MIC and MBC in the evaluation of the clinical relevance of beta-lactams produced in Lubumbashi in the DR of Congo
DOI:
https://doi.org/10.63456/k74x8e32Keywords:
CMI, CMB, Evaluation, Clinical relevance , Beta-lactamsAbstract
Faced with the recurring problems of bacterial resistance to antibiotics and the ineffectiveness of medical therapies used to cure patients with bacterial infections, it is urgent not only to think about the development of new therapeutic strategies to guarantee the future, but above all, for the present to set up mechanisms allowing a judicious selection of antibiotics according to various parameters, in particular microbiological: The minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC).
Methodology
The determination of the MIC and MBC was carried out according to the recommendations of the Clinical & Laboratory Standards Institute (CLSI). The bacterial population consisted of strains typed Staphylococcus aureus (ATCC 25923) and Escherichia coli (ATCC 25922) conditioned under an adjusted turbidity of 0.5 McFarland. We used Mueller Hinton broth and Mueller Hinton agar for MIC and determination of inhibition diameters and trypcase soy agar for subculture of the MBC determination. And a MBC/MIC ratio was calculated for determination of the potency of antibiotics.
Results
After determination of the MIC and MBC values, calculation of the MBC/MIC ratio, it appears that only Meropenem has a bactericidal action on the two ATCC bacteria and for the antibiotics produced by the two firms; Ceftriaxone demonstrated a bactericidal action on Staphylococcus aureus for both firms. For the rest, the antibiotics demonstrated essentially bacteriostatic activity for both bacteria and for both firms.
Conclusion
In this study, their measurement allowed to evaluate the quality of some antibiotics manufactured by two local firms by specifying the power of their activity on the reference strains. These results and practices are recommended in the daily practice of microbiology laboratories as an element of quality control of the routine antibiogram technique. This practice can be extended to the search for MIC and CMB on the serum of patients in order to ensure the good crossing by the antibiotic of the different biological barriers and thus guarantee the effectiveness of the treatment, particularly in intensive care units.
References
https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance , accessed 04-January-2025
Antimicrobial Resistance Collaborators. (2022). Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet; 399(10325): P629-655. DOI: https://doi.org/10.1016/S0140-6736(21)02724-0
Chinemerem Nwobodo D, Ugwu MC, Oliseloke Anie C, Al-Ouqaili MTS, Chinedu Ikem J, Victor Chigozie U, Saki M. Antibiotic resistance: The challenges and some emerging strategies for tackling a global threat. J Clin Lab Anal. 2022 Sep;36(9):e24655. doi:10.1002/jcla.24655. Epub 2022 Aug 10. PMID: 35949048; PMCID: PMC9459344.
Tanvir Mahtab Uddin, Arka Jyoti Chakraborty, Ameer Khusro, BM Redwan Matin Zidan, Saikat Mitra, Talha Bin Emran, Kuldeep Dhama, Md. Kamal Hossain Ripon, Márió Gajdács, Muhammad Umar Khayam Sahibzada, Md. Jamal Hossain, Niranjan Koirala,Antibiotic resistance in microbes: History, mechanisms, therapeutic strategies and future prospects,Journal of Infection and Public Health,Volume 14, Issue 12,2021,Pages 1750-1766, ISSN 876-0341, https://doi.org/10.1016/j.jiph.2021.10.020.(https://www.sciencedirect.com/science/article/pii/S1876034121003403)
Sirwan Khalid Ahmed, Safin Hussein, Karzan Qurbani, Radhwan Hussein Ibrahim, Abdulmalik Fareeq, Kochr Ali Mahmood, Mona Gamal Mohamed,Antimicrobial resistance: Impacts, challenges, and future prospects,Journal of Medicine, Surgery, and Public Health,Volume 2,2024,100081,ISSN 2949-916X,https://doi.org/10.1016/j.glmedi.2024.100081.( https://www.sciencedirect.com/science/article/pii/S2949916X24000343 )
Muteeb G, Rehman MT, Shahwan M, Aatif M. Origin of Antibiotics and Antibiotic Resistance, and Their Impacts on Drug Development: A Narrative Review. Pharmaceuticals (Basel). 2023 Nov 15;16(11):1615. doi:10.3390/ph16111615. PMID: 38004480; PMCID: PMC10675245.
