens 2022; 11:pathogens11020223. [PMID: 35215165 PMCID: PMC8878709 DOI: 10.3390/pathogens11020223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/25/2022] [Accepted: 02/01/2022] [Indexed: 02/01/2023] Open
Abstract
Every laboratory test needs validation by quality controls. For biocide susceptibility testing (BST), neither quality control (QC) strains nor QC ranges applicable to these strains are currently available. As QC strains, four well-defined laboratory reference strains (Staphylococcus aureus ATCC® 6538, Enterococcus hirae ATCC® 10541, Escherichia coli ATCC® 10536 and Pseudomonas aeruginosa ATCC® 15442), which have been used previously for biocide efficacy testing, were selected. In an interlaboratory trial with eleven participating laboratories, BST QC ranges should be developed for the aforementioned four strains and the four biocides benzalkonium chloride, chlorhexidine, octenidine and polyhexanide. The performance of three different lots of tryptic soy broth was explored using the broth microdilution method and the data were subsequently evaluated using the RangeFinder software. As a result, QC ranges were defined for all reference strain–biocide combinations, except for P. aeruginosa ATCC® 15442 with the two biocides chlorhexidine and polyhexanide. The development of the latter two QC ranges was not possible, due to the limited solubility of the biocides in the test range required for P. aeruginosa ATCC® 15442. The newly developed QC ranges comprise three to five dilution steps. The establishment of QC ranges will contribute to the validation of BST in the future.
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Affiliation(s)
- Angela R. Schug
- Institute of Microbiology and Epizootics, Centre for Infection Medicine, Department of Veterinary Medicine, Freie Universität Berlin, 14163 Berlin, Germany; (A.R.S.); (A.D.S.); (S.S.)
- Veterinary Centre for Resistance Research (TZR), Freie Universität Berlin, 14163 Berlin, Germany
| | - Anissa D. Scholtzek
- Institute of Microbiology and Epizootics, Centre for Infection Medicine, Department of Veterinary Medicine, Freie Universität Berlin, 14163 Berlin, Germany; (A.R.S.); (A.D.S.); (S.S.)
- Veterinary Centre for Resistance Research (TZR), Freie Universität Berlin, 14163 Berlin, Germany
- Unit Bacterial Toxins, Food Service, Department Biological Safety, German Federal Institute for Risk Assessment, 10589 Berlin, Germany
| | - John Turnidge
- School of Biological Sciences, University of Adelaide, Adelaide, SA 5005, Australia;
| | - Marita Meurer
- Institute for Biochemistry, University of Veterinary Medicine Hannover, 30559 Hannover, Germany;
- Research Center for Emerging Infections and Zoonoses (RIZ), University of Veterinary Medicine Hannover, 30559 Hannover, Germany
| | - Stefan Schwarz
- Institute of Microbiology and Epizootics, Centre for Infection Medicine, Department of Veterinary Medicine, Freie Universität Berlin, 14163 Berlin, Germany; (A.R.S.); (A.D.S.); (S.S.)
- Veterinary Centre for Resistance Research (TZR), Freie Universität Berlin, 14163 Berlin, Germany
| | - Andrea T. Feßler
- Institute of Microbiology and Epizootics, Centre for Infection Medicine, Department of Veterinary Medicine, Freie Universität Berlin, 14163 Berlin, Germany; (A.R.S.); (A.D.S.); (S.S.)
- Veterinary Centre for Resistance Research (TZR), Freie Universität Berlin, 14163 Berlin, Germany
- Correspondence: ; Tel.: +49-(0)-30-838-63074
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13
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Alonso DA, Cantón R, Giske CG, Kahlmeter G, Vasconcelos MK, Papan C, Turnidge J. Searching high and low: Call for a joint ESPID-EUCAST survey on dosage of antibacterial agents in children - Part One. Clin Microbiol Infect 2022; 28:625-627. [PMID: 34999172 DOI: 10.1016/j.cmi.2021.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 11/03/2022]
Affiliation(s)
- David Aguilera Alonso
- Pediatric Infectious Diseases Unit, Gregorio Marañón Hospital, Instituto de Investigación Gregorio Marañón (IiSGM), Unidad de Investigación Materno-Infantil Fundación Familia Alonso (UDIMIFFA), Madrid, Spain; CIBER en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain.
| | - Rafael Cantón
- CIBER en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain; Servicio de Microbiología. Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; EUCAST Clinical Data Coordinator
| | - Christian G Giske
- Division of Clinical microbiology, Department of Laboratory medicine, Karolinska Institutet, Stockholm, Sweden; Clinical microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Gunnar Kahlmeter
- EUCAST Technical Data Coordinator, EUCAST Development Laboratory, Växjö, Sweden
| | - Malte Kohns Vasconcelos
- Department for Infectious Diseases and Vaccinology and Department for Paediatric Pharmacolgy, University of Basel Children's Hospital (UKBB), Basel, Switzerland; Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK
| | - Cihan Papan
- Centre for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
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Amsalu A, Sapula SA, Whittall JJ, Hart BJ, Bell JM, Turnidge J, Venter H. Worldwide distribution and environmental origin of the Adelaide imipenemase (AIM-1), a potent carbapenemase in Pseudomonas aeruginosa. Microb Genom 2021; 7. [PMID: 34919514 PMCID: PMC8767344 DOI: 10.1099/mgen.0.000715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Carbapenems are potent broad-spectrum β-lactam antibiotics reserved for the treatment of serious infections caused by multidrug-resistant bacteria such as Pseudomonas aeruginosa. The surge in P. aeruginosa resistant to carbapenems is an urgent threat, as very few treatment options remain. Resistance to carbapenems is predominantly due to the presence of carbapenemase enzymes. The assessment of 147 P. aeruginosa isolates revealed that 32 isolates were carbapenem non-wild-type. These isolates were screened for carbapenem resistance genes using PCR. One isolate from wastewater contained the Adelaide imipenemase gene (bla AIM-1) and was compared phenotypically with a highly carbapenem-resistant clinical isolate containing the bla AIM-1 gene. A further investigation of wastewater samples from various local healthcare and non-healthcare sources as well as river water, using probe-based qPCR, revealed the presence of the bla AIM-1 gene in all the samples analysed. The widespread occurrence of bla AIM-1 throughout Adelaide hinted at the possibility of more generally extensive spread of this gene than originally thought. A blast search revealed the presence of the bla AIM-1 gene in Asia, North America and Europe. To elucidate the identity of the organism(s) carrying the bla AIM-1 gene, shotgun metagenomic sequencing was conducted on three wastewater samples from different locations. Comparison of these nucleotide sequences with a whole-genome sequence of a P. aeruginosa isolate revealed that, unlike the genetic environment and arrangement in P. aeruginosa, the bla AIM-1 gene was not carried as part of any mobile genetic elements. A phylogenetic tree constructed with the deduced amino acid sequences of AIM-1 suggested that the potential origin of the bla AIM-1 gene in P. aeruginosa might be the non-pathogenic environmental organism, Pseudoxanthomonas mexicana.
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Affiliation(s)
- Anteneh Amsalu
- UniSA Clinical and Health Sciences, Health and Biomedical Innovation, University of South Australia, Adelaide, Australia.,Department of Medical Microbiology, University of Gondar, Gondar, Ethiopia
| | - Sylvia A Sapula
- UniSA Clinical and Health Sciences, Health and Biomedical Innovation, University of South Australia, Adelaide, Australia
| | - Jonathan J Whittall
- UniSA Clinical and Health Sciences, Health and Biomedical Innovation, University of South Australia, Adelaide, Australia
| | - Bradley J Hart
- UniSA Clinical and Health Sciences, Health and Biomedical Innovation, University of South Australia, Adelaide, Australia
| | - Jan M Bell
- Australian Centre for Antimicrobial Ecology, The University of Adelaide, Adelaide, Australia
| | - John Turnidge
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Henrietta Venter
- UniSA Clinical and Health Sciences, Health and Biomedical Innovation, University of South Australia, Adelaide, Australia
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15
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Turnidge J, Abbott IJ. EUCAST breakpoint categories and the revised "I": a stewardship opportunity for "I"mproving outcomes. Clin Microbiol Infect 2021; 28:475-476. [PMID: 34920117 DOI: 10.1016/j.cmi.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 12/04/2021] [Indexed: 11/03/2022]
Affiliation(s)
- John Turnidge
- Adelaide Medical School and School of Biological Sciences, University of Adelaide; Scientific Secretary, European Committee on Antimicrobial Susceptibility Testing.
