Journal of Antimicrobial Chemotherapy (2001) 48, 87-102
© 2001 The British Society for Antimicrobial Chemotherapy
Supplement |
Interpretative reading: recognizing the unusual and inferring resistance mechanisms from resistance phenotypes
a Antibiotic Resistance Monitoring and Reference Laboratory, Central Public Health Laboratory, 61 Colindale Avenue, London NW9 5HT; b Department of Microbiology, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF; c Department of Infection, Guy's, King's and St Thomas' School of Medicine, King's College London, St Thomas' Hospital, London SE1 7EH, UK
Abstract
If isolates are speciated and if a sufficient range of antibiotics is tested, underlying resistance mechanisms can often be inferred from the antibiogram data. This allows: (i) anomalous combinations of phenotype and organism to be reconsidered; (ii) prediction of further antibiotics that deserve testing; and (iii) the suppression of susceptibilities that are anomalous in the light of the inferred mechanism. This ‘interpretative reading’ is widely undertaken in France but is largely precluded in the UK by limited speciation and the testing of narrow ranges of antibiotics. Nevertheless, UK laboratories should be aware of: (i) grossly anomalous combinations of species and phenotype, demanding reference laboratory confirmation; (ii) useful indicator drugs, where resistance implies a mechanism conferring other resistances that may be less obvious in direct tests; and (iii) antibiotics that are prone to select resistant mutants of particular species during therapy. Details of these combinations of organism and resistance are presented. Relationships between antibiogram and mechanism are also presented to allow full interpretative reading for those testing wide panels of drugs versus speciated isolates.
Notes
* Corresponding author. Tel: +44-20-8200-4400; Fax: +44-20-8358-3292; E-mail: DLivermore{at}phls.nhs.uk
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