A Comparison of Disk Diffusion and Etest with Broth Microdilution Methods for Susceptibility Testing of Ceftazidime and Trimethoprim/Sulfamethoxazole Against Clinical Isolates of Burkholderia pseudomallei in Northeast Thailand

Authors

  • Sereywatana Chea Department of Tropical Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
  • Nuttaya Thonglao Department of Microbiology, Faculty of Medicine, Khon Kaen University, Thailand
  • Lumyai Wonglakorn Microbiology Laboratory, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
  • Waewta Kuwatjanakul Microbiology Laboratory, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
  • Sutas Suttiprapa Tropical Disease Research Center, Tropical Medicine Graduate Program, Department of Tropical Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
  • Sirintip Boonjaraspinyo Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
  • Umaporn Yordpratum Department of Microbiology, Faculty of Medicine, Khon Kaen University, Thailand
  • Pawana Panomket College of Medicine and Public Health, Ubon Ratchathani University, Ubon Ratchathani, Thailand
  • Sorujsiri Chareonsudjai Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand Research and Diagnostic Center for Emerging Infectious Diseases (RCEID), Khon Kaen, Thailand

Keywords:

Burkholderia pseudomallei, broth microdilution, Etest, disk diffusion

Abstract

Background and Objective: Melioidosis caused by Burkholderia pseudomallei, is a neglected infectious disease with a high mortality rate in endemic areas. Antimicrobial susceptibility testing (AST) offers crucial guidance for effective treatment to mitigate the severity of the disease and improve the survival rates. This study aimed to compare the cost-effectiveness and pragmatic viability of two ASTs, disk diffusion and Etest methods, to an automated broth microdilution method (BMD), against ceftazidime (CAZ) and trimethoprim/sulfamethoxazole (TMP-SMX).

Methods: A total of 199 clinical isolates of B. pseudomallei from melioidosis patients with culture-confirmed, were obtained from 3 collection sources in Northeast Thailand. These isolates were assessed using disk diffusion and Etest methods compared with an automated BMD based on the criteria set by the Clinical and Laboratory Standards Institute.

Results: The results revealed non-resistance isolates to CAZ and TMP-SMX by BMD. The disk diffusion for CAZ (30 μg) demonstrated a categorical agreement (CA) of 96% (191/199), with a major error (ME) of 0.5% (1/199) and minor error (MIE) of 3.5% (7/199) compared to the BMD. The Etest for CAZ demonstrated a CA of 98.5% (196/199), with no ME, and an MIE of 1.5% (3/199) compared to the BMD. However, the disk diffusion for TMP-SMX (1.25/23.75 μg) demonstrated the CA, ME, and MIE of 13.6% (27/199), 76.4% (152/199), and 10.1% (20/199) compared to the BMD, respectively. While the Etest for TMP-SMX demonstrated a CA of 46.2% (92/199), ME of 53.8% (107/199), and no MIE compared to the BMD. No very major error (VME) was detected in either test.

Conclusion: Disk diffusion and Etest methods for CAZ could be beneficial in areas with limited resources for the management of melioidosis. However, BMD is still recommended for TMP-SMX to assess the antibiotic’s efficacy and guide appropriate treatment decisions for melioidosis.

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Published

2024-04-24

How to Cite

1.
Chea S, Thonglao N, Wonglakorn L, Kuwatjanakul W, Suttiprapa S, Boonjaraspinyo S, Yordpratum U, Panomket P, Chareonsudjai S. A Comparison of Disk Diffusion and Etest with Broth Microdilution Methods for Susceptibility Testing of Ceftazidime and Trimethoprim/Sulfamethoxazole Against Clinical Isolates of Burkholderia pseudomallei in Northeast Thailand . SRIMEDJ [Internet]. 2024 Apr. 24 [cited 2024 Jun. 19];39(2):167-7. Available from: https://li01.tci-thaijo.org/index.php/SRIMEDJ/article/view/260885

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