Multicenter collaborative evaluation of a standardized serum bactericidal test as a prognostic indicator in infective endocarditis

Weinstein, Melvin P.; Stratton, Charles W.; Ackley, Alexander; Hawley, H. Bradford; Robinson, Patrick; Fisher, Bruce D.; Alcid, David V.; Stephens, David S.; Reller, L. Barth

doi:10.1016/0002-9343(85)90436-x

Cited by 146 publications

(54 citation statements)

References 26 publications

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“…The SBT integrates both pharmacokinetic and pharmacodynamic properties in a single set of determinations that examines the ability of the patient's serum, drawn at various times during the dosing interval, usually at the beginning and end of the administered antimicrobial agent, to kill the infecting organism (7,22,69,74,76,77,86,87). This can be done using dilution methodology to determine the maximum dilution or "titer" of the patient's serum which demonstrates 99.9% killing of the final inoculum (serum bactericidal titer).…”

Section: Standardized Methodsmentioning

confidence: 99%

“…Alternatively, a time-kill method may be used to determine the rate of killing of the infecting organism (change in CFU per milliliter per hour of exposure) produced by exposure to a 1:2 dilution of the patient's serum obtained at the beginning (peak) and end (trough) of the dosing interval (7). As with time-kill and MBC determinations, the SBT is affected by methodological variables and has the additional complications of the need to properly collect timed serum specimens (7,22,52,69,76,86,87). Interpretation of test results is also problematic, and the clinical role of the SBT is controversial at best (52,69,76,86,87).…”

Section: Standardized Methodsmentioning

confidence: 99%

“…As with time-kill and MBC determinations, the SBT is affected by methodological variables and has the additional complications of the need to properly collect timed serum specimens (7,22,52,69,76,86,87). Interpretation of test results is also problematic, and the clinical role of the SBT is controversial at best (52,69,76,86,87). The number of clinical situations in which the test may be useful is limited (e.g., endocarditis, osteomyelitis, and septic arthritis); however, it has been valuable in the research setting and in the evaluation of new antimicrobial agents.…”

Section: Standardized Methodsmentioning

confidence: 99%

“…Given the fact that bactericidal activity is considered necessary for proper treatment of certain infections, numerous investigators have VOL. 17, 2004 FUNGICIDAL ACTIVITIES AGAINST YEASTS AND MOLDS 271 used bactericidal testing (MBC, time-kill, and SBT) in efforts to correlate in vitro data with in vivo treatment results (7,12,14,23,38,51,61,68,74,86,87). Unfortunately, the criterion used to define bactericidal activity (99.9% killing of the final inoculum) is completely arbitrary and results in an all-or-nothing situation that probably has no biological or clinical significance (52,53).…”

Section: In Vivo Correlates Of Bactericidal Testingmentioning

confidence: 99%

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Determination of Fungicidal Activities against Yeasts and Molds: Lessons Learned from Bactericidal Testing and the Need for Standardization

2004

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In certain unique clinical settings, the ability of the antimicrobial agent administered to kill the pathogen outright may be quite important. These situations invariably involve infection of a site not easily accessed by host defenses and/or of a structure with essential anatomic or physiologic function such as the heart (endocarditis), central nervous system (meningitis), or bone (osteomyelitis). Likewise, infections in immunosuppressed hosts, especially those who are neutropenic, are often thought to require microbicidal therapy. Proof of the cidal nature of an antimicrobial agent in vitro is tedious, complex, and fraught with error. Although several methods for assessing in vitro bactericidal activity have been standardized (NCCLS M26-A and M21-A), the clinical relevance of these determinations is questionable and the tests are performed infrequently in most laboratories. Most of the clinical data supporting the need for microbicidal therapy and testing have focused on bacterial infections. However, given the fact that most serious fungal infections occur in profoundly immunosuppressed individuals, it is generally assumed that a cidal regimen would be preferable in that setting as well. In view of this clinical concern and the perceived need to assess the fungicidal activity of a variety of agents, we considered that it would be useful to review what is known about the issues and problems in assessing bactericidal activity and the clinical utility of such measurements. Following this review, we discuss the issue of how one defines fungicidal activity in vitro and in vivo and how feasible it might be to determine the fungicidal activity of organism-drug combinations for purposes of both drug development and clinical care. Proposed methods for fungal time-kill determinations and minimal fungicidal concentration determinations are also discussed

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Section: Standardized Methodsmentioning

confidence: 99%

Section: Standardized Methodsmentioning

confidence: 99%

Section: Standardized Methodsmentioning

confidence: 99%

Section: In Vivo Correlates Of Bactericidal Testingmentioning

confidence: 99%

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Determination of Fungicidal Activities against Yeasts and Molds: Lessons Learned from Bactericidal Testing and the Need for Standardization

2004

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“…Many of these studies are rarely performed in clinical laboratories now, as they can be time-consuming and laborintensive, and their results (e.g., SBA) have rarely correlated with clinical outcomes (170,199). Standard guidelines for the serum bactericidal test (SBT) were approved in 1999, and debates among investigators on the dilution required for bactericidal activity make interpretations of their results difficult (178,202,234,265).…”

Section: Staphylococcimentioning

confidence: 99%

Rifampin Combination Therapy for Nonmycobacterial Infections

2010

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SUMMARY The increasing emergence of antimicrobial-resistant organisms, especially methicillin-resistant Staphylococcus aureus (MRSA), has resulted in the increased use of rifampin combination therapy. The data supporting rifampin combination therapy in nonmycobacterial infections are limited by a lack of significantly controlled clinical studies. Therefore, its current use is based upon in vitro or in vivo data or retrospective case series, all with major limitations. A prominent observation from this review is that rifampin combination therapy appears to have improved treatment outcomes in cases in which there is a low organism burden, such as biofilm infections, but is less effective when effective surgery to obtain source control is not performed. The clinical data support rifampin combination therapy for the treatment of prosthetic joint infections due to methicillin-sensitive S. aureus (MSSA) after extensive debridement and for the treatment of prosthetic heart valve infections due to coagulase-negative staphylococci. Importantly, rifampin-vancomycin combination therapy has not shown any benefit over vancomycin monotherapy against MRSA infections either clinically or experimentally. Rifampin combination therapy with daptomycin, fusidic acid, and linezolid needs further exploration for these severe MRSA infections. Lastly, an assessment of the risk-benefits is needed before the addition of rifampin to other antimicrobials is considered to avoid drug interactions or other drug toxicities.

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Short-Course Therapy for Catheter-Associated Staphylococcus aureus Bacteremia

Ehni

Reller²

1989

Arch Intern Med

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Multicenter collaborative evaluation of a standardized serum bactericidal test as a prognostic indicator in infective endocarditis

Cited by 146 publications

References 26 publications

Determination of Fungicidal Activities against Yeasts and Molds: Lessons Learned from Bactericidal Testing and the Need for Standardization

Determination of Fungicidal Activities against Yeasts and Molds: Lessons Learned from Bactericidal Testing and the Need for Standardization

Rifampin Combination Therapy for Nonmycobacterial Infections

Short-Course Therapy for Catheter-Associated Staphylococcus aureus Bacteremia

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