EUCAST https://www.eucast.org/ EUCAST en EUCAST https://www.eucast.org/main/typo3conf/ext/tt_news/ext_icon.gif https://www.eucast.org/ EUCAST TYPO3 - get.content.right http://blogs.law.harvard.edu/tech/rss Mon, 18 Oct 2021 09:21:38 +0200 EUCAST on "intrinsic resistance and unusual phenotypes" updated https://www.eucast.org/eucast_news/news_singleview/?tx_ttnews%5Btt_news%5D=450&cHash=d75c16db85ee0d4369a4148e463d72a8 The EUCAST document Advice on intrinsic resistance and exceptional phenotypes v 3.3 has been... The EUCAST document Advice on intrinsic resistance and exceptional phenotypes v 3.3 has been updated 18 October, 2021.

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Mon, 18 Oct 2021 09:21:38 +0200
General consultation on colistin breakpoints https://www.eucast.org/eucast_news/news_singleview/?tx_ttnews%5Btt_news%5D=449&cHash=f5d7be735745abc2fcd95fa211a30ed4 EUCAST is proposing to change colistin breakpoints to breakpoints in brackets. The consultation is... EUCAST is proposing to change colistin breakpoints to breakpoints in brackets. The consultation is open for comments between 6 October - 15 November.

In breakpoint table v 12.0 (2022), EUCAST aims to introduce brackets for colistin breakpoints. The same model has been used previously for aminoglycosides. The breakpoints will remain ECOFF-based following these changes, but importantly reporting without communicating caveats should not be done following these changes.

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Wed, 06 Oct 2021 11:06:46 +0200
Seminar on EUCAST Disk diffusion of anaerobic bacteria 9 December https://www.eucast.org/eucast_news/news_singleview/?tx_ttnews%5Btt_news%5D=448&cHash=9fe12cf8958c19f836a2965af3b91702 Disk diffusion of anaerobic bacteria in 16-20 hours (9 December, 2021; at 8AM, 1PM and 4PM CET to... Disk diffusion of anaerobic bacteria in 16-20 hours (9 December, 2021; at 8AM, 1PM and 4PM CET to satisfy different time zones; link below).
EUCAST has developed a disk diffusion method for AST of 5 anaerobic species (Bacteroides spp, Prevotella spp, Fusobacterium necrophorum, Clostridium perfringens and Cutibacterium acnes).
Methodology, QC criteria for ATCC strains and a reading guide has already been published on the website (for anyone who would like to start trimming their method). Breakpoints and disk diffusion correlates will soon follow. 
Link to zoom seminar (same link for all three times).

More info and links at the EUCAST seminar webpage.

Gunnar Kahlmeter is inviting you to a scheduled Zoom meeting.

Topic: Disk diffusion of anaerobic bacteria
Time: Dec 9, 2021 08:00 AM, 1PM and 4PM CET

Join Zoom Meeting (click)
or copy paste the link below into your browser:
https://us02web.zoom.us/j/87275780743?pwd=UVFlQzJHa3pTQjhEK29ncWc4S1NLZz09 

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Mon, 04 Oct 2021 23:26:28 +0200
General consultation on breakpoints for anaerobic bacteria https://www.eucast.org/eucast_news/news_singleview/?tx_ttnews%5Btt_news%5D=447&cHash=926718f527914ffd432f02e90e2520fb EUCAST general and public consultation on breakpoints for anaerobic bacteria. The consultation... EUCAST general and public consultation on breakpoints for anaerobic bacteria. The consultation pertains to the clinical breakpoints for Bacteroides spp., Prevotella spp., Fusobacterium necrophorum, Clostridium perfringens and Cutibacterium acnes that have now been reviewed against the MIC and zone diameter distributions that were produced as part of the development. Several breakpoints were revised and are now different from those originally set 15 years ago. In general, revised breakpoints are more species-specific than previously. The intention of EUCAST is to introduce the clinical breakpoints as the backbone of the recently developed and validated 16 - 20 hour disk diffusion methodology on FAA medium. This was described separately

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Mon, 04 Oct 2021 18:00:23 +0200
General consultation on clinical breakpoints for Vibrio species https://www.eucast.org/eucast_news/news_singleview/?tx_ttnews%5Btt_news%5D=446&cHash=526b76dd8d368b13f24bcda45db45ecc General consultation on clinical breakpoints for Vibrio species 1 October - 15 November. Use the... General consultation on clinical breakpoints for Vibrio species 1 October - 15 November. Use the form available on the consultation webpage to comment. Queries can be addressed to gunnar.kahlmeter@eucast.org. 

