Skip to main content
SpringerLink
Log in

Differences in antimicrobial susceptibility breakpoints for Pseudomonas aeruginosa, isolated from blood cultures, set by the Clinical and Laboratory Standards Institute (CLSI) and the Japanese Society of Chemotherapy

  • ORIGINAL ARTICLE
  • Published:
Journal of Infection and Chemotherapy

Abstract

A study was made of the antimicrobial susceptibility to and efficacy of various kinds of antimicrobial agents against 179 strains of Pseudomonas aeruginosa that were isolated from blood cultures at Kansai Medical University Hospital from 1990 through 2004. The annual detection rate was highest in 1994, at 22 strains (6.5%). There were 9 multidrug resistant strains of Pseudomonas aeruginosa (5.0%). Among 14 antimicrobial agents tested for measurements, ciprofloxacin (CPFX) showed the best minimum inhibitory concentration (MIC) 50 value, of 0.25 µg/ml, followed by pazufloxacin (PZFX) and biapenem (BIPM), each at 0.5 µg/ml. When the period of 15 years was divided into three stages, the MIC50 value for each antimicrobial agent was highest in the middle stage (1995 to 1999). Assuming that the percentage of sensitive strains according to the breakpoints set by the Clinical and Laboratory Standards Institute (CLSI) represents the antimicrobial susceptibility rate, amikacin (AMK) showed the best value, of 85.5%. According to the sepsis breakpoint set by the Japanese Society of Chemotherapy (JSC), the efficacy of CPFX showed the highest rate (77.1%) of all the antimicrobial agents tested. Among β-lactams, BIPM showed the highest efficacy rate, of 67.0%. When the efficacy rates were compared with each other, the difference in efficacy rate between the breakpoint set by the CLSI and the sepsis breakpoint set by the JSC was large for β-lactams. Comparisons made based on the CLSI criteria showed no difference in cross-resistance rates between CPFX, meropenem (MEPM), and BIPM. However, when comparisons were made using the JSC sepsis breakpoint, MEPM showed a cross-resistance rate of 87.8%, while the rate for BIPM was lower, at 56.1%, with the χ2 test showing a significant difference, at P = 0.0014. In accordance with the pharmacokinetics/pharmacodynamics theory that has been advocated, breakpoints which are more suitable for the clinical setting in Japan should be set so that more effective and more appropriate treatment can be carried out.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. MM Neuhauser RA Weinstein R Rydman LH Danziger G Karam JP Quinn (2003) ArticleTitleAntibiotic resistance among gram-negative bacilli in US intensive care units: implications for fluoroquinolone use JAMA 289 885–8 Occurrence Handle12588273 Occurrence Handle10.1001/jama.289.7.885 Occurrence Handle1:CAS:528:DC%2BD3sXht12ksL8%3D

    Article  PubMed  CAS  Google Scholar 

  2. MJ Richards JR Edwards DH Culver RP Gaynes (1999) ArticleTitleNosocomial infections in medical intensive care units in the United States: National Nosocomial Infections Surveillance System Crit Care Med 27 887–92 Occurrence Handle10362409 Occurrence Handle10.1097/00003246-199905000-00020 Occurrence Handle1:STN:280:DyaK1M3ovFamtw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  3. JL Vincent DJ Bihari PM Suter HA Bruining J White MH Nicolas-Chanoin et al. (1995) ArticleTitleThe prevalence of nosocomial infection in intensive care units in Europe: results of the European Prevalence of Infection in Intensive Care (EPIC) study JAMA 274 639–44 Occurrence Handle7637145 Occurrence Handle10.1001/jama.274.8.639 Occurrence Handle1:STN:280:ByqA28vhsV0%3D

    Article  PubMed  CAS  Google Scholar 

  4. K Lolans AM Queenan K Bush A Sahud JP Quinn (2005) ArticleTitleFirst nosocomial outbreak of Pseudomonas aeruginosa producing an integron-borne metallo-ß-lactamase (VIM-2) in the United States Antimicrob Agents Chemother 49 3538–40 Occurrence Handle16048978 Occurrence Handle10.1128/AAC.49.8.3538-3540.2005 Occurrence Handle1:CAS:528:DC%2BD2MXntFCgs7o%3D

