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Related Experiment Video

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Variability of Daptomycin MIC Values for Enterococcus faecium When Measured by Reference Broth Microdilution and

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Antimicrobial Agents and Chemotherapy
|June 27, 2018
PubMed
Summary

Current daptomycin susceptibility testing for vancomycin-resistant Enterococcus faecium is imprecise. This variability impacts treatment decisions for serious infections, highlighting the need for improved diagnostic methods.

Keywords:
CLSIEnterococcus faeciumEtestMIC testbroth microdilutiondaptomycin

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Area of Science:

  • Microbiology
  • Infectious Diseases
  • Clinical Diagnostics

Background:

  • Daptomycin is crucial for treating vancomycin-resistant Enterococcus faecium infections.
  • Concerns exist regarding the accuracy of current daptomycin susceptibility testing methods.
  • Accurate susceptibility testing is vital for predicting treatment outcomes.

Purpose of the Study:

  • To evaluate the precision of daptomycin Minimum Inhibitory Concentration (MIC) determination for Enterococcus faecium using broth microdilution and gradient strip methods.
  • To assess the correlation between daptomycin MIC testing and mutations in the liaFSR system, a key resistance mechanism.
  • To identify the error rates of different testing methods in predicting daptomycin resistance.

Main Methods:

  • Evaluated 40 Enterococcus faecium isolates across three centers.
  • Utilized reference broth microdilution (BMD) and two gradient strip methods (Etest, MIC test strip) for daptomycin MIC determination.
  • Genotyped isolates for mutations in the liaFSR system.

Main Results:

  • Significant variability in daptomycin MICs was observed across isolates and methods.
  • Fifteen isolates showed discordant susceptibility interpretations between tests.
  • High very major error rates were found when comparing phenotypic testing to genotypic determination of liaFSR mutations (BMD: 59.8%, Etest: 63.5%, MIC test strip: 68.5%).

Conclusions:

  • Daptomycin MIC determination for Enterococcus faecium exhibits significant imprecision.
  • Current testing methods do not reliably predict daptomycin resistance mediated by liaFSR mutations.
  • This variability poses challenges for establishing revised breakpoints and impacts clinical decision-making for serious infections.