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Thu, 30 Sep 2021 18:47:16 +0200
Susceptibility testing of anaerobic bacteria https://www.eucast.org/eucast_news/news_singleview/?tx_ttnews%5Btt_news%5D=445&cHash=b6adcb538c66b0873b8ed22077a102f2 EUCAST has developed a disk diffusion method for AST of five important anaerobic species... EUCAST has developed a disk diffusion method for AST of five important anaerobic species (Bacteroides spp, Prevotella spp., Fusobacterium necrophorum, Clostridium perfringens and Cutibacterium acnes).
Methodology, QC criteria and a reading guide was recently published. Breakpoints (reviewed clinical breakpoints and disk diffusion correlates) will be available in breakpoint table v 12.0 (1 January 2022). 

A web based seminar is offered for Thursday 9 December 2021 at 8AM (repeated at 1PM and 4PM) CET. More information at the end of this link.  

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Wed, 22 Sep 2021 13:15:18 +0200
Disk diffusion methodology and QC of anaerobic bacteria https://www.eucast.org/eucast_news/news_singleview/?tx_ttnews%5Btt_news%5D=444&cHash=00f6d5c5f326d9f9f074f7cd90714ff2 Three months ahead of releasing breakpoints and disk diffusion correlates EUCAST publishes the... Three months ahead of releasing breakpoints and disk diffusion correlates EUCAST publishes the methodology, the QC criteria and a disk diffusion reading guide.

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Mon, 20 Sep 2021 16:31:24 +0200
Review: vanco, teico, tela, dalba and oritavancin https://www.eucast.org/eucast_news/news_singleview/?tx_ttnews%5Btt_news%5D=443&cHash=18defd62796a6f9fb3cedf896533efaa Vancomycin, teicoplanin, telavancin, dalbavancin and oritavancin reviewed. Vancomycin, teicoplanin, telavancin, dalbavancin and oritavancin reviewed.

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Mon, 23 Aug 2021 14:20:52 +0200
Review: Azithromycin, Telithromycin, Spiramycin, Tulathromycin https://www.eucast.org/eucast_news/news_singleview/?tx_ttnews%5Btt_news%5D=442&cHash=6974c104616b2d2afff2eb792853327c As part of the 2020-2021 general review and revision of MIC distributions and ECOFFs, these agents... As part of the 2020-2021 general review and revision of MIC distributions and ECOFFs, these agents were now completed.

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Wed, 18 Aug 2021 10:18:33 +0200
Review of MIC distributions of several agents https://www.eucast.org/eucast_news/news_singleview/?tx_ttnews%5Btt_news%5D=441&cHash=ab694d3bd7bd1ffc3572d8f636a620b1 MIC distributions of several agents (trimethoprim-sulfamethoxazole, trimethoprim, rifampicin,... MIC distributions of several agents (trimethoprim-sulfamethoxazole, trimethoprim, rifampicin, erythromycin, clarithromycin) were reviewed as part of the 2021 full review of the entire MIC distribution database

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Tue, 27 Jul 2021 14:00:29 +0200
Brief information on EUCAST definitions of S, I and R to clinical colleagues. https://www.eucast.org/eucast_news/news_singleview/?tx_ttnews%5Btt_news%5D=440&cHash=aa5f2e46ce0ba5ff3fe8b1490821858f An abbreviated information on the EUCAST 2019/20 changes to the definitions and use of S, I and R.... An abbreviated information on the EUCAST 2019/20 changes to the definitions and use of S, I and R.
Please distribute to clinical colleagues who are normally not up to date on susceptibility testing matters. 

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Fri, 09 Jul 2021 17:18:04 +0200
EUCAST calibration and validation graphs updated https://www.eucast.org/eucast_news/news_singleview/?tx_ttnews%5Btt_news%5D=439&cHash=29800bddd5f7ae0b911af2e8aa9a8650 Calibration and validation graphs related to breakpoint table v 11.0 (2021) updated 1 July,... Calibration and validation graphs related to breakpoint table v 11.0 (2021) updated 1 July, 2021. New for 2021, apart from introducing revised and new breakpoints for relevant agents and species, are graphs for Achromobacter xylosoxidansBacillus spp., Cefiderocol, Ceftolozane-tazobactam for H. influenzae, Imipenem-relebactam, Lefamulin.

