Assessment of accuracy of disk diffusion tests for the determination of antimicrobial susceptibility of common bovine mastitis pathogens: a novel approach.

A novel approach was used to assess disk diffusion accuracy for determination of antibiotic susceptibility of various bovine mastitis pathogens (Escherichia coli, Staphylococcus aureus, Staphylococcus chromogenes, and Streptococcus dysgalactiae). MIC and disk diffusion diameters were compared for 587 bovine mastitis bacterial isolates collected in Israel and 3,186 drug-organism combinations. Results were analyzed by ROC curves, Bayesian statistics, and standard descriptive methods. Low correlation was observed between results of disk diffusion and MIC for S. dysgalactiae and all antimicrobial agents, S. aureus and erythromycin and neomycin, and E. coli and gentamicin, neomycin, and polymyxin B. On a few occasions in which correlation was satisfactory, accepted susceptibility breakpoints to some of the antimicrobial agents resulted in high discrepancies with MIC results and new breakpoints were suggested-e.g., 21 mm for S. aureus susceptibility to penicillin G instead of 29 mm recommended by the National Committee for Clinical Laboratory Standards (NCCLS) and <21 mm, resistant, 21-25 mm, intermediate, and >25 mm, susceptible for susceptibility of E. coli to trimethoprim/sulfamethoxazole. Thus, this approach enabled determination of the most accurate breakpoints that best fitted the specific prevalence of susceptibility in Israel. Thus, we suggest its adoption by microbiology diagnostic laboratories for the provision of accurate antimicrobial susceptibility results when using the disk diffusion test.