    Article  PubMed  CAS  Google Scholar 

  5. AP Gibb C Tribuddharat RA Moore TJ Louie W Krulicki DM Livermore et al. (2002) ArticleTitleNosocomial outbreak of carbapenem-resistant Pseudomonas aeruginosa with a new blaIMP allele, blaIMP-7 Antimicrob Agents Chemother 46 255–8 Occurrence Handle11751148 Occurrence Handle10.1128/AAC.46.1.255-258.2002 Occurrence Handle1:CAS:528:DC%2BD38XjtVehuw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  6. H Vahaboglu R Ozturk G Aygun F Coskunkan A Yaman A Kaygusuz et al. (1997) ArticleTitleWidespread detection of PER-1-type extended-spectrum-lactamases among nosocomial Acinetobacter and Pseudomonas aeruginosa isolates in Turkey: a Nationwide Multicenter Study Antimicrob Agents Chemother 41 2265–9 Occurrence Handle9333059 Occurrence Handle1:CAS:528:DyaK2sXms1SnsLo%3D

    PubMed  CAS  Google Scholar 

  7. JP Quinn A Darzins D Miyashiro S Ripp RV Miller (1991) ArticleTitleImipenem resistance in Pseudomonas aeruginosa PAO: mapping of the OprD2 gene Antimicrob Agents Chemother 35 753–5 Occurrence Handle1906263 Occurrence Handle1:CAS:528:DyaK3MXitVens7k%3D

    PubMed  CAS  Google Scholar 

  8. ML Sobel D Hocquet L Cao P Plesiat K Poole (2005) ArticleTitleMutations in PA3574 (nalD) lead to increased MexAB-OprM expression and multidrug resistance in laboratory and clinical isolates of Pseudomonas aeruginosa Antimicrob Agents Chemother 49 1782–6 Occurrence Handle15855496 Occurrence Handle10.1128/AAC.49.5.1782-1786.2005 Occurrence Handle1:CAS:528:DC%2BD2MXktFSntrk%3D

    Article  PubMed  CAS  Google Scholar 

  9. MP Weinstein ML Towns SM Quartey S Mirrett LG Reimer G Parmigiani et al. (1997) ArticleTitleThe clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults Clin Infect Dis 24 584–602 Occurrence Handle9145732 Occurrence Handle1:STN:280:ByiB1M7htFw%3D

    PubMed  CAS  Google Scholar 

  10. CS Bryan KL Reynolds ER Brenner (1983) ArticleTitleAnalysis of 1186 episodes of gram-negative bacteremia in non-university hospitals: the effects of antimicrobial therapy Rev Infect Dis 5 629–38 Occurrence Handle6353525 Occurrence Handle1:STN:280:BiuD3MjhsVE%3D

    PubMed  CAS  Google Scholar 

  11. I Chatzinikolaou D Abi-Said GP Bodey KV Rolston JJ Tarrand G Samonis (2000) ArticleTitleRecent experience with Pseudomonas aeruginosa in patients with cancer: retrospective analysis of 245 episodes Arch Intern Med 160 501–9 Occurrence Handle10695690 Occurrence Handle10.1001/archinte.160.4.501 Occurrence Handle1:CAS:528:DC%2BD3cXhvFGhur0%3D

    Article  PubMed  CAS  Google Scholar 

  12. S Osmon S Ward VJ Fraser MH Kollef (2004) ArticleTitleHospital mortality for patients with bacteremia due to Staphylococcus aureus or Pseudomonas aeruginosa Chest 125 607–16 Occurrence Handle14769745 Occurrence Handle10.1378/chest.125.2.607

    Article  PubMed  Google Scholar 

  13. F Vidal J Mensa M Almela JA Martinez F Marco C Casals et al. (1996) ArticleTitleEpidemiology and outcome of Pseudomonas aeruginosa bacteremia, with special emphasis on the influence of antibiotic treatment: analysis of 189 episodes Arch Intern Med 156 2121–6 Occurrence Handle8862105 Occurrence Handle10.1001/archinte.156.18.2121 Occurrence Handle1:STN:280:ByiD3Mrkt1A%3D

    Article  PubMed  CAS  Google Scholar 

  14. InstitutionalAuthorNameClinical and Laboratory Standards Institute (2005) Performance standards for antimicrobial susceptibility testing: 15th informational supplement. M100-S15 Clinical and Laboratory Standards Institute Wayne, PA

    Google Scholar 

  15. A Saito T Inamatsu J Okada T Oguri H Kanno N Kusano et al. (1999) ArticleTitleClinical breakpoint in pulmonary infections and sepsis: new antimicrobial agents and supplemental information for some agents already released J Infect Chemother 5 223–6 Occurrence Handle11810523 Occurrence Handle10.1007/s101560050041 Occurrence Handle1:CAS:528:DC%2BD3cXjvFaqug%3D%3D

