title: Calibration of the disk diffusion test for trovafloxacin susceptibility testing of four anaerobic species.
abstract: OBJECTIVE
  To study trovafloxacin susceptibility among clinical isolates of four anaerobic bacterial species using minimum inhibitory concentrations (MIC) determinations, E test assays and disk diffusion test results and to calibrate the disk diffusion method for these species using single strain regression analysis (SRA).
  
  
  METHODS
  One-hundred and eighty-seven clinical isolates of four anaerobic bacterial species were included. Trovafloxacin MIC determinations were performed using the agar dilution technique and MIC estimations using the E test. The disk diffusion test was performed according to Swedish Reference Group for Antibiotics standardization. NCCLS limits for susceptibility categories were applied. SRA was performed using 1, 3, 10, 30, and 100 microg trovafloxacin disk contents and ATCC control strains. The regression lines obtained permitted the calculation of zone equivalents to MIC limits as well as an evaluation of various disk potencies.
  
  
  RESULTS
  Trovafloxacin susceptibility (S + I) was noted in 98.9, 100, 100, and 97% of Bacteroides fragilis, Bacteroides thetaiotaomicron, Clostridium perfringens, and Peptostreptococcus magnus strains, respectively, as judged by MIC determinations. Agar dilution and E test estimations gave the same results, but E test values were consistently lower than MIC values by the reference method. Regression lines calculated for the four species using SRA showed different equation constants indicating species-related differences. Interpretive zone diameter breakpoints were calculated for the four species and used for the interpretation of susceptibility.
  
  
  CONCLUSIONS
  The disk diffusion test was successfully calibrated for trovafloxacin susceptibility testing of four anaerobic species using single strain regression analysis, SRA. There was a good agreement between the results of MIC-tests and disk testing. Interpretive errors of type I are prone to occur among Bacteroides isolates and might require species-related MIC limits. SRA calculations permitted the testing of the effect of different disk potencies on inhibition zones produced at the interpretive MIC limits. Criteria for the selection of a minimal disk content showed that 5 microg trovafloxacin is sufficient, but a 10 microg disk will safeguard against residual laboratory variation without producing too large inhibition zones for very susceptible strains.
authors.affiliation: Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska institute, Stockholm, Sweden. kron@mb.ks.se
authors.forename: G
authors.initials: G
authors.lastname: Kronvall
authors.forename: E
authors.initials: E
authors.lastname: Holst
mesh_terms: D000890:Anti-Infective Agents / Q000494:pharmacology*; D001421:Bacteria, Anaerobic / Q000187:drug effects*; D001439:Bacteroides / Q000187:drug effects; D001441:Bacteroides fragilis / Q000187:drug effects; D002138:Calibration; D003016:Clostridium perfringens / Q000187:drug effects; D004058:Diffusion; D024841:Fluoroquinolones; D008826:Microbial Sensitivity Tests / Q000379:methods* / Q000592:standards; D009287:Naphthyridines / Q000494:pharmacology*; D010462:Peptostreptococcus / Q000187:drug effects; D011786:Quality Control; D012044:Regression Analysis
chemical_list: D000890:Anti-Infective Agents; D024841:Fluoroquinolones; D009287:Naphthyridines; C080163:trovafloxacin