Challenges to accurate susceptibility testing and interpretation of quinolone resistance in Enterobacteriaceae: results of a Spanish multicentre study

The objective of this study was to evaluate the proficiency of Spanish laboratories with respect to accurate susceptibility testing and the detection and interpretation of quinolone resistance phenotypes in Enterobacteriaceae. Thirteen strains of Enterobacteriaceae were sent to 62 participating cent...

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Bibliographic Details
Published in:Journal of antimicrobial chemotherapy 2015-07, Vol.70 (7), p.2038-2047
Main Authors: Rodriguez-Martinez, José-Manuel, Machuca, Jesús, Calvo, Jorge, Diaz-de-Alba, Paula, Rodríguez-Mirones, Cristina, Gimeno, Concha, Martinez-Martinez, Luis, Pascual, Álvaro
Format: Article
Language:English
Subjects:
Bacteria
Diagnostic Errors
Enterobacteriaceae
Enterobacteriaceae - drug effects
Genes
Genotype & phenotype
Humans
Laboratory Proficiency Testing
Microbial Sensitivity Tests - methods
Microbial Sensitivity Tests - standards
Mutation
Permeability
Plasmids
Quinolones - pharmacology
Reproducibility of Results
Spain
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Summary:The objective of this study was to evaluate the proficiency of Spanish laboratories with respect to accurate susceptibility testing and the detection and interpretation of quinolone resistance phenotypes in Enterobacteriaceae. Thirteen strains of Enterobacteriaceae were sent to 62 participating centres throughout Spain; strains harboured GyrA/ParC modifications, reduced permeability and/or plasmid-mediated quinolone resistance genes. The centres were requested to evaluate nalidixic acid and five quinolones, provide raw/interpreted clinical categories and to detect/infer resistance mechanisms. Consensus results from reference centres were used to assign minor, major and very major errors (mEs, MEs and VMEs, respectively). Susceptibility testing in the participating centres was frequently performed using the MicroScan WalkAway, Vitek 2 and Wider systems (48%, 30% and 8%, respectively). CLSI/EUCAST breakpoints were used in 71%/29% of the determinations. The percentage of VMEs for all quinolones was well below 2%. Only ofloxacin and moxifloxacin showed higher values for raw VMEs (6.6%), which decreased to 0% and 2.9%, respectively, in the interpreted VMEs. These errors were particularly associated with the CC-03 strain [qnrS2 + aac(6')-Ib-cr]. For MEs, percentages were always
ISSN:0305-7453
1460-2091
DOI:10.1093/jac/dkv059