Evaluation of 500 gram negative isolates to determine the number of major susceptibility interpretation discrepancies between the Vitek and MicroScan Walkaway for 9 antimicrobial agents.

Although the Vitek and MicroScan Walkaway are two of the most commonly used automated antimicrobial susceptibility test systems, few studies have been performed comparing discrepancies between these systems. In this study, 500 Gram negative clinical isolates were tested against ampicillin, ampicillin/sulbactam, ticarcillin, ticarcillin/clavulanate, imipenem, ciprofloxacin, norfloxacin, mezlocillin, and piperacillin to determine the number of major interpretation discrepancies between the two systems. The 500 isolates consisted of 100 isolates each of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Proteus mirabilis and Enterobacter species. Each isolate was tested simultaneously in both systems using the same standardized inoculum. Eighty-four major discrepancies occurred, of which 48 were reproducible. The reproducible discrepancy rate, for the 4,500 isolate/antimicrobic combinations tested, was 48 of 4500 (1.06%). The rate for individual antimicrobics varied from 17 of 500 (3.4%) for ampicillin to no discrepancies for ticarcillin or ciprofloxacin. Of the 48 reproducible discrepancies, 44 (92%) were Vitek resistant, MicroScan susceptible. Fifteen (31%) of the Vitek and 21 (44%) of the MicroScan results were confirmed by broth microdilution. Disk diffusion results were in agreement with 15 (31%) of the Vitek and 21 (44%) of the MicroScan results. Twelve (25%) of the broth microdilution and 12 (25%) of the disk diffusion results were intermediate. The broth microdilution and disk diffusion results for the 48 isolates with reproducible discrepancies were in agreement more often with MicroScan. However, there was less very major error comparing the Vitek results for these isolates to the broth microdilution and disk diffusion. Overall, the result of this evaluation indicate that the number of major interpretation discrepancies between the two systems is minimal for the isolate/antimicrobic combinations tested.

Stability of amoxicillin-clavulanate in BACTEC medium determined by high-performance liquid chromatography and bioassay.

The stabilities of amoxicillin (16 micrograms/ml) and clavulanate (8 micrograms/ml), alone and in combination in BACTEC medium (Middlebrook 7H12B medium), were determined by high-performance liquid chromatography (HPLC) and bioassay. By HPLC, the half-life of amoxicillin (trihydrate and sodium) in combination with clavulanate in nonradiolabelled 7H12B medium was 6.7 days, whereas the half-life of clavulanate in combination with amoxicillin was 2.0 days. By bioassay, the half-lives of amoxicillin trihydrate and clavulanate in radiolabelled 7H12B medium were comparable (7 and 2 days, respectively) to those determined by HPLC. When clavulanate was tested alone, the half-life was determined to be 1.88 days by HPLC and 1.87 days by bioassay. The relatively short half-life of clavulanate can be adjusted by a procedure of "topping up," or adding one-half the concentration of clavulanate every second day, in order to allow accurate amoxicillin-clavulanate MIC testing with the BACTEC mycobacterial susceptibility system.

Susceptibilities of nontuberculosis mycobacterial species to amoxicillin-clavulanic acid alone and in combination with antimycobacterial agents.

Neither amoxicillin nor clavulanic acid used alone was active at the highest level tested, i.e., 256.0 micrograms/ml, in vitro against 24 isolates of Mycobacterium fortuitum, Mycobacterium kansasii, and Mycobacterium marinum. However, the MIC of an amoxicillin-clavulanic acid combination of 2:1 was < or = 8.0/4.0 micrograms/ml for 50 percent of the isolates tested, with all isolates being inhibited in the range of 4.0/2.0 to 32.0/16.0 micrograms/ml, respectively. Titration of amoxicillin-clavulanic acid with a fixed 2-micrograms/ml concentration of ethambutol resulted in synergistic activity against 3 of 9 isolates of M. fortuitum, 10 of 10 isolates of M. kansasii, and 5 of 5 isolates of M. marinum. This observation was confirmed in a checkerboard analysis in which fractional inhibitory concentrations were < or = 0.5 for 20 of the 24 isolates. Synergistic activity was observed against the other four isolates in one of two trials. On the other hand, titration of amoxicillin-clavulanic acid in the presence of either one or two fixed concentrations of isoniazid, rifampin, cycloserine, tetracycline, or amikacin failed to result in synergism.

Comparison of mupirocin susceptibility of nasal and nonnasal Staphylococcus aureus isolates.

Susceptibilities of 414 nasal and 586 nonnasal Staphylococcus aureus isolates, both methicillin resistant and methicillin susceptible, to the topical antimicrobial agent mupirocin were compared. A susceptibility of 99.1% was observed for the 1000 isolates. Nasal and nonnasal isolates showed a similar 90% minimum inhibitory concentration (MIC90) and statistically equivalent percent susceptibilities.

Comparison of three methods for determination of a single MIC of an antimicrobial agent.

Determining a single MIC of an antimicrobial agent that is not included on a routine susceptibility panel can be significantly time-consuming and costly. The UniScept MICRO-MIC, the JustOne, and the E test are single-MIC systems. These systems as well as disk diffusion were compared on the bases of time, cost, and ease of use.

Five Nodulation Mutants of White Sweetclover (Melilotus alba Desr.) Exhibit Distinct Phenotypes Blocked at Root Hair Curling, Infection Thread Development, and Nodule Organogenesis.

In an effort to obtain a developmental sequence of mutations in the Rhizobium-legume interaction within a single legume species, we have characterized the early events of nodule development in 10 nodulation mutants of sweetclover, Melilotus alba Desr. cv U389, representing five genetic loci. Both seed and root exudates from all of the sweetclover mutants induced expression of the nod genes of Rhizobium meliloti. Mutants in three loci were blocked in the early stages of root hair curling. Of these, a mutant in the sym-3 locus exhibited root hair deformations in response to inoculation with R. meliloti but produced no nodules or emerging nodule primordia, suggesting a blockage in the signal transduction events leading to nodule organogenesis. In contrast, mutants in both the sym-1 and sym-5 loci formed ineffective nodules in response to inoculation but differed slightly in the type of root hair response observed. None of these three early mutants formed infection threads. Infection threads were observed in mutant sym-2 as well as in ineffective nodules. Mutant sym-4 also formed infection threads but lacked nodules. The phenotypes observed for mutants from these five loci suggest that a secondary receptor or signal produced by the plant is required for nodule development.