Effects of clinical breakpoint changes in CLSI guidelines 2010/2011 and EUCAST guidelines 2011 on antibiotic susceptibility test reporting of Gram-negative bacilli
Effects of clinical breakpoint changes in CLSI guidelines 2010/2011 and EUCAST guidelines 2011 on antibiotic susceptibility test reporting of Gram-negative bacilli
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DOI：
10.1093/jac/dkr524
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发表时间：
2012-03-01
影响因子：
5.2
通讯作者：
Boettger, Erik C.
中科院分区：
文献类型：
--
作者：
Hombach, Michael;Bloemberg, Guido V.;Boettger, Erik C.
目的：本研究旨在分析CLSI 2010年和2011年指南以及EUCAST 2011年指南中临床断点变化对抗生素敏感性试验（AST）报告的影响。方法：共分析了3713株肠杆菌科、铜绿假单胞菌、嗜麦芽窄食单胞菌和鲍曼不动杆菌的非重复临床分离株。对β-内酰胺类、碳青霉烯类、氟喹诺酮类、氨基糖苷类和甲氧苄氨嘧啶/磺胺甲恶唑的抑菌圈直径进行了测定。应用CLSI 200911和EUCAST 2011临床折点。结果：根据指南定义的耐药性变化对各个种属和药物类别的影响不同。根据CLSI 200911和EUCAST 2011指南，大肠埃希菌和阴沟肠杆菌的头孢吡肟耐药率分别从2.1和1.3增加至8.2和6.9。厄他培南在大肠埃希菌中的耐药率clopidin从CLSI 2009的2.6增加到CLSI 2010和2011的7.2，并在应用EUCAST 2011时增加到10.1。与CLSI 200911和EUCAST 2011相比，铜绿假单胞菌的头孢吡肟和美罗培南耐药率分别从12.2和20.6增加至19.8和27.7。A.妥布霉素和庆大霉素耐药率采用CLSI 200911与EUCAST 2011相比，鲍曼不动杆菌的耐药率分别从15.9和25.4上升到34.9和44.4。结论：CLSI和EUCAST指南中折点的改变导致革兰阴性杆菌多重耐药率的增加。分类为阿莫西林/克拉维酸、头孢吡肟或碳青霉烯耐药的AST报告将导致临床医生使用替代药物。在实施EUCAST指南后，实验室应了解修改后的药物敏感性试验报告对抗生素处方政策的影响。
Objectives: The aim of this study was to analyse the effects of clinical breakpoint changes in CLSI 2010 and 2011 guidelines and EUCAST 2011 guidelines on antibiotic susceptibility testing (AST) reports.Methods:In total, 3713 non-duplicate clinical isolates of Enterobacteriaceae, Pseudomonas aeruginosa, Stenotrophomonas maltophilia and Acinetobacter baumannii were analysed. Inhibition zone diameters were determined for -lactams, carbapenems, fluoroquinolones, aminoglycosides and trimethoprim/sulfamethoxazole. CLSI 200911 and EUCAST 2011 clinical breakpoints were applied.Results:Changes in resistance as defined per the guidelines affected individual species and drug classes differently. The cefepime resistance rate in Escherichia coli and Enterobacter cloacae increased from 2.1 and 1.3 to 8.2 and 6.9, respectively, applying CLSI 200911 versus EUCAST 2011 guidelines. Ertapenem resistance rates in E. cloacae increased from 2.6 with CLSI 2009 to 7.2 for CLSI 2010 and 2011, and to 10.1 when applying EUCAST 2011. Cefepime and meropenem resistance rates in P. aeruginosa increased from 12.2 and 20.6 to 19.8 and 27.7, respectively, comparing CLSI 200911 with EUCAST 2011. Tobramycin and gentamicin resistance rates in A. baumannii increased from 15.9 and 25.4 to 34.9 and 44.4 applying CLSI 200911 versus EUCAST 2011.Conclusions:Higher resistance rates reported due to breakpoint changes in CLSI and EUCAST guidelines will result in increasing numbers of Gram-negative bacilli reported as multidrug resistant. AST reports classifying amoxicillin/clavulanic acid, cefepime or carbapenem resistance will lead clinicians to use alternative agents. Upon implementation of the EUCAST guidelines, laboratories should be aware of the implications of modified drug susceptibility testing reports on antibiotic prescription policies.