The Path of More Resistance: A Comparison of NHSN and CLSI Criteria in Developing Cumulative Antimicrobial Susceptibility Test Reports and Institutional Antibiograms

2021 ◽  
Author(s):  
Alexander Winnett ◽  
Vinay Srinivasan ◽  
Matthew Davis ◽  
Tara Vijayan ◽  
Daniel Z. Uslan ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Susceptibility ◽  
Antimicrobial Agents ◽  
Susceptibility Testing ◽  
Clinical Laboratory ◽  
Empiric Therapy ◽  
Annual Data ◽  
Antimicrobial Susceptibility Test ◽  
Susceptibility Data ◽  
National Healthcare Safety Network

Background In the absence of antimicrobial susceptibility data, the institutional antibiogram is a valuable tool to guide clinicians in the empiric treatment of infections. However, there is a misunderstanding on how best to prepare cumulative antimicrobial susceptibility testing reports (CASTRs) to guide empiric therapy (e.g., routine antibiogram) versus monitoring antimicrobial resistance, with the former following guidance from the Clinical Laboratory Standards Institute (CLSI), and the latter from Center for Disease Control and Preventions National Healthcare Safety Network (NHSN). These criteria vary markedly in their exclusion or inclusion of isolates cultured repeatedly from the same patient. Methods We compared rates of non-susceptibility (NS)using annual data from a large teaching healthcare system subset to isolates eligible by either NHSN criteria or CLSI criteria. Results For a panel of the three most prevalent gram-negative pathogens in combination with clinically relevant antimicrobial agents (or priority pathogen-agent combinations, PPACs), we found that the inclusion of duplicate isolates by NHSN criteria yielded higher NS rates than when CLSI criteria (for which duplicate isolates are not included) were applied. Conclusions Patients with duplicate isolates may not be representative of antimicrobial resistance within a population. For this reason, users of CASTR data should carefully consider that the criteria used to generate these reports can impact resulting NS rates, and therefore maintain the distinction between CASTRs created for different purposes.

Antimicrobial Resistance in Campylobacter jejuni from Broilers and Broiler House Environments in Norway

2007 ◽  
Vol 70 (3) ◽  
pp. 736-738 ◽  
Author(s):  
M. NORSTRÖM ◽  
G. JOHNSEN ◽  
M. HOFSHAGEN ◽  
H. THARALDSEN ◽  
H. KRUSE
Keyword(s):  
Antimicrobial Resistance ◽  
Campylobacter Jejuni ◽  
Antimicrobial Susceptibility ◽  
Antimicrobial Agents ◽  
Monitoring Program ◽  
Outdoor Environment ◽  
Susceptibility Data ◽  
Microdilution Method ◽  
Broth Microdilution Method ◽  
Broiler House

Antimicrobial susceptibility in Campylobacter jejuni collected from the environment outside four broiler houses (n = 63) and from the environment inside these broiler houses (including broiler droppings) (n = 36) from May to September 2004 was studied and compared with isolates from Norwegian broilers analyzed within the frame of the Norwegian monitoring program of antimicrobial resistance in feed, food, and animals (NORM-VET) in 2004 (n = 75). The MICs of oxytetracycline, ampicillin, erythromycin, gentamicin, enrofloxacin, and nalidixic acid were obtained by the broth microdilution method VetMIC. The present study, which to our knowledge is the first Norwegian study on the occurrence of antimicrobial resistance in Campylobacter spp. from the environment of broiler houses, revealed a very low occurrence of antimicrobial resistance in C. jejuni from the broilers and broiler house environments studied. All isolates originating from the four broiler houses studied were susceptible to all the antimicrobial agents tested, except for one isolate from the outdoor environment (courtyard soil), which was resistant to oxytetracycline (MIC, 8 mg/liter). For the isolates from broilers (NORM-VET), low prevalences of resistance to oxytetracycline (1.3%) and ampicillin (4%) were observed. No quinolone resistance was observed. The results for the broiler isolates are in agreement with the earlier findings of a very low prevalence of resistance in Campylobacter from broilers in Norway, which reflects the low usage of antimicrobials in Norwegian broiler production. Furthermore, the present data are in accordance with antimicrobial susceptibility data for C. jejuni from domestically acquired human cases.

