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Tick-tock, beat the clock: comparative analysis of disc diffusion testing with 6-, 10-, and 24-h growth for accelerated antimicrobial susceptibility testing and antimicrobial stewardship

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Abstract

Disc diffusion testing by Kirby-Bauer technique is the most used method for determining antimicrobial susceptibility in microbiological laboratories. The current guidelines by The Clinical and Laboratory Standards Institute (CLSI) 2022 specify using an 18- to 24-h growth for testing by disc diffusion. We aim to determine if using an early growth (6 h and 10 h) would produce comparable results, thus ultimately leading to reduced turnaround time. Six-hour, 10-h, and 24-h growths of 20 quality control strains and 6-h and 24-h growths of 48 clinical samples were used to perform disc diffusion testing using a panel of appropriate antimicrobial agents. Disc diffusion zone sizes were interpreted for all and comparative analyses were performed to determine categorical agreement, minor errors (mE), major errors (ME), and very major errors (VME) according to CLSI guidelines. On comparing with the standard 24 h of incubation, disc diffusion from 6-h and 10-h growths of quality control strains showed 94.38% categorical agreement, 5.10% mE, 0.69% MEs, and no VMEs. Disc diffusion testing for the additional 40 clinical samples yielded a similarly high level of categorical agreement (98.15%) and mE, ME, and VME of 1.29%, 1.22%, and 0% respectively. Disc diffusion testing using early growth is a simple and accurate method for susceptibility testing that can reduce turnaround time and may prove to be critical for timely patient management.

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All data generated or analyzed during this study are included in this published article.

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Acknowledgements

The authors thank our colleagues from the Department of Microbiology, All India Institute of Medical Sciences, New Delhi, for their insight and guidance. We would also like to thank Dr. Maroof Ahmad Khan for his advice on statistical analysis.

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Authors and Affiliations

  1. Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India

    Jaya Biswas, Kavi Priya Appasami, Hitender Gautam, Sarita Mohapatra, Seema Sood, Benu Dhawan, Rama Chaudhry, Arti Kapil & Bimal Kumar Das

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  1. Jaya Biswas
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Contributions

All authors contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by Dr. Kavi Priya Appasami and Dr. Jaya Biswas. The first draft of the manuscript was written by Dr. Kavi Priya Appasami and Dr. Jaya Biswas and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hitender Gautam.

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This study involved the use of quality control strains and established clinical isolates. The AIIMS Research Ethics Committee has confirmed that no ethical approval is required.

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Not applicable as this study involved the use of quality control strains and established clinical isolates.

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Not applicable as no confidential patient information has been included in the manuscript.

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The authors declare no competing interests.

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Biswas, J., Appasami, K.P., Gautam, H. et al. Tick-tock, beat the clock: comparative analysis of disc diffusion testing with 6-, 10-, and 24-h growth for accelerated antimicrobial susceptibility testing and antimicrobial stewardship. Eur J Clin Microbiol Infect Dis 42, 929–943 (2023). https://doi.org/10.1007/s10096-023-04611-y

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