Real-world performance of susceptibility testing for cefiderocol: insights from a prospective multicentre study on Gram-negative bacteria.

IF 3.7 Q2 INFECTIOUS DISEASES

JAC-Antimicrobial Resistance Pub Date : 2024-10-24 eCollection Date: 2024-10-01 DOI:10.1093/jacamr/dlae169

Alvaro Irigoyen-von-Sierakowski, Azahara Ocaña, Rosa Sánchez-Mayoral, Emilia Cercenado

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引用次数: 0

Abstract

Objectives: Cefiderocol is a novel siderophore-conjugated cephalosporin developed for the treatment of multidrug-resistant Gram-negative bacterial (GNB) infections. However, the current gold standard for cefiderocol susceptibility testing, broth microdilution (BMD) using iron-depleted cation-adjusted Mueller-Hinton broth, presents challenges for many microbiology laboratories. In this study, we evaluate the real-world performance of disc diffusion (DD) and a commercial BMD method (ComASP^®) to test cefiderocol susceptibility in a series of isolates collected prospectively from severely ill patients in a multicentre study.

Methods: The susceptibilities of 1472 isolates (632 Enterobacterales, 532 Pseudomonas aeruginosa, 84 Acinetobacter spp. and 224 Stenotrophomonas maltophilia) collected in 60 Spanish hospitals were analysed following the EUCAST 2023 and 2024 criteria. We assessed the performance of DD (cefiderocol 30 μg disc, Liofilchem) and a commercial BMD method (ComASP^® Cefiderocol, Liofilchem).

Results: A total of 1408 and 1450 isolates were susceptible by DD and ComASP^® BMD, respectively. Overall, the agreement between both methods was 96.9%. Forty-four isolates were resistant by DD but susceptible by ComASP^® BMD, and two were susceptible by DD but resistant by ComASP^® BMD (Acinetobacter baumannii isolates). Adoption of the updated 2024 EUCAST DD breakpoints and areas of technical uncertainty (ATUs) led to a decrease in susceptibility among Enterobacterales (95.3% versus 92.6%).

Conclusions: DD is a straightforward, rapid and accessible method for routine determination of cefiderocol susceptibility in real-world practice. ComASP^® BMD shows a high agreement with DD in susceptible isolates and may help to resolve DD interpretability concerns in isolates with susceptibility results within the ATU, but caution is warranted when testing resistant isolates.

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头孢菌素药敏试验的实际效果：革兰氏阴性菌前瞻性多中心研究的启示。

目的：头孢羟氨苄（Cefiderocol）是一种新型嗜苷结合头孢菌素，用于治疗耐多药革兰氏阴性菌（GNB）感染。然而，目前头孢羟氨苄药敏试验的黄金标准--使用贫铁阳离子调整的穆勒-欣顿肉汤进行肉汤微量稀释（BMD）--给许多微生物实验室带来了挑战。在本研究中，我们评估了盘式扩散（DD）和商业 BMD 方法（ComASP®）在真实世界中的性能，以检测在一项多中心研究中从重症患者中收集的一系列前瞻性分离物对头孢菌素的敏感性：方法：我们按照 EUCAST 2023 和 2024 标准分析了从 60 家西班牙医院收集的 1472 株分离株（632 株肠杆菌属、532 株铜绿假单胞菌属、84 株醋杆菌属和 224 株嗜麦芽糖单胞菌属）的药敏性。我们评估了 DD（头孢克洛 30 μg 盘，Liofilchem）和商业 BMD 方法（ComASP® Cefiderocol，Liofilchem）的性能：结果：用 DD 和 ComASP® BMD 方法检测，分别有 1408 株和 1450 株分离物易感。总体而言，两种方法的一致性为 96.9%。有 44 个分离物对 DD 检测呈耐药，但对 ComASP® BMD 检测呈敏感，有 2 个分离物对 DD 检测呈敏感，但对 ComASP® BMD 检测呈耐药（鲍曼不动杆菌分离物）。采用最新的 2024 年 EUCAST DD 断点和技术不确定性区域（ATU）后，肠杆菌类的药敏率有所下降（95.3% 对 92.6%）：结论：在实际应用中，DD 是一种简单、快速、方便的常规头孢菌素药敏测定方法。在易感分离物中，ComASP® BMD 与 DD 的一致性很高，可帮助解决分离物中药敏结果在 ATU 范围内的 DD 可解释性问题，但在检测耐药分离物时需谨慎。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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