Impact of the introduction of EUCAST’s concept of “area of technical uncertainty”

Honacker, Eveline Van; Vandendriessche, Stien; Coorevits, Liselotte; Verhasselt, Bruno; Boelens, Jerina

doi:10.1007/s10096-021-04364-6

Cited by 3 publications

(1 citation statement)

References 3 publications

(3 reference statements)

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“…In the hospital laboratory series, ATUs observed for piperacillin–tazobactam occurred in 9.45% of E. cloacae isolates, 13.47% of K. aerogenes isolates, and 8.05% of C. freundii isolates. These cases require an additional test for confirmation or a change in clinical category [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Antibiotic Resistances of Enterobacteriaceae with Chromosomal Ampc in Urine Cultures: Review and Experience of a Spanish Hospital

et al. 2023

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The Enterobacteriaceae Citrobacter freundii, Enterobacter cloacae, Klebsiella aerogenes, Morganella morganii, Providencia stuartii, and Serratia marcescens (CESPM group) produce numerous urinary tract infections (UTIs) which are difficult to treat due to their high multiresistance rate. The objectives of this study were to carry out a systematic review of antibiotic resistances by UTIs and to determine changes over time in urine cultures from a reference hospital in southern Spain. The literature was searched for European data on the resistance rates of each microorganism, and a retrospective cross-sectional descriptive study was performed in samples with suspicion of UTI from patients in Virgen de las Nieves University Hospital (Granada, Spain) between 2016 and the first half of 2021. Among 21,838 positive urine cultures, 1.85% were caused by E. cloacae, 0.77% by M. Morganii, 0.65% by K. aerogenes, 0.46% by C. freundii, 0.29% by P stuartii, and 0.25% by S. marcescens. The lowest resistance rates by microorganism were: E. cloacae to amikacin (3.47%) and imipenem (5.28%); M. morganii to piperacillin–tazobactam (1.79%), cefepime (4.76%), and tobramycin (7.74%); K. aerogenes to tobramycin (3.55%), gentamicin (4.25%), trimethoprim–sulfamethoxazole (4.96%), imipenem (5.75%), and cefepime (6.43%); C. freundii to imipenem (no resistance), nitrofurantoin (1.96%), fosfomycin (2.80%), and ertapenem (6.12%); P. stuartii to cefepime (3.28%) and ceftazidime (3.28%); and S. marcescens to gentamicin (1.8%), ciprofloxacin (3.64%), cefepime (3.70%), piperacillin–tazobactam (3.70%), and trimethoprim–sulfamethoxazole (5.45%). In our setting, CESMP Enterobacteriaceae showed the lowest resistance to piperacillin–tazobactam, cefepime, imipenem, gentamicin, and colistin, which can therefore be recommended for the empirical treatment of UTIs. The COVID-19 pandemic may have had a clinical impact in relation to the increased resistance of E. cloacae and M. morgani to some antibiotics.

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Section: Discussionmentioning

confidence: 99%

Antibiotic Resistances of Enterobacteriaceae with Chromosomal Ampc in Urine Cultures: Review and Experience of a Spanish Hospital

et al. 2023

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Comment on: In vitro activity of cefiderocol against MBL-producing Gram-negative bacteria collected in North America and Europe in five consecutive annual multinational SIDERO-WT surveillance studies (2014–2019)

Subbarao,

Boyd,

Basarab

et al. 2024

Journal of Antimicrobial Chemotherapy

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Average Nucleotide Identity and Digital DNA-DNA Hybridization Analysis Following PromethION Nanopore-Based Whole Genome Sequencing Allows for Accurate Prokaryotic Typing

Versmessen,

Mispelaere,

Vandekerckhove

et al. 2024

Diagnostics

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Whole-genome sequencing (WGS) is revolutionizing clinical bacteriology. However, bacterial typing remains investigated by reference techniques with inherent limitations. This stresses the need for alternative methods providing robust and accurate sequence type (ST) classification. This study optimized and evaluated a GridION nanopore sequencing protocol, adapted for the PromethION platform. Forty-eight Escherichia coli clinical isolates with diverse STs were sequenced to assess two alternative typing methods and resistance profiling applications. Multi-locus sequence typing (MLST) was used as the reference typing method. Genomic relatedness was assessed using Average Nucleotide Identity (ANI) and digital DNA-DNA Hybridization (DDH), and cut-offs for discriminative strain resolution were evaluated. WGS-based antibiotic resistance prediction was compared to reference Minimum Inhibitory Concentration (MIC) assays. We found ANI and DDH cut-offs of 99.3% and 94.1%, respectively, which correlated well with MLST classifications and demonstrated potentially higher discriminative resolution than MLST. WGS-based antibiotic resistance prediction showed categorical agreements of ≥ 93% with MIC assays for amoxicillin, ceftazidime, amikacin, tobramycin, and trimethoprim-sulfamethoxazole. Performance was suboptimal (68.8–81.3%) for amoxicillin-clavulanic acid, cefepime, aztreonam, and ciprofloxacin. A minimal sequencing coverage of 12× was required to maintain essential genomic features and typing accuracy. Our protocol allows the integration of PromethION technology in clinical laboratories, with ANI and DDH proving to be accurate and robust alternative typing methods, potentially offering superior resolution. WGS-based antibiotic resistance prediction holds promise for specific antibiotic classes.

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Impact of the introduction of EUCAST’s concept of “area of technical uncertainty”

Cited by 3 publications

References 3 publications

Antibiotic Resistances of Enterobacteriaceae with Chromosomal Ampc in Urine Cultures: Review and Experience of a Spanish Hospital

Antibiotic Resistances of Enterobacteriaceae with Chromosomal Ampc in Urine Cultures: Review and Experience of a Spanish Hospital

Comment on: In vitro activity of cefiderocol against MBL-producing Gram-negative bacteria collected in North America and Europe in five consecutive annual multinational SIDERO-WT surveillance studies (2014–2019)

Average Nucleotide Identity and Digital DNA-DNA Hybridization Analysis Following PromethION Nanopore-Based Whole Genome Sequencing Allows for Accurate Prokaryotic Typing

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