New S, I and R definitions

New definitions of S, I and R

EUCAST has decided to change the definitions of susceptibility testing categories S, I and R as shown below. Results of several consultations on the new definitions are available on the EUCAST website under “Consultations”.

  • S - Susceptible, standard dosing regimen: A microorganism is categorised as "Susceptible, standard dosing regimen", when there is a high likelihood of therapeutic success using a standard dosing regimen of the agent.
  • I – Susceptible, increased exposure*: A microorganism is categorised as "Susceptible, Increased exposure*" when there is a high likelihood of therapeutic success because exposure to the agent is increased by adjusting the dosing regimen or by its concentration at the site of infection.
  • R - Resistant: A microorganism is categorised as "Resistant" when there is a high likelihood of therapeutic failure even when there is increased exposure.

*Exposure is a function of how the mode of administration, dose, dosing interval, infusion time, as well as distribution and excretion of the antimicrobial agent will influence the infecting organism at the site of infection.

Terminology

Susceptibility testing categories: S, I and R.

Report isolates S, I or R.

Describe isolates as belonging to the S, I or R categories.

Describe isolates as susceptible (S and I) or resistant (R).

When an isolate is described as susceptible, this excludes resistant.

When an isolate is described as resistant, this excludes susceptible (S and Icategories).

For surveillance purposes, avoid lumping categories – record as S, I and R. If lumping does occur, never lump I and R, only S and I. 

 

The new definitions are clearly related to agent exposure of the organism which is in turn related to dose, dosing frequency (including going from repeated administration to intravenous infusion), dosing route and to the pharmacokinetics of the agent and sometimes to the type of infection (urinary tract infections vs. meningitis). 

Dosing and modes of administration related to S, I and R of agents are available in the last TAB of the EUCAST breakpoint table.

 

To facilitate implementation of the new definitions EUCAST has developed a powerpoint presentation for NACs to translate and distribute. 

The implementation of the new definitions of S, I and R (PDF file)  

The implementation of the new definitions of S, I and R (PPT-file)

 

 Translations: Spanish / Czech