Method preferences and test accuracy of antimicrobial susceptibility testing: updates from the College of Amercian Pathologists Microbiology Surveys Program

Abstract

Objective: To summarize the antimicrobial susceptibility testing results from the College of American Pathologists (CAP) Microbiology Surveys Program for 2000. Specifically, the frequency of tests used and the quantitative and qualitative (susceptibility category) accuracy were assessed.

Design: The CAP Microbiology Surveys challenged subscribers in 2000 with 3 well-characterized organisms for antimicrobial susceptibility testing in pure culture. Each laboratory was to use the test method and reporting procedures routinely applied to patient samples. The strains were National Committee for Clinical Laboratory Standards (NCCLS) quality control organisms with precisely defined antimicrobial susceptibility patterns and reproducibility. Results reported by participants (2685-2979/sample) were graded for categorical accuracy and quantitative performance by comparing reported minimal inhibitory concentrations (microg/mL) or zone diameters (mm) against quality control ranges published by the NCCLS. The appropriateness of reported drugs was determined in the context of the type and anatomic location of the infection.

Results: The tests most often used varied by the species of the organism and growth characteristics of the isolated strains. Nonfastidious, rapid-growing Surveys unknowns (Escherichia coli ATCC 25922, Pseudomonas aeruginosa ATCC 27853) were most often tested with commercial systems (MicroScan, 42.0%-42.4%; Vitek, 41.5%-43.0%) or with the standardized disk diffusion method (12.8%-13.9%). In contrast, fastidious species, such as Streptococcus pneumoniae (ATCC 49619), were predominantly tested by Etest (40.3%), followed by disk diffusion (27.6%) and MicroScan (23.2%). Categorical accuracy was essentially equal between dilution (98.9%) and diffusion (99.0%) methods. Among the minimal inhibitory concentration methods used to test penicillin against S pneumoniae, Etest method quantitative accuracy (96.3%) was greater than that of MicroScan (92.4%). Quantitative accuracy was greatest for dilution minimal inhibitory concentration methods, with more than 90% of results within NCCLS quality control ranges for nearly all reported antimicrobials. Reevaluations of quality control ranges may be needed for 4 to 7 agents, depending on method. Reporting errors were also detected in 2 areas: (1) reporting results for drugs not active at the site of infection and (2) reporting results for drugs tested with suboptimal methods without published NCCLS interpretive criteria.

Conclusions: Antimicrobial susceptibility testing methods used in US laboratories were dominated by commercial products with relatively high accuracy (qualitative and quantitative). As available methods have become better suited to both fastidious and rapid-growing species, reporting errors have assumed a higher level of concern to the CAP Surveys in an effort to minimize prescription errors.