Korean J Lab Med.  2010 Aug;30(4):373-380. 10.3343/kjlm.2010.30.4.373.

Evaluation of MicroScan Synergies plus Positive Combo 3 Panels for Identification and Antimicrobial Susceptibility Testing of Staphylococcus aureus and Enterococcus Species

• Jung H
• Lee NY

• KMID: 1781643
• DOI: http://doi.org/10.3343/kjlm.2010.30.4.373

Abstract

BACKGROUND
Few studies have evaluated the performance of the recently introduced MicroScan Synergies plus Positive Combo 3 Panels (SIPC3) (Dade Behring Inc., USA). We evaluated the clinical efficacy of the panels in identification (ID) and antimicrobial susceptibility testing (AST) of Staphylococcusaureus and enterococci.
METHODS
To evaluate the panels' accuracy of identification, the results obtained using the test panels were compared with those obtained by using conventional biochemical tests in conjunction with VITEK 2 system (bio-Merieux, USA). In addition, the AST results obtained using the panels were compared with those obtained by performing CLSI broth microdilution.
RESULTS
The overall agreement between the approaches for the ID of S. aureus and enterococci was 100% and 96%, respectively. The categorical and essential agreements (CA and EA) for S. aureus were 98%, each. Very major errors (VME), major errors (ME), and minor error (mE) for S. aureus were 0.45%, 0.3%, and 4.2%, respectively. The majority of VMEs were for oxacillin (8.6%), penicillin (2.0%), erythromycin (7.9%), clindamycin (3.8%), and tetracycline (4.1%). For enterococci, the CA, EA, VME, ME, and mE were 88.8%, 93.7%, 4.4%, 0%, and 2.8%, respectively. The 80.5% (29/36) of Enterococcus faecium had concordant ID with the reference. Most of the categorical errors (3 VMEs and 14 mEs) were observed for quinupristin/dalfopristin (Synercid; Catalytica Pharmaceuticals Inc., USA).
CONCLUSIONS
The panels compared favorably with conventional methods for the ID and AST of S. aureus. However, we expected a better performance for ID of E. faecium and AST using Synercid.

Keyword

Staphylococcus aureus; Enterococcus; MicroScan Synergies plus Positive Combo 3 Panels

MeSH Terms

Anti-Bacterial Agents/*pharmacology
Clindamycin/pharmacology
Drug Resistance, Bacterial
Enterococcus/*drug effects/isolation & purification
Erythromycin/pharmacology
Microbial Sensitivity Tests/instrumentation/*methods
Oxacillin/pharmacology
Penicillins/pharmacology
Reagent Kits, Diagnostic
Staphylococcus aureus/*drug effects/isolation & purification
Tetracycline/pharmacology

Reference

1.Lowy FD. Staphylococcus aureus infections. N Engl J Med. 1998. 339:520–32.

2.Tenover FC., McDonald LC. Vancomycin-resistant staphylococci and enterococci: epidemiology and control. Curr Opin Infect Dis. 2005. 18:300–5.

3.Lee K., Park KH., Jeong SH., Lim HS., Shin JH., Yong D, et al. Further increase of vancomycin-resistant Enterococcus faecium, amikacin-and fluoroquinolone-resistant Klebsiella pneumoniae, and imipenemresistant Acinetobacter spp. in Korea: 2003 KONSAR surveillance. Yonsei Med J. 2006. 47:43–54.

4.Kim KM., Yoo JH., Choi JH., Park ES., Kim KS., Kim KS, et al. The nationwide surveillance results of nosocomial infections along with antimicrobial resistance in intensive care units of sixteen university hospitals in Korea, 2004. Korean J Nosocomial Infect Control. 2006. 11:79–86. (김경미, 유진홍, 최정현, 박은숙, 김경숙, 김광숙 등. 2004년도 전국 16개 대학병원 중환자실 병원감염 감시 결과. 병원감염관리 2006;11:79-86.).

5.Ito T., Hiramatsu K. Acquisition of methicillin resistance and progression of multiantibiotic resistance in methicillin-resistant Staphylococcus aureus. Yonsei Med J. 1998. 39:526–33.

6.Livermore DM. Antibiotic resistance in staphylococci. Int J Antimicrob Agents. 2000. 16(S1):3–10.

7.Swenson JM., Tenover FC. Results of disk diffusion testing with cefoxitin correlate with presence of mecA in Staphylococcus spp. J Clin Microbiol. 2005. 43:3818–23.

8.Swenson JM., Williams PP., Killgore G., O'Hara CM., Tenover FC. Performance of eight methods, including two new rapid methods, for detection of oxacillin resistance in a challenge set of Staphylococcus aureus organisms. J Clin Microbiol. 2001. 39:3785–8.

9.Sakoulas G., Gold HS., Venkataraman L., DeGirolami PC., Eliopoulos GM., Qian Q. Methicillin-resistant Staphylococcus aureus: comparison of susceptibility testing methods and analysis of mecA-positive susceptible strains. J Clin Microbiol. 2001. 39:3946–51.

10.Felten A., Grandry B., Lagrange PH., Casin I. Evaluation of three techniques for detection of low-level methicillin-resistant Staphylococcus aureus (MRSA): a disk diffusion method with cefoxitin and moxalactam, the Vitek 2 system, and the MRSA-screen latex agglutination test. J Clin Microbiol. 2002. 40:2766–71.

11.Yamazumi T., Marshall SA., Wilke WW., Diekema DJ., Pfaller MA., Jones RN. Comparison of the Vitek Gram-Positive Susceptibility 106 card and the MRSA-screen latex agglutination test for determining oxacillin resistance in clinical bloodstream isolates of Staphylococcus aureus. J Clin Microbiol. 2001. 39:53–6.

