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Don't Get Wound Up: Revised Fluoroquinolone Breakpoints for Enterobacteriaceae and Pseudomonas aeruginosa
Tam T Van1,2, Emi Minejima3, Chiao An Chiu3
1Department of Pathology, Harbor-UCLA Medical Center, Los Angeles, California, USA.
Abstract:
Fluoroquinolones remain some of the more commonly prescribed antimicrobial agents in the United States, despite the wide array of reported side effects that are associated with their use. In 2019, the Clinical and Laboratory Standards Institute revised the fluoroquinolone antimicrobial susceptibility testing breakpoints for both Enterobacteriaceae and Pseudomonas aeruginosa This breakpoint revision was deemed necessary on the basis of pharmacokinetic and pharmacodynamic analyses suggesting that the previous breakpoints were too high, in addition to the inability of the previous breakpoints to detect low-level resistance to this antibiotic class. In this minireview, we review the published data in support of this revision, as well as the potential challenges that these breakpoint revisions are likely to pose for clinical laboratories.
Insights
The Clinical and Laboratory Standards Institute revised fluoroquinolone breakpoints in 2019. This update aims to better detect resistance in Enterobacteriaceae and Pseudomonas aeruginosa, impacting clinical laboratories.
Area of Science:
- Microbiology
- Infectious Diseases
- Clinical Laboratory Science
Background:
- Fluoroquinolones are frequently prescribed antimicrobials in the US.
- Their use is associated with numerous adverse side effects.
- Previous breakpoints may have overestimated susceptibility and failed to detect emerging resistance.
Purpose of the Study:
- To review data supporting the 2019 Clinical and Laboratory Standards Institute (CLSI) fluoroquinolone breakpoint revisions.
- To discuss the implications of these revised breakpoints for clinical laboratories.
Main Methods:
- Review of published pharmacokinetic and pharmacodynamic data.
- Analysis of Clinical and Laboratory Standards Institute (CLSI) guidelines.
- Evaluation of resistance detection capabilities.
Main Results:
- Pharmacokinetic/pharmacodynamic analyses indicated previous breakpoints were too high.
- Revised breakpoints are expected to improve detection of low-level fluoroquinolone resistance.
- Enterobacteriaceae and Pseudomonas aeruginosa susceptibility testing is affected.
Conclusions:
- The 2019 CLSI fluoroquinolone breakpoint revisions are evidence-based.
- These changes necessitate adaptation in clinical laboratory practices.
- Accurate antimicrobial susceptibility testing is crucial for effective treatment.