Piperacillin/tazobactam antimicrobial susceptibility testing (AST) against Enterobacterales can be challenging. The aim of this study was to assess the reproducibility of various automated (Vitek®2) and non-automated AST methods (broth microdilution (BMD), minimum inhibitory concentration (MIC) test strip, and disk diffusion) for piperacillin/tazobactam in 'challenging' E. coli isolates. We performed 20 repeated AST for seven clinical E. coli isolates: two resistant to piperacillin/ tazobactam but susceptible for amoxicillin/ clavulanic acid, four isolates with various beta-lactamases coding genes (two blaTEM-1, one blaOXA-1, and one with plasmidal blaampC.), and one isolate where VITEK® 2 initially could not produce MIC measurement for piperacillin/ tazobactam (i.e. no results generated). Upon repetition, the same MIC as the mode value (i.e. the most frequent MIC value of each AST method) was found between 21% to 87% (BMD), 46% to 100% (VITEK®2), and 48% to 100 % (gradient test) of the repetitions. The range of percentage essential agreement (EA, i.e. ±1 doubling dilution from this mode value) was 53% to 100% (BMD), 63% to 100% (VITEK®2), and 100% (gradient test). Percentage categorical agreement (CA, same susceptible of resistant category using EUCAST breakpoint v 14.0) ranged from 71% to 100% (BMD), 85% to 92% (VITEK®2), 76% to 100% (gradient test) and 100% (disk diffusion). In conclusion, this study provides insights into the reliability of AST results for piperacillin/ tazobactam in challenging E. coli isolates. While the results indicate that most methods are generally reproducible, certain isolates may present inconsistent MIC results.
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