Evaluation of the effectiveness of different brands' disks in antimicrobial disk susceptibility tests

A total of 813 routine isolates of aerobic and facultatively anaerobic bacteria were employed to determine the efficacy of different branded (Oxoid, Difco, BBL) antimicrobial disks, using disk antimicrobial susceptibility tests, for a total of 22 kinds of antimicrobial disks and 10,740 antibiotic-organism comparisons. Major positive and major negative discrepancies in results were defined as a change from "susceptible" to "both resistant", and a change from "resistant" to "both susceptible" according to the National Committee for Clinical Laboratory Standards' interpretive standards for zone diameters. Minor positive and minor negative discrepancies were defined as a change from "susceptible" to "both intermediate", or "intermediate" to "both resistant"; and a change from "resistant" to "both intermediate", or "intermediate" to "both susceptible". The overall agreements of Oxoid, Difco, and BBL systems were 98%, 98.7%, and 98.4% respectively, and their differences are not statistically significant. Different kinds of antimicrobial disks' representative patterns of these three brands are further analyzed: (A) In the Oxoid series, there were 220 discrepancies. Minor negative discrepancy is predominant, most frequently related to carbenicillin (25), gentamicin (13) and cephalothin (10). Besides minor negative discrepancy, carbenicillin also had six minor positive discrepancies. Tetracyclin had ten minor positive discrepancies. (B) In the Difco series, there were 137 discrepancies. The majority of them are minor positive discrepancies. Moxalactam (11) and cefotaxime (10) are the most common antibiotics involved. (C) In the BBL series, there were 170 discrepancies. Minor positive discrepancy was the predominant one, which mostly related to carbenicillin (24), amikacin (13), and ceftizoxime (12). In addition, tetracyclin had 24 times minor negative discrepancies. Laboratory workers must pay attention to these different patterns of representation. In order to evaluate the quality of 11 pairs of the give-away and the purchased BBL disks, we also compared the results for these 813 routine isolates (a total of 5,482 antibiotic-organism comparisons). The giveaway disks demonstrated 99.1% overall agreement with the purchased disks. There were 48 minor discrepancies [26 (0.47%) minor positive discrepancies and 22 (0.4%) minor negative discrepancies]. These results allow this study to emphasize the followings in order to raise the awareness of the laboratory workers: (i) alteration of disk efficacy during transportation and storage; (ii) major considerations in choosing different brands' antimicrobial disks, and (iii) the important roles played by salespersons and pharmaceutical companies in achieving sound results.