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Performance of the EUCAST disc diffusion method and two MIC methods in detection of Enterobacteriaceae with reduced susceptibility to meropenem: the NordicAST CPE study

OBJECTIVES: To examine performance of EUCAST disc diffusion and supplementary MIC methods for detection of Enterobacteriaceae with reduced susceptibility to meropenem using EUCAST screening recommendations. METHODS: Sixty-one Nordic laboratories delivered data on EUCAST disc diffusion (n = 61), semi...

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Autores principales: Haldorsen, Bjørg, Giske, Christian G, Hansen, Dennis S, Helgason, Kristjan Orri, Kahlmeter, Gunnar, Löhr, Iren H, Matuschek, Erika, Österblad, Monica, Rantakokko-Jalava, Kaisu, Wang, Mikala, Småbrekke, Lars, Samuelsen, Ørjan, Sundsfjord, Arnfinn
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6148324/
https://www.ncbi.nlm.nih.gov/pubmed/30053113
http://dx.doi.org/10.1093/jac/dky276
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author Haldorsen, Bjørg
Giske, Christian G
Hansen, Dennis S
Helgason, Kristjan Orri
Kahlmeter, Gunnar
Löhr, Iren H
Matuschek, Erika
Österblad, Monica
Rantakokko-Jalava, Kaisu
Wang, Mikala
Småbrekke, Lars
Samuelsen, Ørjan
Sundsfjord, Arnfinn
author_facet Haldorsen, Bjørg
Giske, Christian G
Hansen, Dennis S
Helgason, Kristjan Orri
Kahlmeter, Gunnar
Löhr, Iren H
Matuschek, Erika
Österblad, Monica
Rantakokko-Jalava, Kaisu
Wang, Mikala
Småbrekke, Lars
Samuelsen, Ørjan
Sundsfjord, Arnfinn
author_sort Haldorsen, Bjørg
collection PubMed
description OBJECTIVES: To examine performance of EUCAST disc diffusion and supplementary MIC methods for detection of Enterobacteriaceae with reduced susceptibility to meropenem using EUCAST screening recommendations. METHODS: Sixty-one Nordic laboratories delivered data on EUCAST disc diffusion (n = 61), semi-automated meropenem MIC (n = 23; VITEK2, n = 20 and Phoenix, n = 3) and gradient meropenem MIC (n = 58) methods. The strains (n = 27) included the major carbapenemase classes (A, n = 4; B, n = 9; D, n = 6) involved in the global spread of carbapenemase-producing Enterobacteriaceae (CPE) and non-CPE strains (n = 8) covering a range of broth microdilution (BMD) meropenem MICs. RESULTS: A triplicate Klebsiella variicola (meropenem MIC 0.5 mg/L) harbouring OXA-48 and Escherichia coli ATCC 25922 showed an overall good precision. Meropenem zone diameters below the EUCAST screening cut-off (<27 mm) were reported for strains with MIC ≥1 mg/L (n = 21), irrespective of resistance mechanism. For three strains (MIC = 0.5 mg/L) with OXA-48/-181, eight laboratories provided meropenem zone diameters above the screening cut-off. Very major errors (VMEs) were not observed. The overall distributions of major errors (MEs) and minor errors (mEs) were 9% and 36% (disc diffusion), 26% and 18% (VITEK2) and 7% and 20% (gradient MIC), respectively. Differences in ME and mE distributions between disc diffusion and MIC gradient tests compared with semi-automated methods were significant (P < 0.0001), using BMD MICs as a reference for categorization. CONCLUSIONS: The EUCAST disc diffusion method is a robust method to screen for CPE but isolates with meropenem MICs <1 mg/L pose challenges. The high ME rate in semi-automated methods might deter appropriate use of carbapenems in CPE infections with limited therapeutic options.
