Journal List > Korean J Clin Microbiol > v.11(1) > 1038144

Shin, Koo, Kwon, Park, Jung, Ji, and Sung: Evaluation of the Vitek 2 Korean Antimicrobial Susceptibility Testing Cards AST N056 and AST N055

Abstract

Background

The recently issued Korean version of antimicrobial susceptibility cards for Vitek 2 system uses an adjusted antimicrobial combination that reflects Korean clinical practice and CLSI guidelines. We evaluated the two Korean antimicrobial susceptibility testing cards for gram negative rods, AST N056 and AST N055.

Methods

The results of susceptibility tests were compared between the original and Korean cards. A number of the same antimicrobials included in the both cards were 15 in AST N041-AST N056 and 17 in AST N022-AST N055. Susceptibilities to the newly added antimicrobials, aztreonam, tobramycin, and meropenem for AST N056; and cefotaxime, levofloxacin, and minocycline for AST N055 were compared with those obtained by disc diffusion test and, in case of discrepancy, by confirmative Etest or broth dilution method.

Results

In comparison between AST N041 and AST N056 cards, the average discrepancy rate per strain was 0.34, minor error was 88.2%, and major error and very major error were both 5.9%. In comparison between AST N022 and AST055 cards, the average discrepancy rate per strain and very major error were 1.23 and 4.4%, respectively. The three antimicrobial agents added into AST N055 card showed highly discrepant results as a total of 49 items (44.1%) in 111 isolates were discrepant with very major error of 5.9% and major error of 2.0%.

Conclusion

AST N056 showed acceptable results in most items including the newly added antimicrobial agents. However, in the case of AST N055 card that showed a relatively high discrepancy, other indicator antibiotics should be referred to for newly added three antimicrobials. For the antibiotics that showed a high discrepancy between the original and Korean cards, a comparison study should be performed using the standard method and clinical isolates col-lected in Korea.

References

1. Clinical and laboratory standards institute. Performance standards for antimicrobial susceptibility testing; Seventeenth informational supplement. CLSI Document M100-S17. Villanova, PA; CLSI.
2. Pérez-Vázquez M, Oliver A, Sánchez del Saz B, Loza E, Baquero F, Cantón R. Performance of the Vitek 2 system for identification and susceptibility testing of routine Enterobacteriaceae clinical isolates. Int J Antimicrob Agents. 2001; 17:371–6.
4. Gilbert DN, Moellering RC, Sande MA. ed. The Stanford Guide to Antimicrobial Therapy. 33rd ed., Vermont: Antimicrobial Therapy Inc. 2006. 52–6.
5. Jorgensen JH. Selection criteria for an antimicrobial susceptibility testing system. J Clin Microbiol. 1993; 31:2841–4.
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7. Food and Drug Administration. Federal guidelines. Review criteria for assessment of antimicrobial susceptibility testing device. Food and Drug Administration Rockville. 1991.
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Table 1.
The pattern of discrepancy between the Korean AST N056 card and the original AST N041 card
Antimicrobial agents No. of errors
VME ME mE
Amikacin 0 0 2
Amoxicillin/clavulanic acid 0 0 6
Ampicillin 0 0 3
Cefotaxime 0 0 4
Cefoxitin 0 0 2
Ciprofloxacin 0 0 1
Trimethoprim/sulfamethoxazole 0 0 1
Imipenem 0 0 1
Piperacillin/tazobactam 0 0 2
Piperacillin 2 0 3
Tetracycline 0 2 0
Total (%) 2 (5.9) 2 (5.9) 30 (88.2)

Abbreviations: VME, very major error; ME, major error; mE, minor error.

Table 2.
The pattern of discrepancy between Korean AST N055 card and original AST N022 card
Antimicrobial agents No. of errors
VME ME mE
Amikacin 0 0 4
Aztreonam 0 0 22
Cefepime 0 4 10
Ceftazidime 0 1 6
Ciprofloxacin 0 1 5
Colistin 1 2 0
Cotrimoxazole 1 3 0
Gentamicin 0 1 4
Imipenem 1 3 7
Isepamicin 0 1 5
Meropenem 0 3 4
Netilmicin 0 0 10
Piperacillin/tazobactam 1 1 4
Piperacillin 0 1 5
Ticarcillin 1 1 6
Ticarcillin/clavulanic acid 1 2 12
Tobramycin 0 0 2
Total (%) 6 (4.4) 24 (17.7) 106 (77.9)

Abbreviations: VME, very major error; ME, major error; mE, minor error.

Table 3.
The pattern of discrepancy of newly added antimicrobials between Korean cards and broth dilution method
Cards Antimicrobial agents Discrepancy No. with DDT Discrepancy No. with broth dilution method
VME ME mE AM NG
AST N056 Aztreonam 2     2 0  
Tobramycin 6     4 2  
Meropenem 1     1    
Total (%) 9 (8.9)     7 (6.9) 2 (2.0)  
AST N055 Cefotaxime 27 4 0 14 6 3
Levofloxacin 14 2 0 8 3 1
Minocycline 8 0 2 4 1 1
Total (%) 49 (44.1) 6 (5.9) 2 (2.0) 26 (25.7) 10 (9.9) 5 (5)

Abbreviations: VME, very major error; ME, major error; mE, minor error, AM, agreement; NG, no growth; DDT, disk diffusion test.

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