Antimicrobial Synergy Testing: Comparing the Tobramycin and Ceftazidime Gradient Diffusion Methodology Used in Assessing Synergy in Cystic Fibrosis-Derived

Ijeoma N. Okoliegbe; Karolin Hijazi; Kim  Cooper; Corinne Ironside; Ian M  Gould

doi:10.3390/antibiotics10080967

Antimicrobial Synergy Testing: Comparing the Tobramycin and Ceftazidime Gradient Diffusion Methodology Used in Assessing Synergy in Cystic Fibrosis-Derived

Ijeoma N. Okoliegbe^* (Corresponding Author), Karolin Hijazi, Kim Cooper, Corinne Ironside, Ian M Gould

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

The need for synergy testing is driven by the necessity to extend the antimicrobial spectrum, reducing drug dosage/toxicity and the development of resistance. Despite the abundance of synergy testing methods, there is the absence of a gold standard and a lack of synergy correlation among methods. The most popular method (checkerboard) is labor-intensive and is not practical for clinical use. Most clinical laboratories use several gradient synergy methods which are quicker/easier to use. This study sought to evaluate three gradient synergy methods (direct overlay, cross, MIC:MIC ratio) with the checkerboard, and compare two interpretative criteria (the fractional inhibitory concentration index (FICI) and susceptibility breakpoint index (SBPI)) regarding these methods. We tested 70 multidrug-resistant Pseudomonas aeruginosa, using a tobramycin and ceftazidime combination. The agreement between the checkerboard and gradient methods was 60 to 77% for FICI, while agreements for SBPI that ranged between 67 and 82.86% were statistically significant (p ≤ 0.001). High kappa agreements were observed using SBPI (Ƙ > 0.356) compared to FICI (Ƙ < 0.291) criteria, and the MIC:MIC method demonstrated the highest, albeit moderate, intraclass correlation coefficient (ICC = 0.542) estimate. Isolate resistance profiles suggest methoddependent synergism for isolates, with ceftazidime susceptibility after increased exposure. Theresults show that when interpretative criteria are considered, gradient diffusion (especiallyMIC:MIC) is a valuable and practical method that can inform the treatment of cystic fibrosis patients who are chronically infected with P. aeruginosa

Original language	English
Article number	967
Number of pages	12
Journal	Antibiotics
Volume	10
Issue number	8
Early online date	12 Aug 2021
DOIs	https://doi.org/10.3390/antibiotics10080967
Publication status	Published - 12 Aug 2021

Bibliographical note

Funding: This research was funded by the NHS Grampian Endowment fund, grant number EA9431, and the NHS Grampian Clinical Microbiology Fund (NHS Grampian Endowment Funds, Registered Charity Number SC017296).
Acknowledgments: The authors would like to thank the laboratories and clinicians who use the Cystic Fibrosis Susceptibility Testing Service. CFASS is an adult patient-testing facility, funded by the National Services Division of the Common Services Agency of the Scottish Executive.

Keywords

antimicrobials
ceftazidime
combination antimicrobial susceptibility testing
gradient diffusion
Pseudomonas aeruginosa
synergy testing
tobramycin

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Cite this

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title = "Antimicrobial Synergy Testing: Comparing the Tobramycin and Ceftazidime Gradient Diffusion Methodology Used in Assessing Synergy in Cystic Fibrosis-Derived",

abstract = "The need for synergy testing is driven by the necessity to extend the antimicrobial spectrum, reducing drug dosage/toxicity and the development of resistance. Despite the abundance of synergy testing methods, there is the absence of a gold standard and a lack of synergy correlation among methods. The most popular method (checkerboard) is labor-intensive and is not practical for clinical use. Most clinical laboratories use several gradient synergy methods which are quicker/easier to use. This study sought to evaluate three gradient synergy methods (direct overlay, cross, MIC:MIC ratio) with the checkerboard, and compare two interpretative criteria (the fractional inhibitory concentration index (FICI) and susceptibility breakpoint index (SBPI)) regarding these methods. We tested 70 multidrug-resistant Pseudomonas aeruginosa, using a tobramycin and ceftazidime combination. The agreement between the checkerboard and gradient methods was 60 to 77% for FICI, while agreements for SBPI that ranged between 67 and 82.86% were statistically significant (p ≤ 0.001). High kappa agreements were observed using SBPI (Ƙ > 0.356) compared to FICI (Ƙ < 0.291) criteria, and the MIC:MIC method demonstrated the highest, albeit moderate, intraclass correlation coefficient (ICC = 0.542) estimate. Isolate resistance profiles suggest methoddependent synergism for isolates, with ceftazidime susceptibility after increased exposure. Theresults show that when interpretative criteria are considered, gradient diffusion (especiallyMIC:MIC) is a valuable and practical method that can inform the treatment of cystic fibrosis patients who are chronically infected with P. aeruginosa",

