Usefulness of the disk diffusion method for evaluating the sensitivity of Neisseria meningitidis to penicillin and cefotaxime

BACKGROUND: Routine susceptibility testing of Neisseria meningitidis to penicillin and other beta lactams is recommended after the isolation of N. meningitidis of moderately resistant to penicillin (MRP). We have evaluated the disk-diffusion method to determine susceptibility of N. meningitidis to penicillin (using disks of either penicillin or oxacillin) and to cefotaxime. METHODS: Fifty-four strains of N. meningitidis isolated from clinical samples were studied. MICs of penicillin and cefotaxime were determined by microdilution. Disks of 2 U of penicillin, 1 microgram of oxacillin and 30 micrograms of cefotaxime and two culture media, Mueller-Hinton agar (MHA) and MHA supplemented with 5% sheep blood (MHS) were used in the disk-diffusion assay. RESULTS: For disk of 2 U of penicillin assayed in MHA, 86.4% of the susceptible strains and 20% of MRP strains were considered susceptible when a breakpoint of 28 mm was considered. None of the MRP strains was considered susceptible when using MHS, but only 38.6% of susceptible strains appeared as such on this medium. When a 1 microgram oxacillin disk was used all MRP strains presented an inhibition zone < or = 10 mm on both MHA and MHS, but 54.4 and 4.5% of susceptible strains presented an inhibition zone > or = 11 mm on MHA and MHS, respectively. All strains were susceptible to cefotaxime, showing inhibition zones around a 30 micrograms disk on MHA and MHS of > or = 35 mm and > or = 25 mm, respectively. CONCLUSION: Disk diffusion with cefotaxime (30 micrograms) allows to determine susceptibility of N. meningitidis to this antimicrobial agent. Discs of penicillin (2 U) and oxacillin (1 microgram) are not useful for screening of MRP N. meningitidis.