An 11,000-isolate same plate/same day comparison of the 3 most widely used platforms for analyzing multidrug-resistant clinical pathogens

Stewardship of the dwindling number of effective antibiotics relies on accurate phenotyping. We sought to conduct the first large-scale, same plate and day comparison of the 3 most widely used bacterial analyzers. A total of 11,020 multidrug-resistant clinical isolates corresponding to more than 485,000 data points were used to compare the 3 major identification and antibiotic susceptibility testing (AST) platforms. Bacterial suspensions, prepared from a single plate, were simultaneously tested on all platforms in the same laboratory. Discrepancies were derived from MIC values using 2014 interpretive guidelines. Molecular methods and manual microbroth dilution were reference standards. Most discrepancies were due to drug-organism-AST platform combination instead of individual factors. MicroScan misidentified Acinetobacter baumannii (P<0.001) and underestimated carbapenem susceptibility in Klebsiella pneumoniae. Vitek-2 and Phoenix had higher discrepancies for bla_KPC-containing Enterobacteriaceae (P<0.05) and reported false susceptibilities more often. While all platforms performed according to standards, each had strengths and weaknesses for organism identification, assaying specific drug-organism combinations and inferring carbapenemase production.