Kadeřábková, N., Mahmood, AJS & Mavridou, DAI Antibiotic susceptibility testing using minimum inhibitory concentration (MIC) assays. npj Antimicrob Resist 2, 37 (2024). https://doi.org/10.1038/s44259-024-00051-6
Magréault, S., Jauréguy, F., Carbonnelle, E., & Zahar, J.-R. (2022). When and How to Use MIC in Clinical Practice? Antibiotics, 11(12), 1748. https://doi.org/10.3390/antibiotics11121748
Kowalska-Krochmal B, Dudek-Wicher R. The Minimum Inhibitory Concentration of Antibiotics: Methods, Interpretation, Clinical Relevance. Pathogens. 2021 Feb 4;10(2):165. doi:10.3390/pathogens10020165. PMID: 33557078; PMCID: PMC7913839.
InternationalStandard. ISO 20776-1. Susceptibility Testing of Infectious Agents and Evaluation of Performance of Antimicrobial Susceptibility Test Devices—Part 1: Broth Micro-Dilution Reference Method for Testing the In Vitro Activity of Antimicrobial AGENTS Against Rapidly Growing Aerobic Bacteria Involved in Infectious Diseases. 2nd ed. International Organization for Standardization; Geneva, Switzerland: 2019. [Google Scholar]
Andrews JM Determination of minimum inhibitory concentrations. J. Antimicrob. Chemother. 2001;48(SA Suppl.):5–16. doi:10.1093/jac/48.suppl_1.5. [DOI] [PubMed] [Google Scholar]
European Committee for Antimicrobial Susceptibility Testing (EUCAST) of the European Society of Clinical Microbiology and Infectious Diseases EUCAST Definitive Document E.DEF 3.1, June 2000, Determination of minimum inhibitory concentrations (MICs) of antibacterial agents by agar dilution. Clin. Microbiol. Infect. 2000 Jun 20;6:509–515. doi: 10.1046/j.1469-0691.2000.00142.x. [DOI] [PubMed] [Google Scholar]
https://www.sfmmicrobiologie.org/wpcontent/uploads/2019/05/CASFM2019_V2.0_MAI.pdf
The European Committee on Antimicrobial Susceptibility Testing Determination of minimum inhibitory concentrations (MICs) of antibacterial agents by broth microdilution. EUCAST Discussion Document E. Def 2003, 5.1. Clin. Microbiol. Infect. 2003;9:1–7. doi: 10.1046/j.1469-0691.2003.00790.x. [DOI] [Google Scholar
Wiegand I., Hilpert K., Hancock REW Agar and broth dilution methods to determine the minimal inhibitory concentration (MIC) of antimicrobial substances. Nat. Protocol. 2008;3:163–175. doi: 10.1038/nprot.2007.521. [DOI] [PubMed] [Google Scholar]
The European Committee on Antimicrobial Susceptibility Testing Antimicrobial Susceptibility Testing. EUCAST Disk Diffusion Method. Version 8.0. [(accessed on 11 November 2020)];2020 Available online:https://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Disk_test_documents/2020_manuals/Manual_v_8.0_EUCAST_Disk_Test_2020,pdf
The European Committee on Antimicrobial Susceptibility Testing Clinical Breakpoints—Bacteria (v 10.0) [(accessed on 10 November 2020)];2020 Available online: https://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Breakpoint_tables/v_10.0_Breakpoint_Tables.pdf.
