Journal of Clinical Microbiology最新文献

{"title":"Evaluation of antimicrobial susceptibility testing methods for <i>Burkholderia cepacia</i> complex isolates from people with and without cystic fibrosis.","authors":"Peter Jorth, Carmila Manuel, Tracey McLemore, Romney M Humphries, Nicolynn C Cole, Audrey N Schuetz, Dennis Garica, Maria Maldonado, Natasha Rivero, Anna Clara Milesi Galdino, Diana Celedonio, John J LiPuma, Daniel A Green, James E A Zlosnik, Maria Traczewski, Holly K Huse","doi":"10.1128/jcm.01480-24","DOIUrl":"10.1128/jcm.01480-24","url":null,"abstract":"<p><p>The <i>Burkholderia cepacia</i> complex (BCC) is a group of Gram-negative bacteria that cause opportunistic infections, most notably in people with cystic fibrosis (CF), and have been associated with outbreaks caused by contaminated medical products. Antimicrobial susceptibility testing (AST) is often used to guide treatment for BCC infections, perhaps most importantly in people with CF who are being considered for lung transplant. However, recent studies have highlighted problems with AST methods. Here, we address limitations from previous studies to further evaluate BCC AST methods. We assessed the performance of reference broth microdilution (BMD), disk diffusion (DD) using Mueller-Hinton agar (MHA) from three manufacturers, agar dilution (AD), and gradient diffusion (ETEST) for ceftazidime (CAZ), levofloxacin (LVX), meropenem (MEM), minocycline (MIN), and trimethoprim-sulfamethoxazole (TMP-SMX) on a set of 205 BCC isolates. The isolate set included 100 isolates from people with CF and 105 isolates from people without CF from a variety of sources, which enabled us to systematically evaluate whether specimen source impacts AST performance. For all BCC isolates, BMD reproducibility was 93%, 98%, 99%, 98%, and 96% for CAZ, LVX, MEM, MIN, and TMP-SMX, respectively. Using BMD as the comparator method, we show that DD, AD, and ETEST perform poorly, with neither MHA manufacturer nor specimen source significantly impacting method performance. Based on our data, we recommend that routine AST should not be performed for BCC isolates. If a provider requests AST, clinical microbiology laboratories should perform Clinical and Laboratory Standards Institute reference methodology for BMD (stored frozen) and report MIC only.IMPORTANCEAntimicrobial susceptibility testing for the <i>Burkholderia cepacia</i> complex (BCC) is often used to determine eligibility for lung transplant in people with cystic fibrosis. However, problems with method performance have been reported. Here, we systematically evaluate the performance of reference broth microdilution, disk diffusion, agar dilution, and gradient diffusion (ETEST) for BCC organisms isolated from people with and without cystic fibrosis. We show that broth microdilution reproducibility is acceptable for levofloxacin, meropenem, minocycline, and trimethoprim-sulfamethoxazole, while ceftazidime was just below the acceptability cut-off. Regardless of specimen source, the results from disk diffusion, agar dilution, and ETEST do not correlate with broth microdilution. Based on these findings, we recommend that antimicrobial susceptibility testing should not be routinely performed for BCC, and if requested by the provider, only broth microdilution following Clinical and Laboratory Standards Institute guidelines should be used. Providers should be aware of the significant limitations of antimicrobial susceptibility testing methods for BCC.</p>","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0148024"},"PeriodicalIF":6.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11837569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-sensitivity detection of <i>Mycobacterium tuberculosis</i> DNA in tongue swab samples.","authors":"Alaina M Olson, Rachel C Wood, Kris M Weigel, Alexander J Yan, Katherine A Lochner, Rane B Dragovich, Angelique K Luabeya, Paul Yager, Mark Hatherill, Gerard A Cangelosi","doi":"10.1128/jcm.01140-24","DOIUrl":"10.1128/jcm.01140-24","url":null,"abstract":"<p><p>Tongue swab (TS) sampling combined with quantitative PCR (qPCR) to detect <i>Mycobacterium tuberculosis</i> (MTB) DNA is a promising alternative to sputum testing for tuberculosis (TB) diagnosis. In prior studies, the sensitivity of tongue swabbing has usually been lower than sputum. In this study, we evaluated two strategies to improve sensitivity. In one, centrifugation was used to concentrate tongue dorsum bacteria from 2-mL suspensions eluted from high-capacity foam swab samples. The pellets were resuspended as 500-µL suspensions, and then mechanically lysed prior to dual-target qPCR to detect MTB insertion elements IS<i>6110</i> and IS<i>1081</i>. Fractionation experiments demonstrated that most of the MTB DNA signal in clinical swab samples (99.22% ± 1.46%) was present in the sedimentable