[Comparison of microdilution method and Phoenix automated system for testing antimicrobial susceptibilities of...

Enterococcus spp. are important pathogens which are intrinsically resistant to most of the commonly used antimicrobial agents such as aminoglycosides and cephalosporins. Accurate determination of resistance is important to ensure appropriate antimicrobial therapy. This study was undertaken to compare the susceptibility results obtained by Phoenix system (Becton Dickinson, USA) with reference microdilution method. We included 1248 Enterococcus spp. (903 Enterococcus faecalis, 345 Enterococcus faecium) strains isolated from clinical samples between 2005-2007 in routine microbiology laboratory of Hacettepe University Hospital. The strains were identified and the antimicrobial susceptibilities were determined by the Phoenix system. Antimicrobial susceptibilities to ampicillin, teicoplanin, vancomycin, gentamicin and streptomycin were also studied by microdilution method according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Evaluation revealed excellent agreement for all of the antibiotics with category agreement rates of > 97%. Among 1248 strains, 76 revealed discordant results. Very major error rates were 1.5% for ampicillin, 1.3% for gentamicin, and 0.9% for streptomycin. Major error rates were 1.4% for streptomycin, 0.6% for ampicillin and vancomycin and 0.3% for gentamicin. Minor error rates were found as 0.2% for vancomycin, and 0.1% for teicoplanin. Resistance rates obtained by microdilution were as follows; high level streptomycin 44%, high level gentamicin 29.7%, ampicillin 25.6%, vancomycin 2.2% and teicoplanin 2.2%. Resistance rates were higher in E.faecium than E.faecalis and 96.4% of the vancomycin resistant enterococcus isolates were identified as E.faecium. In conclusion, based on the data obtained, Phoenix system is reliable for testing susceptibilities of Enterococcus spp. to these antimicrobials. Since isolation of vancomycin resistant enterococci has an important impact in terms of hospital infection control, vancomycin resistance reported by the Phoenix system should be confirmed with an alternative susceptibility testing method.