Mercedes Delgado-Valverde1, Adoración Valiente-Mendez1, Eva Torres1, Benito Almirante2, Silvia Gómez-Zorrilla3, Nuria Borrell4, Ana Isabel Aller-García5, Mercedes Gurgui6,7, Manel Almela8, Mercedes Sanz9, Germán Bou10, Luis Martínez-Martínez11,12, Rafael Cantón13, Jose Antonio Lepe1, Manuel Causse14, Belén Gutiérrez-Gutiérrez1, Álvaro Pascual1,15, Jesús Rodríguez-Baño1,16. 1. Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío-IBiS, Seville, Spain. 2. Departamento de Enfermedades Infecciosas, Hospital Universitari Vall d'Hebron, Barcelona, Spain. 3. Servicio de Enfermedades Infecciosas, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain. 4. Servicio de Microbiología, Hospital Son Espases, Palma de Mallorca, Spain. 5. Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Seville, Spain. 6. Servicio de Enfermedades Infecciosas, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 7. Facultad de Medicina, Universitat Autònomade Barcelona, Barcelona, Spain. 8. Servicio de Microbiología, Hospital Clínic, Barcelona, Spain. 9. Departamento de Enfermedades Infecciosas, Hospital San Pedro-CIBIR, Logroño, Spain. 10. Servicio de Microbiología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain. 11. Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain. 12. Departamento de Biología Molecular, Universidad de Cantabria, Santander, Spain. 13. Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain. 14. Unidad de Gestión Clínica de Microbiología, Hospital Universitario Reina Sofía-Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain. 15. Departamento de Microbiología, Universidad de Sevilla, Seville, Spain. 16. Departamento de Medicina, Universidad de Sevilla, Seville, Spain.
Abstract
Objectives: To compare results of amoxicillin/clavulanate susceptibility testing using CLSI and EUCAST methodologies and to evaluate their impact on outcome in patients with bacteraemia caused by Enterobacteriaceae. Patients and methods: A prospective observational cohort study was conducted in 13 Spanish hospitals. Patients with bacteraemia due to Enterobacteriaceae who received empirical intravenous amoxicillin/clavulanate treatment for at least 48 h were included. MICs were determined following CLSI and EUCAST recommendations. Outcome variables were: failure at the end of treatment with amoxicillin/clavulanate (FEAMC); failure at day 21; and 30 day mortality. Classification and regression tree (CART) analysis and logistic regression were performed. Results: Overall, 264 episodes were included; the urinary tract was the most common source (64.7%) and Escherichia coli the most frequent pathogen (76.5%). Fifty-two isolates (19.7%) showed resistance according to CLSI and 141 (53.4%) according to EUCAST. The kappa index for the concordance between the results of both committees was only 0.24. EUCAST-derived, but not CLSI-derived, MICs were associated with failure when considered as continuous variables. CART analysis suggested a 'resistance' breakpoint of > 8/4 mg/L for CLSI-derived MICs; it predicted FEAMC in adjusted analysis (OR = 1.96; 95% CI: 0.98-3.90). Isolates with EUCAST-derived MICs >16/2 mg/L independently predicted FEAMC (OR = 2.10; 95% CI: 1.05-4.21) and failure at day 21 (OR= 3.01; 95% CI: 0.93-9.67). MICs >32/2 mg/L were only predictive of failure among patients with bacteraemia from urinary or biliary tract sources. Conclusions: CLSI and EUCAST methodologies showed low agreement for determining the MIC of amoxicillin/clavulanate. EUCAST-derived MICs seemed more predictive of failure than CLSI-derived ones. EUCAST-derived MICs >16/2 mg/L were independently associated with therapeutic failure.
Objectives: To compare results of amoxicillin/clavulanate susceptibility testing using CLSI and EUCAST methodologies and to evaluate their impact on outcome in patients with bacteraemia caused by Enterobacteriaceae. Patients and methods: A prospective observational cohort study was conducted in 13 Spanish hospitals. Patients with bacteraemia due to Enterobacteriaceae who received empirical intravenous amoxicillin/clavulanate treatment for at least 48 h were included. MICs were determined following CLSI and EUCAST recommendations. Outcome variables were: failure at the end of treatment with amoxicillin/clavulanate (FEAMC); failure at day 21; and 30 day mortality. Classification and regression tree (CART) analysis and logistic regression were performed. Results: Overall, 264 episodes were included; the urinary tract was the most common source (64.7%) and Escherichia coli the most frequent pathogen (76.5%). Fifty-two isolates (19.7%) showed resistance according to CLSI and 141 (53.4%) according to EUCAST. The kappa index for the concordance between the results of both committees was only 0.24. EUCAST-derived, but not CLSI-derived, MICs were associated with failure when considered as continuous variables. CART analysis suggested a 'resistance' breakpoint of > 8/4 mg/L for CLSI-derived MICs; it predicted FEAMC in adjusted analysis (OR = 1.96; 95% CI: 0.98-3.90). Isolates with EUCAST-derived MICs >16/2 mg/L independently predicted FEAMC (OR = 2.10; 95% CI: 1.05-4.21) and failure at day 21 (OR= 3.01; 95% CI: 0.93-9.67). MICs >32/2 mg/L were only predictive of failure among patients with bacteraemia from urinary or biliary tract sources. Conclusions: CLSI and EUCAST methodologies showed low agreement for determining the MIC of amoxicillin/clavulanate. EUCAST-derived MICs seemed more predictive of failure than CLSI-derived ones. EUCAST-derived MICs >16/2 mg/L were independently associated with therapeutic failure.
Authors: Jesús M Ramón-Sierra; Marco A Villanueva; Alejandro Yam-Puc; Martha Rodríguez-Mendiola; Carlos Arias-Castro; Elizabeth Ortiz-Vázquez Journal: Food Chem X Date: 2021-12-02
Authors: Chang Ho Yoon; Sean Bartlett; Nicole Stoesser; Koen B Pouwels; Nicola Jones; Derrick W Crook; Tim E A Peto; A Sarah Walker; David W Eyre Journal: J Antimicrob Chemother Date: 2022-08-25 Impact factor: 5.758
Authors: Robin Vanstokstraeten; N Belasri; T Demuyser; F Crombé; K Barbé; D Piérard Journal: Eur J Clin Microbiol Infect Dis Date: 2021-06-26 Impact factor: 3.267