{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T22:35:02Z","timestamp":1789598102092,"version":"build-2803163510"},"reference-count":30,"publisher":"American Society for Microbiology","issue":"8","license":[{"start":{"date-parts":[[2024,8,6]],"date-time":"2024-08-06T00:00:00Z","timestamp":1722902400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,8,6]],"date-time":"2024-08-06T00:00:00Z","timestamp":1722902400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2024,8,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:sec>\n            <jats:title\/>\n            <jats:p>\n              Despite the first-line recommendation of fosfomycin for uncomplicated urinary tract infections (UTIs), there are pressing barriers for optimizing its use for the treatment of non-\n              <jats:italic>Escherichia coli<\/jats:italic>\n              Enterobacterales UTI. There are no approved breakpoints for oral use against other Enterobacterales, and the recommended agar dilution (AD) reference method for minimal inhibitory concentration (MIC) determination is largely impractical. Using 160 clinical\n              <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n              isolates, we sought to understand rates of skipped wells and MIC imprecision in broth microdilution (BMD) and how that compares to rates of error using AD. Though the Clinical and Laboratory Standards Institute refers to the skipped well phenomena in their recommendation against the use of BMD, there is a paucity of data on its frequency. While AD and BMD produced similar MIC\n              <jats:sub>50\/90<\/jats:sub>\n              values (32\/256 \u00b5g\/mL for AD and 64\/256 \u00b5g\/mL for BMD), essential agreement was poor. No-growth wells at concentrations below the MIC occurred in up to 10.9% of wells at a given concentration, as the most frequent scientific error. Growth in concentrations above the measured MIC occurred in up to 3.3% of wells and was seen within three dilutions of the MIC for BMD. Observation of single colonies either at or beyond the measured MIC for AD was also common and occurred up to 8.3% and 2.5% of the time, respectively. The frequent scientific error in both testing methods should prompt re-evaluation of AD guidelines and expansion of MIC testing methods for fosfomycin susceptibility testing, as poor agreement with another method prone to scientific error should not be the main detractor from BMD use.\n            <\/jats:p>\n            <jats:sec>\n              <jats:title>IMPORTANCE<\/jats:title>\n              <jats:p>Despite the recommendation of fosfomycin for uncomplicated urinary tract infections (UTIs), there are barriers for optimizing its use. There are no approved breakpoints for oral use against other Enterobacterales, and the recommended agar dilution (AD) reference method for MIC determination is largely impractical. The use of broth microdilution (BMD) for fosfomycin testing is not recommended by the Clinical and Laboratory Standards Institute due to unsatisfactory precision and skipped wells\u2014occurrence of no-growth in a single well before the minimal inhibitory concentration (MIC)\u2014and trailing endpoints. We sought to understand rates of skipped wells and growth at concentrations above measured MICs in BMD and how that compares to scientific error using AD. No-growth wells at concentrations below the MIC occurred in up to 10.9% of wells for BMD and single colonies at or beyond measured MICs for AD were also common. Frequent scientific error in both methods should prompt re-evaluation of both AD and BMD for fosfomycin susceptibility testing.<\/jats:p>\n            <\/jats:sec>\n          <\/jats:sec>","DOI":"10.1128\/spectrum.04205-23","type":"journal-article","created":{"date-parts":[[2024,6,28]],"date-time":"2024-06-28T13:02:35Z","timestamp":1719579755000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":8,"title":["Skipped wells and scientific error during fosfomycin agar dilution and broth microdilution lead to inconsistent minimal inhibitory concentrations and may be cause for reevaluating testing methods for\n            <i>Klebsiella pneumoniae<\/i>"],"prefix":"10.1128","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8897-5191","authenticated-orcid":false,"given":"Morgan L.","family":"Bixby","sequence":"first","affiliation":[{"name":"University of Minnesota College of Pharmacy, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellora C.","family":"Daley","sequence":"additional","affiliation":[{"name":"University of Minnesota College of Pharmacy, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsey B.","family":"Collins","sequence":"additional","affiliation":[{"name":"University of Minnesota College of Pharmacy, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenna M.","family":"Salay","sequence":"additional","affiliation":[{"name":"University of