Single-disk diffusion testing (Kirby-Bauer) of susceptibility of Proteus mirabilis to chloramphenicol: significance of the intermediate category.

The significance of the intermediate category of the single-disk diffusion test (Kirby-Bauer) of antibiotic susceptibility has never been clearly defined. Thirty-two percent of 756 clinical isolates of Proteus mirabilis were of intermediate susceptibility to chloramphenicol, a higher percentage than for any other species. The breakpoint separating susceptible and intermediate isolates nearly bisected the frequency distribution of zone diameters of P. mirabilis but not that of the other species. The breakpoint separating susceptible and intermediate isolates nearly bisected the frequency distribution of zone diameters of P. mirabillis but not that of the other species tested. By serial broth dilution testing, the minimal inhibitory concentrations (MICs) of chloramphenicol of 50 individual isolates of P. mirabilis were 3.9 to 22.1 micrograms/ml (geometric mean, 8.0), whereas the MICs of susceptible Escherichia coli, Klebsiella, and Enterobacter strains were 2.0 to 3.9 micrograms/ml (geometric mean, 2.9). Seventy percent of isolates of P. mirabilis with MICs of 7.8 to 15.6 micrograms/ml were classified as susceptible by disk testing. We conclude that existing Kirby-Bauer breakpoints do not accurately discriminate P. mirabilis isolates that are marginally susceptible to chloramphenicol. These data underscore the difficulty of applying a single set of breakpoints to all species and suggest that species-specific breakpoints would more accurately predict the MIC equivalent of given zone diameters.