Impact of the introduction of EUCAST’s concept of “area of technical uncertainty”

On the first of January 2019, the European Committee on Antimicrobial Susceptibility Testing, EUCAST, introduced the concept of “area of technical uncertainty” (ATU). The aim was to report on the incidence of ATU test results in a selection of common bacterial species and the subsequent impact on an...

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Bibliographic Details
Published in:European journal of clinical microbiology & infectious diseases 2022-02, Vol.41 (2), p.203-207
Main Authors: Van Honacker, Eveline, Vandendriessche, S., Coorevits, L., Verhasselt, B., Boelens, J.
Format: Article
Language:English
Subjects:
Amoxicillin
Amoxicillin-Potassium Clavulanate Combination
Anti-Bacterial Agents - pharmacology
Antibiotics
Antimicrobial agents
Antimicrobial resistance
Bacteria - drug effects
Bacteria - isolation & purification
Biomedical and Life Sciences
Biomedicine
Cefuroxime
Clavulanic acid
Concentration gradient
Disk Diffusion Antimicrobial Tests - methods
Drug resistance
Drug Resistance, Bacterial - drug effects
Escherichia
Haemophilus influenzae
Haemophilus influenzae - drug effects
Humans
Internal Medicine
Klebsiella
Medical Microbiology
Microbial Sensitivity Tests - methods
Original Article
Piperacillin
Piperacillin, Tazobactam Drug Combination
Piperacillin-tazobactam
Pseudomonas aeruginosa
Pseudomonas aeruginosa - drug effects
Retrospective Studies
Tazobactam
Uncertainty
Workload
Workloads
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Summary:On the first of January 2019, the European Committee on Antimicrobial Susceptibility Testing, EUCAST, introduced the concept of “area of technical uncertainty” (ATU). The aim was to report on the incidence of ATU test results in a selection of common bacterial species and the subsequent impact on antimicrobial resistance categorization and workload. A retrospective analysis of clinical samples collected from February 2019 until November 2019 was performed. Susceptibility to amoxicillin-clavulanic acid and piperacillin-tazobactam in Enterobacterales ( Escherichia spp., Klebsiella spp., Proteus spp.), piperacillin-tazobactam in Pseudomonas aeruginosa , and amoxicillin-clavulanic acid and cefuroxime in Haemophilus influenzae was studied. Disk diffusion antibiotic susceptibility testing was read and interpreted by ADAGIO 93400 automated system (Bio-Rad, France). In case of an inhibition zone in the ATU, strains were retested using gradient minimal inhibitory concentration method (Etest, BioMérieux, France). Overall, 14,164 isolate-antibiotic combinations were tested in 7922 isolates, resulting in 1204 (8.5%) disk zone diameters in the ATU region. Retesting of ATUs with Etest resulted in a category change from S to R for amoxicillin-clavulanic acid in 63/498 (12.7%) of Escherichia spp., 2/58 (3.4%) of Klebsiella spp., 2/37 (5.4%) of Proteus spp., and 6/125 (4.8%) of Haemophilus influenzae . For piperacillin-tazobactam, a category change from S to R was found in 33/92 (35.9%) of Pseudomonas aeruginosa . We conclude that ATU testing has a substantial impact on the correct interpretation of antimicrobial resistance, at the expense of turn-around time and with the cost of additional workload.
ISSN:0934-9723
1435-4373
DOI:10.1007/s10096-021-04364-6