Correlation of methicillin-resistant Staphylococcus aureus vancomycin minimal inhibitory concentration results by Etest and broth microdilution methods with population analysis profile: lack of Etest overestimation of the MIC

Methicillin-resistant Staphylococcus aureus (MRSA) vancomycin minimum inhibitory concentrations (V-MICs) are sometimes reported to be higher according to Etest versus broth microdilution (BMD). These observations are often interpreted as an Etest overestimation of the actual MIC. We measured V-MIC of 484 MRSA blood isolates using Etest, BMD, and a modified BMD (M-BMD) with incremental dilutions parallel to the Etest scale, correlated the results with population analysis profile-area under the curve (PAP-AUC). All MIC tests were done in parallel. The mean V-MIC was comparable (1.83 +/- 0.44 [Etest], 1.88 +/- 0.67 [BMD] and 1.75 +/- 0.57 mg/L [M-BMD]; p = 0.9 [ANOVA]). The V-MICs/PAP-AUC correlation coefficient was 0.555 (Etest), 0.513 (BMD), and 0.586 (M-BMD). Etest MICs were equal (44.2 %), one dilution higher (21.9 %), two dilutions higher (2.5 %), one dilution lower (29.8 %), and two dilutions lower (1.6 %) than BMD MICs and were equal (61.5 %), one dilution higher (28.3 %), two dilutions higher (0.4 %), one dilution lower (9.5 %), and two dilutions lower (0.2 %) than M-BMD MICs. The mean PAP-AUC for Etest vs M-BMD among isolates with similar Etest/M-BMD MIC values was 0.25 +/- 0.15 vs 0.35 +/- 0.13 (p = 0.8), 0.46 +/- 0.16 vs 0.50 +/- 0.17 (p = 0.8), 0.64 +/- 0.19 vs 0.67 +/- 0.21 (p = 0.9), and 0.90 +/- 0.31 vs 0.88 +/- 0.25 (p = 1.0) for isolates with V-MIC of a parts per thousand currency sign1, 1.5, 2, and a parts per thousand yen3 mg/L respectively. These results suggest that Etest might not overestimate V-MIC in comparison to M-BMD or BMD; Etest and M-BMD tests depict comparable PAP-AUC and have a higher correlation with PAP-AUC than the conventional BMD, probably because of the more detailed results. Etest may be more suitable than conventional BMD for MIC outcome assessment because of the more detailed MICs.