Examination of Pseudomonas aeruginosa-gentamicin discrepancies encountered in an Autobac I-disk diffusion comparison

Seven Pseudomonas aeruginosa strains found to be susceptible to gentamicin by the Autobac I system and resistant by the Bauer-Kirby disk diffusion method were tested for the presence of mixed populations of cells. Double zones of inhibition randomly appeared on gentamicin disk diffusion plates, and susceptible and resistant subpopulations were isolated from these plates. Growth kinetic studies of separated strains and mixed subpopulations indicated that the susceptible organisms grew rapidly and were read as susceptible at 5 h with the Autobac I system. Resistant organisms entered a sustained lag phase and did not achieve sufficient turbidity to be read as resistant with the Autobac I system before 6 h. Thus, a false reading of susceptible could be obtained with the Autobac I system, depending on the ratio of susceptible organisms to resistant organisms selected for testing. A mixed susceptible and resistant population could be recognized by extending the incubation time of the Autobac I cuvette or by using other susceptibility methods to test isolates with light-scattering indexes of less than 1.0.