If you are uncertain about how to use or interpret the graphs, contact gunnar.kahlmeter@eucast.org.

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Thu, 01 Jul 2021 12:26:52 +0200
EUCAST at ECCMID 2021 https://www.eucast.org/eucast_news/news_singleview/?tx_ttnews%5Btt_news%5D=438&cHash=d6f097e70c73c1ebcd7755ad4a000da2 EUCAST at ECCMID 2021. Programme. EUCAST at ECCMID 2021. Programme.

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Mon, 28 Jun 2021 18:44:03 +0200
The EUCAST FAQ updated. https://www.eucast.org/eucast_news/news_singleview/?tx_ttnews%5Btt_news%5D=437&cHash=fbd07eaeb2e3ec8f48e7b5b941fe7334 EUCAST updates the FAQ at regular intervals. Mostly questions are added and in some cases replies... FAQ at regular intervals. Mostly questions are added and in some cases replies are modified because of changes in breakpoints or recommendations.]]> Fri, 04 Jun 2021 16:18:10 +0200 Legionella AST - guidance updated https://www.eucast.org/eucast_news/news_singleview/?tx_ttnews%5Btt_news%5D=436&cHash=8b0a5c767da917207a28f8f9c864d2f6 The EUCAST guidance document on susceptibility testing on L.pneumophila is updated. Acquired... The EUCAST guidance document on susceptibility testing on L.pneumophila is updated.

Acquired antimicrobial resistance in L. pneumophila is rare [1-6]. However, a clinical isolate resistant to ciprofloxacin due to a single point mutation in the gyrA gene has been reported [7] and fluoroquinolone resistance have been described from patients during therapy [8]. An efflux pump (LpeAB) has been demonstrated to be responsible for elevated MICs (0.125-2 mg/L) for azithromycin [1]. The efflux pump is found in clinical isolates of L. pneumophila, related to specific sequence types [1,4,9]. Any clinical significance of reduced susceptibility to azithromycin has not been demonstrated. These findings also suggest erythromycin to be a poor predictor of macrolide-decreased susceptibility caused by this efflux pump.

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Sun, 30 May 2021 09:48:40 +0200
Curation of MIC database is fasttracked https://www.eucast.org/eucast_news/news_singleview/?tx_ttnews%5Btt_news%5D=435&cHash=76462d274711814e957495ca73df1acb The EUCAST Subcommittee on MIC and zone diameter distributions and ECOFFs, having redeveloped the... The EUCAST Subcommittee on MIC and zone diameter distributions and ECOFFs, having redeveloped the software for uploading, handling and displaying MIC and zone distributions is now speedily curating existing MIC and zone diameter distributions. Follow this link for an example. Changes to ECOFFs or TECOFFs (added, deleted or changed) are highlighted and explained to users in color coding and flyovers. The work, systematically curating agent after agent but on occasion by species, is performed by G Kahlmeter and J Turnidge and the end result, having used ECOFFinder and visual inspection, follows the rules set down in EUCAST SOP 10.1. Examples of agents that have already been curated are ampicillin, amoxicillin, amoxicillin-clavulanic acid, gentamicin, tobramycin, amikacin, colistin, chloramphenicol and more. Agents and species that have been curated are listed by date in a table organised for that specific purpose.

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Thu, 27 May 2021 08:26:36 +0200
Daptomycin RD v 2.0 uploaded https://www.eucast.org/eucast_news/news_singleview/?tx_ttnews%5Btt_news%5D=434&cHash=27c511cf2b0adf1e021f42c478a25538 The daptomycin rationale document has been updated to v 2.0. daptomycin rationale document has been updated to v 2.0. ]]> Wed, 12 May 2021 16:19:09 +0200 MIC distribution database is being curated https://www.eucast.org/eucast_news/news_singleview/?tx_ttnews%5Btt_news%5D=433&cHash=0161c4176ac9990aea81307179780d5b Following the recent re-programming of the software for the display of MIC and inhibition zone... table will describe and date changes.]]> Wed, 12 May 2021 08:16:50 +0200 How to handle the EUCAST new S, I and R - sign up for webinar https://www.eucast.org/eucast_news/news_singleview/?tx_ttnews%5Btt_news%5D=432&cHash=739a04cabf828e16de478b7314494ac4 UK-NEQAS webinar 12 May, 2021, 3.30 PM CET: Use the link below to sign up. How to handle the... UK-NEQAS webinar 12 May, 2021, 3.30 PM CET: Use the link below to sign up.

