Errors of Antibiotic Susceptibility Testing from Automated and Manual Systems in Clinical Isolates of Acinetobacter baumannii

Acinetobacter baumannii is an aerobic, gram-negative and glucose-non-fermenting bacterium, which has emerged as a serious opportunistic pathogen. Many clinical microbiology laboratories use the Vitek 2 system for the routine antimicrobial susceptibility testing process, including testing on A. baumannii isolates. However, in case of amikacin, it is now recommended to perform additional antimicrobial susceptibility testing for A. baumannii strains due to the relatively lower minimum inhibitory concentration (MIC) in the Vitek 2 system compared to conventional reference methods. In our study, we assessed MIC for amikacin susceptibility testing of A. baumannii isolates in the Vitek 2 system, the agar dilution, Etest, and disk diffusion method. We collected 40 gentamicin-resistant, A. baumannii strains (amikacin MIC by Vitek 2:${\leq}2{\mu}g/mL$, 2 isolates; $4{\mu}g/mL$, 34 isolates; $8{\mu}g/mL$, 4 isolates) from a University hospital and compared the Vitek 2 system to other reference methods for testing susceptibility to amikacin. The Vitek 2 system showed major errors in all of the 40 isolates, yielding a low MIC. The results of our study strongly suggested that the Vitek 2 system was not a reliable method to test the MICs of gentamicin; ranging from ${\geq}16{\mu}g/mL$ for amikacin susceptibility. Other tests, such as agar dilution, Etest, or disk diffusion methods, should be paralleled to determine the MIC of amikacin in A. baumannii.