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Journal of Clinical Microbiology, November 2006, p. 4072-4076, Vol. 44, No. 11
0095-1137/06/$08.00+0     doi:10.1128/JCM.01632-06
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

Influence of Disk Separation Distance on Accuracy of the Disk Approximation Test for Detection of Inducible Clindamycin Resistance in Staphylococcus spp.{triangledown}

Matthew V. N. O'Sullivan,1* Yongwei Cai,1,2 Fanrong Kong,1 Xianyu Zeng,1,3 and Gwendolyn L. Gilbert1

Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology and Medical Research, Westmead, New South Wales, Australia,1 Department of Dermatology, Hangzhou Third People's Hospital, Hangzhou, Zhejiang Province, People's Republic of China,2 Department of Dermatology, Wuhan First Hospital, Wuhan, Hubei Province, People's Republic of China3

Received 7 August 2006/ Returned for modification 24 August 2006/ Accepted 15 September 2006

We undertook this study to assess the accuracy of the clindamycin-erythromycin disk approximation test (D-test) for detection of inducible clindamycin resistance in Staphylococcus spp. One hundred sixty-three Staphylococcus aureus and 68 coagulase-negative Staphylococcus (CoNS) spp. which were erythromycin nonsusceptible but clindamycin susceptible were tested using the D-test performed at both 15-mm and 22-mm disk separations and compared with genotyping as the "gold standard." The rate of inducible clindamycin resistance was 96.3% for S. aureus and 33.8% for CoNS spp. The sensitivities of the D-tests performed at 15 mm and 22 mm were 100% and 87.7%, respectively, and specificities were 100% for both. The use of 22-mm disk separation for the D-test to detect inducible clindamycin resistance results in an unacceptably high very major error rate (12.3%). All isolates with false-negative results harbored the ermA gene, and the majority were methicillin-resistant Staphylococcus aureus. False-negative results were associated with smaller clindamycin zone sizes and double-edged zones. We recommend using a disk separation distance of ≤15 mm. There is wide geographic variation in the rates of inducible clindamycin resistance, and each laboratory should determine the local rate before deciding whether to either perform the D-test routinely or else report that all erythromycin-resistant S. aureus isolates are also clindamycin resistant.

* Corresponding author. Present address: Department of Microbiology, Royal North Shore Hospital, Pacific Highway, St. Leonards 2065, NSW, Australia. Phone: (612) 9926-8478. Fax: (612) 9437-5746. E-mail: maosulli{at}nsccahs.health.nsw.gov.au.

{triangledown} Published ahead of print on 27 September 2006.

Journal of Clinical Microbiology, November 2006, p. 4072-4076, Vol. 44, No. 11
0095-1137/06/$08.00+0     doi:10.1128/JCM.01632-06
Copyright © 2006, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • Yoon, E.-J., Kwon, A.-R., Min, Y.-H., Choi, E.-C. (2008). Foggy D-shaped zone of inhibition in Staphylococcus aureus owing to a dual character of both inducible and constitutive resistance to macrolide-lincosamide-streptogramin B. J Antimicrob Chemother 61: 533-540 [Abstract] [Full Text]  
  • Fernandes, C. J., O'Sullivan, M. V. N., Cai, Y., Kong, F., Zeng, X., Gilbert, G. L., Kotsiou, G. (2007). Agar Dilution Method for Detection of Inducible Clindamycin Resistance in Staphylococcus spp.. J. Clin. Microbiol. 45: 4018-4020 [Abstract] [Full Text]  


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