Evaluation of an expert system linked to a rapid antibiotic susceptibility testing system for the detection of β-lactam resistance phenotypes

Vedel, G.; Peyret, M.; Gayral, Jean-Pierre; Millot, P

doi:10.1016/0923-2508(96)81390-8

Cited by 13 publications

(7 citation statements)

References 26 publications

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“…Overall agreement across the different drug groups varied from 95.7 to 100%. This is similar to results obtained in an earlier study that reported 97.3% agreement between a human expert and an expert system linked to a rapid antibiotic susceptibility test system (8). The major limitation noted for the AES was its inability to rank in order the various phenotypes among the possible phenotypes when more than one matched the MIC distribution.…”

Section: Discussionsupporting

confidence: 77%

Potential Impact of the VITEK 2 System and the Advanced Expert System on the Clinical Laboratory of a University-Based Hospital

Sanders¹,

Peyret

Moland³

et al. 2001

J Clin Microbiol

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A study was designed to assess the impact of the VITEK 2 automated system and the Advanced Expert System (AES) on the clinical laboratory of a typical university-based hospital. A total of 259 consecutive, nonduplicate isolates of Enterobacteriaceae members, Pseudomonas aeruginosa, and Staphylococcus aureus were collected and tested by the VITEK 2 system for identification and antimicrobial susceptibility testing, and the results were analyzed by the AES. The results were also analyzed by a human expert and compared to the AES analyses. Among the 259 isolates included in this study, 245 (94.6%) were definitively identified by VITEK 2, requiring little input from laboratory staff. For 194 (74.9%) isolates, no inconsistencies between the identification of the strain and the antimicrobial susceptibility determined by VITEK 2 were detected by the AES. Thus, no input from laboratory staff was required for these strains. The AES suggested one or more corrections to results obtained with 65 strains to remove inconsistencies. The human expert thought that most of these corrections were appropriate and that some resulted from a failure of the VITEK 2 system to detect certain forms of resistance. Antimicrobial phenotypes assigned to the strains by the AES for ␤-lactams, aminoglycosides, quinolones, macrolides, tetracyclines, and glycopeptides were similar to those assigned by the human expert for 95.7 to 100% of strains. These results indicate that the VITEK 2 system and AES can provide accurate information in tests for most of the clinical isolates examined and remove the need for human analysis of results for many. Certain problems were identified in the study that should be remediable with further work on the software supporting the AES.The VITEK 2 system is a new system that automatically performs rapid identification and antimicrobial susceptibility testing on a manually prepared inoculum (1). The Advanced Expert System (AES) is designed to analyze results generated by the VITEK 2 system for biologic validity and then provide comments on the results. One important function of the AES is to look for inconsistencies between the identification of the organism and the antimicrobial susceptibility of the isolate. Another important function is to ascertain the antimicrobial phenotype of the isolate based on results of susceptibility tests. A third function is to deduce the susceptibility of the organism to drugs not tested based on its susceptibility to the antibiotics actually tested.In a previous study, the ability of the AES to correctly ascertain the ␤-lactam phenotype of isolates of Enterobacteriaceae and Pseudomonas aeruginosa was determined using a panel of 196 strains collected worldwide which had been characterized by biochemical and molecular techniques for their ␤-lactamase content (6). The results of that study showed that the AES correctly identified the ␤-lactam phenotype of 183 (93.4%) of these isolates despite the inclusion of many rare phenotypes in the isolate panel. The study, however, did not assess the...