12.Ribeiro J., Vieira FD., King T., D'Arezzo JB., Boyce JM. Misclassification of susceptible strains of Staphylococcus aureus as methicillin-resistant S. aureus by a rapid automated susceptibility testing system. J Clin Microbiol. 1999. 37:1619–20.

13.Eigner U., Schmid A., Wild U., Bertsch D., Fahr AM. Analysis of the comparative workflow and performance characteristics of the VITEK 2 and Phoenix systems. J Clin Microbiol. 2005. 43:3829–34.

14.Jun KR., Jeon HS., Sung HS., Kim MN. Evaluation of the Phoenix System for the detection of methicillin-resistent Staphylococcus aureus. Korean J Clin Microbiol. 2006. 9:58–63. (전경란, 전홍선, 성흥섭, 김미나. Methicillin 내성 황색포도알균의 검출을 위한 Phoenix System의 평가. 대한임상미생물학회지 2006;9:58-63.).

15.Lee WG., Jung MK., Kwak YS. Vancomycin-resistant enterococci: incidence, antimicrobial susceptibility, and resistance genotype. Korean J Clin Pathol. 1998. 18:51–6. (이위교, 정민권, 곽연식. Vancomycin내성 장구균의 분리율, 항균제 감수성 및 내성형에 관한 연구. 대한임상병리학회지 1998;18:51-56.).

16.Lee WG. Resistance mechanism and epidemiology of vancomycin resistant enterococci. Korean J Clin Microbiol. 2008. 11:71–7. (이위교.Vancomycin-resistant enterococci의 내성 기전 및 역학. 대한임상미생물학회지 2008;11:71-7.).

17.Uh Y., Jang IH., Lee KS., Kwon O., Yoon KJ. Comparison of the MicroScan Combo Panel Synergies plus with the MicroScan Conventional Combo Panel for diagnostic performance of Gram-negative and Gram-positive bacteria. Korean J Clin Microbiol. 2009. 12:193–200. (어영, 장인호, 이관수, 권오건, 윤갑준. 그람양성과 그람음성세균에 대한 MicroScan Synergies plus Combo Panel과MicroScanConventional Combo Panel의 비교. 대한임상미생물학회지 2009;12:193-200.).

18.Clinical and Laboratory Standards Institute. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically: approved standard. CLSI document M07-A7. 7th ed.Wayne, PA: CLSI;2006.

19.Clinical and Laboratory Standards Institute. Performance standards for antimicrobial disk susceptibility tests: approved standard. CLSI document M02-A9. 9th ed.Wayne, PA: CLSI;2006.

20.Schreckenberger P., Tjhio J., Hindler J., Bruckner D., Ward K., Mirrett S, et al. Multicenter evaluation of vancomycin on a Synergies Plus Pos Dired Panel with Staphylococci and Enterococci. American Society for Microbiology. 2007. :Abstract C-011.

21.Nothaft D., Skinner J., Bobolis J., Wong T., Beck C., Tallent T, et al. Staphylococci and rapid identification: primary analysis of the new MicroScan Rapid Pos ID 2 Panel for two hour identification of clinically relevant Staphylococci. American Society for Microbiology. 2006. :Abstract C-014.

22.Kaase M., Baars B., Friedrich S., Szabados F., Gatermann SG. Performance of MicroScan WalkAway and Vitek 2 for detection of oxacillin resistance in a set of methicillin-resistant Staphylococcus aureus isolates with diverse genetic backgrounds. J Clin Microbiol. 2009. 47:2623–5.

23.Bobolis J., Skinner J., Wong T., Beck C., Tallent T., Wehr C, et al. Rapid identification of streptococci and enterococci: preliminary evaluation of new microorganisms with the new MicroScan Rapid Pos ID 2 Panel. American Society for Microbiology. 2006. :Abstract C-015.

24.Song W., Kim HT., Lee KM. Evaluation of identification in Enterococcus species by using MicroScan(R) panels. J Clin Pathol Qual Control. 1997. 19:173–7. (송원근. 김현태. 이규만. MicroScan panel을 이용한 장구균 균종 동정의 평가. 임상병리와정도관리 1997 1997;19:173-7.).

25.Chung JW., Jeon HS., Sung H., Kim MN. Evaluation of MicroScan and Phoenix system for rapid identification and susceptibility testing using direct inoculation from positive BACTEC blood culture bottles. Korean J Lab Med. 2009. 29:25–34. (정재우, 전홍선, 성흥섭,김미나. BACTEC 혈액배양병 양성검체에서 직접접종법에 의한 균종동정과 항균제감수성검사를 위한 MicroScan과 Phoenix 시스템의 평가. Korean J Lab Med 2009;29:25-34.).

26.Iwen PC., Kelly DM., Linder J., Hinrichs SH. Revised approach for identification and detection of ampicillin and vancomycin resistance in Enterococcus species by using MicroScan panels. J Clin Microbiol. 1996. 34:1779–83.

27.d'Azevedo PA., Dias CA., Goncalves AL., Rowe F., Teixeira LM. Evaluation of an automated system for the identification and antimicrobial susceptibility testing of enterococci. Diagn Microbiol Infect Dis. 2001. 40:157–61.

28.Marco F., Jurado A., Jimenez de Anta MT. Evaluation of the Phoenix system for identifying and determining the susceptibility of clinical isolates. Comparative study with the Microscan system. Rev Esp Quimioter. 2004. 17:169–76.

29.Kim YR., Kim SI., Hur JA., Kim YJ., W SH., Park YJ, et al. Comparison of the MicroScan system and the agar dilution assay for quinupristin/dalfopristin susceptibility of Enterococcus facecium. Ann Clin Lab Sci. 2007. 37:260–2.