Exploration of clinical breakpoint of Danofloxacin for Glaesserella parasuis in plasma and in PELF

BackgroundTo establish the clinical breakpoint (CBP) of danofloxacin to G. parasuis, three cutoff values, including epidemiological cutoff value (ECV), pharmacodynamic cutoff value (COPD) and clinical cutoff value (COCL), was obtained in the present study. MethodsThe ECV was calculated using ECOFFinder base on MIC distribution of 347 G. parasuis collected from disease pigs. The COPD was established base on in vivo and ex vivo pharmacokinetic (PK) - pharmacodynamic (PD) modeling of danofloxacin both in plasma and pulmonary epithelial lining fluid (PELF) using Hill formula and Monte Carlo analysis. The COCL was established based on the relationship between possibility of cure (POC) and MIC in the clinical trials using "WindoW" approach, nonlinear regression and CART analysis. ResultsThe MIC50 and MIC90 of danofloxacin against 347 G. parasuis were 2 g/mL and 8 g/mL, respectively. The ECV value was set up as 8 g/mL using ECOFFinder. Concentration-time curve of danofloxacin indicated a two-compartment model for PK analysis. The PK parameters of the maximum concentration (Cmax) and area under concentration-time curve (AUC) in PELF were 3.67 {+/-} 0.25 g/mL and 24.28 {+/-} 2.70 h{middle dot}g/mL, higher than those in plasma (0.67 {+/-} 0.01g/mL and 4.47 {+/-} 0.51 h{middle dot}g/mL). The peak time (Tmax) in plasma was 0.23 {+/-} 0.07 h, shorter than that in PELF (1.61 {+/-} 0.15 h). The COPD in plasma and PELF were 0.125 g/mL and 0.5 g/mL, respectively. The COCL calculated by WindoW approach, nonlinear regression and CART analysis were 0.125[~]4 g/mL, 0.428 g/mL and 0.56 g/mL, respectively. The 0.5 g/mL was selected as eligible COCL. The ECV is much higher than the COPD and COCL, and the clinical breakpoint based on data in plasma was large different with that of in PELF. ConclusionsOur study firstly established three cutoff values of danofloxacin against G. parasuis. It suggested that epidemiological danofloxacin-resistant G. parasuis may lead to the ineffective treatment by danofloxacin. ImportanceG. parasuis, a gram-negative respiratory pathogen, can colonize in the upper respiratory tract in swine and cause Glassers disease. As the abuse of antibiotics, antimicrobial resistant G. parasuis emerged in different degrees, which brought serious threat to global economy and public health. Danofloxacin in quinolones are one of the best choices for treatment of G. parasuis infection, because of their strong bactericidal activity and good absorption into blood and great distribution in the lung. However, the clinical breakpoint (CBP) for danofloxacin against G. parasuis had not yet been established by clinical laboratory of standard Institute (CLSI) and European Commission of antimicrobial susceptibility testing (EUCAST). Our study firstly established three cutoff values of danofloxacin against G. parasuis. It suggested that epidemiological danofloxacin-resistant G. parasuis may lead to the ineffective treatment by danofloxacin.