Rapid methods to determine antimicrobial susceptibility would assist in the timely distribution of effective treatment or postexposure prophylaxis in the aftermath of the release of bacterial biothreat agents such as Bacillus anthracis, Yersinia pestis, or Burkholderia pseudomallei. Conventional susceptibility tests require 16 to 48 h of incubation, depending on the bacterial species. We evaluated a method that is based on laser light scattering technology that measures cell density in real time. We determined that it has the ability to rapidly differentiate between growth (resistant) and no growth (susceptible) of several bacterial threat agents in the presence of clinically relevant antimicrobials. Results were available in <4 h for B. anthracis and <6 h for Y. pestis and B. pseudomallei. One exception was B. pseudomallei in the presence of ceftazidime, which required >10 h of incubation. Use of laser scattering technology decreased the time required to determine antimicrobial susceptibility by 50% to 75% for B. anthracis, Y. pestis, and B. pseudomallei compared to conventional methods.
In the event of a deliberate release of or accidental exposure to potential bacterial agents of bioterrorism, determining phenotypic susceptibility to antimicrobials is essential for the selection of effective treatment or postexposure prophylaxis (1). Several methods can be used to determine antimicrobial susceptibility, although the gold standard is the conventional broth microdilution (BMD) method. Based on guidelines from the Clinical and Laboratory Standards Institute (CLSI), this method requires an incubation period of 16 to 20 h for Bacillus anthracis and Burkholderia pseudomallei and 24 to 48 h for Yersinia pestis (2). Other commonly used methods for antimicrobial susceptibility testing (AST) of bacteria are agar dilution, Etest, and disc diffusion. There are several peer-reviewed publications that describe the use of these methods for biothreat (BT) bacteria (3-6). However, these alternative methods require incubation times that are similar to those of the BMD test since visible growth is required for interpretation of results (3-6).Rapid methods to determine antimicrobial susceptibility of BT bacteria are highly desirable to reduce the morbidity and mortality associated with the diseases caused by B. anthracis (anthrax), B. pseudomallei (melioidosis), and Y. pestis (plague). While genetic susceptibility tests have been described as more rapid than conventional methods, the genetic approaches have disadvantages since the presence of a resistant gene or a mutation does not necessarily result in phenotypic resistance (7). For example, B. anthracis has two -lactamase genes, bla1 and bla2, on the chromosome, but this species is rarely resistant to -lactam antimicrobials such as penicillin. Phenotypic susceptibility of most strains is due to a mutation(s) in the regulatory genes that prevent induction of -lactamase gene expression (8, 9). Another issue associated with the use of genetic analysis to predict antimicrobial ...