Performance of polymyxin B Etest in a setting of high prevalence of KPC-producing Klebsiella pneumoniae
Objectives: Polymyxin resistance has been increasing in many regions, and appropriate determination of polymyxin susceptibility is now a major challenge worldwide. Many clinical laboratories rely on gradient diffusion methods to assess polymyxin susceptibility, although broth microdilution (BMD) is...
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| Format: | Article |
| Language: | English |
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Elsevier
2020-09-01
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| Series: | Journal of Global Antimicrobial Resistance |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213716520300357 |
| _version_ | 1819068375476731904 |
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| author | Alexandre P. Zavascki Cibele Massotti Magagnin Priscila Lamb Wink Vanessa Pimentel de Oliveira Aline Gabrielle Nunes Thaysa Guglieri Krummer Valério Rodrigues Aquino Afonso Luís Barth |
| author_facet | Alexandre P. Zavascki Cibele Massotti Magagnin Priscila Lamb Wink Vanessa Pimentel de Oliveira Aline Gabrielle Nunes Thaysa Guglieri Krummer Valério Rodrigues Aquino Afonso Luís Barth |
| author_sort | Alexandre P. Zavascki |
| collection | DOAJ |
| description | Objectives: Polymyxin resistance has been increasing in many regions, and appropriate determination of polymyxin susceptibility is now a major challenge worldwide. Many clinical laboratories rely on gradient diffusion methods to assess polymyxin susceptibility, although broth microdilution (BMD) is the only method currently recommended by the CLSI and EUCAST. The aim of this study was to assess the performance of the polymyxin B (PMB) Etest in a setting with a high prevalence of KPC-producing Klebsiella pneumoniae (KPC-KP). Methods: A commercial Etest susceptibility testing method was evaluated and compared with the reference BMD method, considering isolates with a minimum inhibitory concentration (MIC) ≤2 mg/L for PMB as susceptible to this drug. A total of 310 clinical KPC-KP isolates were evaluated. Results: Susceptibility was significantly higher by Etest compared with BMD (82.6% vs. 75.8%). The MIC50, MIC90 and modal MICs for PMB were 0.25, 32 and 0.25 mg/L (27.1%) by BMD and 0.5, 16 and 0.5 mg/L (49.7%) by Etest, respectively. Although categorical agreement was 90.0%, there was poor essential agreement (50.6%). A high rate (34.7%) of very major errors (VMEs) and a relatively low rate (2.1%) of major errors were found. Conclusion: The considerable number of resistant isolates in this study allowed an accurate estimation of VME rates and, consequently, a more comprehensive assessment of susceptibility testing for polymyxins. Etest did not meet fully the acceptance criteria for US FDA requirements. These data do not support the use of this commercial method for determining PMB MICs in carbapenem-resistant Enterobacterales populations. |
| first_indexed | 2024-12-21T16:33:09Z |
| format | Article |
| id | doaj.art-464346a559e842fa81edd707232705ea |
| institution | Directory Open Access Journal |
| issn | 2213-7165 |
| language | English |
| last_indexed | 2024-12-21T16:33:09Z |
| publishDate | 2020-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Global Antimicrobial Resistance |
| spelling | doaj.art-464346a559e842fa81edd707232705ea2022-12-21T18:57:17ZengElsevierJournal of Global Antimicrobial Resistance2213-71652020-09-01224042Performance of polymyxin B Etest in a setting of high prevalence of KPC-producing Klebsiella pneumoniaeAlexandre P. Zavascki0Cibele Massotti Magagnin1Priscila Lamb Wink2Vanessa Pimentel de Oliveira3Aline Gabrielle Nunes4Thaysa Guglieri Krummer5Valério Rodrigues Aquino6Afonso Luís Barth7Department of Internal Medicine, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Infectious Diseases Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Laboratório de Pesquisa em Resistência Bacteriana (LABRESIS), Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, BrazilLaboratório de Pesquisa em Resistência Bacteriana (LABRESIS), Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Laboratório Weinmann–Grupo Fleury, Porto Alegre, BrazilLaboratório de Pesquisa em Resistência Bacteriana (LABRESIS), Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Corresponding author. Present address: Laboratório de Pesquisa em Resistência Bacteriana (LABRESIS), Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcelos St., Porto Alegre, RS 90.035-903, Brazil.Infectious Diseases Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, BrazilLaboratório de Pesquisa em Resistência Bacteriana (LABRESIS), Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, BrazilSchool of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, BrazilLaboratório de Microbiologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, BrazilLaboratório de Pesquisa em Resistência Bacteriana (LABRESIS), Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BrazilObjectives: Polymyxin resistance has been increasing in many regions, and appropriate determination of polymyxin susceptibility is now a major challenge worldwide. Many clinical laboratories rely on gradient diffusion methods to assess polymyxin susceptibility, although broth microdilution (BMD) is the only method currently recommended by the CLSI and EUCAST. The aim of this study was to assess the performance of the polymyxin B (PMB) Etest in a setting with a high prevalence of KPC-producing Klebsiella pneumoniae (KPC-KP). Methods: A commercial Etest susceptibility testing method was evaluated and compared with the reference BMD method, considering isolates with a minimum inhibitory concentration (MIC) ≤2 mg/L for PMB as susceptible to this drug. A total of 310 clinical KPC-KP isolates were evaluated. Results: Susceptibility was significantly higher by Etest compared with BMD (82.6% vs. 75.8%). The MIC50, MIC90 and modal MICs for PMB were 0.25, 32 and 0.25 mg/L (27.1%) by BMD and 0.5, 16 and 0.5 mg/L (49.7%) by Etest, respectively. Although categorical agreement was 90.0%, there was poor essential agreement (50.6%). A high rate (34.7%) of very major errors (VMEs) and a relatively low rate (2.1%) of major errors were found. Conclusion: The considerable number of resistant isolates in this study allowed an accurate estimation of VME rates and, consequently, a more comprehensive assessment of susceptibility testing for polymyxins. Etest did not meet fully the acceptance criteria for US FDA requirements. These data do not support the use of this commercial method for determining PMB MICs in carbapenem-resistant Enterobacterales populations.http://www.sciencedirect.com/science/article/pii/S2213716520300357Broth microdilutionCarbapenem resistanceColistinGradient testKlebsiella pneumoniaePolymyxin B |
| spellingShingle | Alexandre P. Zavascki Cibele Massotti Magagnin Priscila Lamb Wink Vanessa Pimentel de Oliveira Aline Gabrielle Nunes Thaysa Guglieri Krummer Valério Rodrigues Aquino Afonso Luís Barth Performance of polymyxin B Etest in a setting of high prevalence of KPC-producing Klebsiella pneumoniae Journal of Global Antimicrobial Resistance Broth microdilution Carbapenem resistance Colistin Gradient test Klebsiella pneumoniae Polymyxin B |
| title | Performance of polymyxin B Etest in a setting of high prevalence of KPC-producing Klebsiella pneumoniae |
| title_full | Performance of polymyxin B Etest in a setting of high prevalence of KPC-producing Klebsiella pneumoniae |
| title_fullStr | Performance of polymyxin B Etest in a setting of high prevalence of KPC-producing Klebsiella pneumoniae |
| title_full_unstemmed | Performance of polymyxin B Etest in a setting of high prevalence of KPC-producing Klebsiella pneumoniae |
| title_short | Performance of polymyxin B Etest in a setting of high prevalence of KPC-producing Klebsiella pneumoniae |
| title_sort | performance of polymyxin b etest in a setting of high prevalence of kpc producing klebsiella pneumoniae |
| topic | Broth microdilution Carbapenem resistance Colistin Gradient test Klebsiella pneumoniae Polymyxin B |
| url | http://www.sciencedirect.com/science/article/pii/S2213716520300357 |
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