國家衛生研究院 NHRI:Item 3990099045/15392

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Title:	In vitro and in vivo evidence discourages routine testing and reporting of piperacillin/tazobactam susceptibility of Elizabethkingia species
Authors:	Tan, MC;Huang, YC;Chen, PJ;Huang, WC;Hsu, SY;Wang, HY;Liou, CH;Sun, JR;Lauderdale, TY;Kuo, SC
Contributors:	National Institute of Infectious Diseases and Vaccinology;Institute of Population Health Sciences
Abstract:	Sir,Elizabethkingia species are increasingly prevalent pathogens, particularly in Asia, and are considered intrinsically resistant to almost all β-lactams.1 However, piperacillin/tazobactam susceptibility testing is performed frequently in clinical laboratories and reported in the literature,1 and piperacillin/tazobactam is used to treat infections caused by susceptible Elizabethkingia strains.2 Herein, we question the practice of routine testing and reporting of piperacillin/tazobactam susceptibility of Elizabethkingia spp. due to variability of broth microdilution (BMD) results read by different laboratorians, discordant results of various susceptibility assays, discrepancy between MICs versus MBC or in vivo efficacy and intrinsic resistance evidenced by knockout experiments. One-hundred and eight Elizabethkingia isolates from our previous nationwide studies (Supplementary Methods, available as Supplementary data at JAC Online)3 frequently demonstrated trailing with faint button or turbidity above 4–8 mg/L in BMD testing of piperacillin/tazobactam susceptibility, thus impeding reading (Figure S1). Trailing was also observed in BMD testing of ceftazidime but at a higher concentration (≥64 mg/L). BMD MIC results of piperacillin/tazobactam read by four experienced staff from separate microbiological laboratories varied greatly. Concordance (defined by all four results falling within a 2-fold range) was only 47.2% (51/108, Figure S2); poor concordance was observed both in Elizabethkingia anophelis (45.6%, 41/90) and other Elizabethkingia spp. (55.6%, 10/18). These results may explain the high variability of piperacillin/tazobactam susceptibility rates reported in the literature, which range from 5% to 100% even when obtained from the same BMD platform (piperacillin/tazobactam susceptibility from 5% to 92.4%).
Date:	2024-01
Relation:	Journal of Antimicrobial Chemotherapy. 2024 Jan 3;79(1):200-202
Link to:	http://dx.doi.org/10.1093/jac/dkad322
JIF/Ranking 2023:	http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=NHRI&SrcApp=NHRI_IR&KeyISSN=0305-7453&DestApp=IC2JCR
Cited Times(WOS):	https://www.webofscience.com/wos/woscc/full-record/WOS:001085659600001
Cited Times(Scopus):	https://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=85181588681
Appears in Collections:	[Shu-Chen Kuo] Periodical Articles [Tsai-Ling Yang Lauderdale] Periodical Articles [Ying-Chi Huang] Periodical Articles [Others] Periodical Articles

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