Abstract
Interpretive criteria for in vitro susceptibility testing criteria, “susceptibility breakpoints,” underpin the evaluation and selection of antimicrobial regimens. However, despite their strengths, susceptibility breakpoints are a relatively blunt instrument employed to address an extremely complex question—what is the likelihood of treatment success for individual patients? With regard to evaluating patients on a case-by-case basis, breakpoints merely allow us to account for pathogen susceptibility. This approach precludes consideration of drug exposures achieved in patients, thus overlooking half of the equation for predicting treatment success. Herein, we propose the framework for considering both pathogen- and patient-specific information to provide clinicians a means of evaluating antimicrobial regimens for individual patients through tools automating pharmacokinetic-pharmacodynamic target attainment analyses. Implementing these tools along with their acceptance by professional organizations will allow for a shift in the paradigm for how antimicrobials are selected and dosed—toward patient-centered care through precision medicine.
Highlights
THE WAY OF THE WORLD We live in a world awash with antimicrobial resistance
For evaluating patients on a case-by-case basis, susceptibility breakpoints allow us to account for pathogen susceptibility but preclude the consideration of drug exposures on the patient level
A great need exists for tools capable of estimating drug exposures and integrating them with pathogen susceptibility information to better predict treatment success in individual patients
Summary
Interpretive criteria for in vitro susceptibility testing criteria, “susceptibility breakpoints,” underpin the evaluation and selection of antimicrobial regimens Despite their strengths, susceptibility breakpoints are a relatively blunt instrument employed to address an extremely complex question—what is the likelihood of treatment success for individual patients? Antimicrobial stewardship efforts tasked with combating these “super bugs” are underpinned by in vitro susceptibility testing criteria (ie, susceptibility breakpoints), which have served as a surrogate for predicting the likelihood of antimicrobial treatment success for over half a century Despite their strengths, susceptibility breakpoints are a relatively blunt instrument employed to address an extremely complex question. We propose a framework for applying the principles of precision medicine to the treatment of infectious diseases, wherein clinicians could be provided a means of evaluating antimicrobial regimens on the basis of more than just pathogen susceptibility
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