fraction. When applied to archived foam swabs collected from 124 South Africans with presumptive TB, this strategy exhibited 83% sensitivity (71/86) and 100% specificity (38/38) relative to sputum microbiological reference standard (MRS; sputum culture and/or Xpert Ultra). The second strategy used sequence-specific magnetic capture (SSMaC) to concentrate DNA released from MTB cells. This protocol was evaluated on archived Copan FLOQSwabs flocked swab samples collected from 128 South African participants with presumptive TB. Material eluted into 500 µL buffer was mechanically lysed. The suspensions were digested by proteinase K, hybridized to biotinylated dual-target oligonucleotide probes, and then concentrated ~20-fold using magnetic separation. Upon dual-target qPCR testing of concentrates, this strategy exhibited 90% sensitivity (83/92) and 97% specificity (35/36) relative to sputum MRS. These results point the way toward automatable, high-sensitivity methods for detecting MTB DNA in TS.</p><p><strong>Importance: </strong>Improved testing for tuberculosis (TB) is needed. Using a more accessible sample type than sputum may enable the detection of more cases, but it is critical that alternative samples be tested appropriately. Here, we describe two new, highly accurate methods for testing tongue swabs for TB DNA.</p>","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0114024"},"PeriodicalIF":6.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11837540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effective mitigation of blood culture bottle shortage with diagnostic stewardship interventions.","authors":"Jessica Hudson, Guillermo Rodriguez Nava, Mindy Marie Sampson, Amy Chang, Alex Maurice Dussaq, Jorge Luis Salinas, Angela Serbest, Tho Pham, Niaz Banaei","doi":"10.1128/jcm.01701-24","DOIUrl":"10.1128/jcm.01701-24","url":null,"abstract":"","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0170124"},"PeriodicalIF":6.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11837545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143032839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of piperacillin-tazobactam disks using contemporary Enterobacterales isolates suggests the need for disk potency optimization.","authors":"Ayesha Khan, Carmila Manuel, Richard Maynard, Romney M Humphries","doi":"10.1128/jcm.01599-24","DOIUrl":"10.1128/jcm.01599-24","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Piperacillin-tazobactam (TZP) is a commonly used broad-spectrum agent. OXA-1 β-lactamases drive global Enterobacterales TZP resistance and raise MICs to the clinical breakpoints (8/4-16/4 µg/mL), making susceptibility testing challenging. Two TZP disks are used globally. The first with 100 µg piperacillin and 10 µg tazobactam, established in 1992, is used by laboratories following U.S. FDA and Clinical and Laboratory Standards Institute (CLSI) standards. The second, with 30 µg piperacillin and 6 µg tazobactam, was developed by the European Committee on Antimicrobial Susceptibility Testing (EUCAST). When CLSI updated Enterobacterales TZP MIC breakpoints in 2022, it became apparent that the 100/10 µg disk may not accurately predict TZP resistance or susceptibility. In this study, we performed a disk mass titration study using 100 contemporary Enterobacterales isolates, including 40 harboring bla&lt;sub&gt;OXA-1&lt;/sub&gt;. Relative to reference broth microdilution with CLSI breakpoints, categorical agreement (CA) for the 100/10 µg disk was 68% with 0.6% major errors (MEs) and 32% minor errors. The CA for the 30/6 µg disk against EUCAST breakpoints was 88% with 15% very major errors and 10% ME. A third disk developed in this study, 20/5 µg, yielded 81% CA with CLSI MIC breakpoints and disk breakpoints generated using the error-rate-bounded method. CA was 62.4%, 63.2%, and 70.9% for isolates with bla&lt;sub&gt;OXA-1&lt;/sub&gt; using the 100/10, 30/6, and 20/5 µg disks, respectively, whereas it was 71.6%, 86.9%, and 83.1% for isolates without bla&lt;sub&gt;OXA-1&lt;/sub&gt;. Decreasing TZP disk potency improved the overall performance of disk diffusion and improved separation between susceptible and non-susceptible isolates, particularly those harboring OXA-1, but no disk yielded optimal results.