How to handle the EUCAST new S, I and R definitions.

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Tue, 04 May 2021 15:09:17 +0200
Will adding Ca++ to Muller Hinton media enhance the detection of colistin resistance https://www.eucast.org/eucast_news/news_singleview/?tx_ttnews%5Btt_news%5D=431&cHash=07799bcea104e4973c0d9822c9b7699d Revisiting colistin susceptibility testing: Will adding calcium to Mueller-Hinton agar improve the... EUCAST publications. ]]> Tue, 04 May 2021 14:31:48 +0200 MIC distributions and ECOFFs for veterinary pathogens updated https://www.eucast.org/eucast_news/news_singleview/?tx_ttnews%5Btt_news%5D=430&cHash=0be9f964a9f40e020aef892ec141fb28 Together with VetCAST EUCAST has updated MIC distributions and ECOFFs for several veterinary... Together with VetCAST EUCAST has updated MIC distributions and ECOFFs for several veterinary pathogens - Pasteurella multocida, Mannheimia hemolytica, Staphylococcus pseudintermedius and Staphylococcus hyicus. Go to the MIC distribution website and display distributions and (T)ECOFFs for these pathogens.

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Tue, 04 May 2021 13:04:22 +0200
Delafloxacin rationale document updated https://www.eucast.org/eucast_news/news_singleview/?tx_ttnews%5Btt_news%5D=429&cHash=56e9471b0971fda63aafd18542557c9c The delafloxacin rationale document has been updated. The delafloxacin rationale document has been updated. 

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Sat, 17 Apr 2021 09:33:12 +0200
"Frequently Asked Questions in EUCAST AST methods" and "How to use ECOFFinder" https://www.eucast.org/eucast_news/news_singleview/?tx_ttnews%5Btt_news%5D=428&cHash=a2f79ff327ab6f043cb1302c84d9bc8a Online seminar 21 April, 2021; 8.00 AM and 1.00 PM. The seminar consisted of two unrelated... Online seminar 21 April, 2021; 8.00 AM and 1.00 PM. The seminar consisted of two unrelated parts  "Frequently Asked Questions in EUCAST AST methods" and "How to use ECOFFinder" with Erika Matuschek dealing with FAQs and John Turnidge explaining the use of ECOFFinder. A recording of the seminar is available here.

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Wed, 14 Apr 2021 14:20:24 +0200
Disk diffusion of anaerobic bacteria https://www.eucast.org/eucast_news/news_singleview/?tx_ttnews%5Btt_news%5D=427&cHash=461224b76f8d9716e51c77aa05f6f9f2 A laboratory trial designed to investigate the robustness of the EUCAST disk diffusion test for... A laboratory trial designed to investigate the robustness of the EUCAST disk diffusion test for rapidly growing anaerobic bacteria (Bacteroides spp, Prevotella spp, Fusobacterium necrophorum, Clostridium perfringens and Cutibacterium acnes) is underway. Twenty laboratories around the world have signed up and today trial isolates are expected to have reached all. The EUCAST Development Laboratory (EDL) planned the trial together with the EUCAST Steering Committtee and colleagues in the EUCAST Subcommittee on Antimicrobial Susceptibility Testing of Anaerobic bacteria. The EDL prepared and distributed the strains and has arranged for the distribution of media and disks to participants. Results are expected before the end of May.

