Netilmicin disk susceptibility tests: effect of cations on the MIC correlates

When testing Pseudomonas aeruginosa against netilmicin, MICs were markedly affected by the concentration of cations added to the test medium. A susceptible disk test result (zone greater than or equal to 15 mm) corresponded to MIC less than or equal to 4.0 micrograms/ml in unsupplemented broth, less than or equal to 12 micrograms/ml in broth with half the usual amount of cations and less than or equal to 32 micrograms/ml in broth with the recommended concentration of cations. Tests with 30 micrograms netilmicin disks best predicted susceptibility as determined by MICs in broth without added cations. When the MICs were determined in cation supplemented broth, the number of interpretive discrepancies increased to an unacceptably high level.