Cambio de CLSI a EUCAST en la interpretación de la sensibilidad a antimicrobianos: ¿cómo influye en nuestro medio? / From CLSI to EUCAST guidelines in the interpretation of antimicrobial susceptibility: What is the effect in our setting?

INTRODUCCIÓN: La aplicación de los puntos de corte establecidos por el European Committee on Antimicrobial Susceptibility Testing (EUCAST) en comparación con los del Clinical and Laboratory Standards Institute (CLSI) modifica los criterios de interpretación de la sensibilidad de algunos antimicrobianos y esto conduce a cambios en los informes de sensibilidad antibiótica acumulada. MÉTODOS: Análisis de la influencia de la aplicación del EUCAST en 10.359 aislados clínicos de Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus y Enterococcus spp. RESULTADOS: Al aplicar los puntos de corte del EUCAST, la mayoría de los porcentajes de sensibilidad a antimicrobianos no se alteró o lo hizo de forma muy leve; sin embargo, se observó una disminución de la sensibilidad a los aminoglucósidos en bacilos gramnegativos, especialmente a la amicacina en Pseudomonas aeruginosa (23,2%), aunque solo el 5,7% fueron totalmente resistentes; además, disminuyó notablemente el porcentaje de aislados sensibles a aztreonam. Es de destacar el aumento de cepas de Staphylococcus aureus resistentes a clindamicina (51,5%) y a aminoglucósidos (gentamicina 43,1%). CONCLUSIONES: El cambio de los criterios del CLSI a los de EUCAST en algunos patógenos supone una alteración en los porcentajes de resistencia a algunos antimicrobianos y, por tanto, en la epidemiología local de la resistencia. Estos cambios deben realizarse por un grupo multidisciplinar, que analice la influencia de los nuevos datos en los protocolos de tratamiento empírico de cada centro

INTRODUCTION: Implementation of the breakpoints established in the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines in comparison with those of the Clinical and Laboratory Standards Institute (CLSI) means that the criteria for interpreting the susceptibility of some antimicrobials have been modified, resulting in changes in the reports of accumulated antibiotic susceptibility. METHODS: The effect of applying EUCAST breakpoints in 10,359 clinical isolates of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus and Enterococcus spp. was analysed. RESULTS: By applying EUCAST breakpoints, most antimicrobial susceptibility percentages did not change or changed very slightly. However, a decrease in aminoglycoside susceptibility was observed in Gram-negative bacilli, mainly for amikacin and Pseudomonas aeruginosa (23.2%), although only 5.7% were completely resistant; a notably decrease in the percentage of isolates susceptible to aztreonam was also observed. There was also a marked increase in the number of Staphylococcus aureus strains resistant to clindamycin (51.5%) and aminoglycosides (gentamicin 43.1%). CONCLUSIONS: Switching from CLSI to EUCAST criteria in some pathogens alters the percentages of resistance to several antimicrobials, and therefore the local epidemiology of the resistance. These changes should be implemented by a multidisciplinary group in order to analyse the influence of the new data on the empirical treatment protocols of each centre

From CLSI to EUCAST guidelines in the interpretation of antimicrobial susceptibility: What is the effect in our setting? / Cambio de CLSI a EUCAST en la interpretación de la sensibilidad a antimicrobianos: ¿cómo influye en nuestro medio?

INTRODUCTION: Implementation of the breakpoints established in the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines in comparison with those of the Clinical and Laboratory Standards Institute (CLSI) means that the criteria for interpreting the susceptibility of some antimicrobials have been modified, resulting in changes in the reports of accumulated antibiotic susceptibility. METHODS: The effect of applying EUCAST breakpoints in 10,359 clinical isolates of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus and Enterococcus spp. was analysed. RESULTS: By applying EUCAST breakpoints, most antimicrobial susceptibility percentages did not change or changed very slightly. However, a decrease in aminoglycoside susceptibility was observed in Gram-negative bacilli, mainly for amikacin and Pseudomonas aeruginosa (23.2%), although only 5.7% were completely resistant; a notably decrease in the percentage of isolates susceptible to aztreonam was also observed. There was also a marked increase in the number of Staphylococcus aureus strains resistant to clindamycin (51.5%) and aminoglycosides (gentamicin 43.1%). CONCLUSIONS: Switching from CLSI to EUCAST criteria in some pathogens alters the percentages of resistance to several antimicrobials, and therefore the local epidemiology of the resistance. These changes should be implemented by a multidisciplinary group in order to analyse the influence of the new data on the empirical treatment protocols of each centre.

Evaluación de una novedosa campaña de vacunación de la gripe en personal sanitario en la temporada 2011-2012 / Evaluation of a novel flu vaccination campaign among health personnel for the 2011-2012 season

El objetivo del trabajo ha sido evaluar el programa de vacunación antigripal en personal sanitario en la temporada 2011-2012. La campaña incluyo actuaciones novedosas (tríptico informativo, recomendación de utilizar mascarilla en no vacunados, cartas de agradecimiento, etc.). Se comparó la cobertura y las características de los profesionales vacunados con la de la temporada previa con la prueba de la Ji cuadrado. La cobertura vacunal en la temporada 2011-2012, fue del 26,5%, frente al 24,5% del 2010-2011 (p=0,052). La mejora encontrada en la cobertura vacunal está en el límite de la significación estadística pero sigue siendo muy baja. Para mejorar las bajas coberturas vacunales, habría que plantearse otro tipo de estrategias, tales como políticas de incentivos o de obligatoriedad

The objective was to evaluate the healthcare personnel seasonal influenza immunization program in the 2011-2012 flu season. The campaign included several innovative actions (informational brochure, recommendations for unvaccinated staff to wear a mask, acknowledgement letters, etc). Coverage and characteristics of the health personnel were compared with the previous season using the chi-square test. Vaccination coverage for the 2011-12 flu season was 26.5%, compared to 24.5% achieved in 2010-2011 (p=0.052). The improvement in vaccination coverage approached statistical significance but remains very low. To improve these low vaccination levels, we recommend developing other strategies, such as incentive policies or making vaccination mandatory

[Evaluation of a novel flu vaccination campaign among health personnel for the 2011-2012 season]. / Evaluación de una novedosa campaña de vacunación de la gripe en personal sanitario en la temporada 2011-2012.

The objective was to evaluate the healthcare personnel seasonal influenza immunization program in the 2011-2012 flu season. The campaign included several innovative actions (informational brochure, recommendations for unvaccinated staff to wear a mask, acknowledgement letters, etc). Coverage and characteristics of the health personnel were compared with the previous season using the chi-square test. Vaccination coverage for the 2011-12 flu season was 26.5%, compared to 24.5% achieved in 2010-2011 (p=0.052). The improvement in vaccination coverage approached statistical significance but remains very low. To improve these low vaccination levels, we recommend developing other strategies, such as incentive policies or making vaccination mandatory.

El objetivo del trabajo ha sido evaluar el programa de vacunación antigripal en personal sanitario en la temporada 2011-2012. La campaña incluyo actuaciones novedosas (tríptico informativo, recomendación de utilizar mascarilla en no vacunados, cartas de agradecimiento, etc.). Se comparó la cobertura y las características de los profesionales vacunados con la de la temporada previa con la prueba de la Ji cuadrado. La cobertura vacunal en la temporada 2011-2012, fue del 26,5%, frente al 24,5% del 2010-2011 (p=0,052). La mejora encontrada en la cobertura vacunal está en el límite de la significación estadística pero sigue siendo muy baja. Para mejorar las bajas coberturas vacunales, habría que plantearse otro tipo de estrategias, tales como políticas de incentivos o de obligatoriedad.