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
Keywords:
Burkholderia pseudomallei, broth microdilution, Etest, disk diffusionAbstract
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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