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Antimicrobial Susceptibility Testing Methods for Bacterial Pathogens

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Antimicrobial Drug Resistance

Abstract

Gone are the days when the antimicrobial susceptibility pattern of a bacterial isolate could be predicted simply on the basis of its species identification. Although Streptococcus pyogenes isolates remain susceptible to penicillin, one has to continually ask—for how long? With the discovery of strains of Staphylococcus aureus that are highly resistant to vancomycin [1], the emergence of carbapenem-resistant Enterobacteriaceae, and strains of Acinetobacter species that are pan resistant [2, 3], the role of antimicrobial susceptibility testing in guiding therapy for infectious diseases is becoming increasingly important [4]; it is a key function of clinical microbiology laboratories. Results guide physicians in their selection of appropriate antimicrobial therapy for patients with infections. Yet, ironically, many of these novel resistance phenotypes are not easily detected using the automated susceptibility testing methods so prevalent in today’s clinical laboratories [5, 6]. The ability of the clinical laboratory to detect emerging resistance profiles is often directly related to the extra efforts expanded to catch novel resistance mechanisms. Although resistant bacteria were common previously only in intensive care units of hospitals, multidrug resistance has become an issue among strains of community-acquired pathogens such as Salmonella, Shigella, and even Neisseria gonorrhoeae [7–9]. To complicate matters even further, resistant organisms that arise in the community are now also spreading into healthcare settings [10, 11]. Thus, it is imperative that changes in resistance patterns of a wide range of bacterial pathogens be monitored continually to insure optimal treatment both of the individual patients and for maintaining the efficacy of empiric therapy regimens. Antimicrobial susceptibility test methods include disk diffusion and minimal inhibitory concentration (MIC) methods, such as broth microdilution, agar dilution, and agar gradient diffusion. MIC tests often utilize semi- or fully automated platforms to decrease time to results and improve workflow. Microbiology laboratories often employ supplemental tests to maximize detection of unusual or borderline-resistant phenotypes or emerging resistance mechanisms that may be missed by standard methods. Qualitative results (susceptible, intermediate, or resistant) for antimicrobial agents may be accompanied by quantitative values for MIC test to help guide dosing regimens. Molecular-based tests, such as polymerase chain reaction assays and film arrays, are used with increasing frequency to provide rapid results, often within 1 h, for resistance genes or mutations associated with antimicrobial resistance to improve antimicrobial therapy. Such assays have gained widespread acceptance for methicillin-resistant Staphylococcus aureus (MRSA) in positive blood cultures, vancomycin resistance genes in enterococci, and multidrug-resistant strains of tuberculosis from patients with respiratory disease. This chapter will explore in detail the methods used for antimicrobial susceptibility testing of bacterial pathogens.

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  1. Cepheid, 904 Caribbean Drive, Sunnyvale, CA, 94089, USA

    Fred C. Tenover Ph.D.

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  1. Fred C. Tenover Ph.D.
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Correspondence to Fred C. Tenover Ph.D. .

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Editors and Affiliations

  1. Treiber Therapeutics, Cambridge, Massachusetts, USA

    Douglas L. Mayers

  2. Wayne State University School of Medicine, Detroit Medical Center, Detroit, Michigan, USA

    Jack D. Sobel

  3. Canada Research Chair in Antimicrobial Resistance, Centre de recherche en Infectiologie, University of Laval, Quebec City, Canada

    Marc Ouellette

  4. Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA

    Keith S. Kaye

  5. Infection Control and Prevention Unit of Infectious Diseases, Assaf Harofeh Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel

    Dror Marchaim

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Tenover, F.C. (2017). Antimicrobial Susceptibility Testing Methods for Bacterial Pathogens. In: Mayers, D., Sobel, J., Ouellette, M., Kaye, K., Marchaim, D. (eds) Antimicrobial Drug Resistance. Springer, Cham. https://doi.org/10.1007/978-3-319-47266-9_32

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