Recommendations of the Spanish Antibiogram Committee (COESANT) for selecting antimicrobial agents and concentrations for in vitro susceptibility studies using automated systems / Recomendaciones del Comité Español del Antibiograma (COESANT) para la selección de antimicrobianos y sus concentraciones en el estudio in vitro de la sensibilidad con métodos automáticos

Automated antimicrobial susceptibility testing devices are widely implemented in clinical microbiology laboratories in Spain, mainly using EUCAST (European Committee on Antimicrobial Susceptibility Testing) breakpoints. In 2007, a group of experts published recommendations for including antimicrobial agents and selecting concentrations in these systems. Under the patronage of the Spanish Antibiogram Committee (Comité Español del Antibiograma, COESANT) and the Study Group on Mechanisms of Action and Resistance to Antimicrobial Agents (GEMARA) from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), and aligned with the Spanish National Plan against Antimicrobial Resistance (PRAN), a group of experts have updated this document. The main modifications from the previous version comprise the inclusion of new antimicrobial agents, adaptation of the ranges of concentrations to cover the EUCAST breakpoints and epidemiological cut-off values (ECOFFs), and the inference of new resistance mechanisms. This proposal should be considered by different manufacturers and users when designing new panels or cards. In addition, recommendations for selective reporting are also included. With this approach, the implementation of EUCAST breakpoints will be easier, increasing the quality of antimicrobial susceptibility testing data and their microbiological interpretation. It will also benefit epidemiological surveillance studies as well as the clinical use of antimicrobials aligned with antimicrobial stewardship programs

Los sistemas automáticos utilizados en el estudio de la sensibilidad a los antimicrobianos están introducidos en la mayoría de los laboratorios de Microbiología Clínica en España, utilizando principalmente los puntos de corte del European Committee on Antimicrobial Susceptibility Testing (EUCAST). En 2007, un grupo de expertos publicó unas recomendaciones para incluir antimicrobianos y seleccionar concentraciones en estos sistemas. Bajo el auspicio del Comité Español del Antibiograma (COESANT) y del Grupo de Estudio de los Mecanismos de Acción y Resistencia a los Antimicrobianos (GEMARA) de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC) y alineado con el Plan Nacional frente a la Resistencia a los Antibióticos (PRAN), un grupo de expertos ha actualizado dicho documento. Las principales modificaciones realizadas sobre la versión anterior comprenden la inclusión de nuevos agentes antimicrobianos, la adaptación de los rangos de concentraciones para cubrir los puntos de corte clínicos y los puntos de corte epidemiológicos (ECOFF) definidos por el EUCAST, y para la inferencia de nuevos mecanismos de resistencia. Esta propuesta debería ser considerada por los diferentes fabricantes y los usuarios cuando se diseñen nuevos paneles o tarjetas. Además, se incluyen recomendaciones para realizar informes selectivos. Con este enfoque, la implementación de los puntos de corte del EUCAST será más fácil, aumentando la calidad de los datos del antibiograma y su interpretación microbiológica. También será de utilidad para los estudios de vigilancia epidemiológica, así como para el uso clínico de los antimicrobianos, de acuerdo con los programas de optimización de uso de antimicrobianos (PROA)

Recommendations of the Spanish Antibiogram Committee (COESANT) for selecting antimicrobial agents and concentrations for in vitro susceptibility studies using automated systems.

Automated antimicrobial susceptibility testing devices are widely implemented in clinical microbiology laboratories in Spain, mainly using EUCAST (European Committee on Antimicrobial Susceptibility Testing) breakpoints. In 2007, a group of experts published recommendations for including antimicrobial agents and selecting concentrations in these systems. Under the patronage of the Spanish Antibiogram Committee (Comité Español del Antibiograma, COESANT) and the Study Group on Mechanisms of Action and Resistance to Antimicrobial Agents (GEMARA) from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), and aligned with the Spanish National Plan against Antimicrobial Resistance (PRAN), a group of experts have updated this document. The main modifications from the previous version comprise the inclusion of new antimicrobial agents, adaptation of the ranges of concentrations to cover the EUCAST breakpoints and epidemiological cut-off values (ECOFFs), and the inference of new resistance mechanisms. This proposal should be considered by different manufacturers and users when designing new panels or cards. In addition, recommendations for selective reporting are also included. With this approach, the implementation of EUCAST breakpoints will be easier, increasing the quality of antimicrobial susceptibility testing data and their microbiological interpretation. It will also benefit epidemiological surveillance studies as well as the clinical use of antimicrobials aligned with antimicrobial stewardship programs.

