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Bad bug, no test: Tigecycline susceptibility testing challenges and way forward
Chaitra Shankar1, Agila Kumari Pragasam1, Balaji Veeraraghavan1
1Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India.
Indian Journal of Medical Microbiology
|August 20, 2019
Summary
Tigecycline susceptibility testing for resistant bacteria like Klebsiella pneumoniae and Acinetobacter baumannii is challenging. Standardized methods and interpretive criteria are needed for appropriate clinical use of this important reserve antibiotic.
Area of Science:
- Microbiology
- Infectious Diseases
- Pharmacology
Background:
- Tigecycline is a critical reserve antibiotic for treating multidrug-resistant (MDR) bacteria, particularly Klebsiella pneumoniae and Acinetobacter baumannii.
- Current tigecycline susceptibility testing methods yield inconsistent results, complicating clinical decision-making.
- There is a significant need for standardized methodologies and interpretive criteria for tigecycline susceptibility testing.
Discussion:
- Inconsistent results from automated antimicrobial susceptibility testing platforms pose a challenge for tigecycline.
- Established European Committee on Antimicrobial Susceptibility Testing (EUCAST) and Food and Drug Administration (FDA) breakpoints vary and are often organism-specific.
- Non-species-related pharmacokinetic/pharmacodynamic (PK/PD) breakpoints, such as those defined by EUCAST, offer a potential solution for K. pneumoniae and A. baumannii.
Key Insights:
- Accurate tigecycline susceptibility testing is crucial for managing infections caused by MDR pathogens.
- Broth microdilution is recommended as an appropriate method for tigecycline susceptibility testing.
- EUCAST PK/PD breakpoints may provide a more consistent approach for tigecycline susceptibility testing in K. pneumoniae and A. baumannii.
Outlook:
- Development of standardized tigecycline susceptibility testing protocols is essential.
- Harmonization of interpretive criteria across different regulatory bodies is needed.
- Further validation of non-species-related PK/PD breakpoints for tigecycline is warranted.
Keywords:
Acinetobacter baumanniiEuropean Committee on Antimicrobial Susceptibility TestingKlebsiella pneumoniaeinterpretationtigecyclineMore Related Videos
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