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Journal of Clinical Microbiology, October 1998, p. 2996-3001, Vol. 36, No. 10
Departments of
Pathology1 and
Internal
Medicine,2 University of Iowa, Iowa City, Iowa
52242;
Washington University School of Medicine/Barnes
Jewish Hospital, St. Louis, Missouri3; and
Department of Pathology and Laboratory Medicine, University
of Wisconsin Hospital and Clinic, Madison,
Wisconsin4
Received 11 May 1998/Returned for modification 22 June
1998/Accepted 13 July 1998
Modified MicroScan gram-positive MIC no. 8 panels (PM-8) were
analyzed for their improved ability to detect vancomycin resistance (VR) and high-level aminoglycoside resistance (HLAR) in enterococci. A
validation study design that utilized selected challenge strains, recent clinical isolates, and reproducibility experiments in a multicenter format was selected. Three independent medical centers compared the commercial panels to reference broth microdilution panels
(RBM) and Synergy Quad Agar (QA). Resistance was verified by
demonstration of VR and HLAR genes by PCR tests. The study was
conducted in three phases. (i) In the challenge phase (CP), two
well-characterized sets of enterococci were obtained from the Centers
for Disease Control and Prevention; one set contained 50 isolates for
VR testing and one contained 48 isolates for HLAR testing. In addition,
a set of 47 well-characterized isolates representing diverse geographic
areas, obtained from earlier national surveillance studies, was tested
at the University of Iowa College of Medicine (UICM). (ii) In the
efficacy phase (EP), each laboratory tested 50 recent, unique clinical
isolates by all methods. (iii) In the reproducibility Phase (RP), each
laboratory tested the same 10 strains by all methods in triplicate on
three separate days. All isolates from the EP were sent to the UICM for
molecular characterization of vanA, -B,
-C1, -C2-3, and HLAR
genes. In the CP, the ranking of test methods by error rates (in
parentheses; very major and major errors combined, versus PCR results)
were as follows: for high-level streptomycin resistance (HLSR), QA (12.0%) > PM-8 (5.2%) > RBM (1.6%); for high-level gentamicin resistance (HLGR), RBM (3.7%) > PM-8 (3.1%) > QA (2.6%); and for VR, RBM = QA (3.0%) > PM-8 (1.2%). In the EP, agreement between all methods and the reference PCR result was 98.0% for HLSR, 99.3% for HLGR, and 98.6% for VR. In the RP, the percentages of results ± 1 log2 dilution of the all-participant mode were as follows: for VR, 100% (PM-8), 98.9% (QA), and 90.0% (RBM); for HLSR, 99.6% (RBM), 98.5% (PM-8), and 82.2% (QA); and for HLGR, 99.6% (RBM), 99.3% (PM-8), and 98.1% (QA). The ability of the PM-8 to detect VR
and HLAR in enterococci was comparable to those for reference susceptibility and molecular PCR methods and was considered acceptable for routine clinical laboratory use.
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.
Use of Molecular and Reference Susceptibility Testing Methods in
a Multicenter Evaluation of MicroScan Dried Overnight Gram-Positive MIC
Panels for Detection of Vancomycin and High-Level Aminoglycoside
Resistances in Enterococci

*
Corresponding author. Mailing address: Medical
Microbiology Division, Department of Pathology, C606 GH, University of
Iowa College of Medicine, Iowa City, Iowa 52242. Phone: (319) 356-2990. Fax: (319) 356-4916. E-mail: ronald-jones{at}uiowa.edu.
Present address: Division of Infectious Diseases, Department of
Internal Medicine, Veterans General Hospital-Kaohsiung, Kaohsiung, Taiwan 813, Republic of China.
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