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SHR Neuro Cancer Cardio Lipid Metab Microb

König, E; Iser, J; Zechner-Sammer, T; Friedl, H; Krause, R; Valentin, T; Leitner, E; Steinmetz, I; Zollner-Schwetz, I.
Establishing breakpoints for amoxicillin/clavulanate and ampicillin/sulbactam for rapid antimicrobial susceptibility testing directly from positive blood culture bottles.
J Med Microbiol. 2023; 72(3): Doi: 10.1099/jmm.0.001672
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Leading authors Med Uni Graz

König Elisabeth

Co-authors Med Uni Graz

Iser Juliane

Krause Robert

Leitner-Meyer Eva

Steinmetz Ivo

Valentin Thomas

Zollner-Schwetz Ines

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Abstract:

Introduction. In 2018, EUCAST released guidelines on rapid antimicrobial susceptibility testing (RAST) directly from positive blood culture bottles for selected bacterial species and antimicrobial agents, but not for the commonly used agents amoxicillin/clavulanate (AMC) and ampicillin/sulbactam (SAM).Hypothesis/Gap statement. This work addresses the Enterobacterales RAST capability gap for betalactam/betalactamase inhibitor combinations.Aim. We aimed to determine RAST breakpoints for AMC and SAM for Escherichia coli and Klebsiella pneumoniae after 4 and 6 h of incubation directly from positive blood cultures.Methodology. Blood culture bottles were spiked with clinical isolates of E. coli (n=89) and K. pneumoniae (n=81). RAST was performed according to EUCAST guidelines and zones were read after 4 and 6 h. Breakpoints were defined to avoid very major errors.Results. The proportion of readable zone diameters after 4 h of incubation were 90.8 % in E. coli and 85.8 % in K. pneumoniae isolates. After 6 h of incubation all zone diameters could be read. The proposed breakpoints for E. coli after 6 h of incubation were ≥16 mm S (susceptible), 14-15 mm ATU (area of technical uncertainty) and <14 mm R (resistant) for AMC; ≥15 mm S, 12-14 mm ATU and <12 mm R for SAM; for K. pneumoniae these were ≥16 mm S, 14-15 mm ATU and <14 mm R for AMC; ≥13 mm S, 12 mm ATU, <12 mm R for SAM. Applying our newly set breakpoints, major errors were infrequent (2.6 %).Conclusion. We propose novel AMC and SAM breakpoints for RAST directly from positive blood cultures for reading after 4 and 6 h of incubation.

Find related publications in this database (using NLM MeSH Indexing)

Sulbactam - pharmacology

Blood Culture - administration & dosage

Escherichia coli - administration & dosage

Ampicillin - pharmacology

Amoxicillin-Potassium Clavulanate Combination - pharmacology

Anti-Infective Agents - administration & dosage

Anti-Bacterial Agents - pharmacology

Microbial Sensitivity Tests - administration & dosage

Find related publications in this database (Keywords)

betalactam

betalactamase inhibitor combinations

blood cultures

bloodstream infection

rapid antimicrobial susceptibility testing

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