In vitro susceptibility of Mycobacterium abscessus complex and feasibility of standardizing treatment regimens

Abstract Objectives To determine the in vitro susceptibility of members of the Mycobacterium abscessus complex to routinely tested antibiotics and to an extended antibiotic panel. Methods Non-duplicate isolates for which susceptibility testing results were available were included in this study. Retrospective laboratory records were reviewed, including tigecycline susceptibility results, and testing was performed with additional drugs, including vancomycin, dalbavancin, telavancin, oritavancin, rifabutin, delafloxacin, eravacycline, clofazimine and bedaquiline using broth microdilution (Sensititre, Thermo Fisher). Results A total of 218 M. abscessus complex isolates were included for retrospective review, of which 151 were respiratory isolates. Of these 218 isolates, 211 were available for additional testing with the extended antibiotic panel. Of these, 146 were respiratory isolates. One isolate had a vancomycin MIC of 2 mg/L and MICs of all other isolates were >8 mg/L. All isolates had MICs of >8 mg/L for oritavancin, dalbavancin and telavancin. One isolate had a delafloxacin MIC of 4 mg/L and MICs of all other isolates were >8 mg/L. The MIC50/MIC90s of rifabutin, tigecycline, eravacycline, clofazimine and bedaquiline were 16/32, 0.5/1, 0.12/0.25, 0.12/0.25 and 0.06/0.12 mg/L, respectively. Conclusions In vitro activity was demonstrated for clofazimine, bedaquiline and eravacycline, indicating potential for inclusion as standardized therapy for M. abscessus complex infections.

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1350. Clofazimine as an Oral Companion Drug for Treatment of Mycobacterium abscessus complex Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1214 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S488-S489

Author(s):

Joy Yong ◽

Ka Lip Chew ◽

Paul Tambyah

Keyword(s):

Active Agent ◽

Liver Function Tests ◽

Mycobacterium Abscessus ◽

Prolonged Treatment ◽

Attractive Alternative ◽

In Vitro Susceptibility ◽

Treatment Regimens ◽

Drug Intolerance ◽

Mycobacterium Abscessus Complex

Abstract Background Infections caused by the multi-drug-resistant Mycobacterium abscessus complex (MabsC) are challenging to treat and often require multiple antimicrobials for a prolonged treatment course and still have poor outcomes. Clofazimine, an oral anti-leprosy drug, has demonstrated good in vitro susceptibility and is being increasingly employed in treatment regimens for MabsC infections. We performed a drug-use-evaluation of clofazimine in the treatment of MabsC infections. Methods A retrospective review was performed for all patients with MabsC infections treated with clofazimine-containing regimens from January 2014 to June 2017. Results Twenty-nine patients were included. Twelve patients had pulmonary MabsC infections and seventeen had extrapulmonary infections. All isolates had clofazimine minimum-inhibitory-concentration of ≤0.5 mg/L as tested by broth microdilution. Clofazimine was prescribed at initiation of therapy in 31.0% (9/29), as a companion drug during maintenance therapy after initial intravenous therapy in 44.8% (13/29) and as part of salvage therapy due to disease progression or drug intolerance in 24.1% (7/29) of patients. Dosing of clofazimine for the pediatric patients was prescribed at 1–2 mg/kg/day while the adult patients received a range of 50–200 mg/day. Clofazimine was given for a median duration of 148.5 days (range: 14–1212) and most commonly in combination with clarithromycin (82.8%), amikacin (58.6%), and cefoxitin (24.1%). Twelve patients had documented adverse reactions attributable to clofazimine: skin hyperpigmentation (66.7%), abnormal liver function tests (16.7%), and gastrointestinal disturbance (16.7%). Table 1 describes the patients who had clofazimine ceased due to an adverse effect. Nine patients with pulmonary MabsC infections and 16 with extrapulmonary MabsC infections had documented improvement in symptoms. Conclusion Clofazimine as a companion drug in the treatment of MabsC infections was reasonably tolerated over a prolonged period of time. Its availability as an oral active agent makes it an attractive alternative to IV companion drugs and potentially improves compliance to the protracted treatment courses for patients with MabsC infections. Disclosures All authors: No reported disclosures.

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In Vitro Antimicrobial Susceptibilities of Streptococcus pneumoniae Clinical Isolates Obtained in Canada in 2002

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.48.9.3305-3311.2004 ◽

2004 ◽

Vol 48 (9) ◽

pp. 3305-3311 ◽

Cited By ~ 44

Author(s):

Jeff Powis ◽

Allison McGeer ◽

Karen Green ◽

Otto Vanderkooi ◽

Karl Weiss ◽

...

