FÜR RISIKOBEWERTUNG BUNDESINSTITUT. Proposal for a common Staphylococci panel design. Andreas Schroeter, BfR Antonio Battisti, ISS Dik Mevius, CIDC
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1 BUNDESINSTITUT FÜR RISIKOBEWERTUNG Proposal for a common Staphylococci panel design Andreas Schroeter, BfR Antonio Battisti, ISS Dik Mevius, CIDC
2 1. Method 2. Requirements 3. Common MRSA plate format 4. Common Staphylococcus spp./mrsa plate format A. Schroeter, A. Battisti, D. Mevius; CRL- Workshop 23./24. April 2009 Seite 2
3 1. Method Inoculation of NaCl-solution A. Schroeter, A. Battisti, D. Mevius; CRL- Workshop 23./24. April 2009 Seite 3
4 Automatic filling of microtitre plates A. Schroeter, A. Battisti, D. Mevius; CRL- Workshop 23./24. April 2009 Seite 4
5 Semi-automatic reading of plates A. Schroeter, A. Battisti, D. Mevius; CRL- Workshop 23./24. April 2009 Seite 5
6 Spectinomycin A. Schroeter, A. Battisti, D. Mevius; CRL- Workshop 23./24. April 2009 Seite 6
7 2. Requirements Normal order volume: 500 plates (lowest) price: tax (Germany 19 % = 3.39 ) = per plate Common plate order volume: 5000 plates (+/- 5 %) price: 5,60 + tax (Germany 19 % = 1.06) = 6.66 per plate Order volume: one box (10 plates) 5000 plates or more Advantages: lower price quick delivery (continous production) but: it can be from different batches quality control!! A. Schroeter, A. Battisti, D. Mevius; CRL- Workshop 23./24. April 2009 Seite 7
8 Ordering: 1. Directly if there is no distributor TREK Diagnostic Systems ( Contact person: Maureen Mansfield Additional information: aquired by Magellan Biosciences Inc. ( 2. Indirectly via a distributor Example Germany: MCS Diagnostics BV, Vorveld 16, NL-6071 RE Swalmen,The Netherlands contact person: Hay Thijssen (hay.thijssen@mcsdiagnostics.com) A. Schroeter, A. Battisti, D. Mevius; CRL- Workshop 23./24. April 2009 Seite 8
9 Ready prepared microtitre plates each plate in an aluminium foil + indicator (blue - dry red - wet) 10 plates per box + foils + writing block + a strip with a bar code 12 boxes per parcel (120 plates) 3. Common MRSA plate format Problem: 1. Number of substances tested 2. Concentration ranges (survaillance) A. Schroeter, A. Battisti, D. Mevius; CRL- Workshop 23./24. April 2009 Seite 9
10 to all countries of the EU For a common plate format the above company needs an order volume from plates per year. If this demand is fulfilled a common plate format is accepted by the company, the price per plate is dropping and the single order volume is 10 plates (one box or more). For explanation: the under limit of a normal order volume is 500 plates!! Therefore it is interesting for countries with a small number of MRSA-isolates. If we can together establish a common plate format the price per plate will not depend on the number of plates ordered, but will be a standard price between 7 and 9 /plate. Further procedure: If the order volume (5.000 plates/year from all participating countries) is reached, we will establish a small working group (3-4 participants), which make a first proposal of a plate format (antimicrobial agents and concentration ranges), which fulfil the EFSA and the participating country requirements. I hope we can find then a good compromise in a general discussion between all participants in a short time. A. Schroeter, A. Battisti, D. Mevius; CRL- Workshop 23./24. April 2009 Seite 10