| | - Iain J Abbott
- Microbiology and Infectious Diseases Departments, The Alfred Hospital; Research Fellow, Monash University, Melbourne
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16
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Prescott JF, Turnidge J, Page SW. The publication of studies involving the use of human critically important antimicrobial agents in veterinary species: Reply from the authors. J Vet Pharmacol Ther 2021; 44:994-995. [PMID: 34755369 DOI: 10.1111/jvp.13025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 10/02/2021] [Indexed: 11/27/2022]
Affiliation(s)
- John F Prescott
- Department of Pathobiology, University of Guelph, Guelph, Ontario, Canada
| | - John Turnidge
- Adelaide Medical School and School of Biological Sciences, University of Adelaide, Adelaide, Australia
| | - Stephen W Page
- Veterinary Clinical Pharmacology and Toxicology, Advanced Veterinary Therapeutics, Newtown, NSW, Australia
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17
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Amsalu A, Sapula SA, Whittall JJ, Hart BJ, Bell J, Turnidge J, Venter H. Taking AIM-(1) at carbapenem resistance in Pseudomonas aeruginosa. Int J Antimicrob Agents 2021. [DOI: 10.1016/j.ijantimicag.2021.106421.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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18
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Prescott JF, Martinez MN, Turnidge J, Page SW. The publication of studies involving the use of human critically important antimicrobial agents in veterinary species. J Vet Pharmacol Ther 2021; 44:986-989. [PMID: 34378797 DOI: 10.1111/jvp.13005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/14/2021] [Accepted: 07/20/2021] [Indexed: 11/28/2022]
Affiliation(s)
- John F Prescott
- Department of Pathobiology, University of Guelph, Guelph, ON, Canada
| | - Marilyn N Martinez
- Office of New Animal Drug Evaluation, Center for Veterinary Medicine, Food and Drug Administration, Rockville, MD, USA
| | - John Turnidge
- Adelaide Medical School and School of Biological Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Stephen W Page
- Veterinary Clinical Pharmacology and Toxicology, Advanced Veterinary Therapeutics, Newtown, NSW, Australia
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19
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Trott DJ, Turnidge J, Kovac JH, Simjee S, Wilson D, Watts J. Comparative macrolide use in humans and animals: should macrolides be moved off the World Health Organisation's critically important antimicrobial list? J Antimicrob Chemother 2021; 76:1955-1961. [PMID: 33956974 DOI: 10.1093/jac/dkab120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Macrolide antibiotics are categorized by the WHO as Highest Priority, Critically Important Antimicrobials due to their recommendation as treatment for severe cases of campylobacteriosis in humans; a self-limiting, rarely life-threatening, zoonotic foodborne infection. Low rates of macrolide resistance in Campylobacter jejuni and the availability of alternative treatments have prompted some regulatory schemes to assign macrolides to a lower importance category. Apart from rare, specific infections, macrolides largely play a supportive role to other drug classes in human medicine. By contrast, although the advent of alternative control methods has seen significant reductions in macrolide use in intensive livestock, they still have a crucial role in the treatment/control of respiratory infections and liver abscesses in cattle. Whilst acknowledging that ongoing surveillance is required to reduce the spread of recently emerged, transferable macrolide resistance among Campylobacter, this article recommends that macrolides should be moved to the WHO Highly Important category.
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Affiliation(s)
- Darren J Trott
- Australian Centre for Antimicrobial Resistance Ecology, School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, South Australia, Australia
| | - John Turnidge
- Australian Centre for Antimicrobial Resistance Ecology, School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, South Australia, Australia
| | - Jessica H Kovac
- Australian Centre for Antimicrobial Resistance Ecology, School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, South Australia, Australia
| | - Shabbir Simjee
- Elanco Animal Health, Form 2, Bartley Way, Bartley Wood Business Park, Hook, England
| | - Danny Wilson
- Research Centre for Infectious Diseases, School of Biological Sciences, University of Adelaide, South Australia, Australia
| | - Jeffrey Watts
- Veterinary Medicine Research and Development, Zoetis, Inc, Kalamazoo, MI, USA
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20
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Drigo B, Brunetti G, Aleer SC, Bell JM, Short MD, Vasileiadis S, Turnidge J, Monis P, Cunliffe D, Donner E. Inactivation, removal, and regrowth potential of opportunistic pathogens and antimicrobial resistance genes in recycled water systems. Water Res 2021; 201:117324. [PMID: 34242935 DOI: 10.1016/j.watres.2021.117324] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 04/30/2021] [Accepted: 05/30/2021] [Indexed: 06/13/2023]
Abstract
With two thirds of the global population living in areas affected by water scarcity, wastewater reuse is actively being implemented or explored by many nations. There is a need to better understand the efficacy of recycled water treatment plants (RWTPs) for removal of human opportunistic pathogens and antimicrobial resistant microorganisms. Here, we used a suite of probe-based multiplex and SYBR green real-time PCR assays to monitor enteric opportunistic pathogens (EOPs; Acinetobacter baumannii, Arcobacter butzlieri, Escherichia coli, Enterococcus faecalis, Klebsiella pneumoniae, Legionella spp., Listeria monocytogenes, Pseudomonas aeruginosa, Salmonella Enteritidis, Streptococcus spp.) and antimicrobial resistance genes (ARGs; qnrS, blaSHV, blaTEM, blaGES, blaKPC, blaIMI, blaSME, blaNDM, blaVIM, blaIMP, blaOXA-48-like, mcr-1 and mcr-3) of key concern from an antimicrobial resistance (AMR), waterborne and foodborne disease perspective. The class 1 integron-integrase gene (intl1) was quantified as a proxy for multi-drug resistance. EOPs, intl1 and ARGs absolute abundance (DNA and RNA) and metabolic activity (RNA) was assessed through three RWTPs with differing treatment trains. Our results indicate that RWTPs produced high quality recycled water for non-potable reuse by removing >95% of EOPs and ARGs, however, subpopulations of EOPs and ARGs survived disinfection and demonstrated potential to become actively growing members of the recycled water and distribution system microbiomes. The persistence of functional intl1 suggests that significant genetic recombination capacity remains in the recycled water, along with the likely presence of multi-drug resistant bacteria. Results provide new insights into the persistence and growth of EOPs, and prevalence and removal of ARGs in recycled water systems. These data will contribute towards the emerging evidence base of AMR risks in recycled water to inform quantitative risk-based policy development regarding water recycling schemes.
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Affiliation(s)
- Barbara Drigo
- Future Industries Institute, University of South Australia, Adelaide, SA 5001, Australia.
| | - Gianluca Brunetti
- Future Industries Institute, University of South Australia, Adelaide, SA 5001, Australia
| | - Samuel C Aleer
- Future Industries Institute, University of South Australia, Adelaide, SA 5001, Australia
| | - Jan M Bell
- Australian Centre for Antimicrobial Resistance Ecology, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Michael D Short
- Future Industries Institute, University of South Australia, Adelaide, SA 5001, Australia
| | - Sotirios Vasileiadis
- Laboratory of Plant and Environmental Biotechnology, Department of Biochemistry and Biotechnology, University of Thessaly, Larissa, Greece
| | - John Turnidge
- Australian Centre for Antimicrobial Resistance Ecology, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Paul Monis
- South Australian Water Corporation, Adelaide, SA 5000, Australia; Future Industries Institute and ARC Centre of Excellence for Convergent Bio and Nano Science, University of South Australia, Adelaide, SA 5095, Australia
| | - David Cunliffe
- Department for Health and Wellbeing, Adelaide, 5000, South Australia, Australia
| | - Erica Donner
- Future Industries Institute, University of South Australia, Adelaide, SA 5001, Australia
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Giske CG, Kahlmeter G, MacGowan A, Turnidge J. Comment on: Efficacy of temocillin against MDR Enterobacterales: a retrospective cohort study. J Antimicrob Chemother 2021; 76:1949-1950. [PMID: 33724352 DOI: 10.1093/jac/dkab081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Christian G Giske
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Gunnar Kahlmeter
- Department of Clinical Microbiology, Central Hospital, Växjö, Sweden
| | - Alasdair MacGowan
- Bristol Centre for Antimicrobial Research and Evaluation (BCARE), Infection Sciences, Severn Pathology, Southmead Hospital, Westbury-on-Trym, Bristol, UK
| | - John Turnidge
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
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22
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Truswell A, Abraham R, O'Dea M, Lee ZZ, Lee T, Laird T, Blinco J, Kaplan S, Turnidge J, Trott DJ, Jordan D, Abraham S. Robotic Antimicrobial Susceptibility Platform (RASP): a next-generation approach to One Health surveillance of antimicrobial resistance. J Antimicrob Chemother 2021; 76:1800-1807. [PMID: 33893498 PMCID: PMC8212771 DOI: 10.1093/jac/dkab107] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/05/2021] [Indexed: 12/20/2022] Open
Abstract
Background Surveillance of antimicrobial resistance (AMR) is critical to reducing its wide-reaching impact. Its reliance on sample size invites solutions to longstanding constraints regarding scalability. A robotic platform (RASP) was developed for high-throughput AMR surveillance in accordance with internationally recognized standards (CLSI and ISO 20776-1:2019) and validated through a series of experiments. Methods Experiment A compared RASP’s ability to achieve consistent MICs with that of a human technician across eight replicates for four Escherichia coli isolates. Experiment B assessed RASP’s agreement with human-performed MICs across 91 E. coli isolates with a diverse range of AMR profiles. Additionally, to demonstrate its real-world applicability, the RASP workflow was then applied to five faecal samples where a minimum of 47 E. coli per animal (239 total) were evaluated using an AMR indexing framework. Results For each drug–rater–isolate combination in Experiment A, there was a clear consensus of the MIC and deviation from the consensus remained within one doubling dilution (the exception being gentamicin at two dilutions). Experiment B revealed a concordance correlation coefficient of 0.9670 (95% CI: 0.9670–0.9670) between the robot- and human-performed MICs. RASP’s application to the five faecal samples highlighted the intra-animal diversity of gut commensal E. coli, identifying between five and nine unique isolate AMR phenotypes per sample. Conclusions While adhering to internationally accepted guidelines, RASP was superior in throughput, cost and data resolution when compared with an experienced human technician. Integration of robotics platforms in the microbiology laboratory is a necessary advancement for future One Health AMR endeavours.
