title: Comparative evaluation of the VITEK 2 Advanced Expert System (AES) in five UK hospitals.
abstract: OBJECTIVE
  We carried out an evaluation of VITEK 2 in five UK laboratories, comparing results with 'gold standard' agar-dilution MIC data, assessing its ability to recognize resistant phenotypes and comparing results with those generated by routine antimicrobial susceptibility testing methods.
  
  
  METHODS
  Laboratories tested a collection of 82 strains selected on the basis of their challenging and characterized resistance mechanisms.
  
  
  RESULTS
  In comparison with the reference MIC method, VITEK 2 gave an essential agreement of 304/315 (enterococci), 1619/1674 (staphylococci) and 2937/3074 (Gram-negative bacilli): overall 96.0% agreement. Corresponding category (SIR) agreements with VITEK 2 were 247/252, 1496/1561 and 2478/2626 (overall 95.1%). Using five routine methodologies, category agreements ranged from 58/63 to 45/45; 222/232 to 174/174, and 333/372 to 250/259 for the three organism groups with an overall agreement of 95.0%. In contrast to VITEK 2 Advanced Expert System (AES), routine microbiology laboratories did not attempt to detect resistance mechanisms for every antibiotic studied. VITEK 2 AES detected all 19 resistance mechanisms in enterococci: where applicable, routine methods detected 14, 10 and 10. Of 30 resistance mechanisms in staphylococci, VITEK 2 AES detected 25 compared with 23, 20, 17 and 18 detected by routine methods. Finally, of 44 resistance mechanisms in Gram-negative bacilli, VITEK 2 AES detected 30 compared with 30, 23, 15 and 10 detected by routine methods.
  
  
  CONCLUSIONS
  VITEK 2 performed susceptibility tests accurately and the AES detected and interpreted resistance mechanisms appropriately. Heavy inocula in a liquid medium possibly favour better expression of certain resistance determinants. Although certain routine microbiology methods performed adequately, VITEK 2 AES offers a rapid, standardized method suited to laboratories lacking experience of resistance mechanisms and/or those not testing an appropriate number, or range, of antibiotics to detect resistance phenotypes.
authors.affiliation: Department of Microbiology, University Hospital, Birmingham, UK.
authors.forename: J
authors.initials: J
authors.lastname: Barry
authors.forename: A
authors.initials: A
authors.lastname: Brown
authors.forename: V
authors.initials: V
authors.lastname: Ensor
authors.forename: U
authors.initials: U
authors.lastname: Lakhani
authors.forename: D
authors.initials: D
authors.lastname: Petts
authors.forename: C
authors.initials: C
authors.lastname: Warren
authors.forename: T
authors.initials: T
authors.lastname: Winstanley
mesh_terms: D001419:Bacteria / Q000187:drug effects; D024881:Drug Resistance, Bacterial; D016983:Enterococcus / Q000187:drug effects; D005103:Expert Systems; D006090:Gram-Negative Bacteria / Q000187:drug effects; D008826:Microbial Sensitivity Tests / Q000295:instrumentation*; D010641:Phenotype; D006113:United Kingdom