Rationale for eliminating Staphylococcus breakpoints for β-lactam agents other than penicillin, oxacillin or cefoxitin, and ceftaroline.
Due to the ongoing concern about the reliability of Staphylococcus breakpoints (interpretive criteria) for other β-lactam agents, the Clinical and Laboratory Standards Institute recently approved the elimination of all breakpoints for antistaphylococcal β-lactams except for penicillin, oxacillin or cefoxitin, and ceftaroline. Routine testing of penicillin and oxacillin or cefoxitin should be used to infer susceptibility for all β-lactams with approved clinical indications for staphylococcal infections. It is critical for laboratories to reject requests for susceptibility testing of other β-lactams against staphylococci and to indicate that susceptibility to these agents can be predicted from the penicillin and oxacillin or cefoxitin results. This article reviews β-lactam resistance mechanisms in staphylococci, current antimicrobial susceptibility testing and reporting recommendations for β-lactams and staphylococci, and microbiologic data and clinical data supporting the elimination of staphylococcal breakpoints for other β-lactam agents.
Department of Pathology and Laboratory Medicine, Keck School of Medicine, University of Southern California and Children's Hospital Los Angeles.
Jennifer
J
Dien Bard
Janet A
JA
Hindler
Howard S
HS
Gold
Brandi
B
Limbago
D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002440:Cefoxitin / Q000494:pharmacology / Q000627:therapeutic use; D002511:Cephalosporins / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D008826:Microbial Sensitivity Tests; D010068:Oxacillin / Q000494:pharmacology / Q000627:therapeutic use; D010406:Penicillins / Q000494:pharmacology / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000188:drug therapy*; D013210:Staphylococcus / Q000187:drug effects; D014481:United States; D014486:United States Food and Drug Administration; D018440:beta-Lactam Resistance; D047090:beta-Lactams / Q000494:pharmacology* / Q000627:therapeutic use; D000097583:Ceftaroline
D000900:Anti-Bacterial Agents; D002440:Cefoxitin; D002511:Cephalosporins; D010068:Oxacillin; D010406:Penicillins; D047090:beta-Lactams; D000097583:Ceftaroline
CLSI breakpoints; Staphylococcus susceptibility; β-lactams and Staphylococcus