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- Publisher Website: 10.1093/jac/dks088
- Scopus: eid_2-s2.0-84862657112
- PMID: 22461311
- WOS: WOS:000305086600001
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Article: Are susceptibility tests enough, or should laboratories still seek ESBLs and carbapenemases directly?
Title | Are susceptibility tests enough, or should laboratories still seek ESBLs and carbapenemases directly? |
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Authors | |
Keywords | Ceftazidime Clinical Laboratory Standards Institute CLSI CTX-M β-lactamases EUCAST European Committee on Antimicrobial Susceptibility Testing KPC β-lactamases |
Issue Date | 2012 |
Publisher | Oxford University Press. The Journal's web site is located at http://jac.oxfordjournals.org/ |
Citation | Journal of antimicrobial chemotherapy, 2012, v. 67 n. 7, p. 1569-1577 How to Cite? |
Abstract | Recent EUCAST advice asserts that, with low breakpoints, susceptibility results for cephalosporins and carbapenems can be reported 'as found', even for strains with extended-spectrum beta-lactamases (ESBLs) and carbapenemases. The CLSI has similar advice, but with higher ceftazidime and cefepime breakpoints than those of EUCAST. Pharmacodynamic and animal data are used to support these views, along with some analysis of clinical case series. We contend that such advice is misguided on three counts. First, whilst there are cases on record where cephalosporins and carbapenems have proved effective against infections due to low-MIC ESBL producers and low-MIC carbapenemase producers, respectively, there are similar numbers of cases where such therapy has failed. Second, routine susceptibility testing is less precise than in research analyses, meaning that ESBL and carbapenemase producers with 'real' MICs of 1-8 mg/L will oscillate between susceptibility categories according to who tests them and how. Third, although EUCAST continues to advocate ESBL and carbapenemase detection for epidemiological purposes, the likely consequence of not seeking these enzymes for treatment purposes is that some laboratories will not seek them at all, leading to a loss of critical infection control information. In short, it is prudent to continue to seek ESBLs and carbapenemases directly and, where they are found, generally to avoid substrate drugs as therapy. |
Persistent Identifier | http://hdl.handle.net/10722/164414 |
ISSN | 2021 Impact Factor: 5.758 2020 SCImago Journal Rankings: 2.124 |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Livermore, DM | en_US |
dc.contributor.author | Andrews, JM | en_US |
dc.contributor.author | Hawkey, PM | en_US |
dc.contributor.author | Ho, PL | en_US |
dc.contributor.author | Keness, Y | en_US |
dc.contributor.author | Doi, Y | en_US |
dc.contributor.author | Paterson, D | en_US |
dc.contributor.author | Wooddord, N | en_US |
dc.date.accessioned | 2012-09-20T07:59:09Z | - |
dc.date.available | 2012-09-20T07:59:09Z | - |
dc.date.issued | 2012 | en_US |
dc.identifier.citation | Journal of antimicrobial chemotherapy, 2012, v. 67 n. 7, p. 1569-1577 | en_US |
dc.identifier.issn | 0305-7453 | - |
dc.identifier.uri | http://hdl.handle.net/10722/164414 | - |
dc.description.abstract | Recent EUCAST advice asserts that, with low breakpoints, susceptibility results for cephalosporins and carbapenems can be reported 'as found', even for strains with extended-spectrum beta-lactamases (ESBLs) and carbapenemases. The CLSI has similar advice, but with higher ceftazidime and cefepime breakpoints than those of EUCAST. Pharmacodynamic and animal data are used to support these views, along with some analysis of clinical case series. We contend that such advice is misguided on three counts. First, whilst there are cases on record where cephalosporins and carbapenems have proved effective against infections due to low-MIC ESBL producers and low-MIC carbapenemase producers, respectively, there are similar numbers of cases where such therapy has failed. Second, routine susceptibility testing is less precise than in research analyses, meaning that ESBL and carbapenemase producers with 'real' MICs of 1-8 mg/L will oscillate between susceptibility categories according to who tests them and how. Third, although EUCAST continues to advocate ESBL and carbapenemase detection for epidemiological purposes, the likely consequence of not seeking these enzymes for treatment purposes is that some laboratories will not seek them at all, leading to a loss of critical infection control information. In short, it is prudent to continue to seek ESBLs and carbapenemases directly and, where they are found, generally to avoid substrate drugs as therapy. | - |
dc.language | eng | en_US |
dc.publisher | Oxford University Press. The Journal's web site is located at http://jac.oxfordjournals.org/ | en_US |
dc.relation.ispartof | Journal of antimicrobial chemotherapy | en_US |
dc.subject | Ceftazidime | - |
dc.subject | Clinical Laboratory Standards Institute | - |
dc.subject | CLSI | - |
dc.subject | CTX-M β-lactamases | - |
dc.subject | EUCAST | - |
dc.subject | European Committee on Antimicrobial Susceptibility Testing | - |
dc.subject | KPC β-lactamases | - |
dc.subject.mesh | Animals | - |
dc.subject.mesh | Bacteria - drug effects - enzymology - isolation and purification | - |
dc.subject.mesh | Bacterial Infections - microbiology | - |
dc.subject.mesh | Microbial Sensitivity Tests - methods | - |
dc.subject.mesh | beta-Lactamases - analysis - genetics | - |
dc.title | Are susceptibility tests enough, or should laboratories still seek ESBLs and carbapenemases directly? | en_US |
dc.type | Article | en_US |
dc.identifier.email | Livermore, DM: d.livermore@uea.ac.uk | en_US |
dc.identifier.email | Ho, PL: plho@hkucc.hku.hk | - |
dc.identifier.authority | Ho, PL=rp00406 | en_US |
dc.description.nature | link_to_subscribed_fulltext | - |
dc.identifier.doi | 10.1093/jac/dks088 | - |
dc.identifier.pmid | 22461311 | - |
dc.identifier.scopus | eid_2-s2.0-84862657112 | - |
dc.identifier.hkuros | 209847 | en_US |
dc.identifier.volume | 67 | en_US |
dc.identifier.issue | 7 | en_US |
dc.identifier.spage | 1569 | en_US |
dc.identifier.epage | 1577 | en_US |
dc.identifier.isi | WOS:000305086600001 | - |
dc.publisher.place | United Kingdom | - |
dc.identifier.issnl | 0305-7453 | - |