Enterobacteriaceae Identification BERT F

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Enterobacteriaceae Identification BERT F JOURNAL OF CLINICAL MICROBIOLOGY, May 1983, p. 807-813 Vol. 17, No. 5 0095-1137/83/050807-07$02.00/0 Copyright © 1983, American Society for Microbiology Evaluation of the AutoSCAN-3 and Sceptor Systems for Enterobacteriaceae Identification BERT F. WOOLFREY,* RICHARD T. LALLY, AND CHARLES 0. QUALL Clinical Microbiology Section, Department ofAnatomic and Clinical Pathology, St. Paul-Ramsey Medical Center, St. Paul, Minnesota 55101 Received 4 October 1982/Accepted 21 January 1983 To evaluate the accuracy and cost effectiveness of the AutoSCAN-3 (Micro- Scan Systems of America, Sacramento, Calif.) and Sceptor (BBL Microbiology Systems, Cockeysville, Md.) systems for identification of members of the Enterobacteriaceae, we performed parallel tests on 678 stock cultures of well- characterized clinical isolates of Enterobacteriaceae. Automated results by AutoSCAN-3 correctly identified 95.1% at the genus level and 94.9% at the species level. However, 15 of 42 Shigella isolates were misidentified as members of other genera. In contrast to the automated results, visual interpretation of panels produced 97.9% agreement at the genus level, missing only three Shigella isolates. Sceptor correctly identified 96.8% at the genus level and 93.4% at the species level. Of 42 Shigella isolates, 3 were missed and were designated as Salmonella spp. Although all Salmonella spp. were correctly identified, six other isolates were misidentified as Salmonella spp. Test costs were found to be comparable for each system, with the cost per test increasing markedly with fewer than 10 to 15 tests performed per day. AutoSCAN-3 (MicroScan Systems of Ameri- were then also tested by the API 20E system as a ca, Sacramento, Calif.) and Sceptor (BBL Mi- check on the original characterization of the stock crobiology Systems, Cockeysville, Md.) are isolates. Tables were designed to evaluate and com- pare the results. During the course of the study, semiautomated systems that provide microbial technical time requirements for performing Auto- identification and minimum inhibitory concen- SCAN and Sceptor tests were determined. These were tration determination. AutoSCAN-3 (Auto- used in conjunction with material costs for an analysis SCAN) uses AutoSCAN instrumentation to read of cost effectiveness. and interpret MicroScan panels which are sup- Microorganisms. A total of 678 clinical isolates of plied frozen. Sceptor provides instrumentation Enterobacteriaceae representing 11 genera (141 Esch- which automatically hydrates and inoculates de- erichia spp., 134 Klebsiella spp., 86 Enterobacter hydrated Sceptor panels. MicroScan and Scep- spp., 89 Serratia spp., 41 Salmonella spp., 42 Shigella tor panels differ slightly in their choice of bio- spp., 27 Citrobacter spp., 101 Proteus spp., 8 Provi- dencia spp., 8 Morganella spp., and 1 Hafnia spp.) chemicals and antimicrobial agents. The present were selected for the study. All had been used for a investigation evaluates the accuracy and cost previous study (2) and had been well characterized by effectiveness of these two systems for identify- the API 20E system and classical biochemical tests. ing members of the Enterobacteriaceae. Isolates were retrieved from frozen stock cultures by sampling each with a hot wire loop and streaking to a MATERIALS AND METHODS sheep blood agar plate which was incubated in air at Experimental design. Microbial identifications were 35C for 24 h. From each blood agar plate, the center performed in parallel by AutoSCAN with MicroScan of a single well-isolated colony was used as a common Gram-Negative Combo Panels and by Sceptor with growth source to initiate the appropriate inoculum Gram-Negative MIC/id Panels for 678 stock cultures suspension required by each system. of clinical isolates which had been previously well AutoSCAN system. AutoSCAN provides instrumen- characterized. Isolates with any discrepancy among tation for automated reading and interpretation of the AutoSCAN, Sceptor, and the original stock cul- MicroScan panels. MicroScan panels are supplied ture identifications were retested by AutoSCAN and frozen and use the following 24 tests for identification Sceptor in parallel with the API 20E system (Analytab of members of the Enterobacteriaceae: fermentation Products, Plainview, N.Y.) as follows. Subculture of adonitol, arabinose, glucose, inositol, melibiose, purity plates, originating from the initial AutoSCAN raffinose, rhamnose, sorbitol, and sucrose; urease; and Sceptor identification tests, were interchanged H2S production; indole production; decarboxylation and processed for identification by the other system. of lysine and ornithine; arginine dihydrolase; trypto- Subcultures derived from the original stock isolate phan