Whole genome sequencing (WGS) offers the potential to predict antimicrobial susceptibility from a single assay. The European Committee on Antimicrobial Susceptibility Testing established a subcommittee to review the current development status of WGS for bacterial antimicrobial susceptibility testing (AST).
The published evidence for using WGS as a tool to infer antimicrobial susceptibility accurately is currently either poor or non-existent and the evidence / knowledge base requires significant expansion. The primary comparators for assessing genotypic–phenotypic concordance from WGS data should be changed to epidemiological cut-off values in order to improve differentiation of wild-type from non-wild-type isolates (harbouring an acquired resistance). Clinical breakpoints should be a secondary comparator.
BSAC recommends UK laboratories to adopt EUCAST disk diffusion methodology in 2016.
The BSAC Standing Committee on Antimicrobial Susceptibility Testing implemented the EUCAST breakpoints in its own disc diffusion susceptibility testing method as harmonized breakpoints were agreed to over the years. Since the development of the EUCAST disc diffusion method, several countries with their own disc diffusion methods have switched to the EUCAST method, and BSAC will replace support of its own disc diffusion method with support for the EUCAST method from January 2016. The EUCAST breakpoints are also available in automated systems. The harmonized breakpoints and methods will help to avoid different reports of susceptibility for the same isolate in different countries and enable more reliable comparison of resistance rates in surveillance studies in different countries. D Brown, M Wootton and R Howe, Leading article in JAC
EUCAST - the 2014 Garrod lecture.
Journal of Antimicrobial Chemotherapy Advance Access published June 18, 2015.
EUCAST in 2014 - Eurosurveillance
Eurosurveillance, Volume 20, Issue 2, 15 January 2015.
D Brown, R Cantón, L Dubreuil, S Gatermann, C Giske, A MacGowan, L Martínez-Martínez, J Mouton, R Skov, M Steinbakk, C Walton, O Heuer, M J Struelens, L Diaz Högberg, G Kahlmeter.
EUCAST Disk Diffusion
Development of the EUCAST Disk Diffusion Method for antimicrobial susceptibility testing method and its implementation in routine microbiology laboratories.
E. Matuschek, D. F. J. Brown and G. Kahlmeter. Published in CMI 2013
The role of Pk/Pd in setting breakpoints
J. W. Mouton, D. F. J. Brown, P. Apfalter, R. Canton, C. G. Giske, M. Ivanova, A. P. MacGowan, A. Rodloff, C.-J. Soussy, M. Steinbakk and G. Kahlmeter. CMI 2012.
EUCAST Expert Rules
EUCAST Expert rules in antimicrobial susceptibility testing.
R. Leclercq, R. Canton, D. F. J. Brown, C. G. Giske, P. Heisig, A. P. MacGowan, J. W. Mouton, P. Nordmann, A. C. Rodloff, G. M. Rossolini, C.-J. Soussy, M. Steinbakk, T. G. Winstanley and G. Kahlmeter. CMI 2012.
European Committee for Antimicrobial Susceptibility Testing (EUCAST) of the European Society for Clinical Microbiology and Infectious Diseases (ESCMID). EUCAST Discussion Document E. Dis 5.1: determination of minimum inhibitory concentrations (MICs) of antibacterial agents by broth dilution. Clin Microbiol Infec 2003; 9 (insert): 1-7.
Link to full document
This discussion document was not developed into a EUCAST definitive document because EUCAST was aware of the proposed development of an international (ISO) standard for broth microdilution, which was eventually published in 2006.
EUCAST Definitive Document E.Def 1.2: terminology relating to methods for the determination of susceptibility of bacteria to antimicrobial agents. Clin Microbiol Infec 2000; 6:503-508.