Professional Documents
Culture Documents
ANTIBIOGRAMS
Trends of Change
Dr.T.V.Rao MD
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Dr.T.V.Rao MD
3/24/2016
The
2 Program file summarises on New Trends of Change
in Antibiotic sensitivity and resistance changes
Problem with Inconsistent on
phenotype
3/24/2016
The purpose of a
susceptibility test is to in
vitro determine the
sensitivity or resistance of
pathogenic aerobic and
facultative anaerobic
bacteria to various
antimicrobial
compounds.
Dr.T.V.Rao MD
3/24/2016
Dr.T.V.Rao MD
It is crucial to monitor
emerging trends in
resistance at the local level
to support clinical decision
making, infection-control
interventions, and
antimicrobial-resistance
containment strategies
Dr.T.V.Rao MD
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Quantitative Methods
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Quantitative Methods
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AST standards
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AST standards
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ISO standard
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Broth microdilution
Mueller-Hinton
Broth
Inoculum 5x105
cfu/mL
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3/24/2016
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What is a Antibiogram
Antibiograms are
collection of
information obtained
from Culture and
Sensitivity performed in
the institution within a
given time frame
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3/24/2016
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Dr.T.V.Rao MD
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Why
things go wrong in Antibiotic Sensitivity
testing
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Contamination
Mutation
Incorrect inoculum density
Uneven inoculation
Old culture used not properly maintained
Prepared by Trevor Winstanley for the BSAC recommendations
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3/24/2016
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Antibiograms
are Important to Clinicians to
make decisions
An antibiogram is an
essential tool for any
clinician when treated an
infection empirically
Antibiogram can serve
as an alternative to a C&S
report until the results of a
C&S are available
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3/24/2016
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Dr.T.V.Rao MD
Antibiogram can
serve as an
alternative to a
C&S report if no
organism is grown
out of a C&S
despite high
clinical suspicion
of an infection
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Clinical utility
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Resistance
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Elizabethkingella Dr.T.V.Rao MD
Exceptional
resistance
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Enterobacteriaceae
Meropenem / imipenem
P. aeruginosa,
Acinetobacter colistin
Bacteroides
metronidazole &
carbapenems
Dr.T.V.Rao MD
3/24/2016
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Colistin AST
Disc testing unreliable
MIC testing remains challenging
(method development)
Vancomycin AST for staphylococci
Disc testing unreliable
MIC testing remains challenging (BP
close to wild-type popln
Dr.T.V.Rao MD
3/24/2016
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B. cepacia complex
(?variable expression)
No reliable gold-standard test
No defined relationship between MIC &
clinical outcome
Wide MIC distribution across PKPD BP
No AST method
Dr.T.V.Rao MD
3/24/2016
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B. cepacia complex:
a reliable/reproducible test?
Gold standard
MIC performed to ISO
20776-1 (2006)
Micro broth dilution
Mueller-Hinton Broth
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Stenotrophomonas maltophilia
outcome
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The
rationale
for
automated
systems
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More reliable AST results
Laboratory workflow
Staff skill mix
Dr.T.V.Rao MD
Automated
systems: an overview
Epidemiological software
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Available systems
BD Phoenix
Dr.T.V.Rao MD
3/24/2016
Micro Scan
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96 well plates
AST based on
conventional micro broth
dilution MIC
ID currently biochemical
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3/24/2016
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Conventional panels
Micro scan
Rapid panels
2 - 2.5 hour ID (pre-formed enzymes)
AST for Gram negative organisms (MIC > 4 hrs)
Additional
Panels read by
WalkAway systems
autoSCAN-4
Manual
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Vitek 2
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Vitek 2
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Up to 22
antibiotics tested
on each card
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MIC
Raw Data
% Change
Slope
Area
SLPAR
0
10 11 12 13 14 15 16 17 18
TIME (hours)
Dr.T.V.Rao MD
3/24/2016
Vitek 2
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Vitek 2
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CARD Type
Time to Result
GN ID
GP ID
2 to 10 hours
2 to 8 hours
NH ID
6 hours
ANC ID
YST ID
GN AST
GP AST
AST-YS01
6 hours
18 hours
2 to 18 Hours
2 to 18 Hours
6 hours
Dr.T.V.Rao MD
3/24/2016
Phoenix
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Phoenix
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GN (Enterobacteriaceae/
Nonfermenters)
GP (Staphylococci/
Enterococci/
Streptococci)
Streptococci ID/AST
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Phoenix
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Phoenix
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Comparison of systems
Microscan
ID available
AST available
Reading
MIC
Expert system
Biochemical ID
Plans for integration with nonbiochemical ID systems
Dr.T.V.Rao MD
Epidemiological software
GPOS
GNEG NH
AnO2
Yeast
GPOS
GNEG
Vitek 2
GPOS
GNEG
NH
AnO2
Yeast
GPOS
GNEG
Yeast
Phoenix
GPOS
GNEG
GPOS
GNEG
Continuous automated
or manual
Y
Published rules
Continuous automated
Continuous automated
+/Phenotypic comparison
+/Published rules
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Performance
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ID
Correct to genus >95%
Correct to Species>90%
Difficulties with difficult organisms
Non-fermenters
Shigella etc
AST
Concordant with other methods >95%
Specific issues with specific drug-bug combinations & certain
instruments
VISA/VRSA
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Performance
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References
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Attention of Viewers
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Raos Microbiology
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Dr.T.V.Rao MD
3/24/2016