deaminase; esculin hydrolysis; Voges-Pros- 807 808 WOOLFREY, LALLY, AND QUALL J. CLIN. MICROBIOL. TABLE 1. Comparison of AutoSCAN identification with referee designations for 678 isolates of Enterobacteriaceae AutoSCAN identification and no. (%) Entero- Entero- Entero- Ece-Kieb- Kleb- Klebsiella Kleb- Entero- bacter bacter Referee identification (total) Escher- rhino- siella bactEbacter~~~~~~~~agglom- aero- gergov- coli Pniepneu-oxytoca scleromatis ozaenae cloacae erans genes iae Escherichia coli (141) 136 (96) 1 Klebsiella pneumoniae (91) 90 (99) Klebsiella oxytoca (42) 1 41 (98) Klebsiella rhinoscleromatis (1) 0 Enterobacter cloacae (53) 50 (94) Enterobacter agglomerans (3) 1 2 (67) Enterobacter aerogenes (29) 29 Enterobacter gergoviae (1) 1 Serratia marcescens (88) Serratia liquefaciens (1) Salmonella spp. (41) Shigella spp. (42) 6 (15) 3 (7) 1 (2) Citrobacterfreundii (18) Citrobacter diversus (9) Proteus mirabilis (91) Proteus vulgaris (10) Providencia stuartii (2) Providencia rettgeri (6) Morganella morganii (8) Hafnia alvei (1) TABLE 1-Continued AutoSCAN identification and no. (%) Serra- Citro Citro- Entero- Serratia tia Serratia Salmo- Shigella bacter eSerratia Lctr Referee identification (total) sakazakii mensas odor- lique rubidea nella spp freundiifreudii diver- sakazakii cens ifer faciens sus Escherichia coli (141) 1 Klebsiella pneumoniae (91) 1 Klebsiella oxytoca (42) Klebsiella rhinoscleromatis (1) Enterobacter cloacae (53) 2 (4) Enterobacter agglomerans (3) Enterobacter aerogenes (29) Enterobacter gergoviae (1) Serratia marcescens (88) 88 Serratia liquefaciens (1) 1 Salmonella spp. (41) 40 (98) Shigella spp. (42) 5 (12) 27 (64) Citrobacterfreundii (18) 18 Citrobacter diversus (9) 9 Proteus mirabilis (91) Proteus vulgaris (10) Providencia stuartii (2) Providencia rettgeri (6) Morganella morganii (8) Hafnia alvei (1) kauer; utilization of citrate, malonate, and tartrate; 0- each microwell by light transmission to detect bacteri- nitrophenyl-4-D-galactopyranoside; and growth in the al growth or color change. The electronic information presence of cephalothin (8 ,ug/ml) and colistin (4 so generated is automatically analyzed by a micro- ,uglml). After inoculation and incubation, panels are processor program which determines the most proba- inserted into the AutoSCAN reader, which examines ble microorganism identifications and likelihood per- VOL. 17, 1983 EVALUATION OF AUTOSCAN AND SCEPTOR 809 TABLE 1-Continued AutoSCAN identification and no. (%) RefereeRefreeidntiictioidentification (ota)(total) Proteus Proteus Provi- denciaProv'i- Morga-nella Hafnia Arizona Yersinia Rare mirabiliSmraili vlgaisdencial!ulgaris stuartii rett- inorganii avial'ei SPs spp.P geri Escherichia coli (141) 2 (1) Klebsiella pneumoniae (91) Klebsiella oxytoca (42) Klebsiella rhinoscleromatis (1) 1 Enterobacter cloacae (53) 1 Enterobacter agglomerans (3) Enterobacter aerogenes (29) Enterobacter gergoviae (1) Serratia marcescens (88) Serratia liquefaciens (1) Salmonella spp. (41) 1 Shigella spp. (42) Citrobacterfreundii (18) Citrobacter diversus (9) Proteus mirabilis (91) 90 (99) Proteus vulgaris (10) 10 Providencia stuartii (2) 2 Prov'idencia rettgeri (6) 6 Morganella morganii (8) 8 Hafnia alvei (1) 0 (0) centages. These results, along with comments or interpreted visually without prior knowledge of the instructions such as requests for visual interpretation automated results. A seven-digit code number was of some or all of the microwell reactions, are displayed constructed, and the microorganism identification was on a cathode ray tube. After review and entry of any found by using the MicroScan Biotype Codebook. needed information relative to visual interpretation of Data so generated were used to compare the results of plates, the results are then printed as a single most automated versus visual interpretation of MicroScan probable microorganism identification. panels. Approximately 50 to 60 isolates, including Inoculum suspensions were prepared by transfer- quality control isolates as suggested by the manufac- ring microorganisms from a common growth source turer, were processed daily for identification. colony, as described above, to a tube containing 0.5 ml Sceptor system. The Sceptor system provides an of brain heart infusion broth. This was incubated for 4 instrument for simultaneous rehydration and inocula- h in air at 35°C, at which time 0.05 ml was transferred tion of desiccated panels and an instrument for visual with a calibrated pipettor (Medical Laboratory Auto- interpretation. For identification of members of the mation, Mount Vernon, N.Y.) to a tube containing 25 Enterobacteriaceae, 21 biochemical tests are used ml of inoculum water with 0.02% Tween 80 supplied which included: fermentation of adonitol, arabinose, by the manufacturer and then to a purity plate.
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