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Affiliation(s)
- Alec Truswell
- Antimicrobial Resistance and Infectious Diseases Laboratory, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Australia
| | - Rebecca Abraham
- Antimicrobial Resistance and Infectious Diseases Laboratory, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Australia
| | - Mark O'Dea
- Antimicrobial Resistance and Infectious Diseases Laboratory, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Australia
| | - Zheng Zhou Lee
- Antimicrobial Resistance and Infectious Diseases Laboratory, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Australia
| | - Terence Lee
- Antimicrobial Resistance and Infectious Diseases Laboratory, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Australia
| | - Tanya Laird
- Antimicrobial Resistance and Infectious Diseases Laboratory, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Australia
| | - John Blinco
- Antimicrobial Resistance and Infectious Diseases Laboratory, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Australia
| | | | - John Turnidge
- Australian Centre for Antimicrobial Resistance Ecology, School of Animal and Veterinary Sciences, The University of Adelaide, SA, Australia
| | - Darren J Trott
- Australian Centre for Antimicrobial Resistance Ecology, School of Animal and Veterinary Sciences, The University of Adelaide, SA, Australia
| | - David Jordan
- Antimicrobial Resistance and Infectious Diseases Laboratory, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Australia.,New South Wales Department of Primary Industries, Wollongbar, NSW, Australia
| | - Sam Abraham
- Antimicrobial Resistance and Infectious Diseases Laboratory, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Australia
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23
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Yang Q, Li X, Jia P, Giske C, Kahlmeter G, Turnidge J, Yu Y, Lv Y, Wang M, Sun Z, Lin J, Li Y, Zheng B, Hu F, Guo Y, Chen Z, Li H, Zhang G, Zhang J, Kang W, Duan S, Wang T, Jing R, Xu Y. Determination of norvancomycin epidemiological cut-off values (ECOFFs) for Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus haemolyticus and Staphylococcus hominis. J Antimicrob Chemother 2021; 76:152-159. [PMID: 33057728 DOI: 10.1093/jac/dkaa414] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 09/08/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To determine the epidemiological cut-off values (ECOFFs) of norvancomycin for Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus haemolyticus and Staphylococcus hominis. METHODS We collected 1199 clinical isolates of Staphylococcus species from five laboratories located in four cities in China. MICs and inhibitory zone diameters of norvancomycin were determined by broth microdilution and the disc diffusion method, separately. ECOFFs of norvancomycin for four species were calculated by ECOFFinder software following EUCAST principles. Methicillin and vancomycin resistance genes (mecA/mecC and vanA/vanB/vanC/vanD/vanE) were screened for by PCR in all isolates. Pearson correlation and χ2 test were used to calculate the correlation of MICs and inhibition zone diameters, and MICs and resistance genes, respectively. RESULTS MICs of norvancomycin for all strains from five laboratories fell in the range of 0.12-2 mg/L. ECOFFs of norvancomycin were determined to be 2 mg/L for S. epidermidis and S. haemolyticus and 1 mg/L for S. aureus and S. hominis. A weak correlation was observed between MIC values and zone diameters for S. haemolyticus (r = -0.36) and S. hominis (r = -0.26), while no correlation was found for S. epidermidis and S. aureus. The mecA gene was detected in 63.1% of Staphylococcus, whereas no isolate carried mecC, vanA, vanB, vanC, vanD or vanE. ECOFFs of norvancomycin were not correlated with mecA gene carriage in Staphylococcus species. CONCLUSIONS ECOFFs of norvancomycin for four Staphylococcus species were determined, which will be helpful to differentiate WT strains. The correlation of MICs and zone diameters of norvancomycin was weak in Staphylococcus species.
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Affiliation(s)
- Qiwen Yang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xue Li
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,Department of Clinical Laboratory, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Peiyao Jia
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Christian Giske
- EUCAST Development Laboratory for Antimicrobial Susceptibility Testing, c/o Clinical Microbiology, Central Hospital, Växjö, Sweden
| | - Gunnar Kahlmeter
- EUCAST Development Laboratory for Antimicrobial Susceptibility Testing, c/o Clinical Microbiology, Central Hospital, Växjö, Sweden
| | - John Turnidge
- Pathology, Paediatrics and Molecular Biosciences, University of Adelaide, SA, Australia
| | - Yunsong Yu
- Department of Clinical Infectious Diseases, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, China
| | - Yuan Lv
- Institute of Clinical Pharmacology, Peking University, Beijing, China
| | - Minggui Wang
- Huashan Hospital of Fudan University, Shanghai, China
| | - Ziyong Sun
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Lin
- Department of Clinical Infectious Diseases, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, China
| | - Yun Li
- Institute of Clinical Pharmacology, Peking University, Beijing, China
| | - Bo Zheng
- Institute of Clinical Pharmacology, Peking University, Beijing, China
| | - Fupin Hu
- Huashan Hospital of Fudan University, Shanghai, China
| | - Yan Guo
- Huashan Hospital of Fudan University, Shanghai, China
| | - Zhongju Chen
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haixia Li
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Ge Zhang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jingjia Zhang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Kang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Simeng Duan
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Tong Wang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ran Jing
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yingchun Xu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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24
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Everts RJ, Gardiner SJ, Zhang M, Begg R, Chambers ST, Turnidge J, Begg EJ. Probenecid effects on cephalexin pharmacokinetics and pharmacodynamics in healthy volunteers. J Infect 2021; 83:182-189. [PMID: 34081957 DOI: 10.1016/j.jinf.2021.05.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We evaluated the effects of probenecid on the Pharmaco Kinetics (PK) and pharmacodynamics (PD) of oral cephalexin in healthy volunteers. METHODS Cephalexin 1000 mg was administered orally to 11 healthy volunteers following a standardized meal, with and without probenecid 500 mg orally, on two separate days one week apart. Total plasma concentrations of cephalexin and probenecid over a 12 h period were measured by liquid chromatography tandem mass spectrometry. Standard pharmacokinetic measures and contemporary PK/PD targets were compared. RESULTS Probenecid increased the mean (95% CI) cephalexin area under the concentration-time curve (AUC0-∞) 1.73-fold (1.61-1.85, p < 0.0001), peak concentration 1.37-fold (1.16-1.58, p < 0.01), time to peak concentration 1.45-fold (1.1-1.8, p < 0.01), and half-life 1.33-fold (1.03-1.62, p < 0.05). The effects resulted in clinically meaningful increases in the probability of PK/PD target attainment (PTA). As an example, the PTA of total concentrations above the minimum inhibitory concentration required to inhibit methicillin-susceptible Staphylococcus aureus isolates (MIC ≤ 8 mg/L) for 70% of a 6 h dose interval approached 100% for cephalexin + probenecid while for cephalexin alone it was <15%. CONCLUSIONS Probenecid prolonged and flattened the plasma concentration-time curve, enhancing the probability of attaining PK/PD targets. Co-administration of probenecid may expand the clinical benefits of oral cephalexin.
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Affiliation(s)
| | - Sharon J Gardiner
- Department of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand; Department of Clinical Pharmacology, Christchurch Hospital, Christchurch, New Zealand; Pharmacy Services, Christchurch Hospital, Christchurch, New Zealand
| | - Mei Zhang
- Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand; Toxicology, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Ronald Begg
- Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Stephen T Chambers
- Department of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand
| | - John Turnidge
- Departments of Pathology, Paediatrics, and Molecular and Biomedical Sciences, University of Adelaide, Adelaide, Australia
| | - Evan J Begg
- Department of Clinical Pharmacology, Christchurch Hospital, Christchurch, New Zealand; Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand
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25
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Roberts JA, Joynt GM, Lee A, Choi G, Bellomo R, Kanji S, Mudaliar MY, Peake SL, Stephens D, Taccone FS, Ulldemolins M, Valkonen MM, Agbeve J, Baptista JP, Bekos V, Boidin C, Brinkmann A, Buizen L, Castro P, Cole CL, Creteur J, De Waele JJ, Deans R, Eastwood GM, Escobar L, Gomersall C, Gresham R, Jamal JA, Kluge S, König C, Koulouras VP, Lassig-Smith M, Laterre PF, Lei K, Leung P, Lefrant JY, Llauradó-Serra M, Martin-Loeches I, Mat Nor MB, Ostermann M, Parker SL, Rello J, Roberts DM, Roberts MS, Richards B, Rodríguez A, Roehr AC, Roger C, Seoane L, Sinnollareddy M, Sousa E, Soy D, Spring A, Starr T, Thomas J, Turnidge J, Wallis SC, Williams T, Wittebole X, Zikou XT, Paul SK, Lipman J. The Effect of Renal Replacement Therapy and Antibiotic Dose on Antibiotic Concentrations in Critically Ill Patients: Data From the Multinational Sampling Antibiotics in Renal Replacement Therapy Study. Clin Infect Dis 2021; 72:1369-1378. [PMID: 32150603 DOI: 10.1093/cid/ciaa224] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 03/03/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The optimal dosing of antibiotics in critically ill patients receiving renal replacement therapy (RRT) remains unclear. In this study, we describe the variability in RRT techniques and antibiotic dosing in critically ill patients receiving RRT and relate observed trough antibiotic concentrations to optimal targets. METHODS We performed a prospective, observational, multinational, pharmacokinetic study in 29 intensive care units from 14 countries. We collected demographic, clinical, and RRT data. We measured trough antibiotic concentrations of meropenem, piperacillin-tazobactam, and vancomycin and related them to high- and low-target trough concentrations. RESULTS We studied 381 patients and obtained 508 trough antibiotic concentrations. There was wide variability (4-8-fold) in antibiotic dosing regimens, RRT prescription, and estimated endogenous renal function. The overall median estimated total renal clearance (eTRCL) was 50 mL/minute (interquartile range [IQR], 35-65) and higher eTRCL was associated with lower trough concentrations for all antibiotics (P < .05). The median (IQR) trough concentration for meropenem was 12.1 mg/L (7.9-18.8), piperacillin was 78.6 mg/L (49.5-127.3), tazobactam was 9.5 mg/L (6.3-14.2), and vancomycin was 14.3 mg/L (11.6-21.8). Trough concentrations failed to meet optimal higher limits in 26%, 36%, and 72% and optimal lower limits in 4%, 4%, and 55% of patients for meropenem, piperacillin, and vancomycin, respectively. CONCLUSIONS In critically ill patients treated with RRT, antibiotic dosing regimens, RRT prescription, and eTRCL varied markedly and resulted in highly variable antibiotic concentrations that failed to meet therapeutic targets in many patients.