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spelling pubmed-61483242018-09-25 Performance of the EUCAST disc diffusion method and two MIC methods in detection of Enterobacteriaceae with reduced susceptibility to meropenem: the NordicAST CPE study Haldorsen, Bjørg Giske, Christian G Hansen, Dennis S Helgason, Kristjan Orri Kahlmeter, Gunnar Löhr, Iren H Matuschek, Erika Österblad, Monica Rantakokko-Jalava, Kaisu Wang, Mikala Småbrekke, Lars Samuelsen, Ørjan Sundsfjord, Arnfinn J Antimicrob Chemother Original Research OBJECTIVES: To examine performance of EUCAST disc diffusion and supplementary MIC methods for detection of Enterobacteriaceae with reduced susceptibility to meropenem using EUCAST screening recommendations. METHODS: Sixty-one Nordic laboratories delivered data on EUCAST disc diffusion (n = 61), semi-automated meropenem MIC (n = 23; VITEK2, n = 20 and Phoenix, n = 3) and gradient meropenem MIC (n = 58) methods. The strains (n = 27) included the major carbapenemase classes (A, n = 4; B, n = 9; D, n = 6) involved in the global spread of carbapenemase-producing Enterobacteriaceae (CPE) and non-CPE strains (n = 8) covering a range of broth microdilution (BMD) meropenem MICs. RESULTS: A triplicate Klebsiella variicola (meropenem MIC 0.5 mg/L) harbouring OXA-48 and Escherichia coli ATCC 25922 showed an overall good precision. Meropenem zone diameters below the EUCAST screening cut-off (<27 mm) were reported for strains with MIC ≥1 mg/L (n = 21), irrespective of resistance mechanism. For three strains (MIC = 0.5 mg/L) with OXA-48/-181, eight laboratories provided meropenem zone diameters above the screening cut-off. Very major errors (VMEs) were not observed. The overall distributions of major errors (MEs) and minor errors (mEs) were 9% and 36% (disc diffusion), 26% and 18% (VITEK2) and 7% and 20% (gradient MIC), respectively. Differences in ME and mE distributions between disc diffusion and MIC gradient tests compared with semi-automated methods were significant (P < 0.0001), using BMD MICs as a reference for categorization. CONCLUSIONS: The EUCAST disc diffusion method is a robust method to screen for CPE but isolates with meropenem MICs <1 mg/L pose challenges. The high ME rate in semi-automated methods might deter appropriate use of carbapenems in CPE infections with limited therapeutic options. Oxford University Press 2018-10 2018-07-24 /pmc/articles/PMC6148324/ /pubmed/30053113 http://dx.doi.org/10.1093/jac/dky276 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Original Research
Haldorsen, Bjørg
Giske, Christian G
Hansen, Dennis S
Helgason, Kristjan Orri
Kahlmeter, Gunnar
Löhr, Iren H
Matuschek, Erika
Österblad, Monica
Rantakokko-Jalava, Kaisu
Wang, Mikala
Småbrekke, Lars
Samuelsen, Ørjan
Sundsfjord, Arnfinn
Performance of the EUCAST disc diffusion method and two MIC methods in detection of Enterobacteriaceae with reduced susceptibility to meropenem: the NordicAST CPE study
title Performance of the EUCAST disc diffusion method and two MIC methods in detection of Enterobacteriaceae with reduced susceptibility to meropenem: the NordicAST CPE study
title_full Performance of the EUCAST disc diffusion method and two MIC methods in detection of Enterobacteriaceae with reduced susceptibility to meropenem: the NordicAST CPE study
title_fullStr Performance of the EUCAST disc diffusion method and two MIC methods in detection of Enterobacteriaceae with reduced susceptibility to meropenem: the NordicAST CPE study
title_full_unstemmed Performance of the EUCAST disc diffusion method and two MIC methods in detection of Enterobacteriaceae with reduced susceptibility to meropenem: the NordicAST CPE study
title_short Performance of the EUCAST disc diffusion method and two MIC methods in detection of Enterobacteriaceae with reduced susceptibility to meropenem: the NordicAST CPE study
title_sort performance of the eucast disc diffusion method and two mic methods in detection of enterobacteriaceae with reduced susceptibility to meropenem: the nordicast cpe study
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6148324/
https://www.ncbi.nlm.nih.gov/pubmed/30053113
http://dx.doi.org/10.1093/jac/dky276
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