Use of an Oxacillin Disk Screening Test for Detection of Penicillin- and Ceftriaxone-Resistant Pneumococci

In a context of worldwide emergence of resistance among Streptococcus pneumoniae strains, early detection of strains with decreased susceptibility to β-lactam antibiotics is important for clinicians. If the 1-μg oxacillin disk diffusion test is used as described by the National Committee for Clinical Laboratory Standards, no interpretation is available for strains showing zone sizes of ≤19 mm, and there is presently no disk diffusion test available for screening cephalosporin resistance. The zones obtained by the diffusion method by using the 1-μg oxacillin disk were compared with penicillin MICs for 1,116 clinical strains and with ceftriaxone MICs for 695 of these strains. Among the 342 strains with growth up to the 1-μg oxacillin disk margin, none were susceptible (MIC, ≤0.06 μg/ml), 62 had intermediate resistance (MIC, 0.12 to 1.0 μg/ml), and 280 were resistant (MIC, ≥2.0 μg/ml) to penicillin. For ceftriaxone, among 98 strains with no zone of inhibition in response to oxacillin, 68 had intermediate resistance (MIC, 1.0 μg/ml), and 22 were resistant (MIC, ≥2.0 μg/ml). To optimize the use of the disk diffusion method, we propose that the absence of a zone of inhibition around the 1-μg oxacillin disk be regarded as an indicator of nonsusceptibility to penicillin and ceftriaxone and recommend that such strains be reported as nonsusceptible to these antimicrobial agents, pending the results of a MIC quantitation method.