Rapid and economical identification and antimicrobial susceptibility test methodology for urinary tract pathogens

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Abstract
To decrease the time and cost of processing urine cultures, we devised a critical pathway to identify and perform antibiotic susceptibility tests on commonly isolated microbial pathogens within 6 h of growth detection. The strategy was based on eliminating expensive kits and automated procedures when not required. A pathway utilizing a statistical matrix and three rapid biochemical tests required to identify the most common pathogen, Escherichia coli, was developed. This species, which represented 82% of urinary isolates, was identified in 1 h for less than 10% the cost of a commercial kit. The specificity of the 1-h E. coli identification battery was greater than or equal to 99.9% with a sensitivity of 93%. In addition, this critical pathway, adapting published methods, permitted the identification of other enteric pathogens, the group D streptococci, and Pseudomonas aeruginosa within 4 to 6 h. Furthermore, it accounted for other microbes that required longer periods of incubation. The pathway also included a rapid disk diffusion sensitivity test. Utilizing the critical pathway strategy, 76% (E. coli frequency of 0.82 X E. coli sensitivity of 0.93) of all urinary pathogens were identified within 1 h, and 98% were identified within 4 h with an antibiotic sensitivity test available within 6 h after the observation of growth. Costs were reduced from 2.5 to 5.0 times. This methodology is applicable to other specimen types.