11 Table 1: MRSA plate MRSA plate format 02. October 2008 Country Responsible person address Order volume per year Year of ordering this plate Austria Burkhard Springer Cyprus Liapi Maria Czech Republic Tomas Cerny Denmark Yvonne Agersø ? Finland Anna-Liesa Myllyniemi VetMIC plates from SVA In future possible Germany Andreas Schroeter Greece Maria Passiotou unknown unknown Ireland Montse Gutierrez (<50) Very small volume is anticipated Italy Alessia Franko Latvia Jelena Avsejenko 10 plates 2009 The Netherlands Dik Mevius Kees Veldmann Poland Jacek Osek Slovakia Andrea Brtkova 20 Per year from 2009 Slovenia Irena Zdovc 150 As soon as possible Spain Manuel Durán Ferrer depending on official request As soon as available Sweden Stina Englund Own VetMIC plates from SVA United Kingdom Christopher Teale 10 Per year from 2009 Norway Marianne Sunde 20 Per year from 2009 Sum 2110 Belgium, Bulgaria, Estonia, France, Hungary, Lithuania, Luxemburg, Malta, Portugal, Romania A. Schroeter, A. Battisti, D. Mevius; CRL- Workshop 23./24. April 2009 Seite 11
12 Number of plates for MRSA: 2110 ( ) Lowest number for TREK per year: 5000 (+/- 5 %) Proposal from Dik Mevius: Create a common plate format for : Staphylococcus aureus and MRSA A. Schroeter, A. Battisti, D. Mevius; CRL- Workshop 23./24. April 2009 Seite 12
13 4. Common Staphylococcus spp./mrsa plate format Fig 1: Plate format Staphylococcus spp./mrsa (Germany/Italy) Letter A CLI ERY VAN TET CHL CIP MUP GEN LZD SYN RIF FOX B CLI ERY VAN TET CHL CIP MUP GEN LZD SYN RIF FOX C CLI ERY VAN TET CHL CIP MUP GEN LZD SYN RIF FOX D CLI ERY VAN TET CHL CIP MUP GEN LZD SYN RIF FOX E CLI ERY VAN TET CHL CIP MUP GEN LZD SYN RIF FOX F CLI ERY VAN TET CHL CIP MUP TIA TIA TIA RIF FOX G KAN KAN KAN KAN KAN FUS FUS FUS FUS TIA RIF Neg H SMX SMX SMX SMX SMX SMX TMP TMP TMP TMP TMP Pos A. Schroeter, A. Battisti, D. Mevius; CRL- Workshop 23./24. April 2009 Seite 13
14 Decision 2008/55/EU : substances, which should be tested for MRSA: Ciprofloxacin, Erythromycin, Fusidic acid, Gentamicin, Linezolid, Mupirocin, Sulfamethoxazole, Trimethoprim, Tetracycline, Chloramphenicol, Vancomycin, Quinupristin/Dalfopristin(Synercid) (should be withdrawn from the panel, Amikacin or tobramycin for neomycin or/and kanamycin D. Mevius) Italy: Rifampicin, Cefoxitin Germany: Tiamulin A. Schroeter, A. Battisti, D. Mevius; CRL- Workshop 23./24. April 2009 Seite 14
15 Table 2: Antimicrobial agent, abbreviations and arguments for using it Substance Abbr. Reasons for using it Further arguments Literature Clindamycin CLI Survaillance antibiotic* 2008/55/EU Erythromycin ERY Survaillance antibiotic* 2008/55/EU Vancomycine VAN Survaillance antibiotic* 2008/55/EU Tetracycline TET Survaillance antibiotic* 2008/55/EU Chloramphenicol CHL Survaillance antibiotic* 2008/55/EU Ciprofloxacin CIP Survaillance antibiotic* 2008/55/EU Mupirocin MUP Used in human medicine only Survaillance antibiotic*;breakpoint: <=4 sens, low level res., >=512 high res.; Staph. Ref. Lab