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Susceptibility

Carbapenem Susceptibility Testing Errors Using Three Automated Systems, Disk Diffusion, Etest, and Broth Microdilution and Carbapenem Resistance Genes in Isolates of Acinetobacter baumannii-calcoaceticus Complex

Ana Elizabeth Markelz, Katrin Mende, Clinton K. Murray, Xin Yu, Wendy C. Zera, Duane R. Hospenthal, Miriam L. Beckius, Tatjana Calvano, Kevin S. Akers
Ana Elizabeth Markelz
1Brooke Army Medical Center, Fort Sam Houston, Texas
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Katrin Mende
1Brooke Army Medical Center, Fort Sam Houston, Texas
3Infectious Disease Clinical Research Program, Bethesda, Maryland
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Clinton K. Murray
1Brooke Army Medical Center, Fort Sam Houston, Texas
2Uniformed Services University of the Health Sciences, Bethesda, Maryland
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  • For correspondence: Clinton.Murray@amedd.army.mil
Xin Yu
1Brooke Army Medical Center, Fort Sam Houston, Texas
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Wendy C. Zera
1Brooke Army Medical Center, Fort Sam Houston, Texas
3Infectious Disease Clinical Research Program, Bethesda, Maryland
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Duane R. Hospenthal
1Brooke Army Medical Center, Fort Sam Houston, Texas
2Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Miriam L. Beckius
1Brooke Army Medical Center, Fort Sam Houston, Texas
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Tatjana Calvano
1Brooke Army Medical Center, Fort Sam Houston, Texas
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Kevin S. Akers
1Brooke Army Medical Center, Fort Sam Houston, Texas
2Uniformed Services University of the Health Sciences, Bethesda, Maryland
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DOI: 10.1128/AAC.00112-11
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This article has a correction. Please see:

  • Carbapenem Susceptibility Testing Errors Using Three Automated Systems, Disk Diffusion, Etest, and Broth Microdilution and Carbapenem Resistance Genes in Isolates of Acinetobacter baumannii-calcoaceticus Complex
    - January 20, 2012

ABSTRACT

The Acinetobacter baumannii-calcoaceticus complex (ABC) is associated with increasing carbapenem resistance, necessitating accurate resistance testing to maximize therapeutic options. We determined the accuracy of carbapenem antimicrobial susceptibility tests for ABC isolates and surveyed them for genetic determinants of carbapenem resistance. A total of 107 single-patient ABC isolates from blood and wound infections from 2006 to 2008 were evaluated. MICs of imipenem, meropenem, and doripenem determined by broth microdilution (BMD) were compared to results obtained by disk diffusion, Etest, and automated methods (the MicroScan, Phoenix, and Vitek 2 systems). Discordant results were categorized as very major errors (VME), major errors (ME), and minor errors (mE). DNA sequences encoding OXA beta-lactamase enzymes (blaOXA-23-like, blaOXA-24-like, blaOXA-58-like, and blaOXA-51-like) and metallo-β-lactamases (MBLs) (IMP, VIM, and SIM1) were identified by PCR, as was the KPC2 carbapenemase gene. Imipenem was more active than meropenem and doripenem. The percentage of susceptibility was 37.4% for imipenem, 35.5% for meropenem, and 3.7% for doripenem. Manual methods were more accurate than automated methods. blaOXA-23-like and blaOXA-24-like were the primary resistance genes found. blaOXA-58-like, MBLs, and KPC2 were not present. Both automated testing and manual testing for susceptibility to doripenem were very inaccurate, with VME rates ranging between 2.8 and 30.8%. International variability in carbapenem breakpoints and the absence of CLSI breakpoints for doripenem present a challenge in susceptibility testing.

  • Copyright © 2011, American Society for Microbiology. All Rights Reserved.
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Carbapenem Susceptibility Testing Errors Using Three Automated Systems, Disk Diffusion, Etest, and Broth Microdilution and Carbapenem Resistance Genes in Isolates of Acinetobacter baumannii-calcoaceticus Complex
Ana Elizabeth Markelz, Katrin Mende, Clinton K. Murray, Xin Yu, Wendy C. Zera, Duane R. Hospenthal, Miriam L. Beckius, Tatjana Calvano, Kevin S. Akers
Antimicrobial Agents and Chemotherapy Sep 2011, 55 (10) 4707-4711; DOI: 10.1128/AAC.00112-11

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Carbapenem Susceptibility Testing Errors Using Three Automated Systems, Disk Diffusion, Etest, and Broth Microdilution and Carbapenem Resistance Genes in Isolates of Acinetobacter baumannii-calcoaceticus Complex
Ana Elizabeth Markelz, Katrin Mende, Clinton K. Murray, Xin Yu, Wendy C. Zera, Duane R. Hospenthal, Miriam L. Beckius, Tatjana Calvano, Kevin S. Akers
Antimicrobial Agents and Chemotherapy Sep 2011, 55 (10) 4707-4711; DOI: 10.1128/AAC.00112-11
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