Keyword(s):

Susceptibility Testing ◽

In Vitro Activity ◽

Local Resistance ◽

Broth Microdilution ◽

Surveillance Network ◽

In Vitro Susceptibility ◽

Resistance Patterns ◽

Sterile Site ◽

In Vitro Susceptibility Testing

ABSTRACT Empirical treatment is best guided by current surveillance of local resistance patterns. The goal of this study is to characterize the prevalence of antimicrobial nonsusceptibility within pneumococcal isolates from Canada. The Canadian Bacterial Surveillance Network is comprised of laboratories from across Canada. Laboratories collected a defined number of consecutive clinical and all sterile site isolates of S. pneumoniae in 2002. In vitro susceptibility testing was performed by broth microdilution with NCCLS guidelines. Rates of nonsusceptibility were compared to previously published reports from the same network. A total of 2,539 isolates were tested. Penicillin nonsusceptibility increased to 15% (8.5% intermediate, 6.5% resistant) compared to 12.4% in 2000 (P ≤ 0.025, χ2). Only 32 (1.3%) isolates had an amoxicillin MIC of ≥4 μg/ml and only 2 of 32 cerebrospinal fluid isolates had an intermediate susceptibility to ceftriaxone by meningeal interpretive criteria (MIC = 1 μg/ml). A total of 354 (13.9%) isolates were macrolide nonsusceptible (46.3% MLSB, 56.7% M phenotype), increasing from 11.4% in 2000 (P ≤ 0.0075, χ2). Only 13 (<1%) isolates had a telithromycin MIC of >1 μg/ml. Ciprofloxacin nonsusceptibility (defined as an MIC of ≥4 μg/ml) increased to 2.7% compared to 1.4% in 2000 (P ≤ 0.0025, χ2) and was primarily found in persons ≥18 years old (98.5%). Nonsusceptibility to penicillin, macrolides, and fluoroquinolones is increasing in Canada. Nonsusceptibility to amoxicillin and ceftriaxone remains uncommon. Newer antimicrobials such as telithromycin and respiratory fluoroquinolones have excellent in vitro activity.

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In Vitro Activities of Daptomycin against 2,789 Clinical Isolates from 11 North American Medical Centers

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.45.6.1919-1922.2001 ◽

2001 ◽

Vol 45 (6) ◽

pp. 1919-1922 ◽

Cited By ~ 115

Author(s):

Arthur L. Barry ◽

Peter C. Fuchs ◽

Steven D. Brown

Keyword(s):

Clinical Isolates ◽

In Vitro Activity ◽

Broth Microdilution ◽

In Vitro Susceptibility ◽

Medical Centers ◽

Mueller Hinton ◽

Calcium Cations ◽

Important Exception ◽

Mueller Hinton Broth

ABSTRACT The in vitro activity of daptomycin is affected by the concentration of calcium cations in the test medium. Mueller-Hinton broth is currently adjusted to contain 10 to 12.5 mg of magnesium per liter and 20 to 25 mg of calcium per liter, but for testing of daptomycin, greater concentrations of calcium (50 mg/liter) are recommended to better resemble the normal concentration of ionized calcium in human serum. Two levels of calcium were used for broth microdilution tests of 2,789 recent clinical isolates of gram-positive bacterial pathogens. MICs of daptomycin were two- to fourfold lower when the broth contained additional calcium. For most species, however, the percentages of strains that were inhibited by 2.0 μg of daptomycin per ml were essentially identical with the two broth media. Enterococci were the important exception; i.e., 92% were inhibited when tested in calcium-supplemented broth but only 35% were inhibited by 2.0 μg/ml without the additional calcium. This type of information should be considered when selecting criteria for defining in vitro susceptibility to daptomycin.

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Evaluation of Amphotericin B Interpretive Breakpoints for Candida Bloodstream Isolates by Correlation with Therapeutic Outcome

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.50.4.1287-1292.2006 ◽

2006 ◽

Vol 50 (4) ◽

pp. 1287-1292 ◽

Cited By ~ 86

Author(s):

Benjamin J. Park ◽

Beth A. Arthington-Skaggs ◽

Rana A. Hajjeh ◽

Naureen Iqbal ◽

Meral A. Ciblak ◽

...

Keyword(s):