scholarly journals Susceptibilities of Corynebacterium bovis and Corynebacterium amylocolatum Isolates from Bovine Mammary Glands to 15 Antimicrobial Agents

2000 ◽  
Vol 44 (12) ◽  
pp. 3476-3477 ◽  
Author(s):  
Jeffrey L. Watts ◽  
Silvia Rossbach
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Susceptibility ◽  
Antimicrobial Agents ◽  
Bovine Mastitis ◽  
Mammary Glands ◽  
Economic Losses ◽  
Coryneform Bacteria ◽  
Susceptibility Data

ABSTRACT Coryneform bacteria are frequently isolated from bovine mastitis and are associated with economic losses. Generally, the MICs of the 15 antimicrobial agents tested at which 90% of the isolates tested are inhibited for 46 Corynebacterium bovis and 13Corynebacterium amylocolatum strains were low. These are the first quantitative antimicrobial susceptibility data available for coryneforms from bovine mastitis. Data from this study suggest that comparable corynebacteria from humans have a much higher level of antimicrobial resistance to a variety of antimicrobial agents.

scholarly journals Antimikrobiyal Aktivitenin Belirlenmesinde Cross-Streak Metodu Kullanımı

2019 ◽  
Vol 7 (sp1) ◽  
pp. 160
Author(s):  
Mustafa Ersal
Keyword(s):  
Antimicrobial Susceptibility ◽  
Antimicrobial Agents ◽  
Susceptibility Testing ◽  
Clinical Laboratory ◽  
Antimicrobial Susceptibility Testing ◽  
Rapid Screening ◽  
Resistant Bacteria ◽  
Production Environment ◽  
Specific Test ◽  
The Cross

Antimicrobial susceptibility testing can be used for prediction of therapeutic results, epidemiology and drug discovery. Microbial infections are an important problem which have developed resistance towards antimicrobial agents. Otherwise, efficacy of these agents is considerable with treatment failures associated with multidrug-resistant bacteria and it has become a global concern to public health. Therefore, explore the new antimicrobial agents and widely use of antimicrobial susceptibility need to be developed. There are many techniques for the determination of antimicrobial activity. Many of these techniques, which are applied to inhibit sensitive microorganisms, are based on diffusion-related methods in the solid or semi-solid production environment. Cross-streak among these techniques is an easy technique that allows for relatively rapid screening of cultures in research for the discovery of the new antibiotics. However, the biggest disadvantage of the Cross-streak test is the difficulty in obtaining quantitative data. Because the edges of the inhibition zone are usually very fuzzy and unclear. Some antimicrobial susceptibility testing techniques were standardized by Clinical Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST) to determine the striking steps in this area. This testing procedure requires the use of specific test conditions and methods. In addition, the medium, incubation conditions and time are among these requirements. It is important to understand and develop the Cross-streak method from the currently used activity determination methods.

scholarly journals Antimicrobial resistance surveillance of Salmonella isolates from the First People’s Hospital of Yunnan Province, China

2015 ◽  
Vol 9 (04) ◽  
pp. 333-337 ◽  
Author(s):  
Jiang Yaxian ◽  
Zuo Hui ◽  
Niu Hua ◽  
Mao Xiaoqin ◽  
Li Fengliang ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Susceptibility ◽  
Yunnan Province ◽  
Antimicrobial Agents ◽  
Susceptibility Testing ◽  
Common Disease ◽  
First Line ◽  
Salmonella Spp ◽  
Resistant Phenotype ◽  
Resistance Rates

Introduction: Typhoid fever is a common disease in Yunnan province; however, the resistant phenotype and epidemic characteristics of Salmonella in this area are still unclear. In this study, a 15-year surveillance of antimicrobial susceptibility of Salmonella is reported. Methodology: From January 1999 to December 2013, Salmonella isolates were recovered from patients in the First People's Hospital of Yunnan Province. Antimicrobial susceptibility was detected and data were analyzed using WHONET5.6. Results: A total of 845 Salmonella isolates were recovered between 1999 and 2013. The most frequently isolated Salmonella serovar was S. Paratyphi A (93%), and 75.1% (635/845) of the isolates were from the young and middle-aged population. The resistance rates of Salmonella spp. to ciprofloxacin, ampicillin, and ceftriaxone increased dramatically during the 15 years. Carbapenems retained the highest and most stable activity against isolates. The resistance rates of all Salmonella isolates to chloramphenicol and sulfamethoxazole were 0.4% (3/845) and 1.8% (15/845), respectively. Conclusions: As Salmonella isolates have been observed to be resistant to first-line antibiotics, antimicrobial agents should be used rationally and prescriptions should be based on case-by-case susceptibility testing.

