Challenging a dogma: antimicrobial susceptibility testing breakpoints for Mycobacterium tuberculosis
The rise in multidrug-resistant tuberculosis makes it increasingly important that antimicrobial susceptibility testing of Mycobacterium tuberculosis produce clinically meaningful and technically reproducible results. Unfortunately, this is not always the case because mycobacteriology specialists hav...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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The World Health Organization
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| Series: | Bulletin of the World Health Organization |
| Online Access: | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862012000900014&lng=en&tlng=en |
| _version_ | 1797284936750727168 |
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| author | Kristian Ängeby Pontus Juréen Gunnar Kahlmeter Sven E Hoffner Thomas Schön |
| author_facet | Kristian Ängeby Pontus Juréen Gunnar Kahlmeter Sven E Hoffner Thomas Schön |
| author_sort | Kristian Ängeby |
| collection | DOAJ |
| description | The rise in multidrug-resistant tuberculosis makes it increasingly important that antimicrobial susceptibility testing of Mycobacterium tuberculosis produce clinically meaningful and technically reproducible results. Unfortunately, this is not always the case because mycobacteriology specialists have not followed generally accepted modern principles for the establishment of susceptibility breakpoints for bacterial and fungal pathogens. These principles specifically call for a definition of the minimum inhibitory concentrations (MICs) applicable to organisms without resistance mechanisms (also known as wild-type MIC distributions), to be used in combination with data on clinical outcomes, pharmacokinetics and pharmacodynamics. In a series of papers the authors have defined tentative wild-type MIC distributions for M. tuberculosis and hope that other researchers will follow their example and provide confirmatory data. They suggest that some breakpoints are in need of revision because they either (i) bisect the wild-type distribution, which leads to poor reproducibility in antimicrobial susceptibility testing, or (ii) are substantially higher than the MICs of wild-type organisms without supporting clinical evidence, which may result in some strains being falsely reported as susceptible. The authors recommend, in short, that susceptibility breakpoints for antituberculosis agents be systematically reviewed and revised, if necessary, using the same modern tools now accepted for all other bacteria and fungi by the scientific community and by the European Medicines Agency and the European Centre for Disease Prevention and Control. For several agents this would greatly improve the accuracy and reproducibility of antimicrobial susceptibility testing of M. tuberculosis |
| first_indexed | 2024-03-07T17:55:00Z |
| format | Article |
| id | doaj.art-aefc7619126c484a8f91e434b3b49d08 |
| institution | Directory Open Access Journal |
| issn | 0042-9686 |
| language | English |
| last_indexed | 2024-03-07T17:55:00Z |
| publisher | The World Health Organization |
| record_format | Article |
| series | Bulletin of the World Health Organization |
| spelling | doaj.art-aefc7619126c484a8f91e434b3b49d082024-03-02T12:36:06ZengThe World Health OrganizationBulletin of the World Health Organization0042-968690969369810.2471/BLT.11.096644S0042-96862012000900014Challenging a dogma: antimicrobial susceptibility testing breakpoints for Mycobacterium tuberculosisKristian Ängeby0Pontus Juréen1Gunnar Kahlmeter2Sven E Hoffner3Thomas Schön4Karolinska University HospitalSwedish Institute for Communicable Disease ControlVäxjö HospitalSwedish Institute for Communicable Disease ControlKalmar County HospitalThe rise in multidrug-resistant tuberculosis makes it increasingly important that antimicrobial susceptibility testing of Mycobacterium tuberculosis produce clinically meaningful and technically reproducible results. Unfortunately, this is not always the case because mycobacteriology specialists have not followed generally accepted modern principles for the establishment of susceptibility breakpoints for bacterial and fungal pathogens. These principles specifically call for a definition of the minimum inhibitory concentrations (MICs) applicable to organisms without resistance mechanisms (also known as wild-type MIC distributions), to be used in combination with data on clinical outcomes, pharmacokinetics and pharmacodynamics. In a series of papers the authors have defined tentative wild-type MIC distributions for M. tuberculosis and hope that other researchers will follow their example and provide confirmatory data. They suggest that some breakpoints are in need of revision because they either (i) bisect the wild-type distribution, which leads to poor reproducibility in antimicrobial susceptibility testing, or (ii) are substantially higher than the MICs of wild-type organisms without supporting clinical evidence, which may result in some strains being falsely reported as susceptible. The authors recommend, in short, that susceptibility breakpoints for antituberculosis agents be systematically reviewed and revised, if necessary, using the same modern tools now accepted for all other bacteria and fungi by the scientific community and by the European Medicines Agency and the European Centre for Disease Prevention and Control. For several agents this would greatly improve the accuracy and reproducibility of antimicrobial susceptibility testing of M. tuberculosishttp://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862012000900014&lng=en&tlng=en |
| spellingShingle | Kristian Ängeby Pontus Juréen Gunnar Kahlmeter Sven E Hoffner Thomas Schön Challenging a dogma: antimicrobial susceptibility testing breakpoints for Mycobacterium tuberculosis Bulletin of the World Health Organization |
| title | Challenging a dogma: antimicrobial susceptibility testing breakpoints for Mycobacterium tuberculosis |
| title_full | Challenging a dogma: antimicrobial susceptibility testing breakpoints for Mycobacterium tuberculosis |
| title_fullStr | Challenging a dogma: antimicrobial susceptibility testing breakpoints for Mycobacterium tuberculosis |
| title_full_unstemmed | Challenging a dogma: antimicrobial susceptibility testing breakpoints for Mycobacterium tuberculosis |
| title_short | Challenging a dogma: antimicrobial susceptibility testing breakpoints for Mycobacterium tuberculosis |
| title_sort | challenging a dogma antimicrobial susceptibility testing breakpoints for mycobacterium tuberculosis |
| url | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862012000900014&lng=en&tlng=en |
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