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Article: Are susceptibility tests enough, or should laboratories still seek ESBLs and carbapenemases directly?
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TitleAre susceptibility tests enough, or should laboratories still seek ESBLs and carbapenemases directly?
 
AuthorsLivermore, DM4 3
Andrews, JM8
Hawkey, PM5
Ho, PL2
Keness, Y6
Doi, Y7
Paterson, D1
Wooddord, N
 
Issue Date2012
 
PublisherOxford University Press. The Journal's web site is located at http://jac.oxfordjournals.org/
 
CitationJournal of antimicrobial chemotherapy, 2012, v. 67 n. 7, p. 1569-1577 [How to Cite?]
DOI: http://dx.doi.org/10.1093/jac/dks088
 
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.
 
ISSN0305-7453
2013 Impact Factor: 5.439
 
DOIhttp://dx.doi.org/10.1093/jac/dks088
 
ISI Accession Number IDWOS:000305086600001
 
DC FieldValue
dc.contributor.authorLivermore, DM
 
dc.contributor.authorAndrews, JM
 
dc.contributor.authorHawkey, PM
 
dc.contributor.authorHo, PL
 
dc.contributor.authorKeness, Y
 
dc.contributor.authorDoi, Y
 
dc.contributor.authorPaterson, D
 
dc.contributor.authorWooddord, N
 
dc.date.accessioned2012-09-20T07:59:09Z
 
dc.date.available2012-09-20T07:59:09Z
 
dc.date.issued2012
 
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.description.naturelink_to_subscribed_fulltext
 
dc.identifier.citationJournal of antimicrobial chemotherapy, 2012, v. 67 n. 7, p. 1569-1577 [How to Cite?]
DOI: http://dx.doi.org/10.1093/jac/dks088
 
dc.identifier.doihttp://dx.doi.org/10.1093/jac/dks088
 
dc.identifier.epage1577
 
dc.identifier.hkuros209847
 
dc.identifier.isiWOS:000305086600001
 
dc.identifier.issn0305-7453
2013 Impact Factor: 5.439
 
dc.identifier.issue7
 
dc.identifier.pmid22461311
 
dc.identifier.scopuseid_2-s2.0-84862657112
 
dc.identifier.spage1569
 
dc.identifier.urihttp://hdl.handle.net/10722/164414
 
dc.identifier.volume67
 
dc.languageeng
 
dc.publisherOxford University Press. The Journal's web site is located at http://jac.oxfordjournals.org/
 
dc.publisher.placeUnited Kingdom
 
dc.relation.ispartofJournal of antimicrobial chemotherapy
 
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?
 
dc.typeArticle
 
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<item><contributor.author>Livermore, DM</contributor.author>
<contributor.author>Andrews, JM</contributor.author>
<contributor.author>Hawkey, PM</contributor.author>
<contributor.author>Ho, PL</contributor.author>
<contributor.author>Keness, Y</contributor.author>
<contributor.author>Doi, Y</contributor.author>
<contributor.author>Paterson, D</contributor.author>
<contributor.author>Wooddord, N</contributor.author>
<date.accessioned>2012-09-20T07:59:09Z</date.accessioned>
<date.available>2012-09-20T07:59:09Z</date.available>
<date.issued>2012</date.issued>
<identifier.citation>Journal of antimicrobial chemotherapy, 2012, v. 67 n. 7, p. 1569-1577</identifier.citation>
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<description.abstract>Recent EUCAST advice asserts that, with low breakpoints, susceptibility results for cephalosporins and carbapenems can be reported &apos;as found&apos;, 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 &apos;real&apos; 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.</description.abstract>
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Author Affiliations
  1. University of Queensland
  2. The University of Hong Kong
  3. Health Protection Agency
  4. University of East Anglia
  5. University of Birmingham
  6. Haemek Medical Center
  7. University of Pittsburgh School of Medicine
  8. City Hospital in Birmingham