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Affiliation(s)
- Jason A Roberts
- The University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia.,Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| | - Gavin M Joynt
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Anna Lee
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Gordon Choi
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Heidelberg and School of Medicine, The University of Melbourne, Melbourne, Australia
| | - Salmaan Kanji
- Department of Pharmacy, The Ottawa Hospital, Ottawa, Canada.,The Ottawa Hospital Research Institute, Ottawa, Canada
| | - M Yugan Mudaliar
- Intensive Care Unit, Westmead Hospital, Sydney, Australia.,Medical School, University of Sydney, Sydney, Australia
| | - Sandra L Peake
- Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Woodville, Australia.,School of Medicine, University of Adelaide, Adelaide, Australia.,School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Dianne Stephens
- Intensive Care Unit, Royal Darwin Hospital, Darwin, Australia.,Flinders University, Adelaide, Australia.,National Critical Care and Trauma Response Centre, Darwin, Australia
| | | | - Marta Ulldemolins
- Critical Care Department, Corporació Sanitària Parc Taulí, Sabadell, Spain.,Fundació Privada Clínic per la Recerca Biomèdica, Barcelona, Spain.,Infectious Diseases-Internal Medicine Departments, Bellvitge University Hospital, l'Hospitalet de Llobregat, Spain
| | - Miia Maaria Valkonen
- Intensive Care Medicine, Department of Perioperative, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Julius Agbeve
- Clinical Trials and Biostatistics Unit, QIMR Berghofer Medical Research Institute, Herston, Australia
| | - João P Baptista
- Intensive Care Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Vasileios Bekos
- Intensive Care Unit, Naval and Veterans Hospital of Athens, Athens, Greece
| | - Clement Boidin
- The University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia.,Université Claude Bernard Lyon 1, UMR CNRS 5558, Laboratoire de Biométrie et Biologie Évolutive, Lyon, France.,Hôpital Pierre Garraud, Hospices Civils de Lyon, Lyon, France
| | - Alexander Brinkmann
- Department of Anesthesia and Critical Care Medicine, General Hospital of Heidenheim, Heidenheim, Germany
| | - Luke Buizen
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Pedro Castro
- Medical Intensive Care Unit, ICMiD. Hospital Clínic de Barcelona, Barcelona, Spain.,IDIBAPS, University of Barcelona, Barcelona, Spain
| | - C Louise Cole
- Medical School, University of Sydney, Sydney, Australia.,Intensive Care Unit, Nepean Hospital, Sydney, Australia
| | - Jacques Creteur
- Department of Intensive Care, Erasme Hospital, Brussels, Belgium
| | - Jan J De Waele
- Department of Critical Care Medicine; Ghent University Hospital, Ghent, Belgium
| | - Renae Deans
- The University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Glenn M Eastwood
- Department of Intensive Care, Austin Hospital, Heidelberg and School of Medicine, The University of Melbourne, Melbourne, Australia
| | - Leslie Escobar
- Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Charles Gomersall
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | - Janattul Ain Jamal
- Department of Pharmacy, Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christina König
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Hospital Pharmacy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Vasilios P Koulouras
- Intensive Care Unit Department, University Hospital of Ioannina, Ioannina, Greece
| | - Melissa Lassig-Smith
- Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | - Katie Lei
- Guy's and St Thomas Hospital, London, United Kingdom
| | - Patricia Leung
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jean-Yves Lefrant
- Intensive Care Unit, Nîmes University Hospital (Centre Hospitalo Universitaire Nimes), Nimes, France
| | - Mireia Llauradó-Serra
- Department of Nursing, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Ignacio Martin-Loeches
- Critical Care Department, Corporació Sanitària Parc Taulí, Sabadell, Spain.,Multidisciplinary Intensive Care Research Organization (MICRO), St James Hospital, Dublin, Ireland
| | - Mohd Basri Mat Nor
- Department of Anesthesiology and Intensive Care, School of Medicine, International Islamic University Malaysia, Selangor, Malaysia
| | | | - Suzanne L Parker
- The University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Jordi Rello
- CIBERES, Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Darren M Roberts
- The University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Michael S Roberts
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.,Therapeutics Research Centre, Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, Australia.,Translational Research Institute, The University of Queensland, Buranda, Australia
| | - Brent Richards
- Intensive Care Unit, Gold Coast University Hospital, Gold Coast, Australia
| | - Alejandro Rodríguez
- Intensive Care Unit, University Hospital Joan XXIII, Tarragona, Spain.,Rovira i Virgili University, IISPV/CIBERES, Tarragona, Spain
| | - Anka C Roehr
- Department of Pharmacy, General Hospital of Heidenheim, Heidenheim, Germany
| | - Claire Roger
- Intensive Care Unit, Nîmes University Hospital (Centre Hospitalo Universitaire Nimes), Nimes, France
| | - Leonardo Seoane
- Faculty of Medicine, An University of Queensland, New Orleans, Louisiana, USA.,Intensive Care Unit, Ochsner Health System, New Orleans, Louisiana, USA
| | - Mahipal Sinnollareddy
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.,Therapeutics Research Centre, Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Eduardo Sousa
- Intensive Care Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Dolors Soy
- IDIBAPS, University of Barcelona, Barcelona, Spain.,Pharmacy Department, Division of Medicines. Hospital Clínic de Barcelona, Barcelona, Spain
| | - Anna Spring
- Intensive Care Unit, Naval and Veterans Hospital of Athens, Athens, Greece
| | - Therese Starr
- Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Jane Thomas
- Intensive Care Unit, Royal Darwin Hospital, Darwin, Australia
| | - John Turnidge
- School of Medicine, University of Adelaide, Adelaide, Australia
| | - Steven C Wallis
- The University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Tricia Williams
- Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Woodville, Australia.,School of Medicine, University of Adelaide, Adelaide, Australia.,School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Xavier Wittebole
- Intensive Care Unit, Clinique Universitaire St Luc UCL, Brussels, Belgium
| | - Xanthi T Zikou
- Nephrology, University Hospital of Ioannina, Ioannina, Greece
| | - Sanjoy K Paul
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Jeffrey Lipman
- The University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia.,Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
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Satlin MJ, Lewis JS, Weinstein MP, Patel J, Humphries RM, Kahlmeter G, Giske CG, Turnidge J. Clinical and Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing Position Statements on Polymyxin B and Colistin Clinical Breakpoints. Clin Infect Dis 2021; 71:e523-e529. [PMID: 32052041 DOI: 10.1093/cid/ciaa121] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 02/10/2020] [Indexed: 12/22/2022] Open
Abstract
Recent data on polymyxin pharmacokinetics, pharmacodynamics, toxicity, and clinical outcomes suggest these agents have limited clinical utility. Pharmacokinetics-pharmacodynamics data show a steady-state concentration of 2 μg/mL is required for killing bacteria with colistin minimum inhibitory concentrations of 2 μg/mL. Less than 50% of patients with normal renal function achieve this exposure, and it is associated with high risk of nephrotoxicity. This exposure does not achieve bacterial stasis in pneumonia models. Randomized and observational studies consistently demonstrate increased mortality for polymyxins compared with alternative agents. The Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST) are 2 global organizations that establish interpretive criteria for in vitro susceptibility data. CLSI has recently taken the step to eliminate the "susceptible" interpretive category for the polymyxins, whereas EUCAST maintains this interpretive category. This viewpoint describes the opinions of these organizations and the data that were used to inform their perspectives.
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Affiliation(s)
- Michael J Satlin
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA
| | - James S Lewis
- Department of Pharmacy, Oregon Health and Science University, Portland, Oregon, USA
| | - Melvin P Weinstein
- Departments of Medicine and Pathology and Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Jean Patel
- Beckman Coulter, Sacramento, California, USA
| | - Romney M Humphries
- Accelerate Diagnostics, Tucson, Arizona, USA.,Department of Pathology, University of Arizona, Tucson, Arizona, USA
| | - Gunnar Kahlmeter
- Department of Clinical Microbiology, Växjö Central Hospital, Växjö, Sweden
| | - Christian G Giske
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - John Turnidge
- Adelaide Medical School, University of Adelaide, South Australia, Australia
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27
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Kahlmeter G, Cantón R, Giske CG, Turnidge J. Re: In the name of common sense: EUCAST breakpoints and potential pitfalls. National dissemination of EUCAST guidelines is a shared responsibility. Clin Microbiol Infect 2020; 26:1692-1693. [PMID: 32827714 PMCID: PMC7438218 DOI: 10.1016/j.cmi.2020.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 08/05/2020] [Accepted: 08/05/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Gunnar Kahlmeter
- European Committee on Antimicrobial Susceptibility Testing (EUCAST), Växjö, Sweden.
| | - Rafael Cantón
- European Committee on Antimicrobial Susceptibility Testing (EUCAST), Madrid, Spain
| | - Christian G Giske
- European Committee on Antimicrobial Susceptibility Testing (EUCAST), Stockholm, Sweden
| | - John Turnidge
- European Committee on Antimicrobial Susceptibility Testing (EUCAST), Adelaide, Australia
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28
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Schön T, Köser CU, Werngren J, Viveiros M, Georghiou S, Kahlmeter G, Giske C, Maurer F, Lina G, Turnidge J, van Ingen J, Jankovic M, Goletti D, Cirillo DM, Santin M, Cambau E. What is the role of the EUCAST reference method for MIC testing of the Mycobacterium tuberculosis complex? Clin Microbiol Infect 2020; 26:1453-1455. [PMID: 32768492 DOI: 10.1016/j.cmi.2020.07.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Thomas Schön
- Department of Clinical Microbiology and Infectious Diseases, Kalmar County Hospital, Linköping University, Linköping, Sweden
| | | | - Jim Werngren
- Public Health Agency of Sweden, Department of Microbiology, Unit of Laboratory Surveillance of Bacterial Pathogens, Solna, Sweden
| | - Miguel Viveiros
- Unit of Medical Microbiology of the Instituto de Higiene e Medicina Tropical and Global Health and Tropical Medicine from Universidade NOVA de Lisboa, Lisbon, Portugal
| | | | - Gunnar Kahlmeter
- EUCAST Development Laboratory, Växjö, Sweden; Department of Clinical Microbiology, Central Hospital, Växjö, Sweden
| | - Christian Giske
- EUCAST Development Laboratory, Växjö, Sweden; Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Florian Maurer
- National Reference Center for Mycobacteria, Research Center Borstel, Borstel, Germany
| | - Gerard Lina
- EUCAST Development Laboratory, Växjö, Sweden; CIRI, Centre International de Recherche en Infectiologie, Université Lyon 1, Ecole Normale Supérieure de Lyon, France; Centre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - John Turnidge
- EUCAST Development Laboratory, Växjö, Sweden; Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Jakko van Ingen
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Mateja Jankovic
- University of Zagreb, School of Medicine University Hospital Centre Zagreb, Clinic for Respiratory Diseases, Zagreb, Croatia
| | - Delia Goletti
- Translational Research Unit, National Institute for Infectious Diseases "L. Spallanzani" IRCCS, Department of Epidemiology and Preclinical Research, Rome, Italy
| | | | - Miguel Santin
- Department of Infectious Diseases, Bellvitge University Hospital-IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Emmanuelle Cambau
- APHP-GHU Nord site Bichat, Service de Mycobactériologie Spécialisée et de Référence, Laboratoire Associé du Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Paris, France; Université de Paris, INSERM, IAME UMR1137, Paris, France.
