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Coagulase-negative staphylococci in outpatient routines: the implications of switching from CLSI to BrCAST/EUCAST guidelines

  • Clinical Microbiology - Research Paper
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Abstract

Coagulase-negative staphylococci (CoNS) are frequently isolated in clinical specimens and are important reservoirs of resistance genes. In 2019, the Brazilian government set the BrCAST/EUCAST (Brazilian Committee on Antimicrobial Susceptibility Testing) guidelines as the national standard, resulting in changes in the interpretation of CoNS susceptibility tests. From outpatients, disk-diffusion susceptibility of 65 CoNS cultures were evaluated and compared using classification criteria from both CLSI and BrCAST/EUCAST. The isolates were identified using matrix assisted laser desorption ionization–time of flight (MALDI-TOF), and the presence of the mecA gene was determined. The most prevalent species were Staphylococcus saprophyticus (32.3%), S. haemolyticus (18.5%), and S. epidermidis (9.2%). Almost perfect agreement was seen between the guidelines, except concerning oxacillin and gentamicin, and the prevalence of multidrug resistant isolates increased with the use of BrCAST/EUCAST. Of all, 15 (23.1%) isolates, mainly S. epidermidis and S. haemolyticus, were positive for the mecA gene, and only three were detected when using CLSI or BrCAST/EUCAST disk-diffusion screening. This, using either guideline, could reveal the difficulty of determining oxacillin resistance. Using warning zones or molecular methods might well be indicated for CoNS. In conclusion, adoption of the BrCAST/EUCAST guidelines will result in certain artificial changes in epidemiological susceptibility profiles, and clinicians and institutions should be aware of the possible implications.

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References

  1. May L, Klein EY, Rothman RE, Laxminarayan R (2014) Trends in antibiotic resistance in coagulase-negative staphylococci in the United States, 1999 to 2012. Antimicrob Agents Chemother 58:1404–1409. https://doi.org/10.1128/AAC.01908-13

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Becker K, Heilmann C, Peters G (2014) Coagulase-negative staphylococci. Clin Microbiol Rev 27:870–926. https://doi.org/10.1128/CMR.00109-13

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Pedroso SHSP, Sandes SHC, Filho RAT, Nunes AC, Serufo JC, Farias LM, Carvalho MAR, Bomfim MRQ, Santos SG (2018) Coagulase-negative staphylococci isolated from human bloodstream infections showed multidrug resistance profile. Microb Drug Resist 24:635–647. https://doi.org/10.1089/mdr.2017.0309

    Article  CAS  PubMed  Google Scholar 

  4. Clinical and Laboratory Standards Institute (CLSI) (2019) Performance standards for antimicrobial susceptibility testing. 29th informational supplement, MS100-S29. CLSI, Pennsylvania, USA

  5. Clinical and Laboratory Standards Institute (CLSI/NCCLS) (2005) Performance standards for antimicrobial susceptibility testing. 15th informational supplement, M100-S15 [Normas de Desempenho para Testes de Sensibilidade Antimicrobiana: 15o Suplemento Informativo, M100-S15]. http://bvsms.saude.gov.br/bvs/publicacoes/metodo_ref_testes_diluicao_modulo4.pdf. Accessed 15 January 2019

  6. Brazil, Ministry of Health, Health Surveillance Secretary (2018) Ordinance no 64 of December 11, 2018 [Portaria no 64, de 11 de dezembro de 2018]. http://pesquisa.in.gov.br/imprensa/jsp/visualiza/index.jsp?data=14/12/2018&jornal=515&pagina=59. Accessed 15 January 2019

  7. Brazilian Committee on Antimicrobial Susceptibility Testing (BrCAST) (2013) Term of cooperation and creation of the committee [Termo de ooperação de criação do comitê]. http://brcast.org.br/documentos/. Accessed 25 February 2019

  8. European Committee on Antimicrobial Susceptibility Testing (EUCAST) (2017) Organization of General Committee.. http://www.eucast.org/organization/general_committee. Accessed 25 February 2019

  9. Meneghetti KL, do Canto Canabarro M, Otton LM, dos Santos Hain T, Geimba MP, Corção G (2018) Bacterial contamination of human skin allografts and antimicrobial resistance: a skin bank problem. BMC Microbiol 18:121. https://doi.org/10.1186/s12866-018-1261-1

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. European Committee on Antimicrobial Susceptibility Testing (EUCAST) (2019) Antimicrobial susceptibility testing: EUCAST disk diffusion method. version 7.0. http://www.eucast.org/ast_of_bacteria/disk_diffusion_methodology/. Accessed 25 February 2019

