August 17, 2010 – ASM Submits Comments on “Multidrug-resistant (MDR), extensively drug-resistant (XDR) and pandrug-resistant (PDR) bacteria in healthcare settings. Expert proposal for a standardized international terminology."

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Organisation

Section of document (Introduction, Background, etc)

Page and line number

Comment and rationale

Proposed Change

American Society for Microbiology (ASM)

Purpose

Page 3, lines 21-23

It would be helpful to clinicians to add a statement that the definitions could be used by clinical specialists for particular applications after review and discussion of this document with pertinent colleagues at their institution.

ASM recommends adding language from p. 8, lines 17-19 to this section, i.e., “after review and discussion of this document with pertinent colleagues in institutions, the definitions could be used by specialists in clinical, reference and public health microbiology laboratories that perform in vitro antimicrobial susceptibility testing and wish to identify MDR, XDR and PDR.”

American Society for Microbiology (ASM)

Defining antimicrobial categories and antimicrobial agents to be tested for each organism or organism group

Page 9, lines 6-10, (c)

ASM concurs with the exclusion of penicillin from the S. aureus list because of widespread acquired resistance; however, penicillin is the drug of choice for S. aureus infections if the organism is susceptible and continues to be tested in many laboratories.

ASM recommends changing (c) to either delete the “infrequently tested” phrase; i.e., “...(c.) the organism exhibits widespread acquired resistance to the agent (e.g. penicillin for S. aureus)” or delete the “infrequently tested” phrase AND include “(d)” which states “...(d.) the agent is infrequently tested.”

 

American Society for Microbiology

(ASM)

Applicability of MDR, PDR, XDR Definitions

Page 12, lines 13-15

Having the necessary software without sophisticated computer programmers that can make these labels fit certain antibiotic profiles, will be very difficult for some laboratories.

 

ASM recommends that the document should more clearly indicate that some laboratories may have difficulty with this task, unless they have the appropriate technological staff available to assist.  ASM also recommends adding that the designations of MDR, PDR, and XDR might be included in the microbiology report if information technology at the institution allows and if infectious disease colleagues agree.

American Society for Microbiology

(ASM)

Tables

Pages 15-20

The definitions for XDR and PDR rely on testing all antimicrobial categories.  Clinical microbiology laboratories may or may not be able to test all of the antibiotics necessary to define an organism as XDR or PDR.  This may limit the use of these definitions for surveillance.

Examples of antibiotics that may not be routinely tested for include the following:

 

Staph aureus

Fusidic acid

Fosfomycin

Chloramphenicol

 

Enterococcus

Tigecycline

Tetracyclines

 

Enterobacteriaceae

Cephamycins

Colistin

Fosfomycin

Chloramphenicol

 

Pseudomonas

Fosfomycin

Polymyxins

 

Acinetobacter

Polymyxins

 

ASM recommends that the document note the limitation of the use of these definitions for surveillance purposes.

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