Ability of Latin America laboratories to detect antimicrobial resistance patterns: experience of the SENTRY antimicrobial surveillance program (1997-2000)

RESUMO

The accuracy of antimicrobial susceptibility tests is a crucial step for the clinical management of patients with serious infections. They must be reliable and precise because they will guide antimicrobial therapy. Our main objective was to compare the results of susceptibility testing performed by the SENTRY coordinator laboratory with those reported by the participating Latin American medical centers. A total of 10,277 bacterial isolates were tested by the reference broth microdilution method at the coordinator laboratory in the United States. The tests were performed and interpreted following the National Committee for Clinical Laboratory Standards (NCCLS) recommendations. Ten antimicrobial agent-organism combinations were analyzed. The susceptibility methods utilized in each of the medical centers were also evaluated. Total agreement of the results was obtained in nearly 88 percent of the antimicrobial agent-organism combinations. "Very major" (false-susceptible results) and "major errors" (false-resistant results) were observed in 12 percent and 6 percent of the cases, respectively. The highest disagreements were observed for coagulase-negative Staphylococcus - oxacillin (20 percent - very major error) and Burkholderia cepacia - imipenem (21 percent - very major error). The susceptibility method with the highest agreement rate was Etest« (92 percent) > PASCO« (91 percent) > agar dilution (91 percent) > MicroScan« (90 percent) > Vitek« (87 percent). External quality assurance data obtained by surveillance programs such as the SENTRY Antimicrobial Surveillance Program are not only helpful for detecting the emergence of patterns of antimicrobial resistance, but also to monitor the performance of the participating microbiology laboratories.