title: Drug susceptibility testing of clinical isolates of streptococci and enterococci by the Phoenix automated microbiology system.
abstract: BACKGROUND
  Drug resistance is an emerging problem among streptococcal and enterococcal species. Automated diagnostic systems for species identification and antimicrobial susceptibility testing (AST) have become recently available. We evaluated drug susceptibility of clinical isolates of streptococci and enterococci using the recent Phoenix system (BD, Sparks, MD). Diagnostic tools included the new SMIC/ID-2 panel for streptococci, and the PMIC/ID-14 for enterococci. Two-hundred and fifty isolates have been investigated: beta-hemolytic streptococci (n = 65), Streptococcus pneumoniae (n = 50), viridans group streptococci (n = 32), Enterococcus faecium (n = 40), Enterococcus faecalis (n = 43), other catalase-negative cocci (n = 20). When needed, species ID was determined using molecular methods. Test bacterial strains were chosen among those carrying clinically-relevant resistance determinants (penicillin, macrolides, fluoroquinolones, glycopeptides). AST results of the Phoenix system were compared to minimal inhibitory concentration (MIC) values measured by the Etest method (AB Biodisk, Solna, Sweden).
  
  
  RESULTS
  Streptococci: essential agreement (EA) and categorical agreement (CA) were 91.9% and 98.8%, respectively. Major (ME) and minor errors (mE) accounted for 0.1% and 1.1% of isolates, respectively. No very major errors (VME) were produced. Enterococci: EA was 97%, CA 96%. Small numbers of VME (0.9%), ME (1.4%) and mE (2.8%) were obtained. Overall, EA and CA rates for most drugs were above 90% for both genera. A few VME were found: a) teicoplanin and high-level streptomycin for E. faecalis, b) high-level gentamicin for E. faecium. The mean time to results (+/- SD) was 11.8 +/- 0.9 h, with minor differences between streptococci and enterococci.
  
  
  CONCLUSIONS
  The Phoenix system emerged as an effective tool for quantitative AST. Panels based on dilution tests provided rapid and accurate MIC values with regard to clinically-relevant streptococcal and enterococcal species.
authors.affiliation: Laboratorio di Microbiologia, Università dell'Insubria e Ospedale di Circolo, Varese, Italy. giocondabrigante@libero.it <giocondabrigante@libero.it>
authors.forename: Gioconda R
authors.initials: GR
authors.lastname: Brigante
authors.forename: Francesco A
authors.initials: FA
authors.lastname: Luzzaro
authors.forename: Beatrice
authors.initials: B
authors.lastname: Pini
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Lombardi
authors.forename: Gertrude
authors.initials: G
authors.lastname: Sokeng
authors.forename: Antonio Q
authors.initials: AQ
authors.lastname: Toniolo
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001331:Automation; D024881:Drug Resistance, Bacterial; D016983:Enterococcus / Q000187:drug effects* / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000379:methods*; D013290:Streptococcal Infections / Q000382:microbiology; D013291:Streptococcus / Q000187:drug effects* / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents