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Lee, Ryoo, Kim, Chae, and Huh: Evaluation of the BD Phoenix Automated Microbiology System SMIC/ID-2 Panel for Antimicrobial Susceptibility Testing of Streptococcus pneumoniae
Original Article

Korean J Leg Med 2009;29(3):212-217.

Published online: 14 January 2009

DOI: https://doi.org/10.3343/kjlm.2009.29.3.212

Evaluation of the BD Phoenix Automated Microbiology System SMIC/ID-2 Panel for Antimicrobial Susceptibility Testing of Streptococcus pneumoniae

Kyo Kwan Lee, M.D.1, Nam Hee Ryoo, M.D.2, Sung Tae Kim, M.T.1, Seok-Lae Chae, M.D.1, Hee Jin Huh, M.D.1

1Department of Laboratory Medicine, Dongguk University International Hospital, Goyang, Korea

2Department of Laboratory Medicine, School of Medicine, Keimyung University, Daegu, Korea

Corresponding author: Hee Jin Huh, M.D. Department of Laboratory Medicine, Dongguk University International Hospital, 814 Siksa-dong, Ilsandong-gu, Goyang 410-773, Korea Tel: +82-31-961-7893, Fax: +82-31-961-7902 E-mail: hjhuh@duih.org

      Revised 9 February 20091 April 2009       Accepted 2 April 2009

Copyright © 2009 Korean Society for Legal Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background:

With the emergence of antimicrobial resistance among Streptococcus pneumoniae, a more accurate and automated antimicrobial susceptibility testing method is essential. We evaluated the BD Phoenix Automated Microbiology System (Becton Dickinson Diagnostic Systems, USA) SMIC/ID-2 panel for antimicrobial susceptibility testing of S. pneumoniae.

Methods:

A total of 113 clinical strains of S. pneumoniae (88 penicillin susceptible strains, 8 intermediate strains, and 17 resistant strains by 2008 CLSI criteria) were tested. Minimum inhibitory concentrations (MICs) for penicillin, cefotaxime, clindamycin, erythromycin, levofloxacin, trimethoprim/sulfamethoxazole, tetracycline, and vancomycin were determined by Etest (AB Biodisk, Sweden) and Phoenix System. The results obtained by Phoenix system were compared to those obtained by Etest.

Results:

The overall essential agreement of MICs (within one dilution of MICs) defined by the Phoenix and Etest was 92.3%. Neither very major errors nor major errors were produced, and minor errors were 6.5%. Minor errors were frequently observed in susceptibility testings for penicillin (22.1%), cefotaxime (12.4%), and trimethoprim/sulfamethoxazole (11.5%).

Conclusions:

The Phoenix SMIC/ID-2 panel provided a simple and rapid susceptibility testing for S. pneumoniae, and the results were in a good agreement with those of Etest. The Phoenix system appears to be an effective automated system in clinical microbiology laboratories.

Keywords: Streptococcus pneumoniae, BD Phoenix, Antimicrobial susceptibility test, Etest

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Table 1.
Antimicrobial susceptibility of 113 S. pneumoniae clinical isolates as determined by Etest
  N (%) of isolates tested
Susceptible Intermediate Resistant
Cefotaxime 90 (79.7) 12 (10.6) 11 (9.7)
Clindamycin 42 (37.2) 1 (0.9) 70 (61.9)
Erythromycin 27 (23.9) 4 (3.5) 82 (72.6)
Levofloxacin 100 (88.5) 2 (1.8) 11 (9.7)
Penicillin (Former criteria) 88 (77.9) 8 (7.1) 17 (15.0)
  19 (16.8) 44 (38.9) 50 (44.3)
Tetracycline 29 (25.7) 0 84 (74.3)
Trimethoprim/Sulfamethoxazole 39 (34.5) 24 (21.2) 50 (44.3)
Vancomycin 113 (100) 0 0
Table 2.
Comparison of the MICs determined by Phoenix SMIC/ID-2 panel with those determined by Etest for S. pneumoniae clinical isolates
  N of MICs by Phoenix SMIC/ID-2 panel within indicated log2 of Etest MICs∗ % Agreement (±1 dilution)
<-2 -2 -1 0 +1 +2 >+2
Cefotaxime 1 5 19 80 7 1   93.8
Clindamycin 4 28 9 72       71.7
Erythromycin 3 3 6 99 2     94.7
Levofloxacin   1 32 70 10     99.1
Penicillin 4 3 14 55 27 8 2 85.0
Tetracycline     2 101 9   1 99.1
Trimethoprim/Sulfamethoxazole     7 93 8 5   95.6
Vancomycin     2 106 4 1   99.1

∗ There were some off-scale MICs that could not be compared accurately.

Abbreviations: MIC, minimum inhibitory concentration.

Table 3.
Interpretative category errors determined by Phoenix SMIC/ID-2 panel and Etest method,
N (%) of Interpretative category errors∗
  CA Very major Major Minor
Cefotaxime 99 (87.6) 0 0 14 (12.4)
Clindamycin† 112 (99.1) 0 0 1 (0.9)
Erythromycin† 109 (97.4) 0 0 4 (3.6)
Levofloxacin 111 (98.2) 0 0 2 (1.8)
Penicillin‡ 88 (77.9) 0 0 25 (22.1)
Tetracycline 113 (100) 0 0 0
Trimethoprim/Sulfamethoxazole 100 (88.5) 0 0 13 (11.5)
Vancomycin 113 (100) 0 0 0
Total 93.5 0 0 59 (6.5)

∗ Very major error, resistant by the reference method but susceptible by Phoenix; major error, susceptible by the reference method but resistant by Phoenix; minor error, intermediate by one method but resistant or susceptible by the other.

† MICs obtained by Etest were interpreted by the manufacture's interpretative criteria.

‡ Penicillin MICs interpreted using nonmeningitis parenteral criteria except for CSF isolates. Abbreviation: CA, Categorical agreement.

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