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Polymyxin Susceptibility Testing and Breakpoint Setting.

John Turnidge1, Katherine Sei2, Johan Mouton3

  • 1Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia. jturnidge@gmail.com.

Advances in Experimental Medicine and Biology
|August 1, 2019
PubMed
Summary
This summary is machine-generated.

The reference method for polymyxin susceptibility testing is broth microdilution without polysorbate 80. Other methods show high error rates and are not recommended for routine use.

Keywords:
Clinical breakpointsColistinNeed for stringent control of conditionsPolymyxin BSusceptibility testing methods

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Area of Science:

  • Clinical Microbiology
  • Antimicrobial Susceptibility Testing

Background:

  • Polymyxin susceptibility testing methods have undergone recent revisions.
  • A joint working group was formed by CLSI and EUCAST to establish a reference method.
  • Key issues included divalent cations, binding to lab materials, and polysorbate 80.

Purpose of the Study:

  • To establish a standardized reference method for polymyxin susceptibility testing.
  • To evaluate alternative testing methods against the reference standard.
  • To consider clinical breakpoint setting for relevant pathogens.

Main Methods:

  • Broth microdilution without polysorbate 80 was recommended as the reference method.
  • Evaluation of agar dilution, disk diffusion, and gradient diffusion methods.
  • Analysis of pharmacokinetic-pharmacodynamic (PK-PD) and PK-toxicodynamic data.

Main Results:

  • Broth microdilution without polysorbate 80 demonstrated superior accuracy.
  • Alternative methods (agar dilution, disk diffusion, gradient diffusion) exhibited high rates of very major errors.
  • Most data focused on colistin, with less available for polymyxin B.

Conclusions:

  • Broth microdilution without polysorbate 80 is the recommended reference method for polymyxin susceptibility testing.
  • Alternative methods are not advised for routine laboratory use due to significant error rates.
  • Current PK-PD targets rely on MICs derived from the reference broth dilution procedure.