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note = "Funding: This research was funded by the NHS Grampian Endowment fund, grant number EA9431, and the NHS Grampian Clinical Microbiology Fund (NHS Grampian Endowment Funds, Registered Charity Number SC017296). Acknowledgments: The authors would like to thank the laboratories and clinicians who use the Cystic Fibrosis Susceptibility Testing Service. CFASS is an adult patient-testing facility, funded by the National Services Division of the Common Services Agency of the Scottish Executive.",

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AU - Cooper, Kim

AU - Ironside, Corinne

AU - Gould, Ian M

N1 - Funding: This research was funded by the NHS Grampian Endowment fund, grant number EA9431, and the NHS Grampian Clinical Microbiology Fund (NHS Grampian Endowment Funds, Registered Charity Number SC017296). Acknowledgments: The authors would like to thank the laboratories and clinicians who use the Cystic Fibrosis Susceptibility Testing Service. CFASS is an adult patient-testing facility, funded by the National Services Division of the Common Services Agency of the Scottish Executive.

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N2 - The need for synergy testing is driven by the necessity to extend the antimicrobial spectrum, reducing drug dosage/toxicity and the development of resistance. Despite the abundance of synergy testing methods, there is the absence of a gold standard and a lack of synergy correlation among methods. The most popular method (checkerboard) is labor-intensive and is not practical for clinical use. Most clinical laboratories use several gradient synergy methods which are quicker/easier to use. This study sought to evaluate three gradient synergy methods (direct overlay, cross, MIC:MIC ratio) with the checkerboard, and compare two interpretative criteria (the fractional inhibitory concentration index (FICI) and susceptibility breakpoint index (SBPI)) regarding these methods. We tested 70 multidrug-resistant Pseudomonas aeruginosa, using a tobramycin and ceftazidime combination. The agreement between the checkerboard and gradient methods was 60 to 77% for FICI, while agreements for SBPI that ranged between 67 and 82.86% were statistically significant (p ≤ 0.001). High kappa agreements were observed using SBPI (Ƙ > 0.356) compared to FICI (Ƙ < 0.291) criteria, and the MIC:MIC method demonstrated the highest, albeit moderate, intraclass correlation coefficient (ICC = 0.542) estimate. Isolate resistance profiles suggest methoddependent synergism for isolates, with ceftazidime susceptibility after increased exposure. Theresults show that when interpretative criteria are considered, gradient diffusion (especiallyMIC:MIC) is a valuable and practical method that can inform the treatment of cystic fibrosis patients who are chronically infected with P. aeruginosa

AB - The need for synergy testing is driven by the necessity to extend the antimicrobial spectrum, reducing drug dosage/toxicity and the development of resistance. Despite the abundance of synergy testing methods, there is the absence of a gold standard and a lack of synergy correlation among methods. The most popular method (checkerboard) is labor-intensive and is not practical for clinical use. Most clinical laboratories use several gradient synergy methods which are quicker/easier to use. This study sought to evaluate three gradient synergy methods (direct overlay, cross, MIC:MIC ratio) with the checkerboard, and compare two interpretative criteria (the fractional inhibitory concentration index (FICI) and susceptibility breakpoint index (SBPI)) regarding these methods. We tested 70 multidrug-resistant Pseudomonas aeruginosa, using a tobramycin and ceftazidime combination. The agreement between the checkerboard and gradient methods was 60 to 77% for FICI, while agreements for SBPI that ranged between 67 and 82.86% were statistically significant (p ≤ 0.001). High kappa agreements were observed using SBPI (Ƙ > 0.356) compared to FICI (Ƙ < 0.291) criteria, and the MIC:MIC method demonstrated the highest, albeit moderate, intraclass correlation coefficient (ICC = 0.542) estimate. Isolate resistance profiles suggest methoddependent synergism for isolates, with ceftazidime susceptibility after increased exposure. Theresults show that when interpretative criteria are considered, gradient diffusion (especiallyMIC:MIC) is a valuable and practical method that can inform the treatment of cystic fibrosis patients who are chronically infected with P. aeruginosa

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KW - gradient diffusion

KW - Pseudomonas aeruginosa

KW - synergy testing

KW - tobramycin

U2 - 10.3390/antibiotics10080967

DO - 10.3390/antibiotics10080967

M3 - Article

SN - 2079-6382

VL - 10

JO - Antibiotics

JF - Antibiotics

IS - 8

M1 - 967

ER -

Antimicrobial Synergy Testing: Comparing the Tobramycin and Ceftazidime Gradient Diffusion Methodology Used in Assessing Synergy in Cystic Fibrosis-Derived

Abstract

Bibliographical note

Keywords

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