Multicategory interpretive reporting of susceptibility testing with selected antimicrobial concentrations. Ten years of laboratory and clinical experience

For the last 10 years, the NIH Microbiology Laboratory has been using a broth microdilution method to perform antibiotic susceptibility tests. Instead of using a continuous twofold dilution series as we had done for the previous 10 years, in 1978 we introduced a susceptibility panel that utilized a minimal number of selected (discontinuous) antimicrobic concentrations. The concentrations selected were those thought to be the most clinically relevant, based on known pharmacologic properties of each antimicrobic agent, as well as known MIC population distributions that we had acquired on 50,000 organisms in the preceding years. In addition to using select concentrations, we also added interpretive codes to aid the physician in selecting the best antimicrobic agent to use. We had previously only reported quantitative MIC results without qualitative interpretations. The present interpretive criteria inform the physician not only if the organism is susceptible or resistant but also if intramuscular or intravenous doses are needed, if the organism is susceptible to an antimicrobic agent but only for lower urinary tract infections, if the organism is resistant to penicillin by virtue of penicillinase production, and in the case of streptococci, if streptomycin or gentamicin can be expected to show synergy when combined with a penicillin. The use of clinically relevant selected concentrations combined with clear interpretive criteria has worked well in our hospital setting. Physicians are able to understand and utilize the information effectively and have found almost no need for exact MICs using a twofold dilution series.