G. >=32 res Gentamicin GEN Survaillance antibiotic* 2008/55/EU Linezolid LZD Survaillance antibiotic* 2008/55/EU Synercid SYN Used in human medicine only 2008/55/EU Rifampicin RIF Used in human medicine only Cefoxitin FOX To predict mec mediated resistance in S. aureus Kanamycin KAN Used in pigs, cattle, calf, sheep and chicken FOX<=4 Oxacillin sens FOX>=8 Oxacillin res Survaillance antibiotic* *Kresken, M.; 2008/55/EU CLSI M100-S18 CLSI M7-A7 Sulfamethoxazole SMX Survaillance antibiotic* 2008/55/EU Trimethoprim TMP Survaillance antibiotic* 2008/55/EU Fusidic acid FUS 2008/55/EU *Cornaglia,G.; ESCMID study group report Tiamulin TIA Used in pigs, cattle, calf, turkey and chicken Proposed:DVG working group Antibiotic Resistance in Germany A. Schroeter, A. Battisti, D. Mevius; CRL- Workshop 23./24. April 2009 Seite 15
16 Literature: Decision 2008/55/EU Cornaglia, G. et al. 2004, Clin. Microbiol. Infect. 10 (4), Kresken, M. et al. 2004, Int. J. Antimicrobial Agents 23, CLI ERY VAN TET CHL CIP GEN LZD SYN RIF FOX KAN FUS TIA SMX TMP MUP SXT ECV <= 0.25*** 1*** 2*** 1*** 16** 1** 2*** 4** 1** 0.016*** 4** 8** 0.5*** 2** 128** 4** 0.5** 0.5** CB > 0.5*** 2*** 8** 2*** 8 1 1** 1** 4*** 2** ** - 1*** - - 4*** - 4/761 CB >= 4* 8* 16** 16* 32* 4* 16* -* 4* 4* -* 64* -* -* 512* 16* -* 4/76* ECV, CB EUCAST, MRSA - ***, Staph. aureus. - **, Staph. spp. - *, Staph. 1 ( see miscellaneous antimicrobials CHL, RIF, SXT), CB CSLI (M100-S19) A. Schroeter, A. Battisti, D. Mevius; CRL- Workshop 23./24. April 2009 Seite 16
17 Fig.2: Proposed assessment Staph./MRSA plate format, EUCAST ECV/CB Letter A CLI ERY VAN TET CHL CIP MUP GEN LZD SYN RIF FOX B CLI ERY VAN TET CHL CIP MUP GEN LZD SYN RIF FOX C CLI ERY VAN TET CHL CIP MUP GEN LZD SYN RIF FOX D CLI ERY VAN TET CHL CIP MUP GEN LZD SYN RIF FOX E CLI ERY VAN TET CHL CIP MUP GEN LZD SYN RIF FOX F CLI ERY VAN TET CHL CIP MUP TIA TIA TIA RIF FOX G KAN KAN KAN KAN KAN FUS FUS FUS FUS TIA RIF Neg H SMX SMX SMX SMX SMX SMX TMP TMP TMP TMP TMP Pos Green - sensitive EUCAST ECV, CB Red resistant ECV and CB, if available Green sensitive EUCAST CB but resistant ECV Green resistant EUCAST CB but sensitive ECV A. Schroeter, A. Battisti, D. Mevius; CRL- Workshop 23./24. April 2009 Seite 17
18 Table 3: Common Staphylococcus spp./mrsa plate format Country Responsible person address Order volume per year Year of ordering this plate Austria Burkhard Springer Cyprus Liapi Maria Czech Republic Tomas Cerny Denmark Yvonne Agersø Finland Anna-Liesa Myllyniemi Germany Andreas Schroeter Greece Maria Passiotou Ireland Montse Gutierrez Italy Alessia Franko Latvia Jelena Avsejenko The Netherlands Dik Mevius, Kees Veldmann Poland Jacek Osek Slovakia Andrea Brtkova Slovenia Irena Zdovc Spain Manuel Durán Ferrer Sweden Stina Englund United Kingdom Christopher Teale Norway Marianne Sunde Belgium, Bulgaria, Estonia, France, Hungary, Lithuania, Luxemburg, Malta, Portugal, Romania A. Schroeter, A. Battisti, D. Mevius; CRL- Workshop 23./24. April 2009 Seite 18
19 Many thanks for your attention Are you resistant too? A. Schroeter, A. Battisti, D. Mevius; CRL- Workshop 23./24. April 2009 Seite 19
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