File Download

There are no files associated with this item.

  Links for fulltext
     (May Require Subscription)
Supplementary

Article: Are susceptibility tests enough, or should laboratories still seek ESBLs and carbapenemases directly?

TitleAre susceptibility tests enough, or should laboratories still seek ESBLs and carbapenemases directly?
Authors
Issue Date2012
PublisherOxford 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?
AbstractRecent 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 Identifierhttp://hdl.handle.net/10722/164414
ISSN
2014 Impact Factor: 5.313
2014 SCImago Journal Rankings: 1.983
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorLivermore, DMen_US
dc.contributor.authorAndrews, JMen_US
dc.contributor.authorHawkey, PMen_US
dc.contributor.authorHo, PLen_US
dc.contributor.authorKeness, Yen_US
dc.contributor.authorDoi, Yen_US
dc.contributor.authorPaterson, Den_US
dc.contributor.authorWooddord, Nen_US
dc.date.accessioned2012-09-20T07:59:09Z-
dc.date.available2012-09-20T07:59:09Z-
dc.date.issued2012en_US
dc.identifier.citationJournal of antimicrobial chemotherapy, 2012, v. 67 n. 7, p. 1569-1577en_US
dc.identifier.issn0305-7453-
dc.identifier.urihttp://hdl.handle.net/10722/164414-
dc.description.abstractRecent 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.languageengen_US
dc.publisherOxford University Press. The Journal's web site is located at http://jac.oxfordjournals.org/en_US
dc.relation.ispartofJournal of antimicrobial chemotherapyen_US
dc.subject.meshAnimals-
dc.subject.meshBacteria - drug effects - enzymology - isolation and purification-
dc.subject.meshBacterial Infections - microbiology-
dc.subject.meshMicrobial Sensitivity Tests - methods-
dc.subject.meshbeta-Lactamases - analysis - genetics-
dc.titleAre susceptibility tests enough, or should laboratories still seek ESBLs and carbapenemases directly?en_US
dc.typeArticleen_US
dc.identifier.emailLivermore, DM: d.livermore@uea.ac.uken_US
dc.identifier.emailHo, PL: plho@hkucc.hku.hk-
dc.identifier.authorityHo, PL=rp00406en_US
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1093/jac/dks088-
dc.identifier.pmid22461311-
dc.identifier.scopuseid_2-s2.0-84862657112-
dc.identifier.hkuros209847en_US
dc.identifier.volume67en_US
dc.identifier.issue7en_US
dc.identifier.spage1569en_US
dc.identifier.epage1577en_US
dc.identifier.isiWOS:000305086600001-
dc.publisher.placeUnited Kingdom-

Export via OAI-PMH Interface in XML Formats


OR


Export to Other Non-XML Formats