Clinical and Laboratory Standards Institute (CLSI) Performance Standards for Antimicrobial Susceptibility Testing. 28th ed. Clinical and Laboratory Standards Institute; Wayne, PA, USA: 2018. CLSI Supplement M100. [Print] [Electronic] [Google Scholar]
The European Committee on Antimicrobial Susceptibility Testing Routine and Extended Internal Quality Control for MIC Determination and Disk Diffusion as Recommended by EUCAST. Version 10.0. [(accessed on 11 November 2020)];2020 Available online: https://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/QC/v_10.0_EUCAST_QC_tables_routine_and_extended_QC.pdf
Murray CJ, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399(10325):629–655. doi: 10.1016/S0140-6736(21)02724-0. [DOI] [PMC free article] [PubMed] [Google Scholar][Ref list]
Dixit A., et al. Antimicrobial resistance: progress in the decade since emergence of New Delhi metallo-β-lactamase in India. Indian journal of community medicine: official publication of Indian Association of Preventive Social Medicine. 2019;44(1):4. doi: 10.4103/ijcm.IJCM_217_18. [DOI] [PMC free article] [PubMed] [Google Scholar][Ref list]
Tadesse, BT, Ashley, EA, Ongarello, S. et al. Antimicrobial resistance in Africa: a systematic review. BMC Infect Dis 17, 616 (2017). https://doi.org/10.1186/s12879-017-2713-1
Chapuma C, Twabi HH, Monk EJM, Jafali J, Weeks A, Beales E, Kulapani D, Selemani A, Nliwasa M, Gadama L, Nyirenda T, Msefula C, Dunlop C, Lissauer S, Feasey N, Van der Veer C, Lissauer D. The aetiology and antimicrobial resistance of bacterial maternal infections in Sub-Saharan Africa-a systematic review and meta-analysis. BMC Infect Dis. 2024 Sep 14;24(1):978. doi:10.1186/s12879-024-09855-3. PMID: 39277737; PMCID: PMC11401422.
Kowalski M, Minka Obama B, Catho G, Dewez JE, Merglen A, Ruef M, Andrey DO, Hassoun-Kheir N, de Kraker MEA, Combescure C, Emonet S, Galetto-Lacour A, Wagner N. Antimicrobial resistance in Enterobacterales infections among children in sub-Saharan Africa: a systematic review and meta-analysis. EClinicalMedicine. 2024 Mar 8;70:102512. doi: 10.1016/j.eclinm.2024.102512. PMID: 38495519; PMCID: PMC10940950.
Ruef M, Emonet S, Merglen A, Dewez JE, Obama BM, Catho G, Andrey DO, Kowalski M, Harbarth S, Combescure C, Wagner N, Galetto-Lacour A. Carriage of third-generation cephalosporin-resistant and carbapenem-resistant Enterobacterales among children in sub-Saharan Africa: a systematic review and meta-analysis. EClinicalMedicine. 2024 Mar 11;70:102508. doi: 10.1016/j.eclinm.2024.102508. PMID: 38500839; PMCID: PMC10945212.
The European Committee on Antimicrobial Susceptibility Testing EUCAST Reading Guide for Broth Microdilution. Version 2.0. [(accessed on 12 November 2020)];2020 Available online: https://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Disk_test_documents/2020_manuals/Reading_guide_BMD_v_2.0_2020,pdf.
Elshikh M., Ahmed S., Funston S., Dunlop P., McGaw M., Marchant R., Banat IM Resazurin-based 96-well plate microdilution method for the determination of minimum inhibitory concentration of biosurfactants. Biotechnology. Lett. 2016;38:1015–1019. doi:10.1007/s10529-016-2079-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
O'Brien J, Wilson I, Orton T, Pognan F. Investigation of the Alamar Blue (resazurin) fluorescent dye for the assessment of mammalian cell cytotoxicity. Eur J Biochem. 2000;267:5421–5426. doi: 10.1046/j.1432-1327.2000.01606.x. [DOI] [PubMed] [Google Scholar][Ref list]
CSLI. Performance Standard for Antimicrobial Susceptibility Testing. 34 th Ed.CSLI Supplement M100/ Clinical and Labioratory Standard Institute, 2024
French Society of Microbiology; DETERMINATION OF SUSCEPTIBILITY TO ANTIBIOTICS. In: CA-SFM / EUCAST: French Society of Microbiology Ed; 2024: p.22-26.
