Letter to the Editor
Standardization of cumulative antimicrobial susceptibility reports: A need
Estandarización de los informes de sensibilidad antibiótica acumulada: una necesidad
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"Standardization of cumulative antimicrobial susceptibility reports: A need" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "166" "paginaFinal" => "168" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "María Felipa Brezmes Valdivieso, María Luz Asensio Calle, Cristina Martín Gómez, Carlos Ochoa Sangrador" "autores" => array:5 [ 0 => array:3 [ "nombre" => "María Felipa" "apellidos" => "Brezmes Valdivieso" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "María Luz" "apellidos" => "Asensio Calle" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Cristina" "apellidos" => "Martín Gómez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:4 [ "nombre" => "Carlos" "apellidos" => "Ochoa Sangrador" "email" => array:1 [ 0 => "cochoas2@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 4 => array:1 [ "colaborador" => "on behalf of the Grupo PROA Hospitalario de Zamora" ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Unidad de Microbiología, Complejo Asistencial de Zamora, Zamora, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Interna, Complejo Asistencial de Zamora, Zamora, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Pediatría, Complejo Asistencial de Zamora, Zamora, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estandarización de los informes de sensibilidad antibiótica acumulada: una necesidad" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3951 "Ancho" => 2925 "Tamanyo" => 1215134 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0140" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Simplified presentation model of a cumulative antimicrobial susceptibility report.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The Executive Committee of the European Committee on Antimicrobial Susceptibility Testing (EUCAST)<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> decided in 2019 to redefine the clinical categories Susceptible (S) and Intermediate (I) used in the interpretation of susceptibility results, but maintaining the abbreviations, such that “susceptible” becomes “Susceptible, standard dosing regimen” (S) and “intermediate” becomes “Susceptible, Increased exposure” (I).</p><p id="par0010" class="elsevierStylePara elsevierViewall">This change directly affects the preparation of the cumulative antimicrobial susceptibility testing (CAST) reports that we periodically produce in microbiology departments/units; it is no longer appropriate to combine the categories “Resistant” and “Intermediate” as “non-susceptible”. Instead, the Comité Español del Antibiograma (COESANT) [Spanish Antibiogram Committee] advises presenting the three categories separately, and if necessary, combining S and I, but indicating at the bottom of the table those cases in which there are two dosage regimens.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> However, it does not establish recommendations regarding the threshold percentage of susceptible strains for the empirical use of an antibiotic.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Although there is no universally recognised susceptibility threshold for the empirical use of an antibiotic, it is common in CAST reports to consider 80%, based on expert recommendations for certain infections (higher thresholds in severe infections).<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Thus, in CAST reports which only show the percentage of susceptibility, colour coding is often assigned to guide the clinician, using green or red depending on whether the percentage is above or below 80% (in other reports, 85% or 90%). Some CAST reports add a third colour to highlight percentages between 50% and 80%–85%, a range which does not correspond to any category of prescription and which does not provide information that is not conveyed by the percentage itself.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">As a consequence of the change in clinical categories, it seems particularly important to differentiate the combinations of antibiotic/microorganism that reach the threshold for empirical use from strains that require increased exposure. We therefore consider it necessary to assign a new colour to said category. If we have accepted green and red to differentiate the antibiotics that we should or should not use, it is logical that we assign yellow for the new category; just as we interpret traffic lights, clinicians will understand that they can use an antibiotic, as long as exposure to it is increased (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Due to the great heterogeneity that exists in the preparation and presentation of the CAST report, which does not always provide all the information that the clinician may need, and considering that its main objective is to be a guide to choosing the most appropriate empirical antibiotic treatment, in our opinion, standardisation is a priority. We therefore propose the following:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0030" class="elsevierStylePara elsevierViewall">Unifying the percentage threshold of susceptible strains for recommending the empirical use of an antibiotic. Due to the extent of their use, to preserve the most powerful antibiotics and until a consensus is reached, we suggest 80% (reflecting in the CAST that in serious infections, options with greater susceptibility should be considered).</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0035" class="elsevierStylePara elsevierViewall">Unifying colour coding: green for percentages of strains meeting the empirical use threshold; yellow for those that reach it with an increase in exposure; and red for the percentages that are below the threshold. A simplified presentation model is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> (all cells express the sum of S<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>I; at the bottom of the table, S and I are detailed separately for those marked in yellow).</p></li></ul></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">No funding was received for the preparation of this article.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3951 "Ancho" => 2925 "Tamanyo" => 1215134 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0140" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Simplified presentation model of a cumulative antimicrobial susceptibility report.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "The European Committee on Antimicrobial Susceptibility Testing – EUCAST. New definitions of S, I and R from 2019 [Accessed 24 October 2023] Available from: <a target="_blank" href="https://www.eucast.org/newsiandr">https://www.eucast.org/newsiandr</a>." ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recomendaciones del Comité Español del Antibiograma (COESANT) para la realización de los Informes de Sensibilidad Antibiótica Acumulada" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.N. Larrosa" 1 => "A. Canut-Blasco" 2 => "N. Benito" 3 => "R. Cantón" 4 => "E. Cercenado" 5 => "F. Docobo-Pérez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eimc.2022.01.004" "Revista" => array:5 [ "tituloSerie" => "Enferm Infecc Microbiol Clin" "fecha" => "2023" "volumen" => "41" "paginaInicial" => "430" "paginaFinal" => "435" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "What is the evidence base of used aggregated antibiotic resistance percentages to change empirical antibiotic treatment? A scoping review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Auzin" 1 => "M. Spits" 2 => "E. Tacconelli" 3 => "J. Rodríguez-Baño" 4 => "M. Hulscher" 5 => "E. Adang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cmi.2021.12.003" "Revista" => array:6 [ "tituloSerie" => "Clin Microbiol Infect" "fecha" => "2022" "volumen" => "28" "paginaInicial" => "928" "paginaFinal" => "935" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34906718" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Informes de sensibilidad antibióticos. Portal del Medicamento. Sacyl. Junta de Castilla y León [Accessed 24 October 2023] Available from: <a target="_blank" href="https://www.saludcastillayleon.es/portalmedicamento/es/estrategias-programas/antimicrobianos/informes-sensibilidad-antibioticos/2022">https://www.saludcastillayleon.es/portalmedicamento/es/estrategias-programas/antimicrobianos/informes-sensibilidad-antibioticos/2022</a>." ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/2529993X/0000004200000003/v1_202403030914/S2529993X24000431/v1_202403030914/en/main.assets" "Apartado" => array:4 [ "identificador" => "66012" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/2529993X/0000004200000003/v1_202403030914/S2529993X24000431/v1_202403030914/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X24000431?idApp=UINPBA00004N" ]
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