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Section: Discussionsupporting

confidence: 77%

Potential Impact of the VITEK 2 System and the Advanced Expert System on the Clinical Laboratory of a University-Based Hospital

Sanders¹,

Peyret

Moland³

et al. 2001

J Clin Microbiol

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“…The purpose of the EUCAST expert rules is to provide a written description of current expert rules. The rules are a comprehensive collection that may be applied manually or incorporated into automated systems [6,7]. The rules were prepared by an expert subcommittee in consultation with European national susceptibility breakpoint committees, EUCAST national representatives, the pharmaceutical and susceptibility device‐manufacturing industries, recognized experts, and others via open consultation through the EUCAST website.…”

Section: Interpretive Reading and Expert Rulesmentioning

confidence: 99%

“…The purpose of the EUCAST expert rules is to provide a written description of current expert rules. The rules are a comprehensive collection that may be applied manually or incorporated into automated systems [6,7]. The rules were In addition to low-level resistance to aminoglycosides, Enterococcus faecium produces a chromosomal AAC(6¢) enzyme that is responsible for the loss of synergism between aminoglycosides (except gentamicin, amikacin, arbekacin, and streptomycin) and penicillins or glycopeptides.…”

Section: Interpretive Reading and Expert Rulesmentioning

confidence: 99%

EUCAST expert rules in antimicrobial susceptibility testing

Leclercq

Cantón²,

Brown³

et al. 2013

Clinical Microbiology and Infection

568

368

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EUCAST expert rules have been developed to assist clinical microbiologists and describe actions to be taken in response to specific antimicrobial susceptibility test results. They include recommendations on reporting, such as inferring susceptibility to other agents from results with one, suppression of results that may be inappropriate, and editing of results from susceptible to intermediate or resistant or from intermediate to resistant on the basis of an inferred resistance mechanism. They are based on current clinical and/or microbiological evidence. EUCAST expert rules also include intrinsic resistance phenotypes and exceptional resistance phenotypes, which have not yet been reported or are very rare. The applicability of EUCAST expert rules depends on the MIC breakpoints used to define the rules. Setting appropriate clinical breakpoints, based on treating patients and not on the detection of resistance mechanisms, may lead to modification of some expert rules in the future.

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“…Extended-spectrum beta-lactamase production was tested with the double-disc synergy test. e comparative study of the results of a set of beta-lactam antibiotics tested simultaneously on the same antibiogram was carried out to determine the acquired or intrinsic phenotype [34][35][36][37].…”

Section: Sampling Period and Sitementioning

confidence: 99%

Prevalence of Extended-Spectrum β-Lactamases in E. coli of Rats in the Region North East of Gabon

Onanga

Nguema

Atome³

et al. 2020

Veterinary Medicine International

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Antibiotic resistance occurs in the environment by multiplication and the spread of multidrug-resistant bacteria that would be due to an improper and incorrect use of antibiotics in human and veterinary medicine. The aim of this study was to establish the prevalence of E.coli producing Extended-Spectrum beta-Lactamase (ESBL) antibiotics from rats and gregarious animals in a semirural area of Gabon and to evaluate the origin of a resistance distribution in the environment from animal feces. The bacterial culture was carried out, and the identification of E. coli strains on a specific medium and the antibiotic susceptibility tests allowed establishing the prevalence. Characterization of resistance genes was performed by gene amplification after DNA extraction. On 161 feces collected in rats, 32 strains were isolated, and 11 strains of E. coli produced ESBL with a prevalence of 34.37%. Molecular tests showed that CTX-M genes 214 bp were identified in rats. The presence of CTX-M genes could have a human origin. So, the rats can carry ESBL-producing Enterobacteriaceae which poses a risk to human health and pets in this region of Gabon.

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Evaluation of an expert system linked to a rapid antibiotic susceptibility testing system for the detection of β-lactam resistance phenotypes

Cited by 13 publications

References 26 publications

Potential Impact of the VITEK 2 System and the Advanced Expert System on the Clinical Laboratory of a University-Based Hospital

Potential Impact of the VITEK 2 System and the Advanced Expert System on the Clinical Laboratory of a University-Based Hospital

EUCAST expert rules in antimicrobial susceptibility testing

Prevalence of Extended-Spectrum β-Lactamases in E. coli of Rats in the Region North East of Gabon

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