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29
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Fallach N, Dickstein Y, Silberschein E, Turnidge J, Temkin E, Almagor J, Carmeli Y. Utilising sigmoid models to predict the spread of antimicrobial resistance at the country level. Euro Surveill 2020; 25:1900387. [PMID: 32553060 PMCID: PMC7403637 DOI: 10.2807/1560-7917.es.2020.25.23.1900387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 01/07/2020] [Indexed: 11/20/2022] Open
Abstract
BackgroundThe spread of antimicrobial resistance (AMR) is of worldwide concern. Public health policymakers and pharmaceutical companies pursuing antibiotic development require accurate predictions about the future spread of AMR.AimWe aimed to identify and model temporal and geographical patterns of AMR spread and to predict future trends based on a slow, intermediate or rapid rise in resistance.MethodsWe obtained data from five antibiotic resistance surveillance projects spanning the years 1997 to 2015. We aggregated the isolate-level or country-level data by country and year to produce country-bacterium-antibiotic class triads. We fitted both linear and sigmoid models to these triads and chose the one with the better fit. For triads that conformed to a sigmoid model, we classified AMR progression into one of three characterising paces: slow, intermediate or fast, based on the sigmoid slope. Within each pace category, average sigmoid models were calculated and validated.ResultsWe constructed a database with 51,670 country-year-bacterium-antibiotic observations, grouped into 7,440 country-bacterium-antibiotic triads. A total of 1,037 triads (14%) met the inclusion criteria. Of these, 326 (31.4%) followed a sigmoid (logistic) pattern over time. Among 107 triads for which both sigmoid and linear models could be fit, the sigmoid model was a better fit in 84%. The sigmoid model deviated from observed data by a median of 6.5%; the degree of deviation was related to the pace of spread.ConclusionWe present a novel method of describing and predicting the spread of antibiotic-resistant organisms.
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Affiliation(s)
- Noga Fallach
- National Institute for Antibiotic Resistance and Infection Control, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yaakov Dickstein
- National Institute for Antibiotic Resistance and Infection Control, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Erez Silberschein
- National Institute for Antibiotic Resistance and Infection Control, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Elizabeth Temkin
- National Institute for Antibiotic Resistance and Infection Control, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Jonatan Almagor
- National Institute for Antibiotic Resistance and Infection Control, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yehuda Carmeli
- National Institute for Antibiotic Resistance and Infection Control, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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30
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Hillock NT, Merlin TL, Karnon J, Turnidge J, Eliott J. Feasibility of de-linking reimbursement of antimicrobials from sales: the Australian perspective as a qualitative case study. JAC Antimicrob Resist 2020; 2:dlaa023. [PMID: 34222987 PMCID: PMC8210305 DOI: 10.1093/jacamr/dlaa023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/03/2020] [Accepted: 03/07/2020] [Indexed: 11/29/2022] Open
Abstract
Background There is a disparity in the economic return achievable for antimicrobials compared with other drugs because of the need for stewardship. This has led to a decline in pharmaceutical companies’ willingness to invest in the development of these drugs and a consequent global interest in funding models where reimbursement is de-linked from sales. Objectives To explore the perspective of stakeholders regarding the feasibility of de-linked reimbursement of antimicrobials in Australia. Methods Semi-structured interviews were conducted with 18 participants sourced from the pharmaceutical industry and individuals representing public-sector payers or regulators. Interviews were transcribed verbatim, coded and thematically analysed using the framework method. Results Five key themes were identified in the interviews: funding silos are a barrier to de-linking reimbursement; varying levels of supporting evidence are (currently) required for funding depending upon setting; funding status or cost is used as a stewardship tool; a de-linked model may cost more; and concerns regarding governance and access to antimicrobials exist in the private sector. Conclusions Australia’s current multi-tiered funding of medicines across different levels of government was perceived as a barrier to de-linked reimbursement. Participants felt that the responsibility for antimicrobial funding and stewardship should be integrated and centralized. Implementing a nationally funded de-linked reimbursement model for new antimicrobials would require a review of funding decision-making criteria, given that most MDR infections are off-label indications and could not then be funded through the Australian Pharmaceutical Benefits Scheme. Findings from this study could be applicable to other countries with reimbursement frameworks similar to Australia.
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Affiliation(s)
- Nadine T Hillock
- School of Public Health, University of Adelaide, Adelaide SA 5000, Australia
| | - Tracy L Merlin
- School of Public Health, University of Adelaide, Adelaide SA 5000, Australia
| | - Jonathan Karnon
- College of Medicine and Public Health, Flinders University, Bedford Park SA 5042, Australia
| | - John Turnidge
- School of Medical Sciences, University of Adelaide, Adelaide SA 5000, Australia
| | - Jaklin Eliott
- School of Public Health, University of Adelaide, Adelaide SA 5000, Australia
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Mouton JW, Meletiadis J, Voss A, Turnidge J. Variation of MIC measurements: the contribution of strain and laboratory variability to measurement precision-authors' response. J Antimicrob Chemother 2020; 74:1761-1762. [PMID: 30989229 DOI: 10.1093/jac/dkz142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Johan W Mouton
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, Netherlands
| | - Joseph Meletiadis
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, Netherlands.,Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Voss
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - John Turnidge
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
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Turnidge J, Kahlmeter G, Cantón R, MacGowan A, Giske CG. Daptomycin in the treatment of enterococcal bloodstream infections and endocarditis: a EUCAST position paper. Clin Microbiol Infect 2020; 26:1039-1043. [PMID: 32353412 DOI: 10.1016/j.cmi.2020.04.027] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/18/2020] [Accepted: 04/21/2020] [Indexed: 12/20/2022]
Abstract
SCOPE This position paper describes the view adopted by EUCAST on the role of daptomycin in the treatment of serious infections caused by Enterococcus species. BACKGROUND High-dose daptomycin is considered effective in the treatment of enterococcal bloodstream infection (BSI) and endocarditis, although published clinical experience with the latter condition is limited. METHODS EUCAST reviewed the available published data on pharmacokinetics-pharmacodynamics (PK-PD), resistance selection, clinical efficacy and safety for the use of 10-12 mg/kg/day of daptomycin for these conditions, noting that the doses licensed by the European Medicines Agency are only 4-6 mg/kg/day, and only for infections caused by Staphylococcus aureus. FINDINGS AND RECOMMENDATIONS The PK-PD evidence shows that, even with doses of 10-12 mg/kg/day, it is not possible to treat infections caused by isolates at the upper end of the wild-type distributions of Enterococcus faecalis (with MICs of 4 mg/L) and E. faecium (with MICs of 4 or 8 mg/L). For this reason, and because there are ongoing issues with the reliability of laboratory testing, EUCAST lists daptomycin breakpoints for Enterococcus species as "IE"-insufficient evidence. EUCAST advises increased vigilance in the use of high-dose of daptomycin to treat enterococcal BSI and endocarditis. Additional PK-PD studies and prospective efficacy and safety studies of serious Enterococcal infections treated with high-dose daptomycin may permit the setting of breakpoints in the future.
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Affiliation(s)
- J Turnidge
- Adelaide Medical School and School of Biological Sciences, University of Adelaide, Adelaide, Australia.
| | - G Kahlmeter
- Clinical Microbiology, Central Hospital, Växjö, Sweden
| | - R Cantón
- Servicio de Microbiología. Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - A MacGowan
- Bristol Centre for Antimicrobial Research & Evaluation (BCARE), Infection Sciences, Severn Pathology Partnership, Southmead Hospital, Bristol, UK
| | - C G Giske
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet and Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
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Mouton JW, Muller AE, Canton R, G Giske C, Kahlmeter G, Turnidge J. MIC-based dose adjustment: facts and fables-authors' response. J Antimicrob Chemother 2020; 73:2585-2586. [PMID: 30137389 DOI: 10.1093/jac/dky195] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Johan W Mouton
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Anouk E Muller
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands.,Department of Medical Microbiology, Haaglanden Medical Centre, The Hague, The Netherlands
| | - Rafael Canton
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYIS), Madrid, Spain
| | - Christian G Giske
- Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Gunnar Kahlmeter
- Department of Clinical Microbiology, Central Hospital, 351 85, Växjö, Sweden
| | - John Turnidge
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
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Hillock NT, Karnon J, Turnidge J, Merlin TL. Estimating the utilisation of unregistered antimicrobials in Australia. Infect Dis Health 2020; 25:82-91. [PMID: 31911133 DOI: 10.1016/j.idh.2019.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/28/2019] [Accepted: 12/01/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify and estimate the usage of unregistered antimicrobial drugs in Australian clinical practice. METHODS A descriptive pharmaco-epidemiological study, utilising three data sources: analysis of Special Access Scheme (SAS) applications for unregistered antimicrobials included in clinical guidelines over a five year period, analysis of antimicrobials dispensed from South Australian public hospital pharmacy departments over a two year period and analysis of National Antimicrobial Utilisation Surveillance Program (NAUSP) data for reported inpatient usage of unregistered antimicrobials in Australian hospitals over the last 5 years. RESULTS 59 unregistered antimicrobials were identified using the mixed methods. 18,362 Special Access Scheme applications were submitted between May 2012 and April 2017 to access the 20 unregistered antimicrobials identified in the Therapeutic Guidelines® (eTG complete); 51.4% were determined by the prescriber to be for life-threatening indications. Annual applications more than doubled over the five years. 34 unregistered antimicrobials were dispensed from South Australian public hospitals between July 2015 and June 2017. On average, 1.1% of total antimicrobial usage (Defined Daily Doses) per month was accessed via the SAS, of which 87.7% were for outpatients or discharged patients. 34 unregistered antimicrobials for systemic use identified in the NAUSP database were used in Australian hospitals between 2013 and 2018. CONCLUSION The use of unregistered antimicrobials in Australian clinical practice is not uncommon. With increasing antimicrobial resistance, there will be a continued reliance on older less-used antimicrobial agents and an increasing need for novel drugs, therefore regulatory pathways need to facilitate security of supply and assurance of medicine quality and safety.
