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BMC Infectious Diseases

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Open Access 01-12-2021 | Pneumococcus | Research article

Predicting Oral Beta-lactam susceptibilities against Streptococcus pneumoniae

Authors: Mark E. Murphy, Eleanor Powell, Joshua Courter, Joel E. Mortensen

Published in: BMC Infectious Diseases | Issue 1/2021

Abstract

Background

Oral beta-lactam antimicrobials are not routinely tested against Streptococcus pneumoniae due to presumed susceptibility based upon penicillin minimum inhibitory concentration (MIC) testing. Currently, Clinical and Laboratory Standards Institute provides comments to use penicillin MIC ≤0.06 to predict oral cephalosporin susceptibility. However, no guidance is provided when cefotaxime MIC is known, leading to uncertainty with interpretation. The purpose of this study was to evaluate cefotaxime and penicillin MICs and their respective correlation to oral beta-lactam categorical susceptibility patterns.

Methods

249 S. pneumoniae isolates were identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-ToF) and then tested by broth microdilution method to penicillin, cefotaxime, amoxicillin, cefdinir, cefpodoxime, and cefuroxime.

Results

Using Clinical and Laboratory Standards Institute (CLSI) non-meningitis breakpoints for cefotaxime, 240/249 isolates were classified as susceptible. Of the cefotaxime susceptible isolates, 23% of the isolates are misrepresented as cefdinir susceptible. Amoxicillin correlated well with penicillin MIC breakpoints with only 1 discordant isolate out of 249.

Conclusion

The correlation between amoxicillin and penicillin creates a very reliable predictor to determine categorical susceptibility. However oral cephalosporins were not well predicted by either penicillin or cefotaxime leading to the possible risk of treatment failures. Caution should be used when transitioning to oral cephalosporins in cefotaxime susceptible isolates, especially with higher cefotaxime MICs.

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Title: Predicting Oral Beta-lactam susceptibilities against Streptococcus pneumoniae
Authors: Mark E. Murphy
Eleanor Powell
Joshua Courter
Joel E. Mortensen
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Pneumococcus
Meningitis
Cefpodoxime
Cefuroxime
Amoxicillin
Penicillins
Cefotaxime
Cephalosporin Antibiotic
Published in: BMC Infectious Diseases / Issue 1/2021
Electronic ISSN: 1471-2334
DOI: https://doi.org/10.1186/s12879-021-06341-y

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