Interpretation of the disk diffusion susceptibility test for amikacin: report of a collaborative study.

Because excessively high rates of false resistance have been encountered with the 10-mug amikacin disk in diffusion susceptibility tests, a study was performed to examine existing zone diameter interpretative criteria and to compare the accuracy of 10- and 30-mug amikacin disks by the error rate-bounded classification scheme. Although current zone diameter interpretative criteria eliminate false susceptibles, there is an unacceptably high rate of false resistants. This problem can be resolved in most instances by revising the zone diameter interpretative criteria for the 10-mug disk (resistant, </=9 mm; indeterminate, 10 to 11 mm; susceptible, >/=12 mm) or, preferably, by replacing the 10-mug disk with a 30-mug disk and adopting new interpretative criteria (resistant, </=14 mm; indeterminate, 15 to 16 mm; susceptible, >/=17 mm). Because of significant differences in performance among media, it is necessary to include Pseudomonas aeruginosa ATCC 27853 among controls routinely tested and to exclude from use lots of Mueller-Hinton agar yielding results outside the 75% tolerance (90% confidence) limits for amikacin.