Current Concepts in Laboratory Testing to Guide Antimicrobial Therapy

Mayo Clin Proc. 2012 Mar;87(3):290-308. doi: 10.1016/j.mayocp.2012.01.007.

Abstract

Antimicrobial susceptibility testing (AST) is indicated for pathogens contributing to an infectious process that warrants antimicrobial therapy if susceptibility to antimicrobials cannot be predicted reliably based on knowledge of their identity. Such tests are most frequently used when the etiologic agents are members of species capable of demonstrating resistance to commonly prescribed antibiotics. Some organisms have predictable susceptibility to antimicrobial agents (ie, Streptococcus pyogenes to penicillin), and empirical therapy for these organisms is typically used. Therefore, AST for such pathogens is seldom required or performed. In addition, AST is valuable in evaluating the activity of new and experimental compounds and investigating the epidemiology of antimicrobial resistant pathogens. Several laboratory methods are available to characterize the in vitro susceptibility of bacteria to antimicrobial agents. When the nature of the infection is unclear and the culture yields mixed growth or usual microbiota (wherein the isolates usually bear little relationship to the actual infectious process), AST is usually unnecessary and results may, in fact, be dangerously misleading. Phenotypic methods for detection of specific antimicrobial resistance mechanisms are increasingly being used to complement AST (ie, inducible clindamycin resistance among several gram-positive bacteria) and to provide clinicians with preliminary direction for antibiotic selection pending results generated from standardized AST (ie, β-lactamase tests). In addition, molecular methods are being developed and incorporated by microbiology laboratories into resistance detection algorithms for rapid, sensitive assessment of carriage states of epidemiologically and clinically important pathogens, often directly from clinical specimens (ie, presence of vancomycin-resistant enterococci in fecal specimens).

Publication types

  • Review

MeSH terms

  • Actinobacteria / drug effects
  • Anti-Infective Agents / therapeutic use*
  • Antifungal Agents / therapeutic use
  • Bacteria, Anaerobic / drug effects
  • Bacterial Infections / drug therapy*
  • Bacterial Infections / microbiology
  • Disk Diffusion Antimicrobial Tests
  • Drug Resistance, Bacterial
  • Drug Resistance, Fungal
  • Enterobacteriaceae / drug effects
  • Enterococcus / drug effects
  • Humans
  • Methicillin-Resistant Staphylococcus aureus / drug effects
  • Microbial Sensitivity Tests*
  • Mycobacterium / drug effects
  • Nocardia / drug effects

Substances

  • Anti-Infective Agents
  • Antifungal Agents