  11. Clinical and Laboratory Standards Institute (CLSI) (2018) Performance standards for antimicrobial susceptibility testing. 28th informational supplement, MS100-S28. CLSI, Pennsylvania, USA

  12. Brazilian Committee on Antimicrobial Susceptibility Testing (BrCAST) (2019) Breakpoint tables for interpretation of MICs and zone diameters [Tabelas de pontos de corte para interpretação de CIMs e diâmetros de halos]. Version 9.0. http://brcast.org.br/documentos/. Accessed 25 February 2019

  13. Lawung R, Chuong LV, Cherdtrakulkiat R, Srisarin A, Prachayasittikul V (2014) Revelation of staphylococcal cassette chromosome mec types in methicillin-resistant Staphylococcus aureus isolates from Thailand and Vietnam. J Microbiol Methods 107:8–12. https://doi.org/10.1016/j.mimet.2014.08.024

    Article  CAS  PubMed  Google Scholar 

  14. Argemi X, Riegel P, Lavigne T, Lefebvre N, Grandpré N, Hansmann Y, Jaulhac B, Prévost G, Schramm F (2015) Implementation of matrix-assisted laser desorption ionization-time of flight mass spectrometry in routine clinical laboratories improves identification of coagulase-negative staphylococci and reveals the pathogenic role of Staphylococcus lugdunensis. J Clin Microbiol 53:2030–2036. https://doi.org/10.1128/JCM.00177-15

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Hitzenbichler F, Simon M, Salzberger B, Hanses F (2017) Clinical significance of coagulase-negative staphylococci other than S. epidermidis blood stream isolates at a tertiary care hospital. Infection 45:179–186. https://doi.org/10.1007/s15010-016-0945-4

    Article  CAS  PubMed  Google Scholar 

  16. Widerström M, Wiström J, Sjöstedt A, Monsen T (2012) Coagulase-negative staphylococci: update on the molecular epidemiology and clinical presentation, with a focus on Staphylococcus epidermidis and Staphylococcus saprophyticus. Eur J Clin Microbiol Infect Dis 31:7–20. https://doi.org/10.1007/s10096-011-1270-6

    Article  CAS  PubMed  Google Scholar 

  17. Lerbech AM, Opintan JA, Bekoe SO, Ahiabu M-A, Tersbøl BP, Hansen M, Brightson KTC, Ametepeh S, Frimodt-Møller N, Styrishave B (2014) Antibiotic exposure in a low-income country: screening urine samples for presence of antibiotics and antibiotic resistance in coagulase negative staphylococcal contaminants. PLoS One 9:e113055. https://doi.org/10.1371/journal.pone.0113055

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Misawa Y, Yoshida A, Okugawa S, Moriya K (2015) First reported case of Staphylococcus condimenti infection associated with catheter-related bacteraemia. New Microbes New Infect 3:18–20. https://doi.org/10.1016/j.nmni.2014.10.002

    Article  CAS  PubMed  Google Scholar 

  19. Khosravi AD, Roointan M, Abbasi Montazeri E, Aslani S, Hashemzadeh M, Taheri Soodejani M (2018) Application of tuf gene sequence analysis for the identification of species of coagulase-negative staphylococci in clinical samples and evaluation of their antimicrobial resistance pattern. Infect Drug Resist 11:1275–1282. https://doi.org/10.2147/IDR.S172144

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Czekaj T, Ciszewski M, Szewczyk EM (2015) Staphylococcus haemolyticus - an emerging threat in the twilight of the antibiotics age. Microbiol Read Engl 161:2061–2068. https://doi.org/10.1099/mic.0.000178

    Article  CAS  Google Scholar 

  21. Cusack TP, Ashley EA, Ling CL, Rattanavong S, Roberts T, Turner P, Wangrangsimakul T, Dance DAB (2019) Impact of CLSI and EUCAST breakpoint discrepancies on reporting of antimicrobial susceptibility and AMR surveillance. Clin Microbiol Infect 25:910–911. https://doi.org/10.1016/j.cmi.2019.03.007

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Sánchez-Bautista A, Coy J, García-Shimizu P, Rodríguez JC (2018) Cambio de CLSI a EUCAST en la interpretación de la sensibilidad a antimicrobianos: ¿cómo influye en nuestro medio? Enfermedades Infecc Microbiol Clínica 36:229–232. https://doi.org/10.1016/j.eimc.2017.03.003