scholarly journals Identification, Genotyping and Antimicrobial Susceptibility Testing of Brucella spp. Isolated from Livestock in Egypt

2019 ◽  
Vol 7 (12) ◽  
pp. 603 ◽  
Author(s):  
Aman Ullah Khan ◽  
Waleed S. Shell ◽  
Falk Melzer ◽  
Ashraf E. Sayour ◽  
Eman Shawkat Ramadan ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Susceptibility ◽  
Molecular Mechanisms ◽  
Antimicrobial Agents ◽  
Susceptibility Testing ◽  
Brucella Melitensis ◽  
Rpob Gene ◽  
Antimicrobial Susceptibility Testing ◽  
Animal Populations ◽  
Microbiological Methods

Brucellosis is a highly contagious zoonosis worldwide with economic and public health impacts. The aim of the present study was to identify Brucella (B.) spp. isolated from animal populations located in different districts of Egypt and to determine their antimicrobial resistance. In total, 34-suspected Brucella isolates were recovered from lymph nodes, milk, and fetal abomasal contents of infected cattle, buffaloes, sheep, and goats from nine districts in Egypt. The isolates were identified by microbiological methods and matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS). Differentiation and genotyping were confirmed using multiplex PCR for B. abortus, Brucella melitensis, Brucella ovis, and Brucella suis (AMOS) and Bruce-ladder PCR. Antimicrobial susceptibility testing against clinically used antimicrobial agents (chloramphenicol, ciprofloxacin, erythromycin, gentamicin, imipenem, rifampicin, streptomycin, and tetracycline) was performed using E-Test. The antimicrobial resistance-associated genes and mutations in Brucella isolates were confirmed using molecular tools. In total, 29 Brucella isolates (eight B. abortus biovar 1 and 21 B. melitensis biovar 3) were identified and typed. The resistance of B. melitensis to ciprofloxacin, erythromycin, imipenem, rifampicin, and streptomycin were 76.2%, 19.0%, 76.2%, 66.7%, and 4.8%, respectively. Whereas, 25.0%, 87.5%, 25.0%, and 37.5% of B. abortus were resistant to ciprofloxacin, erythromycin, imipenem, and rifampicin, respectively. Mutations in the rpoB gene associated with rifampicin resistance were identified in all phenotypically resistant isolates. Mutations in gyrA and gyrB genes associated with ciprofloxacin resistance were identified in four phenotypically resistant isolates of B. melitensis. This is the first study highlighting the antimicrobial resistance in Brucella isolated from different animal species in Egypt. Mutations detected in genes associated with antimicrobial resistance unravel the molecular mechanisms of resistance in Brucella isolates from Egypt. The mutations in the rpoB gene in phenotypically resistant B. abortus isolates in this study were reported for the first time in Egypt.

Antimicrobial resistance in swine production

2008 ◽  
Vol 9 (2) ◽  
pp. 135-148 ◽  
Author(s):  
Frank M. Aarestrup ◽  
C. Oliver Duran ◽  
David G. S. Burch
Keyword(s):  
Antimicrobial Resistance ◽  
Human Health ◽  
Antimicrobial Agents ◽  
Susceptibility Testing ◽  
Acquired Resistance ◽  
Swine Production ◽  
Susceptibility Data ◽  
Development Of Resistance ◽  
The World ◽  
Different Parts

AbstractLarge amounts of antimicrobial agents are still being used in modern swine production in many countries around the world. This facilitates the emergence and development of antimicrobial resistance. Bacteria causing infections in swine have in several cases acquired resistance to a number of the agents most commonly used for treatment, making it difficult to predict the efficacy of different antimicrobial agents without prior susceptibility testing. This review gives an overview of recent susceptibility data from different parts of the world and discusses the importance of the development of resistance not only in the treatment of infections in swine but also taking into account the human health implications of antimicrobial resistance.

