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Journal of Clinical Microbiology, May 2000, p. 1818-1822, Vol. 38, No. 5
0095-1137/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.

Comparison of Agar Diffusion Methodologies for Antimicrobial Susceptibility Testing of Pseudomonas aeruginosa Isolates from Cystic Fibrosis Patients

Jane L. Burns,1,* Lisa Saiman,2 Susan Whittier,3 Davise Larone,3,dagger Jay Krzewinski,1 Zhenling Liu,2 Steven A. Marshall,4 and Ronald N. Jones4

Department of Pediatrics, Division of Infectious Disease, University of Washington, Seattle, Washington1; Department of Pediatrics, Division of Infectious Diseases, Columbia University,2 and Department of Pathology, New York Presbyterian Hospital (Columbia Presbyterian Center),3 New York, New York; and Department of Pathology, University of Iowa College of Medicine, Iowa City, Iowa4

Received 21 July 1999/Returned for modification 22 October 1999/Accepted 8 March 2000

Pseudomonas aeruginosa is the most common pathogen infecting the lungs of patients with cystic fibrosis (CF). Improved antimicrobial chemotherapy has significantly increased the life expectancy of these patients. However, accurate susceptibility testing of P. aeruginosa isolates from CF sputum may be difficult because the organisms are often mucoid and slow growing. This study of 597 CF isolates of P. aeruginosa examined the correlation of disk diffusion and Etest (AB BIODISK, Solna, Sweden) results with a reference broth microdilution method. The rates of interpretive errors for 12 commonly used antipseudomonal antimicrobials were determined. The disk diffusion method correlated well (zone diameter versus MIC) for all of the agents tested. However, for mucoid isolates, correlation coefficients (r values) for piperacillin, piperacillin-tazobactam, and meropenem were <0.80. The Etest correlation with reference broth microdilution results (MIC versus MIC) was acceptable for all of the agents tested, for both mucoid and nonmucoid isolates. Category interpretation errors were similar for the disk diffusion and Etest methods with 0.4 and 0.1%, respectively, very major errors (false susceptibility) and 1.1 and 2.2% major errors (false resistance). Overall, both agar diffusion methods appear to be broadly acceptable for routine clinical use in susceptibility testing of CF isolates of P. aeruginosa.

* Corresponding author. Mailing address: Children's Hospital and Regional Medical Center, 4800 Sand Point Way N.E., CH-32, Seattle, WA 98105. Phone: (206) 526-2073. Fax: (206) 527-3890. E-mail: jburns{at}chmc.org.

dagger Present address: New York Presbyterian Hospital (Weill Cornell Center), New York, N.Y.

Journal of Clinical Microbiology, May 2000, p. 1818-1822, Vol. 38, No. 5
0095-1137/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.


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