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Related Experiment Videos

Problems with the disk diffusion test for detection of vancomycin resistance in enterococci.

J M Swenson1, B C Hill, C Thornsberry

  • 1Antimicrobics Investigation Branch, Centers for Disease Control, Atlanta, Georgia 30333.

Journal of Clinical Microbiology
|September 1, 1989
PubMed
Summary

Accurate vancomycin susceptibility testing is crucial for enterococci. Current disk diffusion methods show errors, necessitating revised breakpoints and MIC testing for reliable results.

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Area of Science:

  • Clinical Microbiology
  • Antimicrobial Resistance
  • Infectious Diseases

Background:

  • Enterococci are significant nosocomial pathogens.
  • High-level vancomycin resistance in enterococci poses a treatment challenge.
  • Accurate susceptibility testing is vital for guiding antimicrobial therapy.

Purpose of the Study:

  • To evaluate vancomycin susceptibility testing methods for enterococci.
  • To assess the accuracy of current and proposed breakpoints for disk diffusion.
  • To identify discrepancies in classifying vancomycin-resistant enterococci.

Main Methods:

  • Tested 53 enterococcal strains, including vancomycin-resistant isolates.
  • Utilized broth microdilution and disk diffusion assays.

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  • Compared results using current and proposed National Committee for Clinical Laboratory Standards breakpoints.

    • Main Results:

    • Current disk diffusion breakpoints led to significant very major (1.9%) and minor (11.5%) errors.
    • Proposed vancomycin breakpoints reduced errors to 13.5% minor, with no very major errors.
    • Revised disk diffusion breakpoints addressed MICs of 32 µg/ml but not 8 µg/ml.

    Conclusions:

    • Current disk diffusion parameters are inadequate for vancomycin susceptibility testing of enterococci.
    • Proposed breakpoints improve accuracy but do not fully resolve discrepancies for certain MIC ranges.
    • MIC testing remains essential for differentiating strains with intermediate vancomycin resistance.