Comparison of E-test with broth microdilution and disk diffusion for susceptibility testing of coryneform bacteria.

The susceptibilities of 135 coryneform bacteria isolated from clinical samples to ampicillin (AMP), cephalothin (CR), cefoxitin (FOX), cefotaxime (CTX), erythromycin (E), ciprofloxacin (CIP), tetracycline (TE), amikacin (AK), vancomycin (VA), and rifampin (R) were determined by disk diffusion, broth microdilution, and the E-test. The following species (number of isolates in parentheses) were included: Corynebacterium urealyticum (30), Corynebacterium minutissimum (20), coryneform CDC group ANF-1 (20), Corynebacterium striatum (20), Corynebacterium jeikeium (15), coryneform CDC group I2 (8), Listeria monocytogenes (7), Corynebacterium xerosis (5), and other coryneform bacteria (10). Agreement within one twofold dilution between the E-test and broth microdilution was 31% (VA), 64% (AK), 71% (CTX), 77% (FOX and CIP), 79% (TE), 84% (AMP), 87% (E), and 88% (CR and R). For the 1,350 combinations of microorganisms and antimicrobial agents, 85 (6.3%) discrepancies in interpretive category were found (4.2% minor, 1.2% major, and 0.9% very major). Seventy (5.1%) disagreements in interpretive category were found between disk diffusion and the E-test (3.8% minor, 0.4% major, and 0.9% very major), and 85 (6.3%) disagreements were found between microdilution (reference method) and disk diffusion (4.2% minor, 0.5% major, and 1.5% very major). MICs obtained with the E-test were highly reproducible. No category discrepancy was observed for VA, despite quantitative results. Considering interpretive categories, there is a good overall agreement between the three methods studied here, but further evaluation of current methodologies for susceptibility testing is required when considering coryneform bacteria and determination of quantitative activity of antimicrobial agents.