Interpretative reading of the

antibiogram

Luis Martnez-Martnez
Service of Microbiology
University Hospital Marqus de Valdecilla
Santander, Spain
 M
RA ANTIMICROBIAL
G
AGENT
BIO
TI
AN

C E Y TO
N LIT
A I PK XIC
IST TIB /P ITY
E S P D
R CE
U S
S

MICRO- VIRULENCE
ORGANISM MECHANISMS OF DEFENSE PATIENT
 Automation and
expert systems
Interpretative
reading
Interpretative
criteria
Susceptibility testing
standardization
Relationship between
resistance and
therapeutic failure
Description of
mechanisms of resistance

Introduction into
clinical practice

Discovery of
antimicrobial agents

1920 1930 1940 1950 1960 1970 1980 1990 2000

Antibiogram Reading

Inh. zone (mm)

MIC (mg/L)

S-I-R
 Clinical Categories

CLSI (NCCLS): Clinical and Laboratory Standards Institute

EUCAST: European Committee on Antimicrobial Susceptibility
Testing

SFM: Socit Franaise de Microbiologie

BSAC: British Society for Antimicrobial Chemotherapy

MENSURA: Mesa Espaola de Normalizacin de la

Sensibilidad y Resistencia a los Antimicrobianos
...
Patrice Courvalin.
Interpretative reading of antimicrobial
susceptibility test.

ASM News 1992, 58:368-375.

 ANTIBIOGRAM
Interpreative reading of the antibiogram

Phenotype - Resistance

Susceptibility testing results for a

concrete microorganism considering
a GROUP of antimicrobial agents
(usually of the same family)
 ANTIBIOGRAM
Interpreative reading of the antibiogram

1.- Define Phenotype of susceptibility and Resistance

2.- Deduce the possible mechanism of resistence

3.- Adequate Clinical Categories to the inferred

mechanism of resistance, and change phenotype if
necessary
 ANTIBIOGRAM
Interpreative reading of the antibiogram

S-I-R Microbiological Knowldge

CLINCAL REPORT OF RESULTS

 AES

S-I-R SOFTWARE
(Expert system)

CLINCAL REPORT OF RESULTS

INTERPRETATION
[Not available in English!]
[Not available in English!]
 Interpreative reading

Identification of the microorganism (To species level))

Analysis of susceptibility/resistance Phenotype

- Groups (families) of antimicrobial agents
- Antimicrobial indicators of resistance

Define Phenotype
- Common Phenotypes
- Unusual Phenotypes
- ImpossiblePhenotypes

Deduce biochemical mechanism of resistance

Clinical Relevance of the inferred resistance
Re-define Clinical Categories
Requirements of Interpretative reading of the
antibiogram

Identification of the microorganism

Analysis of S/I/R phenotype
Use of indicator agents
Study antibiotic-inhibitor combinations
Quantitative study of susceptibility
Use of high inocula (in some occasions)
Local epidemiology information
Availability of reference methods

R. Cantn. Enferm Infecc Microbiol Clin 2002; 20: 176-186

 Identification Antibiogram
Microorganism +
antibiogram Interpretation

Deduce Phenotype of
Resistance
Clinical Relevance of
the mechanism of
resistance

Deduce Biochemical
Mechanism of Resistance

Re-Define Clinical Categories, if necessary REPORT

Deduce susceptibility/resistance to non tested

antimicrobial agents
Livermore D et al JAC 12001, 48 Suppl 1, 87-102
Livermore D et al JAC 12001, 48 Suppl 1, 87-102
Livermore D et al JAC 12001, 48 Suppl 1, 87-102
Livermore D et al JAC 12001, 48 Suppl 1, 87-102
Livermore D et al JAC 12001, 48 Suppl 1, 87-102
Livermore D et al JAC 12001, 48 Suppl 1, 87-102
Livermore D et al JAC 12001, 48 Suppl 1, 87-102
K. pneumoniae K. pneumoniae
ESBL (+)
 CPM
CPM

CTX IMP
CAZ
IMP CAZ
CTX

AMP
AMP

Enterobacter cloacae
SHV-12 IN Enterobacter
 Klebsiella pneumoniae
CMY-2

Mueller- Hinton Mueller-Hinton

Cloxacillin 250 mg/L
ML
 Staphylococcus aureus
E
E
erm Macrolides-14R
-15R
-16 ?
P OX AK

PBP2a CN
APH(2)-AAC(6)

-lactamR AminoglicosydeR
 S. aureus

E
E DA DA E
DA

erm erm msrA-B

Inducible methylase constitutive methylase Active efflux
 qnrS-PRODUCING Enterobacter cloacae

REP-PCR

REP-PCR pattern A B C D E
Isolates number 14 4 2 1 1
MIC nalidixic acid (mg/L) >256 (R) 8 (S) 8-16 (S) >256 (R) 32 (R)
MIC ciprofloxacin (mg/L) >32 (R) 0.38 (S) 2-4 (I/R) 3 (R) 1.5 (I)
Ser83Ile (14) None None Ser83Phe None
Mutations in gyrA
Asp87Asn (1)
Ser80Ile (2) Not None Not done None
Mutations in parC done
Not done (12)

Cano ME et al, submitted

Enterobacteriaceae
COLISTIN RESISTANCE

Calvo J et al unpublished results

 Limitations to interpretative reading of the
antibiogram

High complexity of resistance mechanisms

Limited informatioN about some mechanisms of resistance

Low level resistance

Multifactorial multiresistance

Oversimplification of interrpetative reading

Mistakes when deducing mechanisms of resistance

Modified from: R. Cantn. Enferm Infecc Microbiol Clin 2002; 20:176-186

Benefits of the interpretative reading of the
antibiogram

Adequacy of antimicrobial therapy

Detection of new mechanisms of resistence
Analysis of epidmeiology of resistance
Antimicrobial policy
Improved quality in laboratory testing

Modified from: R. Cantn. Enferm Infecc Microbiol Clin 2002; 20:176-186