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Wed, 14 Apr 2021 07:52:33 +0200
EUCAST aphorisms https://www.eucast.org/eucast_news/news_singleview/?tx_ttnews%5Btt_news%5D=426&cHash=df42351b394612323fbe5a22e4949d99 The manufacturer of antimicrobial susceptibility testing material is responsible for the quality of...
  • The manufacturer of antimicrobial susceptibility testing material is responsible for the quality of the material provided to microbiological laboratories. The laboratory is responsible for the result provided to doctors and patients.
  • To perform AST where there is intrinsic resistance is wasting the time of doctors, patients and laboratory staff. 
  • Expert rules are not the absolute truth, they may change over time.
  • The MIC is a relative measurement which in a standardised system can place the organism inside or outside the wild type distribution, but not quantitate the level of sensitivity inside the wild type1.
  • Two levels of resistant, I and R, were replaced by two levels of susceptible, S and I, when EUCAST changed the definitions of S, I and R, and the breakpoints to match.
  • The EUCAST "increased exposure" is a function of dosing, mode of administration and the pharmacokinetics of the agent. Dosing can be affected by changing the individual dose and/or the interval between doses. Exposure can be affected by changing the dose, or the mode or length of administration, or by the pharmacokinetic properties of the agent.
  • The ECOFF is determined on phenotypic criteria only - it is the highest MIC of wild type organisms, e.g. organisms without phenotypically detectable acquired resistance.
  • The area of technical uncertainty (ATU) is a warning in the laboratory which predicts interpretative difficulties but does not interfere with categorisation to S, I or R.
  • EUCAST RAST (rapid AST) directly from positive blood culture bottles can provide susceptibility results in 4 - 6 hours for pathogens important in blood stream infections - why wait for another 18h only because it requires re-organising the work flow.
  • EUCAST disk diffusion screening tests and algorithms reliably predict susceptibility by excluding resistance.
    • Cefoxitin 30 µg to exclude methicillin resistance in Staphylococci.
    • Oxacillin 1 µg in S. pneumoniae to exclude all mechanisms of beta-lactam resistance.
    • Benzylpenicillin 1U in H. influenzae to exclude all mechanisms of beta-lactam resistance.
    • Norfloxacin 10 µg to exclude fluoroquinolone resistance in grampositive bacteria (Staphylococci, Pneumococci, Enterococci).
    • Pefloxacin 5 µg to exclude fluoroquinolone resistance in Salmonella enterica.
    • Nalidixic acid 30 µg to exclude fluoroquinolone resistance in H. influenzae and M. catarrhalis.
  • 1The variation in the wild type MIC distribution has been a source of debate for quite some time. There are publications indicating that 70% of the variation in a typical wild type distribution is down to technical variation and 30 % to biological variation. Without doubt, a true wild type for any species/agent (where there are not grave technical difficulties) span 3 – 5 twofold dilutions. Look at the EUCAST MIC distribution website at two typical extremes (gentamicin vs. E.coli (0.125 – 2 mg/L) and vancomycin vs. S.aureus (0.5 – 2 mg/L). 

    It is also a known fact that if someone who is expert at performing broth microdilution determine the MIC of a specific isolate over and over again (not changing the material) a mean value plus minus one dilution step will cover 97-99% of the values obtained. If you change batch, operator, atmosphere or systematically change the incubation time from let us say 20 h to 16h (or vice versa) you widen the distribution significantly compared to the original one. If you shorten or extend incubation time even further, your MIC-values will be significantly different – which is why MIC is not an absolute measurement but a relative one.

    So subtracting three dilution steps from 3 – 5 dilution steps leaves very little room, for variation between organisms inside the wild type. The representative examples of gentamicin and vancomycin, are based on very large numbers of results from very many investigators using standardised but not coordinated methods. Adding the variation between them, there is very little room for true, and above all no room at all for USEFUL AND PREDICTABLE, biological variation. 

    This is why EUCAST since many years considers the wild type to be a “unity” which should not be divided by a breakpoint. And indeed we manage to achieve this. 

    If we cannot have breakpoints divide wild type distributions (always defined by a species and an agent) it follows that you cannot determine the MIC of an organism inside the wild type to predict outcome of therapy beyond the prediction valid for the entire wild type distribution of isolates..

    This is the basis for the EUCAST aphorism: "The MIC is a relative measurement which in a standardised system can place the organism inside or outside the wild type distribution, but not quantitate the level of sensitivity inside the wild type".

    See also: J Antimicrob Chemother. 2018 Mar 1;73(3):564-568. doi: 10.1093/jac/dkx427.

