Multicentre evaluation of the VITEK 2 Advanced Expert System for interpretive reading of antimicrobial resistance tests

D. M. Livermore, M. Struelens, J. Amorim, F. Baquero, J. Bille, R. Canton, S. Henning, S. Gatermann, A. Marchese, H. Mittermayer, C. Nonhoff, K. J. Oakton, F. Praplan, H. Ramos, G. C. Schito, J. Van Eldere, J. Verhaegen, J. Verhoef, M. R. Visser

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

Interpretive reading analyses the complete resistance profiles of bacteria to multiple antibiotics and infers the resistance mechanisms present; it aids therapeutic choice and enhances surveillance data. We evaluated the Advanced Expert System (AES), which interprets MICs generated by the VITEK 2. Ten European laboratories tested 42 reference strains and 76-106 of their own strains, representing important resistance genotypes. Interpretive reading by the VITEK 2 AES achieved full agreement with genotype data for 88-89% of strains, with the correct mechanism identified as one of two possibilities for a further 5-6%. Mechanisms inferred with ≥90% agreement with reference data included methicillin resistance in staphylococci, glycopeptide resistance in enterococci, quinolone resistance in staphylococci and Enterobacteriaceae, AAC(6′)-APH(2″)-mediated aminoglycoside resistance in Gram-positive cocci, erm-mediated macrolide resistance in pneumococci, extended-spectrum β-lactamases (ESBLs) in Enterobacteriaceae and Pseudomonas aeruginosa, and acquired penicillinases in Enterobacteriaceae. VanA, VanB and VanC phenotypes of enterococci were distinguished reliably, and ESBL production was accurately inferred in AmpC-inducible species as well as Escherichia coli and Klebsiella spp. Mechanisms identified, but only as possibilities among several, included IRT-type β-lactamases and individual aminoglycoside-modifying enzymes in Enterobacteriaceae. Most disagreements with reference data concerned pneumococci found to have high-level penicillin resistance by the VITEK 2 AES but previously determined, phenotypically, to have intermediate resistance. When ESBL production was inferred in E. coli and klebsiellae, the VITEK 2 AES edited susceptible results for cephalosporins (except cefoxitin) to resistant; when an acquired penicillinase was inferred in Enterobacteriaceae, piperacillin results were edited to resistant; and when staphylococci were found methicillin resistant, resistance was reported for all β-lactams. Further editing may be desirable (e.g. of cephalosporin results for salmonellas inferred to have ESBLs).

Original languageEnglish
Pages (from-to)289-300
Number of pages12
JournalJournal of Antimicrobial Chemotherapy
Volume49
Issue number2
Publication statusPublished - 2002

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Expert Systems
Enterobacteriaceae
Reading
Methicillin Resistance
Staphylococcus
Penicillinase
Enterococcus
Aminoglycosides
Cephalosporins
Streptococcus pneumoniae
Genotype
Escherichia coli
Penicillin Resistance
Cefoxitin
Lactams
Gram-Positive Cocci
Piperacillin
Klebsiella
Glycopeptides
Quinolones

ASJC Scopus subject areas

  • Pharmacology
  • Microbiology

Cite this

Livermore, D. M., Struelens, M., Amorim, J., Baquero, F., Bille, J., Canton, R., ... Visser, M. R. (2002). Multicentre evaluation of the VITEK 2 Advanced Expert System for interpretive reading of antimicrobial resistance tests. Journal of Antimicrobial Chemotherapy, 49(2), 289-300.

Multicentre evaluation of the VITEK 2 Advanced Expert System for interpretive reading of antimicrobial resistance tests. / Livermore, D. M.; Struelens, M.; Amorim, J.; Baquero, F.; Bille, J.; Canton, R.; Henning, S.; Gatermann, S.; Marchese, A.; Mittermayer, H.; Nonhoff, C.; Oakton, K. J.; Praplan, F.; Ramos, H.; Schito, G. C.; Van Eldere, J.; Verhaegen, J.; Verhoef, J.; Visser, M. R.

In: Journal of Antimicrobial Chemotherapy, Vol. 49, No. 2, 2002, p. 289-300.

Research output: Contribution to journalArticle

Livermore, DM, Struelens, M, Amorim, J, Baquero, F, Bille, J, Canton, R, Henning, S, Gatermann, S, Marchese, A, Mittermayer, H, Nonhoff, C, Oakton, KJ, Praplan, F, Ramos, H, Schito, GC, Van Eldere, J, Verhaegen, J, Verhoef, J & Visser, MR 2002, 'Multicentre evaluation of the VITEK 2 Advanced Expert System for interpretive reading of antimicrobial resistance tests', Journal of Antimicrobial Chemotherapy, vol. 49, no. 2, pp. 289-300.
Livermore, D. M. ; Struelens, M. ; Amorim, J. ; Baquero, F. ; Bille, J. ; Canton, R. ; Henning, S. ; Gatermann, S. ; Marchese, A. ; Mittermayer, H. ; Nonhoff, C. ; Oakton, K. J. ; Praplan, F. ; Ramos, H. ; Schito, G. C. ; Van Eldere, J. ; Verhaegen, J. ; Verhoef, J. ; Visser, M. R. / Multicentre evaluation of the VITEK 2 Advanced Expert System for interpretive reading of antimicrobial resistance tests. In: Journal of Antimicrobial Chemotherapy. 2002 ; Vol. 49, No. 2. pp. 289-300.
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AU - Bille, J.

AU - Canton, R.

AU - Henning, S.

AU - Gatermann, S.

AU - Marchese, A.

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AU - Oakton, K. J.

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AU - Ramos, H.

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N2 - Interpretive reading analyses the complete resistance profiles of bacteria to multiple antibiotics and infers the resistance mechanisms present; it aids therapeutic choice and enhances surveillance data. We evaluated the Advanced Expert System (AES), which interprets MICs generated by the VITEK 2. Ten European laboratories tested 42 reference strains and 76-106 of their own strains, representing important resistance genotypes. Interpretive reading by the VITEK 2 AES achieved full agreement with genotype data for 88-89% of strains, with the correct mechanism identified as one of two possibilities for a further 5-6%. Mechanisms inferred with ≥90% agreement with reference data included methicillin resistance in staphylococci, glycopeptide resistance in enterococci, quinolone resistance in staphylococci and Enterobacteriaceae, AAC(6′)-APH(2″)-mediated aminoglycoside resistance in Gram-positive cocci, erm-mediated macrolide resistance in pneumococci, extended-spectrum β-lactamases (ESBLs) in Enterobacteriaceae and Pseudomonas aeruginosa, and acquired penicillinases in Enterobacteriaceae. VanA, VanB and VanC phenotypes of enterococci were distinguished reliably, and ESBL production was accurately inferred in AmpC-inducible species as well as Escherichia coli and Klebsiella spp. Mechanisms identified, but only as possibilities among several, included IRT-type β-lactamases and individual aminoglycoside-modifying enzymes in Enterobacteriaceae. Most disagreements with reference data concerned pneumococci found to have high-level penicillin resistance by the VITEK 2 AES but previously determined, phenotypically, to have intermediate resistance. When ESBL production was inferred in E. coli and klebsiellae, the VITEK 2 AES edited susceptible results for cephalosporins (except cefoxitin) to resistant; when an acquired penicillinase was inferred in Enterobacteriaceae, piperacillin results were edited to resistant; and when staphylococci were found methicillin resistant, resistance was reported for all β-lactams. Further editing may be desirable (e.g. of cephalosporin results for salmonellas inferred to have ESBLs).

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