Interlaboratory comparison of agar dilution and Etest methods for determining the MICs of antibiotics used in management of Neisseria meningitidis infections.
Previous studies have shown that there is considerable variation in the methods and media used to determine the susceptibility of Neisseria meningitidis to antimicrobial agents in different countries. In this study, national and regional reference laboratories used a standardized methodology to determine the MICs of antibiotics used in the management of meningococcal infection. Fourteen laboratories participated in the study, determining the susceptibility to penicillin G, rifampin, cefotaxime, ceftriaxone, ciprofloxacin, and ofloxacin of a collection of 17 meningococci, of which 11 strains were previously defined as having intermediate resistance to penicillin (Pen(I)) by sequencing and restriction fragment length polymorphism analysis of the penA gene. The MIC was determined by agar dilution and Etest with Mueller-Hinton agar (MH), MH supplemented with sheep blood (MH+B), and MH supplemented with heated (chocolated) blood. Several laboratories encountered problems obtaining confluent growth with unsupplemented MH. MH+B was considered to give the most congruent and reproducible results among the study laboratories. The modal MIC for MH+B for each antibiotic and method was calculated to define the MIC consensus, allowing assessment of each individual laboratory's data in relation to the others. The agreement in each antibiotic/method/medium combination was defined as the percentage of laboratories with a result within one dilution of the modal result. For the whole study, an agreement of 90.6% was observed between agar dilution and Etest methods. The agreement in each laboratory/antibiotic/method combination ranged from 98.2% to 69.7%, with six laboratories demonstrating agreement higher than 90% and 11 more than 80%. The ability of the laboratories to detect the Pen(I) isolates ranged from 18.2% to 100%. The apparent difficulty in interpreting susceptibility to rifampin, particularly with the Etest method, is very interesting.
Vázquez
Julio A
JA
National Institute of Health Carlos III, Majadahonda, Madrid, Spain. jvazquez@iscii.es
Arreaza
Luisa
L
Block
Colin
C
Ehrhard
Ingrid
I
Gray
Stephen J
SJ
Heuberger
Sigrid
S
Hoffmann
Steen
S
Kriz
Paula
P
Nicolas
Pierre
P
Olcen
Per
P
Skoczynska
Anna
A
Spanjaard
Lodewijk
L
Stefanelli
Paola
P
Taha
Muhamed-Kheir
MK
Tzanakaki
Georgina
G
D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D003470:Culture Media; D005060:Europe; D008589:Meningococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D008826:Microbial Sensitivity Tests / Q000379:methods*; D009345:Neisseria meningitidis / Q000187:drug effects*; D012150:Polymorphism, Restriction Fragment Length; D012015:Reference Standards
D000900:Anti-Bacterial Agents; D003470:Culture Media