Amphotericin B ◽

Susceptibility Testing ◽

Clinical Laboratory ◽

National Committee ◽

Restricted Range ◽

Broth Microdilution ◽

Therapeutic Success ◽

In Vitro Susceptibility ◽

In Vitro Susceptibility Testing

ABSTRACT One hundred seven Candida bloodstream isolates (51 C. albicans, 24 C. glabrata, 13 C. parapsilosis, 13 C. tropicalis, 2 C. dubliniensis, 2 C. krusei, and 2 C. lusitaniae strains) from patients treated with amphotericin B alone underwent in vitro susceptibility testing against amphotericin B using five different methods. Fifty-four isolates were from patients who failed treatment, defined as death 7 to 14 days after the incident candidemia episode, having persistent fever of ≥5 days' duration after the date of the incident candidemia, or the recurrence of fever after two consecutive afebrile days while on antifungal treatment. MICs were determined by using the Clinical Laboratory Standards Institute (formally National Committee for Clinical Laboratory Standards) broth microdilution procedure with two media and by using Etest. Minimum fungicidal concentrations (MFCs) were also measured in two media. Broth microdilution tests with RPMI 1640 medium generated a restricted range of MICs (0.125 to 1 μg/ml); the corresponding MFC values ranged from 0.5 to 4 μg/ml. Broth microdilution tests with antibiotic medium 3 produced a broader distribution of MIC and MFC results (0.015 to 0.25 μg/ml and 0.06 to 2 μg/ml, respectively). Etest produced the widest distribution of MICs (0.094 to 2 μg/ml). However, none of the test formats studied generated results that significantly correlated with therapeutic success or failure.

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Comparison of disc diffusion, E-Test and a modified CLSI broth microdilution method for in vitro susceptibility testing of itraconazole, posaconazole and voriconazole against Madurella mycetomatis

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00433-21 ◽

2021 ◽

Author(s):

Bertrand Nyuykonge ◽

Lukas van Amelsvoort ◽

Kimberly Eadie ◽

Ahmed H. Fahal ◽

Annelies Verbon ◽

...

Keyword(s):

Low Income ◽

Susceptibility Testing ◽

Fungal Infections ◽

Disc Diffusion ◽

Broth Microdilution ◽

In Vitro Susceptibility ◽

Bead Beating ◽

Broth Microdilution Method ◽

Madurella Mycetomatis

For many fungal infections, in vitro susceptibility testing is used to predict if an isolate is resistant or susceptible to the antifungal agent used to treat the fungal infection. For Madurella mycetomatis , the main causative agent of mycetoma, in vitro susceptibility testing currently is not performed on a routine basis. The current in vitro susceptibility testing method is labor intensive and sonication must be done to generate a hyphal inoculum. For endpoint visualization, expensive viability dyes are needed. Here we investigated if the currently used in vitro susceptibility method could be adapted to make it amendable for use in a routine setting which can be used in low income countries, where mycetoma is endemic. First, we developed a methodology in which hyphal fragments can be generated without the need for sonication, by comparing different bead beating methodologies. Next, in vitro susceptibility was assessed using standard broth microdilution assays as well as disc diffusion, E-testing and VIPcheck™ methodologies. We demonstrate that after a hyphal suspension is generated by glass bead beating, disc diffusion, E-testing and VIPcheck™ can be used to determine susceptibility towards itraconazole, posaconazole and voriconazole of Madurella mycetomatis . The MICs found with the E-test were comparable to those obtained with our modified CLSI-based broth microdilution in vitro susceptibility assay for itraconazole and posaconazole. Furthermore, we found an inverse relationship between the zone of inhibition and MIC obtained with E-test and the modified CLSI broth microdilution technique.

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Comparison of the In Vitro Activity of the Glycylcycline Tigecycline (Formerly GAR-936) with Those of Tetracycline, Minocycline, and Doxycycline against Isolates of Nontuberculous Mycobacteria

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.46.10.3164-3167.2002 ◽

2002 ◽

Vol 46 (10) ◽

pp. 3164-3167 ◽

Cited By ~ 148

Author(s):

Richard J. Wallace ◽

Barbara A. Brown-Elliott ◽

Christopher J. Crist ◽

Linda Mann ◽

Rebecca W. Wilson

Keyword(s):

Therapeutic Potential ◽

Nontuberculous Mycobacteria ◽

Mycobacterium Abscessus ◽

Vitro Activity ◽

In Vitro Activity ◽

Broth Microdilution ◽

Rapidly Growing Mycobacteria

ABSTRACT We compared the in vitro activity of the glycylcycline tigecycline (formerly GAR-936) with those of tetracycline, doxycycline, and minocycline by broth microdilution against 76 isolates belonging to seven species of rapidly growing mycobacteria (RGM) and 45 isolates belonging to five species of slowly growing nontuberculous mycobacteria (NTM). By using a resistance breakpoint of >4 μg/ml for tigecycline and >8 μg/ml for tetracycline, all RGM were highly susceptible to tigecycline, with inhibition of 50% of isolates at ≤0.12 μg/ml and inhibition of 90% of isolates at 0.25 μg/ml for Mycobacterium abscessus and inhibition of both 50 and 90% of isolates at ≤0.12 μg/ml for M. chelonae and the M. fortuitum group. The MICs of tigecycline were the same for tetracycline-resistant and -susceptible strains, and RGM isolates were 4- to 11-fold more susceptible to tigecycline than to the tetracyclines. In contrast, no slowly growing NTM were susceptible to tigecycline, and isolates of M. marinum and M. kansasii were less susceptible to this agent than to minocycline. This new antimicrobial offers exciting therapeutic potential for the RGM, especially for isolates of the M. chelonae-M. abscessus group, against which the activities of the currently available drugs are limited.

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