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Affiliation(s)
- Nadine T Hillock
- School of Public Health, University of Adelaide, Adelaide, SA, 5000, Australia.
| | - Jonathan Karnon
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, 5042, Australia.
| | - John Turnidge
- School of Medical Sciences, University of Adelaide, Adelaide, SA, 5000, Australia.
| | - Tracy L Merlin
- School of Public Health, University of Adelaide, Adelaide, SA, 5000, Australia.
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Hillock NT, Paradiso L, Turnidge J, Karnon J, Merlin TL. Clinical indications treated with unregistered antimicrobials: regulatory challenges of antimicrobial resistance and access to effective treatment for patients. AUST HEALTH REV 2020; 44:263-269. [DOI: 10.1071/ah18240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/08/2019] [Indexed: 11/23/2022]
Abstract
Objective
Increasing antimicrobial resistance and a concurrent paucity of new antimicrobials marketed increases the risk that patients will develop infections resistant to currently available drugs. This study aimed to determine the range of clinical indications for which unregistered antimicrobials are prescribed at two tertiary hospitals in South Australia to identify any trends over a 2-year period. The effects of recent regulatory changes to the Special Access Scheme (SAS) were assessed.
Methods
Data were extracted from application forms submitted to the Therapeutic Goods Administration to access unregistered antimicrobials via the SAS pathway at two Australian tertiary hospitals for the period July 2015–June 2017. Average weighted antimicrobial prices were retrieved from the hospital iPharmacy (DXC Technology, Macquarie Park, NSW, Australia) dispensing system. To estimate the effect of a new access pathway (Category C), the SAS classification for each application was retrospectively assessed over time with each regulatory change.
Results
Between July 2015 and June 2017, 477 SAS applications for 29 different antimicrobials were submitted for 353 patients at the two hospitals. The most common indications were tuberculosis (43.6%) and refractory Helicobacter pylori (10%). Regulatory changes reduced the proportion of applications requiring preapproval for access.
Conclusions
Although the introduction of a new pathway has decreased the administrative burden when accessing unregistered antimicrobials, this study highlights the range of clinical conditions for which there are no registered drugs available in Australia.
What is known about the topic?
With increasing antimicrobial resistance and a paucity of novel antimicrobials entering the market, access to older, previously less-used antimicrobials is increasingly important in clinical practice. Accessing unregistered antimicrobials is common practice in Australian hospitals, but the range of clinical indications for which they are used is unclear.
What does this paper add?
Increasing antimicrobial resistance and a concurrent paucity of new antimicrobials being marketed globally is increasing the risk that patients may develop infections that cannot be treated with registered products. This study describes the range of clinical conditions for which registered antimicrobials are not available or appropriate, illustrating the challenges associated with sustainable access to effective treatments.
What are the implications for practitioners?
Access to effective antimicrobials in a timely manner is essential for optimal patient outcomes. Reliance on unregistered products is associated with increased risks regarding timely access to safe, quality-assured, effective medicines.
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Kluytmans J, Voss A, Kahlmeter G, Giske C, MacGowan A, Brown D, Gatermann S, Lina G, Lindemann C, Turnidge J, Canton R, Petinaki E, Vaz CP, Rodriguez Baño J. Obituary: Johan Willem Mouton. Clin Microbiol Infect 2020. [DOI: 10.1016/j.cmi.2019.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mouton JW, Meletiadis J, Voss A, Turnidge J. Variation of MIC measurements: the contribution of strain and laboratory variability to measurement precision. J Antimicrob Chemother 2019; 73:2374-2379. [PMID: 30137390 DOI: 10.1093/jac/dky232] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 05/23/2018] [Indexed: 11/12/2022] Open
Abstract
Objectives Although testing of antimicrobial agents for susceptibility has inherent variability like any assay, it is generally held that there are also real differences in susceptibility between strains. In the routine laboratory, variability of the MIC measurement may be sufficient to mask real strain differences. We determined which factors contributed to the variability, using linezolid against Staphylococcus aureus as one example. Methods Twenty-five S. aureus strains were sent to five different laboratories in quadruplicate in a blinded fashion. Laboratories determined MICs of linezolid using Etest. Results of 22 strains corresponding to 440 observations were available for analysis. Sources of variability were explored and quantified using an ANOVA approach. Results The overall geometric mean MIC was 1.8 mg/L, comparable to that of the published WT distribution of 1.7 mg/L (www.eucast.org). The total variation amounted to ∼1.3 2-fold dilutions for a one-sided CI of 95% and two 2-fold dilutions for a CI of 99%. Variation between laboratories and variation between strains contributed 10% and 48%, and in a subset analysis averaging 17% and 26%, respectively. Strain-to-strain variation (biological variation) could not be reliably determined, even with four replicates. Conclusions This analysis serves as an example of an approach to discerning various sources of MIC variation. Here, at best, a single measurement of an MIC may provide an indication of whether it likely belongs to the WT distribution. Only repeated measurements of MICs for individual strains within one laboratory may provide an indication of differences in susceptibility between strains.
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Affiliation(s)
- Johan W Mouton
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Joseph Meletiadis
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands.,Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Voss
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - John Turnidge
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
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Abstract
Susceptibility testing of polymyxins has been subject to intensive review and revision in recent years. A joint working group was established by the Clinical and Laboratory Standards Institute and the European Committee on Antimicrobial Susceptibility Testing to establish a reference method. Issues examined included the effects of divalent cations, binding to laboratory materials, and addition of polysorbate 80. The working group recommended the use of broth microdilution without the addition of polysorbate 80 as the reference method. Published studies have shown that other testing methods, including agar dilution, disk diffusion and gradient diffusion, have unacceptably high levels of very major errors compared to the reference method, and are not recommended for routine laboratory use. Most data were for the testing of colistin; less information was available for polymyxin B. The joint working group was also asked to consider the setting of clinical breakpoints for relevant pathogens. This task involved examination of the available pharmacokinetic-pharmacodynamic, pharmacokinetic-toxicodynamic and population clinical pharmacokinetic data. All current pharmacokinetic-pharmacodynamic targets are based on MICs generated using the reference broth dilution procedure.
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Affiliation(s)
- John Turnidge
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.
| | | | - Johan Mouton
- Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Centre, Rotterdam, The Netherlands
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Everts RJ, Begg R, Gardiner SJ, Zhang M, Turnidge J, Chambers ST, Begg EJ. Probenecid and food effects on flucloxacillin pharmacokinetics and pharmacodynamics in healthy volunteers. J Infect 2019; 80:42-53. [PMID: 31521742 DOI: 10.1016/j.jinf.2019.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/07/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To measure the effect of probenecid, fasting and fed, on flucloxacillin pharmacokinetic and pharmacodynamic endpoints. METHODS Flucloxacillin 1000 mg orally was given to 11 volunteers alone while fasting ('flucloxacillin alone'), and with probenecid 500 mg orally while fasting ('probenecid fasting') and with food ('probenecid fed'). Flucloxacillin pharmacokinetic and pharmacodynamic endpoints were compared. RESULTS Probenecid, fasting and fed, increased free plasma flucloxacillin area under the concentration-time curve (zero to infinity) ∼1.65-fold (p < 0.01) versus flucloxacillin alone. Probenecid fed prolonged time to peak flucloxacillin concentrations ∼2-fold versus the other two regimens (p < 0.01). Probenecid fasting or fed increased free flucloxacillin concentrations exceeding 30%, 50% and 70% of the first 6, 8 and 12 h post-dose by 1.58- to 5.48-fold compared with flucloxacillin alone. As an example of this pharmacodynamic improvement, the probability of target attainment of free concentrations above the minimum inhibitory concentration for Staphylococcus aureus (0.5 mg/L) for 50% of a 6-hour dose interval was > 80% for flucloxacillin plus probenecid (fasting or fed) and < 20% for flucloxacillin alone. CONCLUSIONS Probenecid increased flucloxacillin exposure, with predicted pharmacodynamic effects greater than pharmacokinetic effects because of the altered shape of the concentration-time curve. Probenecid may improve the applicability of oral flucloxacillin regimens.
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Affiliation(s)
| | - Ronald Begg
- Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Sharon J Gardiner
- Department of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand; Department of Clinical Pharmacology, Christchurch Hospital, Christchurch, New Zealand; Pharmacy Services, Christchurch Hospital, Christchurch, New Zealand
| | - Mei Zhang
- Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand; Toxicology, Canterbury Health Laboratories, Christchurch, New Zealand
| | - John Turnidge
- Departments of Pathology, Paediatrics, and Molecular and Biomedical Sciences, University of Adelaide, Australia
| | - Stephen T Chambers
- Department of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand; Department of Pathology, University of Otago-Christchurch, Christchurch, New Zealand
| | - Evan J Begg
- Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand; Department of Clinical Pharmacology, Christchurch Hospital, Christchurch, New Zealand
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Henderson A, Harris P, Hartel G, Paterson D, Turnidge J, Davis JS, Tong SYC. Benzylpenicillin versus flucloxacillin for penicillin-susceptible Staphylococcus aureus bloodstream infections from a large retrospective cohort study. Int J Antimicrob Agents 2019; 54:491-495. [PMID: 31181352 DOI: 10.1016/j.ijantimicag.2019.05.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/14/2019] [Accepted: 05/25/2019] [Indexed: 10/26/2022]
Abstract
In clinical practice, differing opinions exists regarding the optimal management of patients with penicillin-susceptible Staphylococcus aureus (PSSA) bloodstream infection (BSI). The aim of this study was to compare the 30-day mortality of patients treated with benzylpenicillin or flucloxacillin for PSSA BSI from a large prospectively collected data set from Australia and New Zealand. A logistic regression model and propensity score treatment analysis using inverse probability of treatment weighting were used. A total of 915 patients were included in the study, with an overall mortality rate of 12.9% (118/915) [benzylpenicillin 10.5% (33/315) and flucloxacillin 14.2% (85/600)]. Endocarditis was associated with benzylpenicillin treatment choice, whereas skin and soft-tissue infection was associated with flucloxacillin treatment choice. In the multivariate analysis, increased 30-day mortality was associated with flucloxacillin compared with benzylpenicillin [odds ratio (OR) = 1.6, 95% confidence interval (CI) 1.0-2.5; P = 0.05). When adjusted for treatment choice in the propensity score analysis, flucloxacillin was again associated with increased 30-day mortality (OR = 1.06, 95% CI 1.01-1.1; P = 0.03). An increase in 30-day mortality associated with flucloxacillin use suggests a potential benefit for benzylpenicillin therapy in patients with PSSA BSI.