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;In this article, we address major gaps in contemporary data for piperacillin-tazobactam (TZP) susceptibility testing and evaluate the performance of disk diffusion. TZP is the most common empiric broad-spectrum agent against Gram-negative pathogens and is used as a carbapenem-sparing regimen. OXA-1 β-lactamases drive global Enterobacterales TZP resistance and raise MICs to the clinical breakpoints, making susceptibility testing challenging. In 2022, CLSI revised the Enterobacterales TZP MIC breakpoints. Due to the lack of contemporary correlates, disk diffusion breakpoints were revised using outdated historical data from 1991 and 2003 and yielded unacceptable error rates. Additionally, there is a lack of global consensus on disk potency. The EUCAST TZP disks contain 30 μg piperacillin and 6 μg tazobactam. The CLSI disks, established after TZP approval in 1979 and prior to the widespread prevalence of ESBLs, contain 100 μg piperacillin and 10 μg tazobactam. Here, we evaluate disk diffusion using the 100/10 and 30/6 μg TZP disks with 100 contemporary Enterobacterales isolates, including 40 harboring bla&lt;sub&gt;OXA-1&lt;/sub&gt;. We conducted a disk development st","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0159924"},"PeriodicalIF":6.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11837518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of antimicrobial susceptibility of pneumococci based on whole-genome sequencing data: a direct comparison of two genomic tools to conventional antimicrobial susceptibility testing.","authors":"Gerardo J Sanchez, Lize Cuypers, Lies Laenen, Peter Májek, Katrien Lagrou, Stefanie Desmet","doi":"10.1128/jcm.01079-24","DOIUrl":"10.1128/jcm.01079-24","url":null,"abstract":"<p><p>Determination of antimicrobial resistance (AMR) in pneumococcal isolates is important for surveillance purposes and in a clinical context. Antimicrobial susceptibility testing (AST) of pneumococci is complicated by the need for exact minimal inhibitory concentrations (MICs) of beta-lactam antibiotics. Two next-generation sequencing (NGS) analysis tools have implemented the prediction of AMR in their analysis workflow, including the prediction of MICs: Pathogenwatch (https://pathogen.watch/) and AREScloud (OpGen). The performance of these tools in comparison to phenotypic AST following EUCAST guidelines is unknown. A total of 538 <i>Streptococcus pneumoniae</i> isolates were used to compare both tools with phenotypic AST for penicillin, amoxicillin, cefotaxime/ceftriaxone, erythromycin, trimethoprim-sulfamethoxazole, and tetracycline. Disk diffusion was performed for all isolates, and broth microdilution was performed for isolates with reduced beta-lactam susceptibility. Demultiplexed FASTQ files from Illumina sequencing, covering the whole genome of pneumococci, were used as input for the NGS tools. Categorical agreement (CA), major error (ME), and very major error (VME) rates were calculated. For beta-lactam antibiotics, CA was high (>94%) associated with none or only one ME and VME (<1%). For erythromycin and tetracycline, CA was >93% for predictions by AREScloud, while for Pathogenwatch, this ranged around 88%. For trimethoprim-sulfamethoxazole, CA was for both tools <86%. High VME rates were observed for erythromycin and tetracycline, higher for Pathogenwatch (53.6% and 47.0%, respectively) compared to AREScloud (14.3% and 19.1%, respectively). Both tools performed excellently despite the complexity of predicting beta-lactam resistance in pneumococci. Further optimization and validation are needed for non-beta-lactams since high (very) major error rates were observed.</p>","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0107924"},"PeriodicalIF":6.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11837510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of voriconazole to predict susceptibility and resistance to isavuconazole for <i>Aspergillus fumigatus</i> using CLSI methods and interpretive criteria.","authors":"Marisa L Winkler, Paul R Rhomberg, Kelley A Fedler, Michael D Huband, Maura Karr, John H Kimbrough, Mariana Castanheira","doi":"10.1128/jcm.01207-24","DOIUrl":"10.1128/jcm.01207-24","url":null,"abstract":"<p><p><i>Aspergillus fumigatus</i> is a common cause of pulmonary and invasive mold infections among immunocompromised hosts. Mortality in immunocompromised hosts with invasive <i>Aspergillus</i> infections (IAI) has been reported to be as high as 80%. Therefore, appropriate therapy is essential in treating IAI. Both isavuconazole and voriconazole are first-line agents in treatment guidelines for IAI, but isavuconazole has favorable properties, often leading it to be preferred over voriconazole, given the lengthy duration of treatment. It is difficult to perform mold antifungal susceptibility testing, which often requires a reference lab and several weeks to determine results. Therefore, use of surrogate markers can be helpful to infer susceptibility when testing is not possible or delayed. We performed isavuconazole and voriconazole broth microdilution susceptibility testing by the Clinical and Laboratory Standards Institute (CLSI) method on a collection of 976 non-duplicate <i>A. fumigatus</i> isolates from a global surveillance program between 2017 and 2022. We found that voriconazole and isavuconazole have a very high essential agreement within two doubling dilutions at 99.9% and a categorical agreement of 92.7% with no very major errors, one major error (0.11%), and <10% minor errors. Many of the minor errors were in the setting of voriconazole testing at a MIC of 0.5 mg/L (susceptible) but isavuconazole at 2 mg/L (intermediate). Genetic analysis of <i>cyp51</i> genes confirmed that isavuconazole and voriconazole susceptibility testing identified isolates with <i>cyp51A</i> and <i>cyp51B</i> mutations. Voriconazole can be used to predict the isavuconazole susceptibility testing result when <i>A. fumigatus</i> is tested by CLSI broth microdilution methodology.