Karakonstantis, S.; Rousaki, M.; Kritsotakis, E. I. Cefiderocol: Systematic Review of Mechanisms of Resistance, Heteroresistance and In Vivo Emergence of Resistance. Antibiotics 2022, 11, 723. [Google Scholar] [CrossRef] [PubMed]
Falagas ME, Tansarli GS, Rafailidis PI, Kapaskelis A, Vardakas KZ. Impact of antibiotic MIC on infection outcome in patients with susceptible Gram-negative bacteria: a systematic review and meta-analysis. Antimicrob Agents Chemother. 2012 Aug;56(8):4214-22. doi: 10.1128/AAC.00663-12. Epub 2012 May 21. PMID: 22615292; PMCID: PMC3421594.
Gajic I, Kabic J, Kekic D, Jovicevic M, Milenkovic M, Mitic Culafic D, Trudic A, Ranin L, Opavski N. Antimicrobial Susceptibility Testing: A Comprehensive Review of Currently Used Methods. Antibiotics (Basel). 2022 Mar 23;11(4):427. doi: 10.3390/antibiotics11040427. PMID: 35453179; PMCID: PMC9024665.
Johan Bengtsson-Palme, Anna Abramova, Thomas U. Berendonk, Luis Pedro Coelho, Sofia K. Forslund, Rémi Gschwind, Annamari Heikinheimo, Víctor Hugo Jarquín-Díaz, Ayaz Ali Khan, Uli Klümper, Ulrike Löber, Marmar Nekoro, Adriana D. Osińska, Svetlana Ugarcina Perovic, Tarja Pitkänen, Ernst Kristian Rødland, Etienne Ruppé, Yngvild Wasteson, Astrid Louise Wester, Rabaab Zahra,Towards monitoring of antimicrobial resistance in the environment: For what reasons, how to implement it, and what are the dataneeds?,EnvironmentInternational,Volume178,2023,108089,ISSN01604120,https://doi.org/10.1016/j.envint.2023.108089.(https://www.sciencedirect.com/science/article/pii/S0160412023003628)
Magréault S, Jauréguy F, Carbonnelle E, Zahar JR. When and How to Use MIC in Clinical Practice? Antibiotics (Basel). 2022 Dec 3;11(12):1748. doi: 10.3390/antibiotics11121748. PMID: 36551405; PMCID: PMC9774413.
CA-SFM/EUCAST . Antibiogram Committee of the French Society of Microbiology. French Society of Microbiology; Paris, France: 2022. Haemophilus Spp. pp. 105–110. V.1.0 May 2022. [Google Scholar][Ref list]
Peterson LR Antibiotic Policy and Prescribing Strategies for Therapy of Extended-Spectrum β -Lactamase-Producing Enterobacteriaceae: The Role of Piperacillin–Tazobactam. Clin. Microbiol. Infect. 2008;14:181–184. doi: 10.1111/j.1469-0691.2007.01864.x. [ DOI ] [ PubMed ] [ Google Scholar ]
Karaiskos I., Giamarellou H. Carbapenem-Sparing Strategies for ESBL Producers: When and How. Antibiotics. 2020;9:61. doi: 10.3390/antibiotics9020061. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
Perez F., Bonomo RA Can We Really Use SS-Lactam/ß-Lactam Inhibitor Combinations for the Treatment of Infections Caused by Extended-Spectrum ß-Lactamase-Producing Bacteria? Clin. Infect. Say. 2012;54:175–177. doi: 10.1093/cid/cir793. [ DOI ] [ PubMed ] [ Google Scholar ]
Rodriguez-Bano J., Navarro MD, Retamar P., Picon E., Pascual A. The Extended-Spectrum Beta-Lactamases-Red Espanola de Investigacion en Patologia Infecciosa/Grupo de Estudio de Infeccion Hospitalaria Group -Lactam/ -Lactam Inhibitor Combinations for the Treatment of Bacteremia Due to Extended-Spectrum -Lactamase-Producing Escherichia Coli: A Post Hoc Analysis of Prospective Cohorts. Clin. Infect. Say. 2012;54:167–174. doi: 10.1093/cid/cir790. [ DOI ] [ PubMed ] [ Google Scholar ]
