Disk diffusion antimicrobial susceptibility testing of members of the family Legionellaceae including erythromycin-resistant variants of Legionella micdadei

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Abstract
Disk diffusion antimicrobial susceptibility testing of members of the family Legionellaceae was accomplished on buffered charcoal yeast extract agar by allowing the bacteria to grow for 6 h before placement of the disks, followed by an additional 42-h incubation period before the inhibitory zones were measured. This system was standardized by comparing the zone sizes with the MICs for 20 antimicrobial agents of nine bacterial strains in five Legionella species and of 19 laboratory-derived, erythromycin-resistant variants of Legionella micdadei. A high, linear correlation between zone size and MIC was found for erythromycin, trimethoprim, penicillin, ampicillin, carbenicillin, cephalothin, cefamandole, cefoxitin, moxalactam, chloramphenicol, vancomycin, and clindamycin. Disk susceptibility testing could be employed to screen Legionella isolates for resistance to any of these antimicrobial agents, of which only erythromycin is known to be efficacious in the treatment of legionellosis. With selected antibiotics, disk susceptibility patterns also appeared to accurately identify to the species level the legionellae. The range of the MICs of the legionellae for rifampin and the aminoglycosides was too small to determine whether the correlation of zone size with MIC was linear. However, laboratory-derived, high-level rifampin-resistant variants of L. micdadei demonstrated no inhibition zone around the rifampin disk, indicating that disk susceptibility testing would likely identify a rifampin-resistant clinical isolate. Of the antimicrobial agents tested, the only agents for which disk susceptibility testing was definitely not possible on buffered charcoal yeast extract agar were oxacillin, the tetracyclines, and the sulfonamides.