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    Sun, 28 Mar 2021 17:45:43 +0200
    EUCAST breakpoints offer two levels of susceptible (S and I). https://www.eucast.org/eucast_news/news_singleview/?tx_ttnews%5Btt_news%5D=425&cHash=a886772b1fcd86b0aa055faa6a2527f9 In 2019, EUCAST abandoned the previously used definitions of S, I and R, and introduced...

    In 2019, EUCAST abandoned the previously used definitions of S, I and R, and introduced categories S (Susceptible, standard dose), I (Susceptible, increased exposure) and R (Resistant). All breakpoints, dosages and modes of administration were reviewed and revised to match the changed definitions. The new system has two levels of "susceptible" whereas the previous system in effect offered two levels of resistance. Microbiological laboratories were expected to implement the new definitions by the end of 2020. To do so is paramount for any lab on EUCAST breakpoints since all breakpoints in breakpoint table v 11.0 have been reviewed to fit the new definitions. For more information, see the EUCAST webpage explaining the changed definitions.

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    Fri, 19 Mar 2021 15:14:38 +0100
    Temocillin breakpoints - discussion in JAC https://www.eucast.org/eucast_news/news_singleview/?tx_ttnews%5Btt_news%5D=424&cHash=efee8e79e5009acbbe5ef87a3ea53f66 A discussion of temocillin breakpoints is published in Journal of Antimicrobial Chemotherapy. See... A discussion of temocillin breakpoints is published in Journal of Antimicrobial Chemotherapy. See EUCAST publications.

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    Wed, 17 Mar 2021 08:34:00 +0100
    Breakpoint table v. 11: a mistake in the Staphylococcus spp tab. https://www.eucast.org/eucast_news/news_singleview/?tx_ttnews%5Btt_news%5D=423&cHash=687a00fcffc9b0832c6b2baa4934f17f There is a mistake in the EUCAST breakpoint table v 11.0 where, in the Staphylococcus spp tab, the... EUCAST breakpoint table v 11.0 where, in the Staphylococcus spp tab, the fluroquinolone section, the footnote C should read:  Isolates categorised as susceptible to norfloxacin can be reported susceptible (S) to moxifloxacin and "susceptible increased exposure" (I) to ciprofloxacin and levofloxacin. Isolates non-wild type to norfloxacin should be tested for susceptibility to individual agents. ]]> Thu, 11 Mar 2021 21:59:35 +0100 Cefiderocol MIC and zone diameter correlates available. https://www.eucast.org/eucast_news/news_singleview/?tx_ttnews%5Btt_news%5D=422&cHash=b96af5d0dd73b6a5fa3a6d0778557730 The EUCAST MIC and zone diameter correlates for cefiderocol are now available. The isolates used... The EUCAST MIC and zone diameter correlates for cefiderocol are now available. The isolates used for the analysis were selected to be difficult and there are isolates with many different resistance mechanisms. Disk diffusion provides results which can reliably be reproduced as belonging to the wild type and to the non-wild type part of the population with high MICs to cefiderocol. Providing a wider than usual ATU (Area of Technical Uncertainty) is to increase the robustness of disk diffusion, but also because MIC-testing is not necessarily straightforward, and the poorer correlation between MIC and zone diameter in this area is not necessarily a result of a failed disk test.

    If you have questions on cefiderocol AST, please email the EUCAST Development Laboratory. 

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    Thu, 25 Feb 2021 10:33:00 +0100
    Dosing in children https://www.eucast.org/eucast_news/news_singleview/?tx_ttnews%5Btt_news%5D=421&cHash=f7ff1e3c4afb2b36876e795f7982d144 The European Society for Pediatric Infectious Disease (ESPID) has accepted an invitation from... ESPID) has accepted an invitation from EUCAST to discuss dosing of antibiotics in children with specific reference to the EUCAST Dosing Table (https://www.eucast.org/clinical_breakpoints/). EUCAST breakpoints, for both susceptible categories, S and I, are related to the exposure of the infecting organism at the site of infection. The current dosing table is the result of several years of work and international consultation. This needs to be translated into dosing and administration in children. The joint task force, consisting of representatives from ESPID and EUCAST, will start working on the 1st of March 2021. The ensuing proposal will be subject to public consultation. Questions can be directed to gunnar.kahlmeter@eucast.org.]]> Wed, 24 Feb 2021 09:46:19 +0100