</p>","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0120724"},"PeriodicalIF":6.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11837495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative performances of the Qvella FAST system and conventional methods for rapid identification and antibiotic susceptibility testing on monomicrobial positive blood cultures.","authors":"Malo Penven, Manon Louazon, Charlotte Freret, Alexandra Sauron, Meghane Pilard, Elisa Creignou, Ophélie Gardan, Maryne Haumont, Asma Zouari, Stéphane Lorre, Vincent Cattoir","doi":"10.1128/jcm.01332-24","DOIUrl":"10.1128/jcm.01332-24","url":null,"abstract":"<p><p>Rapid and accurate diagnosis of sepsis is of paramount importance to reduce associated morbidity and mortality. The Qvella FAST System is a new instrument that concentrates and purifies bacteria from positive-flagged blood culture bottles (PFBCBs) to produce a \"liquid\" colony comparable to a subcultured colony in less than 40 min for rapid ID and calibrated antibiotic susceptibility testing (AST). In this study, we evaluated performances of the FAST System workflow and our rapid routine manual workflow (bacterial pellet obtained after lysis, cleaning, washing, and centrifugation for ID; AST by disc diffusion by direct inoculation after dilution) by comparison to the reference method based on 24-h bacterial subcultures. Two panels of PFBCBs were studied: panel A (including 107 prospective BCs from septic patients, October-November 2022) and panel B (including 102 BCs spiked with difficult-to-identify bacteria [mostly streptococci] and multidrug-resistant isolates), resulting in a total of 209 evaluable samples. The FAST System provided a correct ID to the species level in 178/209 (85.2%) of cases. For AST, the categorical agreement (CA) of the FAST System was 99.4%, with rates of very major (VME), major (ME), and minor (mE) errors of 0.59%, 0.20%, and 0.26%, respectively. Our rapid routine workflow based on manual methods show similar results for ID (86.2%) and AST (CA, 99.6%; VME, 0.50%; ME, 0.16%; mE, 0.13%). In conclusion, the Qvella FAST system, a promising tool that can reduce diagnostic time by approximately 1 day, shows excellent performances for rapid ID and AST.</p>","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0133224"},"PeriodicalIF":6.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11837511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel technologies for the diagnosis of urinary tract infections.","authors":"Tomas Bermudez, Jonathan E Schmitz, Malcolm Boswell, Romney Humphries","doi":"10.1128/jcm.00306-24","DOIUrl":"10.1128/jcm.00306-24","url":null,"abstract":"<p><p>Urinary tract infections (UTIs) impose a substantial burden on patient quality of life and urine testing accounts for the majority of workload in many clinical microbiology laboratories. Traditional UTI diagnosis relies on symptoms, urinalysis, and culture which are interpreted based on historical guidelines. This approach, while foundational, presents limitations, particularly in complex cases. Low-level bacteriuria and the presence of fastidious organisms are often overlooked or entirely missed in standard urine culture, stressing the need for novel diagnostic methods and technologies. This mini-review summarizes the existing state of UTI diagnostics in 2024 and covers current and upcoming technologies including rapid molecular-based pathogen identification, next-generation sequencing, and advanced antimicrobial susceptibility testing. However, these methods represent unique challenges, and as they are implemented, they will require the field to adapt to new concepts to avoid misdiagnosis and overtreatment.</p>","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0030624"},"PeriodicalIF":6.