[Interpretive reading of the antibiogram: Intellectual exercise or clinical need?].
Clinical categorisation of susceptibility testing results according to criteria established by different committees is daily performed in clinical microbiology laboratories. By this process clinicians can predict the therapeutic success of antimicrobial treatment in patients infected with susceptible microorganisms. In addition, microbiology laboratories that include a suitable number of antimicrobial agents in susceptibility tests can perform interpretive reading of the antibiogram. With this approach, resistance phenotypes are recognized and allow microbiologist: a) detection of mechanisms of resistance, including low levels of expression; b) modification of clinical classifications that are inconsistent with the inferred resistance mechanism; and c) inference of susceptibility values for antimicrobials that are not included in the antibiogram. In the laboratory, this approach facilitates quality control and validation of susceptibility results. Moreover, it increases the value of the results obtained because new mechanisms of resistance can be characterized and the epidemiology of resistance can be established. From the clinical point of view, this approach contributes to improving the adequacy of treatment (since it is useful for predicting therapeutic failure with the use of antimicrobials in patients with infections due to resistant microorganisms) and to controlling and defining antimicrobial policies. Despite the growing complexity of resistance mechanisms, which makes interpretative reading of the antibiogram difficult, this process should be incorporated into routine practice in microbiology laboratories. Interpretive reading of antibiograms is clinically necessary and not simply a intellectual exercise.
Cantón Moreno
Rafael
R
Servicio de Microbiología, Hospital Ramón y Cajal, Madrid, Spain. rcanton@hrc.insalud.es
D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000145:classification / Q000494:pharmacology; D001331:Automation; D001419:Bacteria / Q000145:classification / Q000187:drug effects; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D003657:Decision Making; D004305:Dose-Response Relationship, Drug; D024881:Drug Resistance, Bacterial; D024901:Drug Resistance, Multiple, Bacterial; D005544:Forecasting; D006801:Humans; D007600:Judgment; D019359:Knowledge; D017056:Medical Laboratory Personnel / Q000523:psychology*; D008826:Microbial Sensitivity Tests / Q000379:methods / Q000592:standards / Q000639:trends; D010641:Phenotype; D012015:Reference Standards; D012680:Sensitivity and Specificity
D000900:Anti-Bacterial Agents