Autobac susceptibility testing of methicillin-resistant Staphylococcus aureus isolated in an Australian hospital

Semiautomated rapid broth elution (Autobac Multi-Test System; General Diagnostics, Div. Warner-Lambert Co., Morris Plains, N.J.) and disk diffusion tests were compared with an agar dilution breakpoint method to determine the antibiotic susceptibility of 147 methicillin-resistant Staphylococcus aureus isolates from our hospital. Although the disk diffusion method, in general, correlated well with the agar dilution tests, the overall agreement of the Autobac tests with agar dilution tests was only 79%, with many very major discrepancies occurring with clindamycin (88%), gentamicin (33%), and methicillin (15%). When we used a 10-fold higher inoculum for the Autobac tests, all isolates were shown to be resistant to methicillin, but significant numbers of major and minor discrepancies occurred with chloramphenicol, fusidic acid, and neomycin. The majority of isolates were shown to belong to three biotypes, distinguishable by lactose fermentation, lipolysis, hemolysis, and pigment production. The antibiotic susceptibility profile of one biotype was found to be markedly different from those of the other biotypes and contained a high incidence of clindamycin susceptibility and neomycin, gentamicin, and kanamycin resistance. In contrast, the other two biotypes had a high incidence of clindamycin, gentamicin, and kanamycin resistance and neomycin susceptibility and accounted for most of the very major discrepancies in the clindamycin and aminoglycoside tests. In these methicillin-resistant S. aureus strains, discrepancies possibly may arise from partial expression of methicillin resistance, dissociated or inducible clindamycin resistance, and instability of gentamicin resistance.