Canadian recommendations for laboratory interpretation of multiple or extensive drug resistance in clinical isolates of Enterobacteriaceae, Acinetobacter species and Pseudomonas aeruginosa

Abstract

The goal of this document was to provide Canadian laboratories with a framework for consistent reporting and monitoring of multidrug resistant organisms (MDRO) and extensively drug resistant organisms (XDRO) for common gram-negative pathogens. This is the final edition of the interim recommendations, which were modified after one year of broad consultative review. This edition represents a consensus of peer-reviewed information and was co-authored by the Canadian Public Health Laboratory Network and the Canadian Association of Clinical Microbiology and Infectious Diseases. There are two main recommendations. The first recommendation provides standardized definitions for MDRO and XDRO for gram-negative organisms in clinical specimens. These definitions were limited to antibiotics that are commonly tested clinically and, to reduce ambiguity, resistance (rather than non-susceptibility) was used to calculate drug resistance status. The second recommendation identifies the use of standardized laboratory reporting of organisms identified as MDRO or XDRO. Through the broad consultation, which included public health and infection prevention and control colleagues, these definitions are ready to be applied for policy development. Both authoring organizations intend to review these recommendations regularly as antibiotic resistance testing evolves in Canada.

Microbiology Investigation Criteria for Reporting Objectively (MICRO): a framework for the reporting and interpretation of clinical microbiology data

“…For each organism type, an MDR test panel must be defined, consisting of the minimum panel of individual antimicrobial agents/classes against which an isolate must be tested for that isolate to be considered tested for MDR status. Antimicrobials to which an organism is intrinsically resistant cannot be part of the test panel or contribute to MDR status [10, 22]. Quality assurance12*External quality assurance: State whether the microbiology laboratory participates in an external quality control programme and, if so, provide scheme details.…”

“…The definition of MDR often reflects local AST selection and antibiotic availability and thus rates are difficult to compare meaningfully [21]. MDR definitions for major bacterial pathogens have been proposed recently but overall consensus is lacking for many species [10, 21, 22]. Changes to published antimicrobial susceptibility breakpoints over timeChanges in the definition of resistance can result in misleading time trends and difficulties in inter-study comparisons, if not explicitly dealt with during analysis.…”

Laboratory Diagnostic Approach and Interpretation in Gram-Negative Bacterial Infection: A-Case Report of Sepsis in Secondary Hospital Settings

“…The microbiology finding from various specimens confirms the systemic bacterial infection of Gram-negative and highly indicative of sepsis. Therefore, Klebsiella pneumoniae is categorized as Extensively Drug-Resistant Organisms (XDRO) and potentially 2,11 contributes to septic shock.…”

Consenso latinoamericano para definir, categorizar y notificar patógenos multirresistentes, con resistencia extendida o panresistentes

“…Para la elaboración de este consenso se emplearon como base las publicaciones antes mencionadas (10-12). Además, se tomó en cuenta un documento de la OMS donde se enlistan las bacterias prioritarias resistentes a los antibióticos, en la que se incluyen las 12 familias de bacterias patógenas multirresistentes de mayor riesgo para la salud humana, encabezadas por Acinetobacter baumannii , Pseudomonas aeruginosa y Enterobacteriaceae resistentes a antibióticos carbapenémicos (13).…”

“…Se han descrito tres categorías generales, denominadas multirresistencia (MDR, del inglés multidrug-resistance ), resistencia extendida (XDR, del inglés extensively drug-resistance ) y panresistencia (PDR, del inglés pandrug-resistance ), sin un acuerdo en cuanto a sus definiciones (8, 9). Los primeros intentos colaborativos en este sentido se plasmaron en dos publicaciones: una iniciativa conjunta de los Centros para la Prevención y Control de Enfermedades de la Unión Europea y de los Estados Unidos de América (10), y una iniciativa de la Red Canadiense de Laboratorios de Salud Pública (11, 12). En ambos consensos, el objetivo fue proveer definiciones normalizadas acerca de las formas más apropiadas de detectar y reportar un fenotipo adquirido de resistencia múltiple a antibióticos.…”