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Affiliation(s)
- A Henderson
- Infection Management Services, Building 17, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia; Centre for Clinical Research, Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, QLD 4006, Australia; School of Chemistry and Molecular Sciences, University of Queensland, Brisbane, QLD 4072, Australia.
| | - P Harris
- Infection Management Services, Building 17, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia; Centre for Clinical Research, Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, QLD 4006, Australia; Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, QLD 4006, Australia
| | - G Hartel
- Department of Statistics, QIMR Berghofer Institute of Medical Research, Herston, QLD 4006, Australia; School of Population Health, University of Queensland, Royal Brisbane and Women's Hospital, Herston, QLD 4006, Australia
| | - D Paterson
- Centre for Clinical Research, Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, QLD 4006, Australia
| | - J Turnidge
- Adelaide Medical School, University of Adelaide, Adelaide, SA 5000, Australia
| | - J S Davis
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, NT 0811, Australia; Department of Infectious Diseases, John Hunter Hospital, Newcastle, NSW 2305, Australia
| | - S Y C Tong
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, NT 0811, Australia; Victorian Infectious Disease Service, The Royal Melbourne Hospital, Melbourne, VIC 3050, Australia; Doherty Department, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, VIC 3000, Australia
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Mouton JW, Muller AE, Canton R, Giske CG, Kahlmeter G, Turnidge J. MIC-based dose adjustment: facts and fables. J Antimicrob Chemother 2019; 73:564-568. [PMID: 29216348 DOI: 10.1093/jac/dkx427] [Citation(s) in RCA: 211] [Impact Index Per Article: 42.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Over recent decades, several publications have described optimization procedures for antibiotic therapy in the individual patient based on antimicrobial MIC values. Most methods include therapeutic drug monitoring and use a single MIC determination plus the relevant pharmacokinetics/pharmacodynamics to adjust the dose to optimize antimicrobial drug exposure and antibacterial effects. However, the use of an MIC obtained by a single MIC determination is inappropriate. First, routine clinical laboratories cannot determine MICs with sufficient accuracy to guide dosage owing to the inherent assay variation in the MIC test. Second, the variation in any MIC determination, whatever method is used, must be accounted for. If dose adjustments are made based on therapeutic drug monitoring and include MIC determinations, MIC variation must be considered to prevent potential underdosing of patients. We present the problems and some approaches that could be used in clinical practice.
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Affiliation(s)
- Johan W Mouton
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Anouk E Muller
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands.,Department of Medical Microbiology, Haaglanden Medical Centre, The Hague, The Netherlands
| | - Rafael Canton
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYIS), Madrid, Spain
| | - Christian G Giske
- Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Gunnar Kahlmeter
- Department of Clinical Microbiology, Central Hospital, 351 85, Växjö, Sweden
| | - John Turnidge
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
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Turnidge J, Lina G, Giske C. A plea from EUCAST for standardization of disc susceptibility testing antimicrobial codes. Clin Microbiol Infect 2018; 24:1345. [PMID: 30107280 DOI: 10.1016/j.cmi.2018.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 08/06/2018] [Indexed: 11/26/2022]
Affiliation(s)
- J Turnidge
- Adelaide Medical School and School of Biological Sciences, University of Adelaide, Adelaide, SA, Australia.
| | - G Lina
- Institut des Agents Infectieux, Centre de Biologie Nord, Hôpital de la Croix-Rousse, Lyon, France
| | - C Giske
- Department of Clinical Microbiology, Karolinska University Hospital, Solna, Sweden
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Richards (Chair) M, Cruickshank M, Cheng A, Gandossi S, Quoyle C, Stuart R, Sutton B, Turnidge J, Bennett N, Buising K, Cooper C, Cooley L, Ferguson J, Gilbert L, Greenough J, Greig S, Harrington G, Howden B, Iredell J, Lum G, Peleg A, Rogers B, Romanes F, Waters MJ. Recommendations for the control of carbapenemase-producing Enterobacteriaceae (CPE): A guide for acute care health facilities. Infect Dis Health 2017. [DOI: 10.1016/j.idh.2017.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Saputra S, Jordan D, Mitchell T, Wong HS, Abraham RJ, Kidsley A, Turnidge J, Trott DJ, Abraham S. Antimicrobial resistance in clinical Escherichia coli isolated from companion animals in Australia. Vet Microbiol 2017; 211:43-50. [PMID: 29102120 DOI: 10.1016/j.vetmic.2017.09.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
Abstract
Multidrug-resistant (MDR) Escherichia coli have become a major public health concern to both humans and animal health. While the frequency of antimicrobial resistance (AMR) in clinical E. coli is monitored regularly in human medicine, current frequency of AMR in companion animals remains unknown in Australia. In this study we conducted antimicrobial susceptibility testing (AST) and where possible, determined potential risk factors for MDR infection among 883 clinical Escherichia coli isolated from dogs (n=514), cats (n=341) and horses (n=28). AST was undertaken for 15 antimicrobial agents according to the Clinical Laboratory Standards Institute (CLSI) guidelines and interpreted using epidemiological cut-off values (ECOFFs) as well as CLSI veterinary and human clinical breakpoints. The AST revealed complete absence of resistance to carbapenems while resistance to amikacin was observed at a low level in isolates from dogs (1.6%) and cats (1.5%) compared to horses (10.7%). Among dog isolates, resistance to fluoroquinolones ranged from 9.1%-9.3% whereas among cat isolates, it ranged from 3.2%-5%. Among dog isolates, the proportion showing a 3rd generation cephalosporin (3GC) non-wild type phenotype was significantly higher (P<0.05) in skin and soft tissue infection (SSTI, n=122) isolates (17.2%-20.5%) compared to urinary tract infection (UTI, n=392) isolates (9.9%-10.2%). The frequency of multidrug resistance was 18.1%, 11.7% and 42.9% in dog, cat and horse isolates, respectively. Risk factor analysis revealed that MDR E. coli isolated from UTI were positively associated with chronicity of infection and previous antimicrobial treatment. Dogs and cats with chronic UTI that had been previously treated with antimicrobials were eight times and six times more likely to be infected with MDR E. coli compared to dogs and cats with non-chronic UTI, and no history of antimicrobial treatment, respectively. This study revealed that pre-existing disease condition and prior antimicrobial use were the major risks associated with UTI with MDR E. coli in companion animals.
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Affiliation(s)
- Sugiyono Saputra
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia; Research Center for Biology, Indonesian Institute of Sciences, Cibinong, West Java, Indonesia
| | - David Jordan
- New South Wales Department of Primary Industries, Wollongbar, NSW, Australia
| | - Tahlia Mitchell
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia
| | - Hui San Wong
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia
| | - Rebecca J Abraham
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia; Antimicrobial Resistance and Infectious Diseases Laboratory, School of Veterinary and Life Sciences, Murdoch University, Perth, WA, Australia
| | - Amanda Kidsley
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia
| | - John Turnidge
- Australian Commission on Safety and Quality in Health Care, Sydney, NSW, Australia
| | - Darren J Trott
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia.
| | - Sam Abraham
- Antimicrobial Resistance and Infectious Diseases Laboratory, School of Veterinary and Life Sciences, Murdoch University, Perth, WA, Australia.
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Lappin M, Blondeau J, Boothe D, Breitschwerdt E, Guardabassi L, Lloyd D, Papich M, Rankin S, Sykes J, Turnidge J, Weese J. Antimicrobial use Guidelines for Treatment of Respiratory Tract Disease in Dogs and Cats: Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases. J Vet Intern Med 2017; 31:279-294. [PMID: 28185306 PMCID: PMC5354050 DOI: 10.1111/jvim.14627] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 09/05/2016] [Accepted: 11/07/2016] [Indexed: 12/21/2022] Open
Abstract
Respiratory tract disease can be associated with primary or secondary bacterial infections in dogs and cats and is a common reason for use and potential misuse, improper use, and overuse of antimicrobials. There is a lack of comprehensive treatment guidelines such as those that are available for human medicine. Accordingly, the International Society for Companion Animal Infectious Diseases convened a Working Group of clinical microbiologists, pharmacologists, and internists to share experiences, examine scientific data, review clinical trials, and develop these guidelines to assist veterinarians in making antimicrobial treatment choices for use in the management of bacterial respiratory diseases in dogs and cats.
