Automated AST Options for Switching to EUCAST Guidelines
Explore the process of switching to EUCAST guidelines for automated AST, focusing on the Vitek system. Learn about the background, challenges, and solutions for implementing the new 104-well cards and interfacing changes. Discover the recommended options for maintaining accuracy and compliance with EUCAST standards.
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Presentation Transcript
EUCAST and automated AST Andrew Whitelaw
Scope and purpose Focus on Vitek Explore options for EUCAST switch
Background Physically switching is easy setting changes on instrument Current cards have 64 wells New 104 well cards coming Gram neg - late 2016/ early 2017 Gram pos late 2017 New cards will also require changes to LIS interfacing
Gram negative card Enterobacteriaceae S <= 8,0 8 (32) 8,0 1,0 1,0 Pseudomonas Drug MIC range 2 - 64 2/1 - 32/16 2 - 32 1 - 64 1 - 64 4 - 64 1 - 64 1 - 64 0.25 - 4 0.5 - 16 0.5 - 8 1 - 16 0.25 - 16 0.25 - 16 16 - 512 4/4 - 128/4 0.5 - 8 20 (1/19) - 320 (16/304) 1 - 16 R > 16 8 (32) 8 4 2 Amikacin Amoxicillin/Clav.acid (CLSI) Ampicillin Cefepime Cefotaxime Cefoxitin Ceftazidime Cefuroxime Ciprofloxacin Colistin Ertapenem Gentamicin Imipenem Meropenem Nitrofurantoin Piperacillin/Tazobactam Tigecycline 8 16 8 8 1,0 8,0 4 8 1 2 1 4 8 8 8 8 0,5 (0.06 Sal) 2,0 0,5 2,0 2,0 2,0 64 8 1 0.5 1 4 4 4 4 8 8 4 2 64 16 2 16 16 Trimethoprim/Sulfa 2 4 Tobramycin 2 4 4 4
Gram negative card Acinetobacter S <= 8 Drug MIC range 2 - 64 2/1 - 32/16 2 - 32 1 - 64 1 - 64 4 - 64 1 - 64 1 - 64 0.25 - 4 0.5 - 16 0.5 - 8 1 - 16 0.25 - 16 0.25 - 16 16 - 512 4/4 - 128/4 0.5 - 8 R > 16 Amikacin Amoxicillin/Clav.acid (CLSI) Ampicillin Cefepime Cefotaxime Cefoxitin Ceftazidime Cefuroxime Ciprofloxacin Colistin Ertapenem Gentamicin Imipenem Meropenem Nitrofurantoin Piperacillin/Tazobactam Tigecycline Trimethoprim/Sulfa Tobramycin NC NC 1 2 1 2 4 2 2 4 8 8 IE IE 2 4 IE 4 4 20 (1/19) - 320 (16/304) 1 - 16
Some reporting issues Co-amoxiclav for uncomplicated UTI May need a comment; hard to differentiate complicated from uncomplicated based on request form Cipro and Salmonella (current problem as well) Can t report piptazo, cefepime, ceftazidime for Acinetobacter
Options Keep current card, but co-amoxiclav formulation incorrect (?report on CLSI criteria) Keep current card, and test co-amox manually Design new cards (pvt and NHLS) with EUCAST co-amox instead of CLSI (same # wells) Approx 8-12 weeks Also plan for a nationally standardised card when 104 well card comes out ?cost implications Use an existing EUCAST compliant card
Amikacin Amoxicillin/Clav.acid (EUCAST) Ampicillin Cefalexin Cefazolin Cefepime Cefixime Cefotaxime Cefoxitin Ceftazidime Ceftriaxone Cefuroxime Ciprofloxacin Colistin Ertapenem ESBL Confirm Fosfomycin Gentamicin Imipenem Meropenem Nitrofurantoin Norfloxacin Piperacillin/Tazobactam Tigecycline Tobramycin Trimethoprim Trimethoprim/Sulfa x x x x x x x x x x x x x x x x 0.12-32 x x x 0.25 - 64 x x x x x x x x x x x x x x x x x x x 0.12-64 0.25-64 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x
Whats missing Turkey, N325: Imipenem and tobramycin Turkey, N327: Tigecycline, cefepime, colistin and tobramycin Poland, N330: Imipenem, tigecycline, colistin, tobramycin Poland, N332: Ampicillin, ertapenem Netherlands, N344: Amikacin, ertapenem, tigecycline, cefepime
Proposal Enterics Turkey, N325: Imipenem and tobramycin Turkey, N327: Tigecycline, cefepime, colistin and tobramycin Poland, N330: Imipenem, tigecycline, colistin, tobramycin Poland, N332: Ampicillin, ertapenem Netherlands, N344: Amikacin, ertapenem, tigecycline, cefepime Non-fermenters
