Detecting imipenem resistance in Acinetobacter baumannii by automated systems (BD Phoenix, Microscan WalkAway, Vitek 2); high error rates with Microscan WalkAway.
BACKGROUND
Increasing reports of carbapenem resistant Acinetobacter baumannii infections are of serious concern. Reliable susceptibility testing results remains a critical issue for the clinical outcome. Automated systems are increasingly used for species identification and susceptibility testing. This study was organized to evaluate the accuracies of three widely used automated susceptibility testing methods for testing the imipenem susceptibilities of A. baumannii isolates, by comparing to the validated test methods.


METHODS
Selected 112 clinical isolates of A. baumanii collected between January 2003 and May 2006 were tested to confirm imipenem susceptibility results. Strains were tested against imipenem by the reference broth microdilution (BMD), disk diffusion (DD), Etest, BD Phoenix, MicroScan WalkAway and Vitek 2 automated systems. Data were analysed by comparing the results from each test method to those produced by the reference BMD test.


RESULTS
MicroScan performed true identification of all A. baumannii strains while Vitek 2 unidentified one strain, Phoenix unidentified two strains and misidentified two strains. Eighty seven of the strains (78%) were resistant to imipenem by BMD. Etest, Vitek 2 and BD Phoenix produced acceptable error rates when tested against imipenem. Etest showed the best performance with only two minor errors (1.8%). Vitek 2 produced eight minor errors(7.2%). BD Phoenix produced three major errors (2.8%). DD produced two very major errors (1.8%) (slightly higher (0.3%) than the acceptable limit) and three major errors (2.7%). MicroScan showed the worst performance in susceptibility testing with unacceptable error rates; 28 very major (25%) and 50 minor errors (44.6%).


CONCLUSIONS
Reporting errors for A. baumannii against imipenem do exist in susceptibility testing systems. We suggest clinical laboratories using MicroScan system for routine use should consider using a second, independent antimicrobial susceptibility testing method to validate imipenem susceptibility. Etest, whereever available, may be used as an easy method to confirm imipenem susceptibility.
Kulah
Canan
C
Zonguldak Karaelmas University, Faculty of Medicine, Department of Microbiology and Clinical Microbiology, Zonguldak, Turkey. canankulah@yahoo.com
Aktas
Elif
E
Comert
Fusun
F
Ozlu
Nagihan
N
Akyar
Isin
I
Ankarali
Handan
H
D040981:Acinetobacter baumannii / Q000187:drug effects*; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D006801:Humans; D015378:Imipenem / Q000494:pharmacology*; D008826:Microbial Sensitivity Tests / Q000379:methods / Q000592:standards*; D011237:Predictive Value of Tests; D011786:Quality Control; D018440:beta-Lactam Resistance
D000900:Anti-Bacterial Agents; D015378:Imipenem