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Susceptibility of enterococci to daptomycin is dependent upon testing methodology.

Kendall A Bryant1, Amity L Roberts, Mark E Rupp

  • 1Department of Pathology and Microbiology, College of Medicine, University of Nebraska Medical Center, 984031 Nebraska Medical Center, Omaha, NE 68198-4031, USA.

Diagnostic Microbiology and Infectious Disease
|May 31, 2013
PubMed
Summary

MicroScan methods may overestimate daptomycin nonsusceptible enterococci (DNSE) prevalence. Further testing is needed to determine the most accurate method for confirming DNSE nonsusceptibility.

Keywords:
DaptomycinEnterococcusSusceptibility testing

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Area of Science:

  • Clinical Microbiology
  • Infectious Diseases
  • Antimicrobial Resistance

Background:

  • An increasing prevalence of daptomycin nonsusceptible enterococci (DNSE) was observed, potentially due to overestimation by current laboratory methods.
  • Enterococci infections are a growing concern, particularly those exhibiting resistance to critical antibiotics like daptomycin.

Purpose of the Study:

  • To evaluate the accuracy of different antimicrobial susceptibility testing (AST) methods for detecting daptomycin nonsusceptibility in enterococci.
  • To compare MicroScan (prompt and turbidity), Etest, and Sensititre methods against broth microdilution (BMD) for DNSE detection.

Main Methods:

  • 150 clinical isolates of enterococci were tested for daptomycin susceptibility using BMD, Etest, Sensititre, MicroScan prompt (MSP), and MicroScan turbidity (MST).
  • Categorical and essential agreement were assessed, along with error rates (very major, major, minor).
  • Pulsed-field gel electrophoresis (PFGE) was used to investigate potential clonal outbreaks.

Main Results:

  • Only 20% of isolates initially identified as DNSE by MicroScan were confirmed nonsusceptible by BMD.
  • MSP and MST showed high categorical agreement but missed a majority of resistant isolates (70% and 87%, respectively).
  • Etest yielded higher MICs, with a high rate of falsely nonsusceptible results (22%) and a low very major error rate (37%). Sensititre missed 57% of DNSE.

Conclusions:

  • MicroScan methods likely overestimate DNSE prevalence.
  • Significant discrepancies between AST methods highlight challenges in accurately confirming daptomycin nonsusceptibility.
  • Further research is required to establish a gold standard for DNSE susceptibility testing.