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[Detection of antibiotic resistance in Enterococcus sp. Comparison of GPS-TA (BioMérieux-Vitek), Uniscept MIC-3
1Unidad de Microbiología, Hospital Nuestra Señora del Pino, Las Palmas de Gran Canaria.
Background:
The treatment of severe enterococcus infections requires synergism of a beta-lactamic or glycopeptide and a aminoglycoside, but when resistance to first one or high-level resistance to aminoglycosides are present, synergism would be lost. We compared the adequacy of two commercially available systems to detect antibiotic resistance.
Methods:
We studied 158 isolates of Enterococcus sp., with high-level resistance to gentamicin (40 isolates) and streptomycin (89 isolates), resistance to ciprofloxacin (34 isolates), resistance to ampicillin (7 isolates) and with intermediate susceptibility to vancomycin (3 isolates). No one was beta-lactamase producer by Cefinase disk method. We use disk diffusion as reference technique to detect high-level streptomycin resistance. The susceptibility to the remainder antibiotics was studied by agar dilution method, according to NCCLS. We studied the accuracy of GPS-TA cards and Uniscept MIC-3 in relation to the degree of agreement with conventional means, following FDA criteria.
Results:
Essential agreement for MIC was less than 90 with MIC-3 for ampicillin (81.5%) and ciprofloxacin (71.3%). Categorical agreement rate was less than 90% (76.4%) and major error rate was higher than 3% (10.9%) with the use of MIC-3 for ciprofloxacin. Very major errors for ampicillin, vancomycin and ciprofloxacin were not produced by any system. The very major error rates for high level resistance to gentamicin and streptomycin with GPS-TA card were 5 and 15.7%, respectively.
Conclusions:
We do not recommend the use of the Uniscept MIC-3 panel with visual reading to detect susceptibility to ciprofloxacin. Detection of high levels of aminoglucoside resistance by GPS-TA card should be supplemented with conventional techniques because of the high rate of major error. Due to the low number of strains that have been studied, we can not assure the suitability of these systems to detect ampicillin or vancomycin resistance.