scholarly journals A survey of methods used for antimicrobial susceptibility testing in veterinary diagnostic laboratories in the United States

2017 ◽  
Vol 29 (5) ◽  
pp. 669-675 ◽  
Author(s):  
David A. Dargatz ◽  
Matthew M. Erdman ◽  
Beth Harris
Keyword(s):  
United States ◽  
Antimicrobial Resistance ◽  
Antimicrobial Susceptibility ◽  
Susceptibility Testing ◽  
Clinical Laboratory ◽  
The United States ◽  
Antimicrobial Susceptibility Testing ◽  
Disk Diffusion ◽  
Diffusion Method ◽  
Broth Microdilution

Antimicrobial resistance is a serious threat to animal and human health worldwide, requiring a collaborative, holistic approach. The U.S. Government has developed a national strategy to address antimicrobial resistance, with one component being to monitor antimicrobial resistance in agricultural settings. We developed a survey to collect information about antimicrobial susceptibility testing (AST) from the veterinary diagnostic laboratory community in the United States, assessing current practices and technologies and determining how AST information is shared. Of the 132 surveys administered, 52 (39%) were returned. Overall, responding laboratories conducted susceptibility tests on 98,788 bacterial isolates in 2014, with Escherichia coli being the most common pathogen tested across all animal species. The 2 most common AST methods employed were the disk diffusion method (71%) and the Sensititre platform broth microdilution system (59%). Laboratories primarily used the Clinical Laboratory Standards Institute (CLSI) VET-01 standard (69%) and the automatically calculated interpretations provided by the commercial AST systems (61%) for interpreting their AST data. Only 22% of laboratories published AST data on a periodic basis, usually via annual reports published on the laboratory’s website or through peer-reviewed journals for specific pathogens. Our results confirm that disk diffusion and broth microdilution remain the standard AST methods employed by U.S. veterinary diagnostic laboratories, and that CLSI standards are commonly used for interpreting AST results. This information will help determine the most efficient standardized methodology for future surveillance. Furthermore, the current infrastructure within laboratories, once harmonized, will help provide a mechanism for conducting national surveillance programs.

Effect on Physician Prescribing Practices of Changing from a Qualitative to a Quantitative Antimicrobial Susceptibility Test Reporting System

1983 ◽  
Vol 17 (7-8) ◽  
pp. 552-555 ◽  
Author(s):  
Thomas T. Ward ◽  
Michael J. Regner ◽  
Karen L. Collell ◽  
Ronald R. Brown ◽  
David L. Sewell
Keyword(s):  
Antimicrobial Susceptibility ◽  
Antimicrobial Agents ◽  
Susceptibility Testing ◽  
Antimicrobial Susceptibility Testing ◽  
Susceptibility Test ◽  
Disc Diffusion ◽  
Prescribing Practices ◽  
Susceptibility Data ◽  
Before And After ◽  
Physician Prescribing

The use of disc diffusion susceptibility testing has been criticized because it often fails to take into consideration achievable levels of antimicrobial agents at the actual sites of infection. An increasing number of hospitals are converting from disc diffusion antimicrobial susceptibility testing to more quantitative susceptibility testing techniques. Advocates of these latter techniques have suggested that providing information beyond sensitive, intermediate, and resistant reporting will emphasize, more effectively, the importance of considering achievable antibiotic concentrations at the site of infection, when choosing an antimicrobial agent. This study examined whether providing more quantitative susceptibility test reports would affect physicians' antimicrobial prescribing practices. Results obtained on the preeducation and posteducation questionnaires indicate success in improving the collective knowledge of physicians. In retrospective audits of the appropriateness of antimicrobial use, both before and after the educational program, physician usage of antimicrobial agents was categorized as inappropriate in more than ⅔ of the cases. The major reason for the negative outcome in this study is probably due to physicians' indifference to the results of urine culture and susceptibility test data. A change was made in antimicrobial therapy after return of the susceptibility report less than 20 percent of the time. As more laboratories convert to quantitative antimicrobial susceptibility testing, there will be a need for a closer liaison among physicians, clinical pharmacists, microbiologists, and infectious disease specialists, to ensure optimum utilization of the additional susceptibility data provided.

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