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Table 6 Pathogen/antibiotic combinations that present major changes and potential therapeutic consequences

From: Does the adoption of EUCAST susceptibility breakpoints affect the selection of antimicrobials to treat acute community-acquired respiratory tract infections?

Pathogen/antibiotic

CLSI

CLSI

CLSI

EUCAST

EUCAST

EUCAST

Major categorical shift

Potential therapeutic consequences

Possible alternative/s

%S

% I

% R

%S

% I

% R

S. pneumoniae/

         

Amoxicillin-clavulanate

95.6

4.3

0.1

73.4

13.9

12.7

S→I/R

Reduced or no efficacy

Increased dosage of amoxicillin-clavulanate

(2457)

(110)

(2)

(1884)

(358)

(326)

   

(2568)

Cefaclor

92.3

1.7

5.9

0.5

86.7

13

S→I/R

Reduced or no efficacy

Other oral cephalosporin/high dosage of amoxicillin-clavulanate

(2581)

(2384)

(45)

(152)

(13)

(2238)

(330)

   

Ofloxacin

95.4

4.3

0.3

0.0

99.5

0.3

S→I

Reduced efficacy

Fluoroquinolones (moxifloxacin, levofloxacin, gemifloxacin)

(4412)

(4208)

(190)

(14)

 

(4388)

(14)

   

H. influenzae/

         

Cefaclor

92.6

5.2

2.3

3.5

/

96.5

S→R

No efficacy

Other cephalosporin/amoxicillin-clavulanate

(28338)

(26337)

(1481)

(654)

(990)

 

(27482)

   

Cefuroxime-axetil

97.9

1.5

0.6

1.3

75.6

23.1

S→I/R

Reduced or no efficacy

Other cephalosporin/amoxicillin-clavulanate

(94671)

(92668)

(1390)

(613)

(1249)

(71574)

(21848)

   

Cefuroxime-

97.9

1.5

0.6

76.9

10.5

12.6

S→ I/R

Reduced or no efficacy

Other cephalosporin/amoxicillin-clavulanate

parenteral

(92668)

(1390)

(613)

(72823)

(9963)

(11885)

   

(94671)

Azithromycin

99.3

/

/

1.2

98.1

0.7

S→I

Reduced or no efficacy

Betalactam/fluoroquinolones

(29942)

(29733)

  

(350)

(29383)

(209)

   

Clarithromycin

82.9

15.3

1.8

1.5

98.1

0.3

S→I

Reduced or no efficacy

Betalactam/fluoroquinolones

(27816)

(23045)

(4257)

(514)

(424)

(27296)

(96)

   

Telithromycin

89.9

9.0

1.1

0.5

99.1

0.4

S→I

Reduced or no efficacy

Betalactam/fluoroquinolones

(5382)

(4837)

(486)

(59)

(26)

(5335)

(21)

   

M. catarrhalis/

         

Cefaclor

95.1

3.4

1.6

0.27

/

99.7

S→R

No efficacy

Other cephalosporin/amoxicillin-clavulanate

(7536)

(7163)

(253)

(120)

(21)

 

(7515)

   

Cefuroxime-axetil

98.7

1.1

0.1

1.2

97.5

1.3

S→I/R

Reduced or no efficacy

Other cephalosporin/amoxicillin-clavulanate

(15381)

(15183)

(175)

(23)

(189)

(14994)

(198)

   
  1. S. pneumoniae CLSI 2012 intermediate breakpoint (mg/L) amoxicillin-clavulanate 4/2, cefaclor 2, ofloxacin 4; EUCAST 2012 intermediate breakpoint (mg/L) amoxicillin-clavulanate 1–2, cefaclor 0.06-0.5, ofloxacin 0.25-4; CLSI 2012 resistance breakpoint (mg/L) amoxicillin-clavulanate ≥8/4, cefaclor ≥4, ofloxacin ≥8; EUCAST 2012 resistance breakpoint (mg/L) amoxicillin-clavulanate >2, cefaclor >0.5, ofloxacin >4.
  2. H. influenzae CLSI 2012 intermediate breakpoint (mg/L) cefaclor 16, cefuroxime axetil 8, cefuroxime parenteral 8, azithromycin ND, clarithromycin 16, telithromycin 4; EUCAST 2012 intermediate breakpoint (mg/L) cefaclor ND, cefuroxime axetil 0.25-1, cefuroxime parenteral 2, azithromycin 0.25-4, clarithromycin 2–32, telithromycin 0.25-8; CLSI 2012 resistance breakpoint (mg/L) cefaclor ≥32, cefuroxime axetil ≥16, cefuroxime parenteral ≥16, azithromycin ND, clarithromycin ≥32, telithromycin ≥8; EUCAST 2012 resistance breakpoint (mg/L) cefaclor >0.5, cefuroxime axetil >1, cefuroxime parenteral >2, azithromycin >4, clarithromycin >32, telithromycin >8.
  3. M. catarrhalis CLSI 2012 intermediate breakpoint (mg/L) cefaclor 16, cefuroxime axetil 8; EUCAST 2012 intermediate breakpoint (mg/L) cefaclor ND, cefuroxime axetil 0.25-4.
  4. CLSI 2012 resistance breakpoint (mg/L) cefaclor ≥32, cefuroxime axetil ≥16; EUCAST 2012 resistance breakpoint (mg/L) cefaclor >0.12, cefuroxime axetil >4.
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BMC Infectious Diseases

ISSN: 1471-2334

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