Retamar P., López-Cerero L., Muniain MA, Pascual Á., Rodríguez-Baño J. The ESBL-REIPI/GEIH Group Impact of the MIC of Piperacillin-Tazobactam on the Outcome of Patients with Bacteremia Due to Extended-Spectrum- β -Lactamase-Producing Escherichia Coli. Antimicrob. Agents Chemother. 2013;57:3402–3404. doi: 10.1128/AAC.00135-13. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
Abdul-Aziz MH, Alffenaar J.-WC, Bassetti M., Bracht H., Dimopoulos G., Marriott D., Neely MN, Paiva J.-A., Pea F., Sjovall F., et al. Antimicrobial Therapeutic Drug Monitoring in Critically Ill Adult Patients: A Position Paper. Intensive Care Med. 2020;46:1127–1153. doi:10.1007/s00134-020-06050-1. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
IK Minichmayr, E. Dreesen, M. Centanni, Z. Wang, Y. Hoffert, LE Friberg, SG Wicha,Model-informed precision dosing: State of the art and future perspectives,Advanced Drug Delivery Reviews,Volume 215,2024,115421,ISSN 0169-409X,https://doi.org/10.1016/j.addr.2024.115421.( https://www.sciencedirect.com/science/article/pii/S0169409X24002436 )
CRyPTIC Consortium. Epidemiological cut-off values for a 96-well broth microdilution plate for high-throughput research antibiotic susceptibility testing of M. tuberculosis. Eur Respir J. 2022 Oct 13;60(4):2200239. doi:10.1183/13993003.00239-2022. PMID: 35301246; PMCID: PMC9556810.
Johan W Mouton, Anouk E Muller, Rafael Canton, Christian G Giske, Gunnar Kahlmeter, John Turnidge, MIC-based dose adjustment: facts and fables, Journal of Antimicrobial Chemotherapy, Volume 73, Issue 3, March 2018, Pages 564–568, https://doi.org/10.1093/jac/dkx427
Eckburg PB, Lister T, Walpole S, Keutzer T, Utley L, Tomayko J, Kopp E, Farinola N, Coleman S. Safety, Tolerability, Pharmacokinetics, and Drug Interaction Potential of SPR741, an Intravenous Potentiator, after Single and Multiple Ascending Doses and When Combined with β-Lactam Antibiotics in Healthy Subjects. Antimicrob Agents Chemother. 2019 Sep;63(9) [PMC free article] [PubMed] [Reference list]
Angela Ishak, Nikolaos Mazonakis, Nikolaos Spernovasilis, Karolina Akinosoglou, Constantinos Tsioutis, Bactericidal versus bacteriostatic antibacterials: clinical significance, differences and synergistic potential in clinical practice, Journal of Antimicrobial Chemotherapy, Volume 80, Issue 1, January 2025, Pages 1–17, https://doi.org/10.1093/jac/dkae380
Jeong JY, Jung IG, Yum SH, Hwang YJ. In Vitro Synergistic Inhibitory Effects of Plant Extract Combinations on Bacterial Growth of Methicillin-Resistant Staphylococcus aureus. Pharmaceuticals. 2023; 16(10):1491. https://doi.org/10.3390/ph16101491
Pai Mangalore R, Peel TN, Udy AA, Peleg AY. The clinical application of beta-lactam antibiotic therapeutic drug monitoring in the critical care setting. J Antimicrob Chemother. 2023 Oct 3;78(10):2395-2405. doi:10.1093/jac/dkad223. PMID: 37466209; PMCID: PMC10566322.
Oliveira M, Antunes W, Mota S, Madureira-Carvalho Á, Dinis-Oliveira RJ, Dias da Silva D. An Overview of the Recent Advances in Antimicrobial Resistance. Microorganisms. 2024; 12(9):1920. https://doi.org/10.3390/microorganisms12091920
Mounira Mesbah, Tahar Douadi, Farida Sahli, Saifi Issaadi, Soraya Boukazoula, Salah Chafaa,Synthesis, characterization, spectroscopic studies and antimicrobial activity of three new Schiff bases derived from Heterocyclic moiety,Journal of Molecular Structure,Volume 1151,2018,Pages 41-48,ISSN 0022-2860, https://doi.org/10.1016/j.molstruc.2017.08.098 .
