E test as susceptibility test and epidemiologic tool for evaluation of Neisseria meningitidis isolates

The E test (AB Biodisk, Solna, Sweden), a new approach developed to test antimicrobial susceptibility, was compared with the agar dilution method for seven-drug antibiogram analysis of Neisseria meningitidis isolates. The overall E-test quantitative accuracy (+/- 1 log2 dilution) was 93% compared with that of agar dilution testing. The E test was then used to perform the susceptibility tests on a 10-year sample of 102 N. meningitidis isolates, including 5 from a recent epidemic outbreak in the University of Iowa (Iowa City) community. The E test proved to be an efficient methodology for identifying common source clusters of meningococcal disease having resistance to rifampin or sulfonamides. Moreover, the data demonstrated a recent increase in penicillin MICs (MIC for 90% of strains, 0.094 microgram/ml) and an escalation of high-level resistance to trimethoprimsulfamethoxazole (33%) and rifampin (14%). The E test should be considered a simple and accurate susceptibility method for the emerging need to test meningococci and other pathogenic neisserias. Chocolate Mueller-Hinton agar was observed to provide the best support of growth and E-test MIC results that correlated well with results of the reference agar dilution method previously used for neisserias.