Staph. - 0.03 - 0.5 +/- 1-64 0.5 - 8 0.25 - 8 0.125-4 0.12 - 8 0.25 - 8 0.25 - 8 0.5 - 32 0.5 - 16 Ent. 2 - 32 0.12 - 64 GBS 0.25 - 16 0.12 - 64 Staph Ent 4 to 8 NC GBS Drug Ampicillin Benzylpenicillin Cefoxitin Screen Cefuroxime Ciprofloxacin Clindamycin Clindamycin Daptomycin Erythromycin (for CLSI only) Erythromycin (for EUCAST only) Fusidic acid Gentamicin Gentamicin HL (CLSI) Inducible Clindamycin Resistance Linezolid Moxifloxacin Mupirocin Mupirocin Nitrofurantoin Oxacillin Rifampicin Streptomycin HL (CLSI) Teicoplanin Telithromycin Tetracycline Tigeycline Trimethoprim/Sulfa Vancomycin 0.125 0.25 1-64 0.5 - 8 0.25 - 8 0.125-4 0.12 - 8 0.25 - 8 0.25 - 8 1-64 0.5 - 8 0.25 - 8 NC 1 NC 4 (u) NC NC IE 0.25 to 0.5 0.25 to 0.5 1 0.5 0.5 1 0.12 - 8 0.25 - 8 0.25 - 8 1 to 2 1 1 NC NC 0.25 to 0.5 IE +/- 128 +/- 0.5 - 8 0.25 - 8 2 - 8 1 - 512 16 - 512 0.25 - 4 0.5 - 32 0.5 - 8 0.25 - 8 0.5 - 8 0.25 - 8 4 4 2 to 4 0.5 to 1 0.5 - 1 1 to 256 1 to 256 64 0.25 or 2 0.06 to 0.5 NC 16 - 512 16 - 512 64 NC NC 512 2 NC NC 64 0.06 to 0.5 +/- 0.5 - 32 0.25 - 4 1 - 16 0.12 - 2 1 - 16 0.5 - 32 0.5 - 32 - 1 - 16 0.12 - 2 1 - 16 0.5 - 32 0.5 - 32 - 1 - 16 0.12 - 2 1 - 16 0.5 - 32 2 or 4 IE 1 to 2 0.5 2 to 4 2 or 4 2 0.25 to 0.5 1 to 2 0.25 to 0.5 2 2 0.25 to 0.5 0.03 to 1 4
Key issues Erythromycin in current card is not EUCAST compliant HLAR is not EUCAST compliant (?if any Vitek HLAR is EUCAST compliant) Mupirocin MIC range in NHLS card is inappropriate Needs 1 extra well Rifampicin MIC range inappropriate Need extra well Trimeth/sulfa range inappropriate for enterococci No telithromycin criteria for Staphs
Options Keep current card, Stop reporting erythromycin, or test manually Manual HL gent Stop reporting rif for staphs Design new 64 well cards, pending the 104 well card Doesn t solve HLAR Change to alternative erythromycin compliant cards
Ampicillin Benzylpenicillin Benzylpenicillin Benzylpenicillin Cefoxitin Screen Cefuroxime Ciprofloxacin Clindamycin Clindamycin Daptomycin Erythromycin (EUCAST) Fusidic acid Gentamicin Gentamicin HL (CLSI) Gentamicin HL Inducible Clindamycin Resistance Linezolid Moxifloxacin Mupirocin 2-8 Mupirocin 2-512 Mupirocin 1-512 Nitrofurantoin Oxacillin Rifampicin 0.5 - 32 Rifampicin 0.03 - 4 Streptomycin HL (CLSI) Teicoplanin 0.5 - 32 Teicoplanin 0.25 - 4 Telithromycin Tetracycline Tigeycline Trimethoprim/Sulfa Trimethoprim/Sulfa Vancomycin X X x x x x x x X X X X x x x X x x x x x x X X X x x x x X x x X x x x x x x x x x x x x x x x x x x x x x X X X X X X X x x x x x x X X X x x x X X X X x x x X X X X x x x x x x x x x x x x x X x x x x x x x x X X x x x x X X X X x x x x X x x x x x x X X X X x x x x x x x x x X X X X x X X x x x x x x x x X x X X X X x x x x X x x x x x
Ent. 2 - 32 0.12 - 64 S.agalactiae 0.25 - 16 0.12 - 64 Drug Ampicillin Benzylpenicillin Benzylpenicillin Benzylpenicillin Cefuroxime Ciprofloxacin Clindamycin Clindamycin Daptomycin Erythromycin EUCAST Fusidic acid Gentamicin Gentamicin HL (CLSI) Gentamicin HL Resistance Linezolid Moxifloxacin Nitrofurantoin Streptomycin HL (CLSI) Teicoplanin Teicoplanin Telithromycin Tetracycline Tigeycline Trimethoprim/Sulfa Vancomycin X X X X x 0.12 - 64 1-64 0.5 - 8 0.25 - 8 0.125-4 0.12 - 8 0.25 - 8 0.12 - 64 1-64 0.5 - 8 0.25 - 8 X X x x X X x X X x x x x x x x 0.12 - 8 0.25 - 8 X X X X X x x x +/- X X +/- +/- 0.5 - 8 0.25 - 8 16 - 512 +/- 0.5 - 32 0.5 - 32 - 1 - 16 0.12 - 2 10 - 320 0.5 - 32 0.5 - 8 0.25 - 8 16 - 512 X X x x x X X X X X X x X X X X X 0.5 - 32 0.5 - 32 - 1 - 16 0.12 - 2 10 - 320 0.5 - 32 x x x x X X X X X X X x x x x x x X X X
Proposal Switch to P636 for staphs No moxiflox Keep current Gram pos card for enterococci/streps (ie don t report erythromycin) OR Design a new card/s
