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Therefore, the reclassification of isolates that are intermediate by CLSI to susceptible by EUCAST is unlikely to contribute to adverse outcomes for patients with urinary tract infections.
The EUCAST guidelines have slightly more stringent breakpoints for some antibiotics in an effort to curb the inappropriate use of antibiotics and control the rising rates of antibiotic resistance. For S.
The two guidelines performed equally in the detection of the rate of methicillin resistant Staphylococcus aureus MRSA of 7.
EUCAST eliminated the intermediate category for vancomycin in a bid to discourage the reporting of Glycopeptide-intermediate Staphylococcus aureus GISA due to poor response even to increased doses of vancomycin [ 8 , 16 ].
In view of the fact that no vancomycin resistant Staphylococcus aureus VRSA has been identified in our set up as yet, these changes are unlikely to influence interpretation of breakpoints. The moderate level of agreement for gentamicin is due to the more stringent breakpoints by EUCAST leading to a much higher resistance rate of 8.
The difference between the two susceptibility cut-offs is two dilutions and this may require further harmonization. Gentamicin is rarely used as monotherapy in treating gram positive bacteria and as such this difference in MIC cut off is unlikely to be clinically significant.
For P. This accounts for the slightly reduced level of agreement. These accounted for the reduced level of agreement and may require further harmonization between the two breakpoints. In effect this has led to a slightly higher meropenem resistance of This is another aspect that will require harmonization. Our study is limited by the fact that we only compared the susceptibility for three bacteria whose results may not necessarily be generalizable to all clinically relevant gram positive and negative bacteria.
Guide complet des Techniques de pilotage
However, these three bacteria represent a significant proportion of common bacterial pathogens both in the community and healthcare settings namely Enterobacteriaceae, non-fermenting gram negative bacteria and Staphylococci. The results obtained are also limited to MICs generated by an automated bacterial identification system which is not widely used in developing countries.
In most laboratories in sub-Saharan Africa, disk diffusion is the preferred mode of antibiotic susceptibility testing. This was the first report on complete nucleotide of a blaIMPcarrying plasmid in E. Plasmid pIMP26 hosted high phylogenetic mosaicism, transferability and plasticity.
Introduction Notoriously, extended and overuse of antibiotics have potentiated globally rapid emergence and spread of carbapenem-resistant Enterobacterales CRE , posing a serious threat to clinical therapy and infection control 1 , 2 , 3. The major driving force for the diversification and dissemination of CRE has been confirmed as the horizontal transfer of plasmid-mediated carbapenem-hydrolyzing enzymes i. However, since then, there have been only sporadic reports on the IMPproduction in Gram-negative bacilli 13 , 14 , 15 , especially in Enterobacterales Notably, isolates expressing IMP were found significantly more resistant to doripenem and meropenem than that expressing IMP-1 Enterobacter cloacae was one member of the normal intestinal microflora of humans and animals, which has also assumed clinical importance and emerged as a major human pathogen causing hospital-acquired bacteremia, nosocomial pneumonia, urinary tract infections and so on 16 , In the past decade, the emergence of IMP-producing E.
As for IMPproducing E. Our pilot study firstly reported two IMPproducing E.
Considering the higher carbapenem-hydrolyzing activities and emerging reports in China of IMP, we subsequently analyzed the transferability and full nucleotide sequence of the corresponding multi-drug-resistance plasmid pIMP26 in this study, which carried several important resistance determinants, such as blaIMP, blaDHA-1, aacA4, qnrB4 and fosA5, conferring resistance to carbapenems, cephalosporins, aminoglycoside and fosfomycin, respectively.
Methods Isolate and antimicrobial susceptibility testing Isolate RJ was obtained from the blood of a female patient with uterine malignancy at Ruijin Hospital in April The carbapenem-resistant isolate was first isolated at day 28 after admission. The previous travel history of the patient was not documented. Escherichia coli ATCC was used as the quality control.
Plasmid conjugation, S1-nuclease pulsed-field gel electrophoresis S1-PFGE , and southern hybridization The transferability of the resistance genes was assessed in broth culture using E. The membrane was hybridized with digoxigenin-labeled blaIMP specific probes. The final assembly generated a circular genome sequence with no gap existed. The precise species identification was established based on average nucleotide identity ANI between RJ and other type strains of E.
Open reading frames ORFs were identified using Glimmer version 3. ORFs less than bp were discarded. Ethics approval and informed consent The study was approved by Ruijin Hospital Ethics Committee Shanghai Jiao Tong University School of Medicine , and the Review Board exempted the requirements for informed consent as this study only focused on bacteria.
Results Precise species identification RJ was initially identified as E.
Additionally, RJ showed Therefore, RJ was precisely identified as E. Table 1 Antibiotic susceptibilities of E. B The Southern blotting profile of E.
Full size image Genome sequencing of RJ Whole genome sequencing generated 1,, single reads and 4. The bases in all contigs of RJ was 5.
The size of chromosome was 4,, bp, and the bases in all contigs of two plasmids in RJ were , bp pIMP26 and 78, bp respectively. Figure 2 Circular map of plasmid pIMP The location of discussed resistance genes and intI were also demonstrated on the outer cyan-blue circle. The annotation of the genetic components were added manually using the Microsoft PowerPoint program.In response, CLSI established three separate penicillin clinical breakpoint categories in meningitis intravenous , non-meningitis intravenous , and non-meningitis oral.
Currently, there is a critical need to expedite the regulatory pathways for new drug development and approval [ FDA assigned only a susceptible category because of the lack of data on resistant isolates.
The plasmid was analyzed through conjugation experiments, S1-nuclease pulsed-field gel electrophoresis and hybridization. These accounted for the reduced level of agreement and may require further harmonization between the two breakpoints.
Since dalbavancin commercial susceptibility methods are not currently available at the time of this publication and disk diffusion and agar dilution methods are not currently recommended for dalbavancin, reference broth dilution methods are the current options available 12, In 2 additional studies, the addition of P to the initial and intermediate stock solutions Table 6 and the use of glass or plastic tubes for the preparation of the initial and intermediate stock solutions Table 7 did not have an effect on the dalbavancin MIC results.
Besides, pIMP26 contained a wide variety of transposable elements carrying known antibiotic resistance genes. The MIC panel format used for the purpose of this video publication is shown in Table 1.
However, PK-PD may play yet another important role in the development of new antimicrobial agents.
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