    Article  PubMed  CAS  Google Scholar 

  16. CI Kang SH Kim WB Park KD Lee HB Kim EC Kim et al. (2005) ArticleTitleBloodstream infections caused by antibiotic-resistant gram-negative bacilli: risk factors for mortality and impact of inappropriate initial antimicrobial therapy on outcome Antimicrob Agents Chemother 49 760–6 Occurrence Handle15673761 Occurrence Handle10.1128/AAC.49.2.760-766.2005 Occurrence Handle1:CAS:528:DC%2BD2MXht12ntbk%3D

    Article  PubMed  CAS  Google Scholar 

  17. R Reynolds N Potz M Colman A Williams D Livermore MacGowan A. BSAC (2004) ArticleTitleExtended Working Party on Bacteraemia Resistance Surveillance. Antimicrobial susceptibility of the pathogens of bacteraemia in the UK and Ireland 2001–2002: the BSAC Bacteraemia Resistance Surveillance Programme J Antimicrob Chemother 53 1018–32 Occurrence Handle15128723 Occurrence Handle10.1093/jac/dkh232 Occurrence Handle1:CAS:528:DC%2BD2cXksVaitbc%3D

    Article  PubMed  CAS  Google Scholar 

  18. N Shibata Y Doi K Yamane T Yagi H Kurokawa K Shibayama et al. (2003) ArticleTitlePCR typing of genetic determinants for metallo-beta-lactamases and integrases carried by gram-negative bacteria isolated in Japan, with focus on the class 3 integron J Clin Microbiol 41 5407–13 Occurrence Handle14662918 Occurrence Handle10.1128/JCM.41.12.5407-5413.2003 Occurrence Handle1:CAS:528:DC%2BD2cXjtFyqsw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  19. MD Obritsch DN Fish R MacLaren R Jung (2004) ArticleTitleNational surveillance of antimicrobial resistance in Pseudomonas aeruginosa isolates obtained from intensive care unit patients from 1993 to 2002 Antimicrob Agents Chemother 48 4606–10 Occurrence Handle15561832 Occurrence Handle10.1128/AAC.48.12.4606-4610.2004 Occurrence Handle1:CAS:528:DC%2BD2cXhtVKmtrnF

    Article  PubMed  CAS  Google Scholar 

  20. InstitutionalAuthorNameNational Nosocomial Infections Surveillance System. National Nosocomial Infections (1999) ArticleTitleSurveillance (NNIS) System report, data summary from January 1990–May 1999, issued June 1999 Am J Infect Control 27 520–32 Occurrence Handle10.1016/S0196-6553(99)70031-3

    Article  Google Scholar 

  21. AH Mutnick PR Rhomberg HS Sader RN Jones (2004) ArticleTitleAntimicrobial usage and resistance trend relationships from the MYSTIC Programme in North America (1999–2001) J Antimicrob Chemother 53 290–6 Occurrence Handle14711839 Occurrence Handle10.1093/jac/dkh039 Occurrence Handle1:CAS:528:DC%2BD2cXos1aqsQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  22. WA Craig (1998) ArticleTitlePharmacokinetic/pharmacodynamic parameters: rationale for antibacterial dosing of mice and men Clin Infect Dis 26 1–12 Occurrence Handle9455502 Occurrence Handle1:CAS:528:DyaK1cXltVaqtw%3D%3D

    PubMed  CAS  Google Scholar 

  23. H Pai J Kim J Kim JH Lee KW Choe N Gotoh (2001) ArticleTitleCarbapenem resistance mechanisms in Pseudomonas aeruginosa clinical isolates Antimicrob Agents Chemother 45 480–4 Occurrence Handle11158744 Occurrence Handle10.1128/AAC.45.2.480-484.2001 Occurrence Handle1:CAS:528:DC%2BD3MXmsVGltw%3D%3D

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical Sciences and Laboratory Medicine, Kansai Medical University, Hirakata Hospital, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan

    Tatsuya Nakamura, Chihiro Shimizu, Mayumi Kasahara, Chiyo Nakata, Machiko Munakata & Hakuo Takahashi

  2. Division of Biomedical Informatics, Course of Health Science, Osaka University Graduate School of Medicine, Osaka, Japan

    Tatsuya Nakamura

Authors
  1. Tatsuya Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chihiro Shimizu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mayumi Kasahara
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chiyo Nakata
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Machiko Munakata
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hakuo Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hakuo Takahashi.

About this article

Cite this article

Nakamura, T., Shimizu, C., Kasahara, M. et al. Differences in antimicrobial susceptibility breakpoints for Pseudomonas aeruginosa, isolated from blood cultures, set by the Clinical and Laboratory Standards Institute (CLSI) and the Japanese Society of Chemotherapy. J Infect Chemother 13, 24–29 (2007). https://doi.org/10.1007/s10156-006-0493-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10156-006-0493-4

Key words

Search

Navigation