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Bacteriology

Testing of In Vitro Susceptibility of Neisseria gonorrhoeae to Azithromycin: Comparison of Disk Diffusion and Reference Agar Dilution Methods

Ricardo Gianecini, Lucia Irazu, Marcelo Rodríguez, Paula Cristaldo, Claudia Oviedo, Marisa Turco, Veronica Rodrigo, Liliana Fernández Canigia, Ana Schneider, Liliana Guelfand, Laura Scocozza, GASSP-AR Working Group, Patricia Galarza
Erik Munson, Editor
Ricardo Gianecini
aWorld Health Organization Collaborating Centre for Antimicrobial Resistance, National Reference Laboratory of Sexually Transmitted Diseases (STD), National Institute of Infectious Diseases-ANLIS Dr. Carlos G. Malbrán, Buenos Aires, Argentina
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Lucia Irazu
bNational Institute of Infectious Diseases-ANLIS Dr. Carlos G. Malbrán, Buenos Aires, Argentina
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Marcelo Rodríguez
bNational Institute of Infectious Diseases-ANLIS Dr. Carlos G. Malbrán, Buenos Aires, Argentina
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Paula Cristaldo
aWorld Health Organization Collaborating Centre for Antimicrobial Resistance, National Reference Laboratory of Sexually Transmitted Diseases (STD), National Institute of Infectious Diseases-ANLIS Dr. Carlos G. Malbrán, Buenos Aires, Argentina
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Claudia Oviedo
aWorld Health Organization Collaborating Centre for Antimicrobial Resistance, National Reference Laboratory of Sexually Transmitted Diseases (STD), National Institute of Infectious Diseases-ANLIS Dr. Carlos G. Malbrán, Buenos Aires, Argentina
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Marisa Turco
cSección Microbiología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
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Veronica Rodrigo
cSección Microbiología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
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Liliana Fernández Canigia
dLaboratorio Bacteriología, Hospital Alemán, Buenos Aires, Argentina
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Ana Schneider
dLaboratorio Bacteriología, Hospital Alemán, Buenos Aires, Argentina
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Liliana Guelfand
eLaboratorio Bacteriología, Hospital Fernández, Buenos Aires, Argentina
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Laura Scocozza
eLaboratorio Bacteriología, Hospital Fernández, Buenos Aires, Argentina
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fGonococcal Antimicrobial Susceptibility Surveillance Programme-Argentina (GASSP-AR)
Patricia Galarza
aWorld Health Organization Collaborating Centre for Antimicrobial Resistance, National Reference Laboratory of Sexually Transmitted Diseases (STD), National Institute of Infectious Diseases-ANLIS Dr. Carlos G. Malbrán, Buenos Aires, Argentina
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Erik Munson
Marquette University
Roles: Editor
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DOI: 10.1128/JCM.01398-20
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ABSTRACT

Azithromycin in combination with ceftriaxone is recommended as the first-line treatment for uncomplicated gonorrhea in many countries. Therefore, monitoring of azithromycin susceptibility of Neisseria gonorrhoeae isolates is essential. In 2019, the Clinical and Laboratory Standards Institute (CLSI) listed the MIC breakpoint for a susceptible-only category to azithromycin, but breakpoints for disk diffusion are not yet available. In this study, we evaluated the usefulness of disk diffusion for testing the susceptibility of N. gonorrhoeae isolates to azithromycin. A total of 189 clinical isolates susceptible and nonsusceptible to azithromycin were used. Agar dilution MICs were correlated with inhibition zone diameters of azithromycin disks (15-μg) manufactured by BBL and Oxoid. In addition, an interlaboratory study involving two clinical microbiology laboratories was conducted. There was a strong correlation between disk diffusion and agar dilution for BBL disks (r = −0.74; P < 0.001) and Oxoid disks (r = −0.75; P < 0.001). Using a zone diameter breakpoint of ≥27 mm (susceptible) and ≤26 mm (nonsusceptible) yielded good separation between susceptible and nonsusceptible isolates and the least number of discrepancies. Compared to agar dilution, disk diffusion showed high agreement and kappa values of 95.2% and 0.899 (P < 0.001) for BBL disks and 96.8% and 0.933 (P < 0.001) for Oxoid disks, respectively. Major and very major discrepancies were observed in isolates with azithromycin MICs (1 and 2 μg/ml, respectively) near to the breakpoint. These data illustrate that disk diffusion could be a reliable method in clinical laboratories to test susceptibility to azithromycin in N. gonorrhoeae isolates.

FOOTNOTES

    • Received 5 June 2020.
    • Returned for modification 6 July 2020.
    • Accepted 8 August 2020.
    • Accepted manuscript posted online 12 August 2020.
  • Supplemental material is available online only.

  • Copyright © 2020 American Society for Microbiology.

All Rights Reserved.

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Testing of In Vitro Susceptibility of Neisseria gonorrhoeae to Azithromycin: Comparison of Disk Diffusion and Reference Agar Dilution Methods
Ricardo Gianecini, Lucia Irazu, Marcelo Rodríguez, Paula Cristaldo, Claudia Oviedo, Marisa Turco, Veronica Rodrigo, Liliana Fernández Canigia, Ana Schneider, Liliana Guelfand, Laura Scocozza, GASSP-AR Working Group, Patricia Galarza
Journal of Clinical Microbiology Oct 2020, 58 (11) e01398-20; DOI: 10.1128/JCM.01398-20

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Testing of In Vitro Susceptibility of Neisseria gonorrhoeae to Azithromycin: Comparison of Disk Diffusion and Reference Agar Dilution Methods
Ricardo Gianecini, Lucia Irazu, Marcelo Rodríguez, Paula Cristaldo, Claudia Oviedo, Marisa Turco, Veronica Rodrigo, Liliana Fernández Canigia, Ana Schneider, Liliana Guelfand, Laura Scocozza, GASSP-AR Working Group, Patricia Galarza
Journal of Clinical Microbiology Oct 2020, 58 (11) e01398-20; DOI: 10.1128/JCM.01398-20
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KEYWORDS

azithromycin
disk diffusion
Neisseria gonorrhoeae

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