Can antimicrobial susceptibility testing results for ciprofloxacin or levofloxacin predict susceptibility to a newer fluoroquinolone, gatifloxacin?: Report from The SENTRY Antimicrobial Surveillance Program (1997-99)
Abstract
A serious problem confronting clinical laboratories and hospital formulary practices is the delayed availability of approved, commercially prepared susceptibility test reagents for newer antimicrobials. A current example is gatifloxacin, a new 8-methoxy fluoroquinolone with expanded potency against many Gram-positive pathogens. This study addresses the use of "surrogate marker" fluoroquinolones to predict susceptibility for gatifloxacin. Reference broth microdilution MIC results for 29,632 strains isolated in United States medical centers (SENTRY Antimicrobial Surveillance Program, 1997-99) were used: staphylococci (9,940 strains), enterococci (2,570), Streptococcus pneumoniae (3,784), Enterobacteriaceae (10,670) and Pseudomonas aeruginosa (2,668). Gatifloxacin interpretation categories were compared to those of ciprofloxacin and levofloxacin by regression statistics and error rate bounding analyses. For the Enterobacteriaceae, the absolute categorical agreement was 97.9 to 98.7% (false-susceptible or very-major error [VME], 0.03%-0.1%) for comparisons of both ciprofloxacin and levofloxacin with gatifloxacin. P. aeruginosa testing was more problematic (higher minor error rates), but acceptable at 0.6% to 1.1% VME and a 85.7% to 89.9% overall agreement. Ciprofloxacin results used to predict gatifloxacin in Gram-positive species was almost without VME (0.0%-0.2%) because gatifloxacin was significantly superior against these species, especially for S. pneumoniae, where…
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