Accuracy and reproducibility of the Etest to detect drug-resistant Neisseria gonorrhoeae to contemporary treatment

John R. Papp; Marie-Claire Rowlinson; Norman P. O’Connor; Jason Wholehan; Jafar H. Razeq; Anita Glennen; Dapne Ware; Peter C. Iwen; Lillian V. Lee; Celia Hagan

doi:10.1099/jmm.0.000651

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f Accuracy and reproducibility of the Etest to detect drug-resistant Neisseria gonorrhoeae to contemporary treatment

Authors: John R. Papp¹ , Marie-Claire Rowlinson² , Norman P. O’Connor³ , Jason Wholehan⁴ , Jafar H. Razeq^5,† , Anita Glennen⁶ , Dapne Ware⁷ , Peter C. Iwen⁸ , Lillian V. Lee⁹ , Celia Hagan¹⁰
- VIEW AFFILIATIONS
- ¹ 1Centers for Disease Control and Prevention, Atlanta, GA, USA ² 2Bureau of Public Health Laboratories, Jacksonville, FL, USA ³ 3State Laboratory Division, Hawaii Department of Health, Pearl City, HI, USA ⁴ 4Michigan Department of Community Health, Lansing, MI, USA ⁵ 5Maryland Department of Health, Baltimore, MD, USA ⁶ 6Minnesota Department of Health, St. Paul, MN, USA ⁷ 7Mississippi Public Health Laboratories, Jackson, MS, USA ⁸ 8Nebraska Public Health Laboratory, Omaha, NE, USA ⁹ 9New York City Department of Health and Mental Hygiene, New York City, NY, USA ¹⁰ 10Association of Public Health Laboratories, Silver Spring, MD, USA ^† †Present address: Department of Public Health, Rocky Hill, CT, USA.
*Correspondence: John R. Papp [email protected]
First Published Online: 08 December 2017, Journal of Medical Microbiology 67: 68-73, doi: 10.1099/jmm.0.000651
Subject: Clinical Microbiology

Received: 31/07/2017
Accepted: 15/11/2017
Cover date: 01/01/2018

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Purpose. Neisseria gonorrhoeae is a sexually transmitted bacterial pathogen that continues to evolve to become resistant to known antibiotics. In preparing for potential emergence, the Centers for Disease Control and Prevention recommends that clinical laboratories maintain or develop protocols to assess antibiotic susceptibly for this organism. This study examines the intra-laboratory variability of using the Etest method to provide consistent MIC values for N. gonorrhoeae and also compared the results of the Etest to known agar dilution MIC values.

Methodology. Clinical N. gonorrhoeae isolates, 100 paired duplicates, were tested by eight laboratories for antibiotic susceptibility to ceftriaxone, cefixime and azithromycin using Etest strips.

Results/Key findings. Overall, >80 % of the paired Etest MIC values were within one log₂ dilution of the replicate. When compared to the agar dilution reference method, the cefixime Etest MIC values were consistently underreported by one dilution (seven laboratories) or two dilutions (one laboratory). The azithromycin Etest MIC values agreed 90.7 % with the agar dilution MIC values while the agreement with ceftriaxone was 90.9 %.

Conclusion. Overall, the Etest method yielded reproducible MIC values within each laboratory with the azithromycin and ceftriaxone MIC results consistent to the reference agar dilution method while the cefixime result tended to provide a lower MIC value.

Keyword(s): Etest reproducibility, Etest accuracy, Gonorrhea, antimicrobial susceptibility

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