Changing MIC Breakpoints: Do Mechanisms Count
Changing MIC Breakpoints: Do Mechanisms Count Changing MIC Breakpoints: Do Mechanisms Count
New CLSI Guidelines 2010 • Problem with this approach Clinical studies show patients with “susceptible” MICs + ESBL fail therapy Inoculum used in bmd (10 5 ) too low and may dilute out resistant subpopulations giving false susceptible results Different susceptibility testing methods give varying results 20
CAP Survey D-C 2007 D-19 C. freundii with PER-1 ESBL with MIC 16 g/ml Method/system tested (no.) Reported Cefepime MIC or zone in Susceptible category BD Phoenix (24) Not reported >16 MicroScan (311) 15% >16 Vitek (244) 97.2% 4 Vitek 2 (230) 85.5% 2 Final Critique Survey 2007 D-C College of American Pathologists Modal MIC Disk Diffusion (74) 34% 15.5 mm 21
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- Page 5 and 6: CLSI Guidelines Staph spp. Table 2
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- Page 15 and 16: Efficacy of different beta-lactams
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New CLSI Guidelines 2010<br />
• Problem with this approach<br />
Clinical studies show patients with “susceptible”<br />
<strong>MIC</strong>s + ESBL fail therapy<br />
Inoculum used in bmd (10 5 ) too low and may dilute<br />
out resistant subpopulations giving false susceptible<br />
results<br />
Different susceptibility testing methods give<br />
varying results<br />
20
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