title: Use of the E test to predict high-level resistance to aminoglycosides among enterococci.
abstract: The E test and the reference agar dilution methods were compared for detecting high-level aminoglycoside resistance (HLAR) among 71 selected clinical isolates, including 62 Enterococcus faecalis and 9 Enterococcus faecium isolates. High-level gentamicin resistance alone was found in 11% (5 E. faecalis and 3 E. faecium strains) and high-level streptomycin resistance was found in 42% (28 E. faecalis, 2 E. faecium strains) of the strains tested, and 31% of the strains demonstrated high-level resistance to both antimicrobial agents (21 E. faecalis and 1 E. faecium strains). The E test detected all HLAR populations, but the streptomycin strip may require recalibration to achieve absolute MIC comparisons with the reference value (twofold less) or the use of an alternative interpretive resistance breakpoint, e.g., > 1,000 micrograms/ml. By the E test, MIC results indicate that ampicillin, imipenem, penicillin, piperacillin, and vancomycin remain active against the HLAR E. faecalis isolates; however, these tested drugs were less effective on the HLAR E. faecium isolates (< 50%).
authors.affiliation: Anti-Infectives Research Centre, Department of Pathology, University of Iowa, College of Medicine, Iowa City 52242.
authors.forename: M L
authors.initials: ML
authors.lastname: Sanchez
authors.forename: M S
authors.initials: MS
authors.lastname: Barrett
authors.forename: R N
authors.initials: RN
authors.lastname: Jones
mesh_terms: D000362:Agar; D000617:Aminoglycosides; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology; D004352:Drug Resistance, Microbial; D013293:Enterococcus faecalis / Q000187:drug effects* / Q000302:isolation & purification; D016984:Enterococcus faecium / Q000187:drug effects* / Q000302:isolation & purification; D005069:Evaluation Studies as Topic; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000379:methods*
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D000362:Agar