Medical Microbiology Report: Antibiotic Selection and Resistance Study

This report analyzes a research article on bacterial clonal diagnostics as a tool for evidence-based empirical antibiotic selection. The study investigates the impact of antimicrobial resistance on antibiotic prescription and explores the use of clonal diagnostic approaches, specifically the 7-SNP test, to facilitate the selection of effective antibiotics. The research utilizes an observational cohort study with quantitative PCR tests to determine clonal groups of Escherichia coli and assess the reduction in antibiotic mismatch risk. The methodology includes various tests and statistical analyses, incorporating resistance thresholds. The results highlight the prevalence of resistance to different antibiotics and demonstrate the potential of clonal diagnostics to improve antibiotic therapy choices, including the ability to quickly determine clonal identity. The study concludes that using antibiograms and clonal diagnostics helps in the identification of empirical treatment accurately and cost-effectively, by reducing the prescribing of ineffective antibiotics.

Running head: MEDICAL MICROBIOLOGY
MEDICAL MICROBIOLOGY
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Introduction
Antimicrobial resistance has become one of the major issues of healthcare system as
there are no such approaches to determine the antimicrobial susceptibility. Hence, requirement of
different speed approaches for determination of susceptibility becomes very crucial. In this
paper, the researchers assessed the clonal diagnostic approach for the empirical antibiotic
selection. For this purpose, it uses an observational cohort study and used the quantitative PCR
tests to determine the clonal groups of 50 Escherichia Coli and within which they significantly
reduced the risk of antibiotic mismatch.
Methods
There are several material and methods that were used for the determination of antibiotic
cloning and susceptibility and these were prospective clonal diagnostic study, 7- SNP test, local
reference set, multinational reference set, urine culture and isolate testing and statistical analysis
and finally the calculations related to prescription mismatch rates. Based on the data that was
derived from the different tests, the data had been analyzed using the statistical analysis. Besides
in this process, while determining the methodology 20, 10 and 30% resistance threshold was
allowed.
Results
From the 750 urinalysis samples, it was seen that 274 people contain E coli which was
determined from the 7-SNP test. Between the 267 samples that were discovered to have E. coli
by both the 7-SNP test and culture, in 260 (97%) the clonotype determined directly in urine
corresponded with that determined by single-colony testing. The study isolates encompassed a

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higher prevalence of resistance to FQs (21% vs. 15%, P = .004) and a lower prevalence of
resistance to CZ (8 vs. 15%, P = .001) and NIT (0.4 vs. 5%, P < .001). with respect to the
antiobiotic therapy options allowed by the 7-SNP tests, he 7-SNP test would allow use of FQs
for 78.6%, T/S for 57.3%, CZ for 73.6%, and NIT for 100%. In this test the level of E. coli was
detected as 102 cfu/ml. Within this, 267 were positive and 39 were negative results. Further in
more than 300 samples infection of other bacteria were also seen that indicated the cloning of
microorganism in the within host body.
Conclusion:
This paper assessed and evaluated the prospective observational study conducted in
cohort study manner and selected the empirical therapy. This is because, the process was able to
detect clonal identity and the specificity and sensitivity was very high in this process that
determined the sensitivity and specificity within few hours of the process. The primary cost
related advantage of utilizing clonal diagnostics must result in reducing the prescribing of
ineffective antibiotics. Therefore, using the antibiograms helps the researchers to identify the
empirical process treatment accurately.

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Relevant questions:
 How does the phenomenon of antimicrobial resistance affect the process of prescribing
antibiotic medication?
 How does the clonal diagnostic approach facilitate the selection of empirical antibiotics?
 What is the rationale behind the inclusion of 10%, 20% and 30% of the antibiotic
resistance threshold value?
Bibliography
Tchesnokova, V., Avagyan, H., Rechkina, E., Chan, D., Muradova, M., Haile, H. G., ... &
Johnson, J. R. (2017). Bacterial clonal diagnostics as a tool for evidence-based empiric
antibiotic selection. PloS one, 12(3), e0174132.