Impact of Reappraisal of Fluoroquinolone Minimum Inhibitory Concentration Susceptibility Breakpoints in Gram-Negative Bloodstream Isolates
The Clinical Laboratory Standards Institute lowered the fluoroquinolone minimum inhibitory concentration (MIC) susceptibility breakpoints for <i>Enterobacteriaceae</i> and glucose non-fermenting Gram-negative bacilli in January 2019. This retrospective cohort study describes the impact o...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-04-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/9/4/189 |
| _version_ | 1797570439521763328 |
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| author | Stephanie C. Shealy Matthew M. Brigmon Julie Ann Justo P. Brandon Bookstaver Joseph Kohn Majdi N. Al-Hasan |
| author_facet | Stephanie C. Shealy Matthew M. Brigmon Julie Ann Justo P. Brandon Bookstaver Joseph Kohn Majdi N. Al-Hasan |
| author_sort | Stephanie C. Shealy |
| collection | DOAJ |
| description | The Clinical Laboratory Standards Institute lowered the fluoroquinolone minimum inhibitory concentration (MIC) susceptibility breakpoints for <i>Enterobacteriaceae</i> and glucose non-fermenting Gram-negative bacilli in January 2019. This retrospective cohort study describes the impact of this reappraisal on ciprofloxacin susceptibility overall and in patients with risk factors for antimicrobial resistance. Gram-negative bloodstream isolates collected from hospitalized adults at Prisma Health-Midlands hospitals in South Carolina, USA, from January 2010 to December 2014 were included. Matched pairs mean difference (MD) with 95% confidence intervals (CI) were calculated to examine the change in ciprofloxacin susceptibility after MIC breakpoint reappraisal. Susceptibility of <i>Enterobacteriaceae</i> to ciprofloxacin declined by 5.2% (95% CI: −6.6, −3.8; <i>p</i> < 0.001) after reappraisal. The largest impact was demonstrated among <i>Pseudomonas aeruginosa</i> bloodstream isolates (MD −7.8, 95% CI: −14.6, −1.1; <i>p</i> = 0.02) despite more conservative revision in ciprofloxacin MIC breakpoints. Among antimicrobial resistance risk factors, fluoroquinolone exposure within the previous 90 days was associated with the largest change in ciprofloxacin susceptibility (MD −9.3, 95% CI: −16.1, −2.6; <i>p</i> = 0.007). Reappraisal of fluoroquinolone MIC breakpoints has a variable impact on the susceptibility of bloodstream isolates by microbiology and patient population. Healthcare systems should be vigilant to systematically adopt this updated recommendation in order to optimize antimicrobial therapy in patients with bloodstream and other serious infections. |
| first_indexed | 2024-03-10T20:24:37Z |
| format | Article |
| id | doaj.art-dd5f9e71efb84399b4d1e04c271c0b41 |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-10T20:24:37Z |
| publishDate | 2020-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-dd5f9e71efb84399b4d1e04c271c0b412023-11-19T21:55:38ZengMDPI AGAntibiotics2079-63822020-04-019418910.3390/antibiotics9040189Impact of Reappraisal of Fluoroquinolone Minimum Inhibitory Concentration Susceptibility Breakpoints in Gram-Negative Bloodstream IsolatesStephanie C. Shealy0Matthew M. Brigmon1Julie Ann Justo2P. Brandon Bookstaver3Joseph Kohn4Majdi N. Al-Hasan5Department of Pharmacy, Prisma Health Richland Hospital, Columbia, SC 29203, USADepartment of Medicine, Baylor Scott and White, Texas A&M Health Science Center College of Medicine, Temple, TX 76502, USADepartment of Pharmacy, Prisma Health Richland Hospital, Columbia, SC 29203, USADepartment of Pharmacy, Prisma Health Richland Hospital, Columbia, SC 29203, USADepartment of Pharmacy, Prisma Health Richland Hospital, Columbia, SC 29203, USADepartment of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC 29208, USAThe Clinical Laboratory Standards Institute lowered the fluoroquinolone minimum inhibitory concentration (MIC) susceptibility breakpoints for <i>Enterobacteriaceae</i> and glucose non-fermenting Gram-negative bacilli in January 2019. This retrospective cohort study describes the impact of this reappraisal on ciprofloxacin susceptibility overall and in patients with risk factors for antimicrobial resistance. Gram-negative bloodstream isolates collected from hospitalized adults at Prisma Health-Midlands hospitals in South Carolina, USA, from January 2010 to December 2014 were included. Matched pairs mean difference (MD) with 95% confidence intervals (CI) were calculated to examine the change in ciprofloxacin susceptibility after MIC breakpoint reappraisal. Susceptibility of <i>Enterobacteriaceae</i> to ciprofloxacin declined by 5.2% (95% CI: −6.6, −3.8; <i>p</i> < 0.001) after reappraisal. The largest impact was demonstrated among <i>Pseudomonas aeruginosa</i> bloodstream isolates (MD −7.8, 95% CI: −14.6, −1.1; <i>p</i> = 0.02) despite more conservative revision in ciprofloxacin MIC breakpoints. Among antimicrobial resistance risk factors, fluoroquinolone exposure within the previous 90 days was associated with the largest change in ciprofloxacin susceptibility (MD −9.3, 95% CI: −16.1, −2.6; <i>p</i> = 0.007). Reappraisal of fluoroquinolone MIC breakpoints has a variable impact on the susceptibility of bloodstream isolates by microbiology and patient population. Healthcare systems should be vigilant to systematically adopt this updated recommendation in order to optimize antimicrobial therapy in patients with bloodstream and other serious infections.https://www.mdpi.com/2079-6382/9/4/189sepsisbacteremiaciprofloxacinchemotherapeutics<i>Escherichia coli</i>non-fermenters/<i>Pseudomonas aeruginosa</i> |
| spellingShingle | Stephanie C. Shealy Matthew M. Brigmon Julie Ann Justo P. Brandon Bookstaver Joseph Kohn Majdi N. Al-Hasan Impact of Reappraisal of Fluoroquinolone Minimum Inhibitory Concentration Susceptibility Breakpoints in Gram-Negative Bloodstream Isolates Antibiotics sepsis bacteremia ciprofloxacin chemotherapeutics <i>Escherichia coli</i> non-fermenters/<i>Pseudomonas aeruginosa</i> |
| title | Impact of Reappraisal of Fluoroquinolone Minimum Inhibitory Concentration Susceptibility Breakpoints in Gram-Negative Bloodstream Isolates |
| title_full | Impact of Reappraisal of Fluoroquinolone Minimum Inhibitory Concentration Susceptibility Breakpoints in Gram-Negative Bloodstream Isolates |
| title_fullStr | Impact of Reappraisal of Fluoroquinolone Minimum Inhibitory Concentration Susceptibility Breakpoints in Gram-Negative Bloodstream Isolates |
| title_full_unstemmed | Impact of Reappraisal of Fluoroquinolone Minimum Inhibitory Concentration Susceptibility Breakpoints in Gram-Negative Bloodstream Isolates |
| title_short | Impact of Reappraisal of Fluoroquinolone Minimum Inhibitory Concentration Susceptibility Breakpoints in Gram-Negative Bloodstream Isolates |
| title_sort | impact of reappraisal of fluoroquinolone minimum inhibitory concentration susceptibility breakpoints in gram negative bloodstream isolates |
| topic | sepsis bacteremia ciprofloxacin chemotherapeutics <i>Escherichia coli</i> non-fermenters/<i>Pseudomonas aeruginosa</i> |
| url | https://www.mdpi.com/2079-6382/9/4/189 |
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