Susceptibility of enterococci to daptomycin is dependent upon testing methodology

An increase in daptomycin nonsusceptible enterococci (DNSE) was noted in our institution (8.3% 2008 to 34.5% 2011) using MicroScan methods which may overestimate DNSE prevalence. DNSE (N = 150) from the clinical laboratory (2008-2011) underwent susceptibility testing using broth microdilution (BMD), Etest, Sensititire, MicroScan prompt (MSP), and MicroScan turbidity (MST) with only 20% of isolates confirmed as nonsusceptible. Categorical and essential agreement were highest with MSP and MST, but both missed the majority of resistant isolates (70% and 87% missed). Etest MIC values were statistically higher, more likely to be nonsusceptible, had the lowest very major error rate (37%), and the highest falsely nonsusceptible rate (22%). Sensititre MIC values were not statistically different from BMD, but missed 57% of DNSE. PFGE analysis did not define a clonal outbreak. These findings suggest that MicroScan methods overestimate nonsusceptibility, and the lack of correlation between methods raises questions regarding which method is most effective at confirming nonsusceptibility.