Use of colistin-containing products within the European Union and European Economic Area (EU/EEA): development of resistance in animals and possible impact on human and animal health.

Since its introduction in the 1950s, colistin has been used mainly as a topical treatment in human medicine owing to its toxicity when given systemically. Sixty years later, colistin is being used as a last-resort drug to treat infections caused by multidrug-resistant (MDR) Pseudomonas aeruginosa, Acinetobacter baumannii and Enterobacteriaceae (e.g., Escherichia coli, Klebsiella pneumoniae), for which mortality can be high. In veterinary medicine, colistin has been used for decades for the treatment and prevention of infectious diseases. Colistin has been administered frequently as a group treatment for animal gastrointestinal infections caused by Gram-negative bacteria within intensive husbandry systems. Given the ever-growing need to retain the efficacy of antimicrobials used to treat MDR infections in humans, the use of colistin in veterinary medicine is being re-evaluated. Despite extensive use in veterinary medicine, there is limited evidence for the development of resistance to colistin and no evidence has been found for the transmission of resistance in bacteria that have been spread from animals to humans. Since surveillance for colistin resistance in animals is limited and the potential for such transmission exists, there is a clear need to reinforce systematic monitoring of bacteria from food-producing animals for resistance to colistin (polymyxins). Furthermore, colistin should only be used for treatment of clinically affected animals and no longer for prophylaxis of diseases, in line with current principles of responsible use of antibiotics.

Uso prudente de antimicrobianos y propuestas de mejora en veterinaria / Prudent use of antimicrobial agents and proposals for improvement in veterinary medicine

Las alertas que se produjeron en las dos últimas décadas del siglo XX en relación con las resistencias a antimicrobianos en ganadería, han conducido al desarrollo de diferentes medidas que han mejorado sustancialmente el uso de los antimicrobianos en veterinaria. Estas medidas tienen que ver fundamentalmente con la aplicación de la nueva ley del medicamento y del paquete de higiene. Aunque el nivel de concienciación de los organismos reguladores es muy satisfactorio, y los sistemas de vigilancia implantados y la promoción del uso prudente comienzan a dar sus frutos, es necesario seguir insistiendo en ellas, al mismo tiempo que se promueven acciones alternativas al empleo de antimicrobianos, especialmente las dirigidas a la prevención de las enfermedades bacterianas, tanto de forma específica, mediante vacunación y mejora de la bioseguridad (utilización de insecticidas, desinfectantes y repelentes), como de forma general mejorando las instalaciones ganaderas y el bienestar animal. Todas estas alternativas conducirían a una menor necesidad de utilización de antimicrobianos en animales. Estas actuaciones deben complementarse con las acciones formativas y de concienciación de todos los agentes implicados (veterinarios, ganaderos, industria farmacéutica, distribuidores de medicamentos y grandes distribuidores de alimentos), así como con el establecimiento de cauces de cooperación más eficaces entre la medicina humana y la veterinaria

The alarms that have sounded in the last two decades of the 20th century in the feld of antimicrobial resistance in livestock farming have led to the development of various measures that have substantially improved the use of antimicrobial agents in veterinary medicine. These measures mainly involve the implementation of new pharmaceutical legislation and the hygiene package provisions. Even though awareness of the regulations is high, surveillance systems have been implemented and the promotion of appropriate use has begun to show results, it is necessary to maintain these measures while promoting alternatives to the use of antimicrobials. In particular, alternatives are needed for those agents used for prevention of bacterial diseases, either specifically, through vaccination and improvement of biosafety (use of insecticides, disinfectants and insect repellents), or generally by improving farm facilities and animal welfare. All of these alternatives would reduce the need to use antimicrobial agents in animals. These actions should be complemented by training for all those players involved (veterinarians, farmers, the pharmaceutical industry, veterinary medicines suppliers and food retailers), and by establishing more effective cooperation between human and veterinary medicine