Antimicrobial Susceptibilities of Commonly Encountered ...



Agreement Assessment of Tigecycline Susceptibilities Determined by the Disk Diffusion and Broth Microdilution Methods among Commonly Encountered Resistant Bacterial Isolates: Results from the Tigecycline In-vitro Surveillance in Taiwan [TIST] Study, 2008-2010

Jien-Wei Liu 1, Wen-Chien Ko2, Cheng-Hua Huang3, Chun-Hsing Liao4, Chin-Te Lu5, Yin-Ching Chuang6, Shih-Ming Tsao7, Yao-Shen Chen8, Yung-Ching Liu8,9, Wei-Yu Chen10, Tsrang-Neng Jang10, Hsiu-Chen Lin11, Chih-Ming Chen12, Zhi-Yuan Shi13, Sung-Ching Pan14, Chia-Ling Yang, 14 Hsiang-Chi Kung14, Chun-Eng Liu,15 Yu-Jen Cheng15, Yen-Hsu Chen 16, Po-Liang Lu16, Wu Sun17, Lih-Shinn Wang18, Kwok-Woon Yu19, Ping-Cherng Chiang20, Ming-Hsun Lee20, Chun-Ming Lee21,

Gwo-Jong Hsu22 and Po-Ren Hsueh23*

Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University Medical College, Kaohsiung, Taiwan1; Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan2;Division of Infectious Diseases, Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan3; Section of Infectious Diseases, Department of Internal Medicine, Far Eastern Memorial Hospital, Taiwan4;Section of Infectious Diseases, Department of Internal Medicine, Lotung Poh-Ai Hospital, Lotung, Taiwan5;Department of Internal Medicine, Chi-Mei Hospital, Tainan, Taiwan6; Section of Infectious Diseases, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan7; Section of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan8; Section of Infectious Diseases, Shuang Ho Hospital, Taipei Medical University and School of Medicine, Taipei Medical University, Taipei, Taiwan9; Section of Infectious Diseases, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan10; Department of Laboratory Medicine, Taipei Medical University Hospital, Taipei, Taiwan11; Section of Infectious Diseases, Department of Internal Medicine, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan12; Section of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan13; Section of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Taiwan14; Section of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan15; Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan16; Department of Infection Control, Pao-Chien Hospital, Taitung, Taiwan17;

Section of Infectious Diseases, Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualein, Taiwan 18; Division of Infectious Diseases, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan19;

Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Medical Foundation Linkou Branch, Linkou, Taiwan20; Section of Infectious Diseases, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan21; Section of Infectious Diseases, Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan22; Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan23

*Corresponding author. Mailing address for Po-Ren Hsueh: Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Rd., Taipei 100, Taiwan. Phone: 886-2-23123456, ext. 65355. Fax: 886-2-23224263. E-mail: hsporen@ntu.edu.tw.

ABSTRACT

The Tigecycline In-vitro Surveillance in Taiwan (TIST) study, initiated in 2006, is a nationwide surveillance program designed to longitudinally monitor the in-vitro activity of tigecycline against commonly encountered drug-resistant bacteria. This study compared the in-vitro activity of tigecycline against 3,014 isolates of clinically important drug-resistant bacteria using the standard broth microdilution and disk diffusion methods. Species studied included methicillin-resistant Staphylococcus aureus (MRSA, n=759), vancomycin-resistant Enterococcus faecium (VRE, n=191), extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (n=602), ESBL-producing Klebsiella pneumoniae (n=736), and Acinetobacter baumannii (n=726) that had been collected from patients treated between 2008 and 2010 at 20 hospitals in Taiwan. Minimum inhibitory concentrations (MICs) and inhibition zone diameters were interpreted according to the currently recommended US Food and Drug Administration (US FDA) criteria and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria. The MIC90 values of tigecycline against MRSA, VRE, ESBL-producing E. coli, ESBL-producing K. pneumoniae, and A. baumannii were 0.5, 0.125, 0.5, 2, and 8 (g/ml, respectively. The total error rates between the two methods using the US FDA criteria were high: 38.4% for ESBL-producing K. pneumoniae and 33.8% for A. baumannii. Using the EUCAST criteria, the total error rate was also high (54.6%) for A. baumannii isolates. The total error rates between these two methods were 2 |(16/(24 |13-15/20-23 |(12/(19 |

The interpretations MIC in the broth microdilution testing and the diameter of the inhibitory zone in the disk diffusion testing were based on the criteria proposed by the U.S. Food and Drug Administration (US FDA)/European Committee on Antimicrobial Susceptibility Testing-2011 (EUCAST-2011) (6, 16, 17, 23).

MRSA, methicillin-resistant Staphylococcus aureus; VRE, vancomycin-resistant enterococci

“-” indicates that the interpretive criteria were not established.

TABLE 2. Susceptibilities to tigecycline as determined by the broth microdilution and disk diffusion methods

| | |Susceptibility results |

| | |(broth microdilution method/disk diffusion method) |

| | |Categorized by US FDA interpretive criteria |Categorized by EUCAST interpretive criteria |

|Bacteria (no. of isolates) |MIC ((g/ml) | | |

| |Range |50% |90% |S (%) |

| |VME |MaE |MiE |Total errors |VME |MaE |MiE |Total errors |

|MRSA (759) |- |- |- |- |0 |2.5 |0 |2.5 |

|VRE (191) |- |- |- |- |0.5 |2.6 |1.1 |4.2 |

|ESBL-producing E. coli (602) |0 |0.2 |1.7 |1.9 |0.2 |0.2 |1.3 |1.7 |

|ESBL-producing |0 |1.9 |26.5 |38.4 |- |- |- |- |

|K. pneumoniae (736) | | | | | | | | |

|A. baumannii (726) |2.5 |0.6 |30.7 |33.8 |0.3 |11.2 |43.1 |54.6 |

MRSA, methicillin-resistant Staphylococcus aureus; VRE, vancomycin-resistant Enterococus faecium; VME, very major error; MaE, major error; MiE, minor error; US FDA, US Food and Drug Administration; EUCAST, European Committee on Antimicrobial Susceptibility Testing.

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