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Disk diffusion susceptibility tests: need for laboratory-specific breakpoints

R Manninen¹, E Eerola, P Huovinen

¹Antimicrobial Research Laboratory, National Public Health Institute, Turku, Finland.

Scandinavian Journal of Infectious Diseases

|January 1, 1995

Summary

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Antimicrobial resistance testing using different methods can yield varying results for bacteria like Escherichia coli and Staphylococcus aureus. Laboratory-specific breakpoints are recommended for accurate resistance monitoring.

Area of Science:

Clinical microbiology
Antimicrobial resistance surveillance
Diagnostic test evaluation

Background:

Disk susceptibility testing is crucial for monitoring bacterial resistance.
Changes in testing methodologies can impact resistance level interpretation.
Standardized breakpoints may not accurately reflect species-specific resistance trends.

Purpose of the Study:

To evaluate the impact of switching disk susceptibility testing methods on measured resistance levels.
To assess the accuracy of non-species-specific breakpoints in reflecting true resistance development.
To recommend adjustments for accurate antimicrobial resistance monitoring.

Main Methods:

Comparison of resistance data for Escherichia coli and Staphylococcus aureus before and after method change (Biodisk to Oxoid).

Related Experiment Videos

Analysis of resistance percentages and population distribution histograms.

Evaluation of antimicrobial susceptibility test breakpoints.

Main Results:

Significant discrepancies in measured resistance levels were observed after changing the susceptibility testing method.
Resistance percentages for cephalotin-resistant and intermediately resistant E. coli changed dramatically between 1992 and 1993.
Population distribution histograms remained largely unchanged, suggesting the observed percentage changes did not reflect true resistance development.

Conclusions:

Antimicrobial resistance percentages derived from different testing methods and non-species-specific breakpoints may be misleading.
Laboratory-specific breakpoints should be considered and validated for each bacterial species.
Utilizing tools like the WHONET computer program can aid in establishing adjusted laboratory-specific breakpoints.