Hoffman SJ, Caleo GM, Daulaire N, Elbe S, Matsoso P, Mossialos E, Rizvi Z, Røttingen JA. Strategies for achieving global collective action on antimicrobial resistance. Bull World Health Organ. 2015 Dec 1;93(12):867-76. doi: 10.2471/BLT.15.153171. Epub 2015 Oct 13. PMID: 26668439; PMCID: PMC4669731.
Tan R, Yu A, Liu Z, Liu Z, Jiang R, Wang X, Liu J, Gao J and Wang Forehead. Microbiol. 12:712886. doi: 10.3389/fmicb.2021.712886
Pataki, BA, Matamoros, S., van der Putten, BCL, Remondini, D., Giampieri, E., Aytan-Aktug, D., et al. (2020). Understanding and predicting ciprofloxacin minimum inhibitory concentration in Escherichia coli with machine learning. Sci. Rep. 10:15026. doi:10.1038/s41598-020-71693-5
Ronette Gehring, Jim E. Riviere,Limitations of MIC as the sole criterion in antimicrobial drug dosage regimen design: The need for full characterization of antimicrobial pharmacodynamic profile especially for drug-resistant organisms,The Veterinary Journal,Volume 198, Issue 1,2013,Pages 15-18,ISSN 1090-0233,https://doi.org/10.1016/j.tvjl.2013.07.034.
Pasquau-Liaño J, Sadyrbaeva-Dolgova S, Sequera-Arquellada S, García-Vallecillos C, Hidalgo-Tenorio C. Timing of antibiotic therapy: when and how to start, taper, and stop antibiotics. Suggestions from an established antimicrobial stewardship program. Rev Esp Quimioter. 2022 Oct;35 Suppl 3(Suppl 3):102–107. doi: 10.37201/req/s03.22.2022. Epub 2022 Oct 24. PMID: 36285869; PMCID: PMC9717451.
Mounyr Balouiri, Moulay Sadiki, Saad Koraichi Ibnsouda,Methods for in vitro evaluating antimicrobial activity: A review,Journal of Pharmaceutical Analysis,Volume 6, Issue 2, 2016,Pages 71-79,ISSN 2095-1779,https://doi.org/10.1016/j.jpha.2015.11.005.
Gjini E, Paupério FFS, Ganusov VV. Treatment timing shifts the benefits of short and long antibiotic treatment over infection. Evol Med Public Health. 2020 Nov 23;2020(1):249-263. doi:10.1093/emph/eoaa033. PMID: 33376597; PMCID: PMC7750949.
Onufrak NJ, Forrest A, Gonzalez D. Pharmacokinetic and Pharmacodynamic Principles of Anti-infective Dosing. Clin Ther. 2016 Sep;38(9):1930-47. doi: 10.1016/j.clinthera.2016.06.015. Epub 2016 Jul 20. PMID: 27449411; PMCID: PMC5039113.
Kadeřábková, N., Mahmood, AJS & Mavridou, DAI Antibiotic susceptibility testing using minimum inhibitory concentration (MIC) assays. npj Antimicrob Resist 2, 37 (2024). https://doi.org/10.1038/s44259-024-00051-6
Barnes VL, Heithoff DM, Mahan SP, House JK, Mahan MJ. Antimicrobial susceptibility testing to evaluate minimum inhibitory concentration values of clinically relevant antibiotics. STAR Protoc. 2023 Sep 15;4(3):102512. doi: 10.1016/j.xpro.2023.102512. Epub 2023 Aug 10. PMID: 37566547; PMCID: PMC10448204.
Wen, X., Gehring, R., Stallbaumer, A. et al. Limitations of MIC as sole metric of pharmacodynamic response across the range of antimicrobial susceptibilities within a single bacterial species. SciRep 6, 37907 (2016). https://doi.org/10.1038/srep37907
Dewachter L, Fauvart M, Michiels J. Bacterial Heterogeneity and Antibiotic Survival: Understanding and Combating Persistence and Heteroresistance. Mol Cell. 2019 Oct 17;76(2):255-267. doi: 10.1016/j.molcel.2019.09.028. PMID: 31626749.
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