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11837515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapidly spreading <i>Enterobacterales</i> with OXA-48-like carbapenemases.","authors":"Gisele Peirano, Johann D D Pitout","doi":"10.1128/jcm.01515-24","DOIUrl":"10.1128/jcm.01515-24","url":null,"abstract":"<p><p><i>Enterobacterales</i> (mostly <i>Klebsiella pneumoniae</i>, <i>Escherichia coli</i>) with OXA-48-like carbapenemases (e.g., OXA-48, -181, -232, -244) are undermining the global efficiency of carbapenem therapy. In the Middle East, North Africa, and some European countries, OXA-48-like carbapenemases are the most common types of carbapenemases among <i>Enterobacterales</i>. Currently, OXA-48 is endemic in the Middle East, North Africa, Spain, France, and Belgium; OXA-181 is endemic in Sub-Saharan Africa and the Indian Subcontinent, while OXA-232 has been increasing in the Indian Subcontinent. European countries (e.g., Germany, Denmark, Switzerland, France) are experiencing community outbreaks with <i>E. coli</i> ST38 that produce OXA-244, and these strains have been introduced into Norwegian, Polish, and Czech hospitals. The global ascendancy of OXA-48-like genes is due to the combination of carbapenemases with horizontal spread through promiscuous plasmids (e.g., IncL, IncX3, ColE2) and vertical spread with certain high-risk multidrug-resistant clones (e.g., <i>K. pneumoniae</i> ST14, ST15, ST147, ST307; <i>E. coli</i> ST38, ST410). This is a powerful \"gene survival strategy\" that has assisted with the survival of OXA-48-like genes in different environments including the community setting. The laboratory diagnosis is complex; therefore, bacteria with \"difficult to detect\" variants (e.g., OXA-244, OXA-484) are likely underreported and are spreading silently \"beneath the radar\" in hospital and community settings. <i>K. pneumoniae</i> and <i>E. coli</i> with OXA-48-like carbapenemases are forces to be reckoned with.</p>","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0151524"},"PeriodicalIF":6.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11837536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A multicenter performance evaluation of cefiderocol MIC results: ComASP in comparison to CLSI broth microdilution.","authors":"L M Koeth, J M DiFranco-Fisher, E Palavecino, A Kilic, D Hardy, D Vicino, S Stracquadanio, S Stefani","doi":"10.1128/jcm.00926-24","DOIUrl":"10.1128/jcm.00926-24","url":null,"abstract":"<p><p>The performance of the Liofilchem Compact Antimicrobial Susceptibility Panel (ComASP) Cefiderocol was evaluated in a multicenter study. Enterobacterales, <i>Acinetobacter baumannii</i>, and <i>Pseudomonas aeruginosa</i> clinical isolates and challenge isolates were tested by three and one sites, respectively. Minimum inhibitory concentration (MIC) testing was performed by the Clinical and Laboratory Standards Institute (CLSI) broth microdilution and ComASP, which included two reading endpoints (CLSI read; MIC is the first well in which reduction of growth is <1 mm or light haze/faint turbidity] and ComASP [ComASP read; MIC is the first well at which 100% inhibition of growth occurs]). Each site performed reproducibility and quality control (QC) by ComASP and broth microdilution (BMD). Reproducibility was excellent (97.4% within ±1 dilution of modal MIC). All QC results were within CLSI QC ranges by BMD and ComASP, except for two <i>E. coli</i> ATCC 25922 results from one site. Essential agreement for combined clinical and challenge Enterobacterales was 84.3% (CLSI read) and 95.7% (ComASP read), <i>P. aeruginosa</i> was 83.3% (CLSI read) and 93.7% (ComASP read), and <i>A. baumannii</i> was 78.3% (CLSI read) and 96.7% (ComASP read). Categorical agreement for Enterobacterales was 92.4% for both CLSI read and ComASP read, for <i>P. aeruginosa</i> was 89.7% (CLSI read) and 92.1% (ComASP read), and for <i>A. baumannii</i> was 72.8% (CLSI read) and 91.3% (ComASP read). There were no very major errors using the ComASP read. One very major error for <i>P. aeruginosa</i> occurred using the CLSI read method. Three very major errors for <i>A. baumannii</i> occurred using the CLSI read method. ComASP Cefiderocol was shown to be a reliable method for testing cefiderocol MIC against relevant clinical isolates when ComASP read is used.</p><p><strong>Importance: </strong>There are very limited commercial methods available to clinical laboratories for cefiderocol minimum inhibitory concentration (MIC) testing. The Compact Antimicrobial Susceptibility Panel (ComASP) Cefiderocol method includes iron-depleted cation-adjusted Mueller-Hinton broth, which eliminates variability in cefiderocol MIC results based on iron levels. The lyophilized multi-well format of ComASP also provides for room temperature storage. In comparison to what an individual lab may do for method verification, this multi-site, multi-isolate study provides a robust evaluation and greater assurance to clinical microbiologists of the method's accurate and reproducible performance.</p>","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0092624"},"PeriodicalIF":6.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11837567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}