Minnesota College of Pharmacy, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2957-7829","authenticated-orcid":false,"given":"Alexandra L.","family":"Bryson","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University Health System, Richmond, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0462-0421","authenticated-orcid":false,"given":"Elizabeth B.","family":"Hirsch","sequence":"additional","affiliation":[{"name":"University of Minnesota College of Pharmacy, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00402-12"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diagmicrobio.2019.06.008"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1159\/000449422"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkw178"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2009.03.009"},{"key":"e_1_3_1_7_2","unstructured":"The European Committee on Antimicrobial Susceptibility Testing. 2024. Breakpoint tables for interpretation of MICs and zone diameters. http:\/\/www.eucast.org."},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.3855\/jidc.10658"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-016-1888-1"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dku495"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e318298dd26"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/9681632"},{"key":"e_1_3_1_13_2","volume-title":"CLSI supplement M100","author":"Clinical and Laboratory Standards Institute","year":"2024","unstructured":"Clinical and Laboratory Standards Institute. 2024. Performance standards for antimicrobial susceptibility testing. In CLSI supplement M100, 34rd. Clinical and Laboratory Standards Institute, Wayne, PA.","edition":"34"},{"key":"e_1_3_1_14_2","unstructured":"The European Committee on Antimicrobial Susceptibility Testing. 2020. Rationale for the EUCAST clinical Breakpoints. https:\/\/www.eucast.org\/fileadmin\/src\/media\/PDFs\/EUCAST_files\/Consultation\/2020\/EUCAST_General_Consultation_on_Fosfomycon_trometamol_2020.pdf."},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01708240"},{"key":"e_1_3_1_16_2","volume-title":"CLSI standard M07","author":"CLSI","year":"2018","unstructured":"CLSI. 2018. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically. In CLSI standard M07, 11th ed. Clinical and Laborotory Standards Institute, Wayne PA.","edition":"11"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics11101392"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics11122352"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1590\/S1678-9946201961029"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.4102\/sajid.v35i1.173"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgar.2016.11.011"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1089\/mdr.2018.0393"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.3390\/pathogens11121441"},{"key":"e_1_3_1_25_2","first-page":"338","article-title":"Antimicrobial resistance changing trends of Klebsiella pneumoniae isolated over the last 5 years","volume":"45","author":"Della Rocca MT","year":"2022","unstructured":"Della Rocca MT, Foglia F, Crudele V, Greco G, De Filippis A, Franci G, Finamore E, Galdiero M. 2022. Antimicrobial resistance changing trends of Klebsiella pneumoniae isolated over the last 5 years. New Microbiol 45:338\u2013343.","journal-title":"New Microbiol"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2015.08.012"},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgar.2020.04.017"},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.03363-22"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01934-17"},{"key":"e_1_3_1_30_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciz181"},{"key":"e_1_3_1_31_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkz519"},{"key":"e_1_3_1_32_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkab313"}],"container-title":["Microbiology Spectrum"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/spectrum.04205-23","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/spectrum.04205-23","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,6]],"date-time":"2024-08-06T13:17:45Z","timestamp":1722950265000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.asm.org\/doi\/10.1128\/spectrum.04205-23"}},"subtitle":[],"editor":[{"given":"Rosemary C.","family":"She","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,8,6]]},"references-count":30,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2024,8,6]]}},"alternative-id":["10.1128\/spectrum.04205-23"],"URL":"https:\/\/doi.org\/10.1128\/spectrum.04205-23","relation":{},"ISSN":["2165-0497"],"issn-type":[{"value":"2165-0497","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,6]]},"assertion":[{"value":"2023-12-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-05-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-06-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e04205-23"}}