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Affiliation(s)
- M.R. Lappin
- Colorado State UniversityFort CollinsCODenmark
| | | | | | | | | | | | - M.G. Papich
- North Carolina State UniversityRaleighNCDenmark
| | - S.C. Rankin
- University of PennsylvaniaPhiladelphiaPAAustralia
| | - J.E. Sykes
- University of CaliforniaDavisCAAustralia
| | - J. Turnidge
- The Women's and Children HospitalAdelaideSA,Australia
| | - J.S. Weese
- Ontario Veterinary CollegeGuelphONAustralia
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Affiliation(s)
- John Turnidge
- Senior consultant, Australian Commission on Safety and Quality in Health Care, Sydney
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Holmes N, Robinson JO, Van Hal S, Munckhof W, Athan E, Korman T, Cheng AC, O'Sullivan M, Anderson T, Roberts SA, Warren S, Turnidge J, Johnson P, Howden B. Prediction Model to Identify Patients at Risk of 30-Day Treatment Failure in Patients With Staphylococcus aureus Bacteremia. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Natasha Holmes
- Department of Infectious Diseases, Austin Health, Heidelberg Victoria, Australia
| | - J. Owen Robinson
- Department of Microbiology and Infectious Diseases, Royal Perth Hospital and Fiona Stanley Hospital, Perth Western Australia, Australia
| | - Sebastian Van Hal
- Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Wendy Munckhof
- Infection Management Services, Princess Alexandra Hospital, Woolloongabba Queensland, Australia
| | - Eugene Athan
- Infectious Diseases, Barwon Health, Deakin University, Geelong, Australia
| | - Tony Korman
- Department of Infectious Diseases, Monash Infectious Diseases, Clayton Victoria, Australia
| | - Allen C. Cheng
- Infection Prevention and Hospital Epidemiology Unit, The Alfred Hospital, Melbourne, Australia
| | - Matthew O'Sullivan
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead New South Wales, Australia
| | - Tara Anderson
- Department of Infectious Diseases, Royal Hobart Hospital, Hobart Tasmania, Australia
| | - Sally A. Roberts
- Labplus, Department of Microbiology, Auckland District Health Board, Auckland, New Zealand
| | - Sanchia Warren
- Department of Infectious Diseases, Royal Hobart Hospital, Hobart Tasmania, Australia
| | - John Turnidge
- Australian Commission on Safety and Quality in Health Care, Sydney New South Wales, Australia
| | - Paul Johnson
- Infectious Diseases, Austin Health/University of Melbourne, Melbourne, Australia
| | - Benjamin Howden
- Microbiological Diagnostic Unit, Parkville Victoria, Australia
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Holmes N, Owen Robinson J, Van Hal S, Munckhof W, Athan E, Korman T, Cheng AC, O'Sullivan M, Anderson T, Roberts SA, Warren S, Turnidge J, Howden B, Johnson P. Combination Therapy Did Not Reduce 30-Day Treatment Failure in Patients With Staphylococcus aureus Bacteremia (SAB). Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Natasha Holmes
- Department of Infectious Diseases, Austin Health, Heidelberg Victoria, Australia
- Department of Infectious Diseases, Austin Health, Heidelberg Victoria, Australia
| | - J. Owen Robinson
- Department of Microbiology and Infectious Diseases, Royal Perth Hospital and Fiona Stanley Hospital, Perth Western Australia, Australia
- Department of Infectious Diseases, Austin Health, Heidelberg Victoria, Australia
| | - Sebastian Van Hal
- Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, Australia
- Department of Infectious Diseases, Austin Health, Heidelberg Victoria, Australia
| | - Wendy Munckhof
- Infection Management Services, Princess Alexandra Hospital, Woolloongabba Queensland, Australia
- Department of Infectious Diseases, Austin Health, Heidelberg Victoria, Australia
| | - Eugene Athan
- Infectious Diseases, Barwon Health, Deakin University, Geelong, Australia
- Department of Infectious Diseases, Austin Health, Heidelberg Victoria, Australia
| | - Tony Korman
- Department of Infectious Diseases, Monash Infectious Diseases, Clayton Victoria, Australia
- Department of Infectious Diseases, Austin Health, Heidelberg Victoria, Australia
| | - Allen C. Cheng
- Infection Prevention and Hospital Epidemiology Unit, The Alfred Hospital, Melbourne, Australia
- Department of Infectious Diseases, Austin Health, Heidelberg Victoria, Australia
| | - Matthew O'Sullivan
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead New South Wales, Australia
- Department of Infectious Diseases, Austin Health, Heidelberg Victoria, Australia
| | - Tara Anderson
- Department of Infectious Diseases, Royal Hobart Hospital, Hobart Tasmania, Australia
- Department of Infectious Diseases, Austin Health, Heidelberg Victoria, Australia
| | - Sally A. Roberts
- Labplus, Department of Microbiology, Auckland District Health Board, Auckland, New Zealand
- Department of Infectious Diseases, Austin Health, Heidelberg Victoria, Australia
| | - Sanchia Warren
- Department of Infectious Diseases, Royal Hobart Hospital, Hobart Tasmania, Australia
- Department of Infectious Diseases, Austin Health, Heidelberg Victoria, Australia
| | - John Turnidge
- Australian Commission on Safety and Quality in Health Care, Sydney New South Wales, Australia
- Department of Infectious Diseases, Austin Health, Heidelberg Victoria, Australia
| | - Benjamin Howden
- Microbiological Diagnostic Unit, Parkville Victoria, Australia
- Department of Infectious Diseases, Austin Health, Heidelberg Victoria, Australia
| | - Paul Johnson
- Infectious Diseases, Austin Health/University of Melbourne, Melbourne, Australia
- Department of Infectious Diseases, Austin Health, Heidelberg Victoria, Australia
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McMullan BJ, Bowen A, Blyth CC, Van Hal S, Korman TM, Buttery J, Voss L, Roberts S, Cooper C, Tong SYC, Turnidge J. Epidemiology and Mortality of Staphylococcus aureus Bacteremia in Australian and New Zealand Children. JAMA Pediatr 2016; 170:979-986. [PMID: 27533601 DOI: 10.1001/jamapediatrics.2016.1477] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Staphylococcus aureus bacteremia (SAB) in children causes significant morbidity and mortality, but the epidemiology in children is not well characterized. OBJECTIVE To describe the epidemiology of SAB in children and adolescents younger than 18 years from Australia and New Zealand. DESIGN, SETTING, AND PARTICIPANTS A prospective cohort study, using data from the Australian New Zealand Cooperative on Outcomes in Staphylococcal Sepsis cohort for 1153 children with SAB from birth to less than 18 years in pediatric and general hospitals across Australia and New Zealand, collected between January 1, 2007, and December 31, 2012. Multivariate analysis was performed to identify risk factors for mortality. Incidence calculations were calculated separately for Australasian children younger than 15 years using postcode population denominator data from Australian and New Zealand census data. MAIN OUTCOMES AND MEASURES Demographic data, hospital length of stay, principal diagnosis, place of SAB onset (community or hospital), antibiotic susceptibility and principal antibiotic treatment, and 7- and 30-day mortality. RESULTS Of the 1153 children with SAB, complete outcome data were available for 1073 children (93.1%); of these, males accounted for 684 episodes (63.7%) of SAB. The median age was 57 months (interquartile range, 2 months to 12 years). The annual incidence of SAB for Australian children was 8.3 per 100 000 population and was higher in indigenous children (incident rate ratio, 3.0 [95% CI, 2.4-3.7]), and the incidence for New Zealand children was 14.4 per 100 000 population and was higher in Māori children (incident rate ratio, 5.4 [95% CI, 4.1-7.0]). Community-onset SAB occurred in 761 cases (70.9%), and 142 cases (13.2%) of the infections were methicillin-resistant S aureus (MRSA). Bone or joint infection was most common with 348 cases (32.4%), and endocarditis was uncommon with 30 cases (2.8%). Seven- and 30-day mortality rates were 2.6% (n = 28) and 4.7% (n = 50), respectively. Risk factors for mortality were age younger than 1 year; Māori or Pacific ethnicity; endocarditis, pneumonia, or sepsis; and receiving no treatment or treatment with vancomycin. Mortality was 14.0% (6 of 43) in children with methicillin-susceptible S aureus (MSSA) treated with vancomycin compared with 2.6% (22 of 851) in children treated with alternative agents (OR, 6.1 [95% CI, 1.9-16.7]). MRSA infection was associated with increased length of stay but not mortality. CONCLUSIONS AND RELEVANCE In this large cohort study of the epidemiology of SAB in children, death was uncommon, but the incidence was higher for infants and varied by treatment, ethnicity, and clinical presentation. This study provides important information on the epidemiology of SAB in children and risk factors for mortality.
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Affiliation(s)
- Brendan J McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, New South Wales, Australia2School of Women's and Children's Health, University of New South Wales, New South Wales, Australia
| | - Asha Bowen
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia4Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia5Menzies School of Health Research, Darwin, Northern Territory, Australia6School of Pediatrics and Child Health, University of Western Australia, Subiaco, Western Australia, Australia
| | - Christopher C Blyth
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia4Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia6School of Pediatrics and Child Health, University of Western Australia, Subiaco, Western Australia, Australia7Department of Microbiology, Princess Margaret Hospital, PathWest Laboratory Medicine, Western Australia, Australia
| | - Sebastiaan Van Hal
- Department of Microbiology and Infectious Diseases, Royal Prince Alfred Hospital Camperdown, Sydney, New South Wales, Australia
| | - Tony M Korman
- Monash Infectious Diseases, Monash University, Monash Health, Victoria, Australia
| | - Jim Buttery
- Department of Infection and Immunity, Monash Children's Hospital, Department of Pediatrics, Monash University, Victoria, Australia
| | - Lesley Voss
- Department of Pediatric Infectious Disease, Starship Children's Hospital, Auckland, New Zealand
| | - Sally Roberts
- Microbiology Department, LabPlus, Auckland Hospital, Auckland, New Zealand
| | - Celia Cooper
- Department of Microbiology and Infectious Diseases, South Australia Pathology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Steven Y C Tong
- Menzies School of Health Research, Darwin, Northern Territory, Australia14Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - John Turnidge
- Department of Anatomy and Pathology, University of Adelaide, Adelaide, South Australia, Australia16Department of Pediatrics, University of Adelaide, Adelaide, South Australia, Australia17Department of Molecular and Cellular Biology, University of Adelaide, Adelaide, South Australia, Australia18Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia
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