Journal of Antimicrobial Chemotherapy, Vol 39, 277-284, Copyright © 1997 by The British Society for Antimicrobial Chemotherapy
A MacGowan, C McMullin, P James, K Bowker, D Reeves and L White
Two hundred microbiology laboratories in the UK took part in two separate
experimental external quality assessment distributions related to the serum
bactericidal test (SBT). In the first, Staphylococcus aureus NCTC 6571
(vancomycin MIC 1 mg/L), was tested against a human serum containing
vancomycin 38 mg/L plus gentamicin 0.5 mg/L. In the second, Streptococcus
oralis PAJ 112/4183 (penicillin MBC < or = 0.03 mg/L) and Streptococcus
sanguis PAJ 107/4184 (penicillin MBC = 128 mg/L) were tested against human
serum containing penicillin 15 mg/L. Respondents returned their laboratory
results and a questionnaire on clinical interpretation and technical
aspects. Most laboratories (194/199, 97.5%) recommend the use of the SBT in
the management of infective endocarditis but only 48 (25.2%) often or
always change therapy on the basis of the result. A wide range of
interpretative criteria, definitions of bactericidal endpoints and
methodologies are used. Performance in the first distribution was
acceptable for 75% of laboratories but in the second only 34% could
identify penicillin tolerance; 34 respondents reported an SBT result of
< or = 2 for the tolerant strain, 81 laboratories reported one of >
or = 16. Technical factors related to acceptable performance were:
sonication of broth before counting the inoculum; knowing the inoculum size
in cfu/mL; use of a 4-8 h broth culture to make the inoculum; incubation of
recovery plates for > 36 h; use of a calibrated pipette to sample for
surviving bacteria; use of measured volumes to add the inoculum. Use of
uncalibrated pipettes or standard loops to recover survivors was related to
poor performance. Microbiology departments in the UK should review the
clinical need to perform the SBT in the light of their local circumstances
and if they elect to continue to offer this test, revise their
methodologies which could be producing misleading results when testing
alpha-haemolytic streptococci.
JOURNAL ARTICLE
External quality assessment of the serum bactericidal test: results of a methodology/interpretation questionnaire
Bristol Centre for Antimicrobial Research & Evaluation, University of Bristol, UK. lesassays@ukneqasaa.win-uk.net
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