    Article  Google Scholar 

  23. Marchese A, Esposito S, Barbieri R, Bassetti M, Debbia E (2012) Does the adoption of EUCAST susceptibility breakpoints affect the selection of antimicrobials to treat acute community-acquired respiratory tract infections? BMC Infect Dis 12:181. https://doi.org/10.1186/1471-2334-12-181

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kassim A, Omuse G, Premji Z, Revathi G (2016) Comparison of clinical laboratory standards institute and European committee on antimicrobial susceptibility testing guidelines for the interpretation of antibiotic susceptibility at a university teaching hospital in Nairobi, Kenya: a cross-sectional study. Ann Clin Microbiol Antimicrob 15:21. https://doi.org/10.1186/s12941-016-0135-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Farrell DJ, Mendes RE, Bensaci M (2019) In vitro activity of tedizolid against clinical isolates of Staphylococcus lugdunensis and Staphylococcus haemolyticus from Europe and the United States. Diagn Microbiol Infect Dis 93:85–88. https://doi.org/10.1016/j.diagmicrobio.2018.08.006

    Article  CAS  PubMed  Google Scholar 

  26. Sader HS, Castanheira M, Farrell DJ, Flamm RK, Mendes RE, Jones RN (2016) Tigecycline antimicrobial activity tested against clinical bacteria from Latin American medical centres: results from SENTRY Antimicrobial Surveillance Program (2011-2014). Int J Antimicrob Agents 48:144–150. https://doi.org/10.1016/j.ijantimicag.2016.04.021

    Article  CAS  PubMed  Google Scholar 

  27. Pinheiro L, Mello PL, Abraão LM, Corrente JE, Lourdes RS, Cunha M d (2018) Evaluation of reference values for phenotypic tests to detect oxacillin resistance in coagulase-negative staphylococci. Future Microbiol 13:565–575. https://doi.org/10.2217/fmb-2017-0221

    Article  CAS  PubMed  Google Scholar 

  28. Ferreira AM, Bonesso MF, Mondelli AL, Camargo CH, Cunha M d LRS (2012) Oxacillin resistance and antimicrobial susceptibility profile of Staphylococcus saprophyticus and other staphylococci isolated from patients with urinary tract infection. Chemotherapy 58:482–491. https://doi.org/10.1159/000346529

    Article  CAS  PubMed  Google Scholar 

  29. Le Bouter A, Leclercq R, Cattoir V (2011) Molecular basis of resistance to macrolides, lincosamides and streptogramins in Staphylococcus saprophyticus clinical isolates. Int J Antimicrob Agents 37:118–123. https://doi.org/10.1016/j.ijantimicag.2010.10.008

    Article  CAS  PubMed  Google Scholar 

  30. Khashei R, Malekzadegan Y, Sedigh Ebrahim-Saraie H, Razavi Z (2018) Phenotypic and genotypic characterization of macrolide, lincosamide and streptogramin B resistance among clinical isolates of staphylococci in southwest of Iran. BMC Res Notes 11:711. https://doi.org/10.1186/s13104-018-3817-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Teeraputon S, Santanirand P, Wongchai T, Songjang W, Lapsomthob N, Jaikrasun D, Toonkaew S, Tophon P (2017) Prevalence of methicillin resistance and macrolide-lincosamide-streptogramin B resistance in Staphylococcus haemolyticus among clinical strains at a tertiary-care hospital in Thailand. New Microbes New Infect 19:28–33. https://doi.org/10.1016/j.nmni.2017.05.007

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Departamento de Fisiologia e Patologia, Universidade Federal da Paraíba, Campus I - Cidade Universitaria, João Pessoa, PB, 58051-900, Brazil

    Vinícius Pietta Perez

  2. Curso de Biomedicina, Centro Universitário Metodista IPA, Porto Alegre, Brazil

    Jéssica Karoliny Baptista Porto Carvalho & Caroline Dani

  3. Laboratório Endocrimeta, Porto Alegre, Brazil

    Marianne Schrader de Oliveira

  4. Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil

    Adriana Medianeira Rossato & Pedro Alves d’Azevedo

  5. Departamento de Microbiologia, Imunologia e Parasitologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

    Gertrudes Corção

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Correspondence to Vinícius Pietta Perez.

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The author d’Azevedo PA is member of the General Committee of BrCAST in 2019–2020.

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Perez, V.P., Carvalho, J.K.B.P., de Oliveira, M.S. et al. Coagulase-negative staphylococci in outpatient routines: the implications of switching from CLSI to BrCAST/EUCAST guidelines. Braz J Microbiol 51, 1071–1078 (2020). https://doi.org/10.1007/s42770-020-00278-1

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