RT Journal Article
T1 MIC of amoxicillin/clavulanate according to CLSI and EUCAST: discrepancies and clinical impact in patients with bloodstream infections due to Enterobacteriaceae.
A1 Delgado-Valverde, Mercedes
A1 Valiente-Mendez, Adoracion
A1 Torres, Eva
A1 Almirante, Benito
A1 Gomez-Zorrilla, Silvia
A1 Borrell, Nuria
A1 Aller-Garcia, Ana Isabel
A1 Gurgui, Mercedes
A1 Almela, Manel
A1 Sanz, Mercedes
A1 Bou, German
A1 Martinez-Martinez, Luis
A1 Canton, Rafael
A1 Antonio Lepe, Jose
A1 Causse, Manuel
A1 Gutierrez-Gutierrez, Belen
A1 Pascual, Alvaro
A1 Rodriguez-Baño, Jesus
K1 Área de Gestión Sanitaria Sur de Sevilla
K1 Amoxicillin-potassium clavulanate combination
K1 Anti-bacterial agents
K1 Bacteremia
K1 Enterobacteriaceae
AB To compare results of amoxicillin/clavulanate susceptibility testing using CLSI and EUCAST methodologies and to evaluate their impact on outcome in patients with bacteraemia caused by Enterobacteriaceae. A prospective observational cohort study was conducted in 13 Spanish hospitals. Patients with bacteraemia due to Enterobacteriaceae who received empirical intravenous amoxicillin/clavulanate treatment for at least 48 h were included. MICs were determined following CLSI and EUCAST recommendations. Outcome variables were: failure at the end of treatment with amoxicillin/clavulanate (FEAMC); failure at day 21; and 30 day mortality. Classification and regression tree (CART) analysis and logistic regression were performed. Overall, 264 episodes were included; the urinary tract was the most common source (64.7%) and Escherichia coli the most frequent pathogen (76.5%). Fifty-two isolates (19.7%) showed resistance according to CLSI and 141 (53.4%) according to EUCAST. The kappa index for the concordance between the results of both committees was only 0.24. EUCAST-derived, but not CLSI-derived, MICs were associated with failure when considered as continuous variables. CART analysis suggested a 'resistance' breakpoint of > 8/4 mg/L for CLSI-derived MICs; it predicted FEAMC in adjusted analysis (OR = 1.96; 95% CI: 0.98-3.90). Isolates with EUCAST-derived MICs >16/2 mg/L independently predicted FEAMC (OR = 2.10; 95% CI: 1.05-4.21) and failure at day 21 (OR= 3.01; 95% CI: 0.93-9.67). MICs >32/2 mg/L were only predictive of failure among patients with bacteraemia from urinary or biliary tract sources. CLSI and EUCAST methodologies showed low agreement for determining the MIC of amoxicillin/clavulanate. EUCAST-derived MICs seemed more predictive of failure than CLSI-derived ones. EUCAST-derived MICs >16/2 mg/L were independently associated with therapeutic failure.
PB Oxford University Press
YR 2016
FD 2016-12-02
LK http://hdl.handle.net/10668/10780
UL http://hdl.handle.net/10668/10780
LA en
NO Delgado-Valverde M, Valiente-Mendez A, Torres E, Almirante B, Gómez-Zorrilla S, Borrell N, et al. MIC of amoxicillin/clavulanate according to CLSI and EUCAST: discrepancies and clinical impact in patients with bloodstream infections due to Enterobacteriaceae. J Antimicrob Chemother. 2017 May 1;72(5):1478-1487
DS RISalud
RD Apr 7, 2025