Medical Microbiology

Antimicrobial Susceptibility Testing

isolation and identification
treatment of systemic bacterial or fungal
determination of antimicrobial susceptibility to various
agents
measurement of the amount of antimicrobial present in
serum or other body fluids.

Fig. 12.15a

Fig. 12.15b

Fig. 12.15c

Medical Microbiology
Methods for susceptibility testing should be:
reproducible
robust
reliable

Breakpoint concentrations
Qualitative
Susceptible
resistant
intermediate

Enzyme testing
B-lactamase
Synergism and antagonism

Medical Microbiology
Disc testing methods

cheap
flexible
visible
fiddly
CDS
NCCLS
Stokes

Fig. 12.18a

Fig. 12.18b

Fig. 12.18c

Medical Microbiology
Minimum inhibitory concentration (MIC)
Dilution testing:
agar
broth
E test

Minimum bactericidal concentration (MBC)

Serum bactericidal titre

Fig. 12.19 E-test

Fig. 12.20a MIC test

Fig. 12.20b MIC test

Antibacterial Agents
Classified according to:
Bactericidal or bacteriostatic
Target site

Cell wall synthesis

Protein synthesis
Nucleic acid synthesis
Cell membrane function

Chemical structure

Antibacterial Agents (1)

Inhibitors of cell wall synthesis
Targets peptidoglycan on the cell wall
-lactams
Penicillins
>10 different types

Glycopeptides
Vancomycins

Antibacterial Agents (2)

Inhibitors of protein synthesis
Aminoglycosides
Interfere with the binding of mRNA
Streptomycin, gentamycin

Tetracyclines
Inhibit RNA from entering acceptor sites on ribosomes

Chloroamphenicol
Prevents protein bond synthesis

Macrolides
Erythromycin, lincomycin, clindamycin

Antibacterial Agents (3)

Inhibitors of nucleic acid synthesis
Sulphonamides
Trimethoprim
Quinolones
Prevents coiling of bacterial chromosome

Rifamycin (rifampicin)
Blocks RNA synthesis

Antibacterial Agents (4)

Cell membrane function
Polymyxin B
Binds to plasma membrane to disrupt structure &
permeability properties

Resistance
Not inhibited or killed by an antibacterial agent, at
concentrations that can be achieved in the body.
Some bacteria can be innately resistant due to
cell wall structure or lack of target site.

Genetics of Resistance
Chromosomal mutation
Single mutations
Series of mutations

Transmissible plasmids
R plasmids

Jumping genes
Transposons

Mechanisms of
Resistance
Target site may be altered
Lower affinity for the drug

Altered uptake
Decreasing the permeability of the cell wall
Pumping the drug out of the cell

Enzyme production
Active against the drug

Betalactamase

 Extensive drug treatment eradicates susceptible

bacteria
Favours the increase of drug resistant strains
Superinfection

Fig. 12.17