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The E-test (bioMérieux) is a method that integrates disk diffusion and agar dilution to determine the MIC and provides accurate, reproducible quantitative results. Quality control depends on the use of American Tissue Culture Collection organisms. 94,95 Data coming through the computer interface must be verified for accuracy. 92 The initial capital investment may be prohibitive for some facilities, and a backup system is always needed in case of system failure. pneumoniae, enterococci, Stenotrophomonas maltophilia, and coagulase-negative staphylococci. Systems are not appropriate for all organisms unacceptable results (usually falsely susceptible test results) can occur for bacteria such as P. Panels and cards are formatted by the manufacturer with predetermined antimicrobial agents and concentrations that may not be discerning enough for many clinical situations. Systems may be too restrictive for some laboratories. The Sensititre ARIS 2X system has a 64-plate capacity and can perform a combination of 192 MIC, breakpoint, or identification tests on a single instrument.Īdvantages of automated systems are that they can be connected to the laboratory information system, provide rapid test results, allow intralaboratory and interlaboratory standardization, are less labor intensive, and have the potential of artificial intelligence for data review.
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Sensititre is customizable with a choice of completely automated, semi-automated, or manual equipment. Reliable results can be available after approximately 10 hours of incubation. An indicator is added to the broth of each isolate, and the redox indicator measures bacterial growth. Depending on the organism, results are available between 4.5 and 18 hours of incubation.īD Phoenix can accommodate up to 100 panels simultaneously. 92 To solve this problem, MicroScan has incorporated rapid, turbidimetric readers in the panels. A major disadvantage is that some bacteria fail to release fluorophores after growth. MicroScan uses substrates that release fluorophores after interaction with bacterial enzymes, a process resulting in increased fluorescence. It uses turbidimetrically determined kinetic measurements of growth to compute MIC values by regression analysis. Growth is detected by means of a densitometer. Plastic reagent cards contain small wells or microcuvettes that allow simultaneous testing for many different antimicrobial agents.
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VITEK 2 provides susceptibility and identification as early as 2 hours after inoculation. 91 Four automated systems commonly used in the United States are the bioMérieux VITEK Legacy or VITEK 2, the Beckman Coulter MicroScan WalkAway, the BD Phoenix, and the Trek Diagnostic Systems Sensititre. Interpretation of these somewhat arbitrary standards must be made in the context of the organism, the likely site of infection, the density of the organism at the site, and the host's immunocompetence.Īutomated instruments can provide results in 2 to 18 hours. The latter allows only qualitative assessment of susceptibility the exact MIC is unknown. Usually, five to eight concentrations of antibiotics representing therapeutically achievable ranges are tested against each organism, or one to three concentrations are used to determine activity at the breakpoint MIC. 90 MIC trays can be custom made in the laboratory or purchased commercially. The broth microdilution assay is used commonly to determine MICs quantitatively. Specific incubation time ranges are outlined in the Clinical and Laboratory Standards Institute documents. Filter paper disks impregnated with a standardized concentration of an antimicrobial agent are placed on the surface, and the size of the zone of inhibition around the disk is measured after overnight incubation. Because reproducibility depends on the log growth phase of organisms, fresh subcultures are used. 89 Briefly, a standardized inoculum (i.e., direct suspension of colonies to yield a standardized inoculum is acceptable) is swabbed onto the surface of MH agar (i.e., 150-mm plate diameter). Relich, in Principles and Practice of Pediatric Infectious Diseases (Fifth Edition), 2018 Susceptibility Test Methodsĭisk diffusion by the Kirby-Bauer method is a standardized technique for testing rapidly growing pathogens.