DEVICE FOR SUSCEPTIBILITY TESTING OF MICROORGANISMS

Abstract: A device for susceptibility testing of microorganisms comprising a transparent, sealable container (1), a rectangular carrier (3) coated with a growth medium, means (2) for sealing the container (1), and a rectangular, transparent, non-porous, inert test strip (4) optionally provided a grip, two antimicrobial substances separated by a substance-free zone being applied on one side of the strip in concentration gradients exhibiting maxima and minima, on the other side of the test strip is a scale for direct reading of the susceptibility the above-mentioned concentration gradient(s) being pre-defined and adapted to the reading scale.

Description: DEVICE FOR SUSCΞPTI3ILITY TESTING OF MICROORGANISMS The present invention is concerned with a device for susceptibility testing of microorganisms comprising 5 a sealable container, a square carrier coated with a growth medium for microorganisms and a rectangular, transparent, non-porous, inert test strip, on one side of which is applied two antimicrobial substances sep¬ arated by a zone free of substance, and on the other 10 side of which is a scale for direct reading of the sus¬ ceptibility . Susceptibility testing of microorganisms is carried out by exposing the antibiotic(s) and/or chemotherapeutic< s ) to be tested to a growing culture 15 of the microorganisms. After incubation the size of the inhibition zone demarcating a circular area of no growth from the general lawn of microbial growth* is read. The susceptibility of microorganisms for various antibacterial substances can be established m this 20 way . This can be used as a guidance for the selection of an appropriate antimicrobial therapy for the treatment of infections caused by the microorganism in question. Susceptibili y testing or " microorganisms can be carried out by applying either a suspension of 25 colonies from pure isolates or biological fluids containing the infected microorganism directly on a growth medium. Devices for the determination of the susceptibili¬ ty of microorganisms are described m US-A-3 , 416 , 998 , * 30 D -C-137089 and SΞ-C-403382. US-A-3.416 , 998 relates to •M a dried, transparent sheet of agar , m which an active substance, such as a chemotherapeutIC agent or the l ke has been incorporated. These agar reagent sheets can .a. be produced by the dropping of agar incorporated 35 with a reagent on a moving sheet of plastic material. After the agar reagent sheet has dried the plastic material is removed, whereafter pieces of suitable < Z shapes and sizes are cut and are ready to be used. These are intended to replace i.a. antibiotic discs. DK-C-137089 concerns an indicator for the determination of the susceptibility of microorganisms comprising an absorbing carrier, on which growth medium mixed with bactericides has been applied, and on one side of which a moisture-proof layer has been applied. In SE-C-403382 is disclosed means in which the active substance is applied on the growth medium with the aid of a porous carrier. The concentration of the active substance is said to vary continuously along the whole length of the carrier. From this patent is evident that the active substance is essentially transferred from the porous carrier to the cultivation medium in the longitudinal direction of the carrier, the consequence of which is that in the cultivation medium it is not possible to achieve a variation of the concentration of active substance with such an accuracy that it can be read against a pre-determined scale. According to this patent it is also possible to apply two active sub¬ stances on the growth medium, but only in such a way that concentrations of the substances varying in two directions perpendicular to each other are achieved. Susceptibility testing of microorganisms using biological fluids can further be exemplified in more detail by describing a method for the determination of the susceptibility of urinary pathogens to antibacte¬ rial substances. In this method a so called dip-slide is used, i.e. a rectangular carrier coated with a growth medium for microorganisms, e.g. a suitable agar medium. This dip-slide is e.g. attached to a lid, which fits to a tube. The dip-slide is dipped into a urine specimen, whereby the specimen with the bacteria in t is exposed to the agar surface. Thereafter one or more so called antibiotic discs are applied on the agar surface. These are small discs of a porous material, -f which have been impregnated with a predetermined amount of an antibacterial agent. When these discs are in con¬ tact with the agar surface the antimicrobial agent dif- 5 fuses out into the agar medium. After applying the discs tα the dip-slide, it is placed into a tube, which is then sealed. Thereafter the dip-slide is incubated over night in an incubator (a temperature of about 37°C) after which the dip-slide is removed from the 10 tube. The results are read by looking for the appear¬ ance of an inhibition zone , i.e. a zone with no or ve¬ ry little bacterial growth, and measuring the diameter of this zone. This gives an indication on whether the antibiotic being tested may be effective for the treat- 15 ment of an infection caused by the microorganism in question. This method is described inter alia in Chemo¬ therapy 25:227-232 (1979) and The Practioner, vol. 224, 931-934. September 1980. The disadvantages with this method are among others the difficulty of handling such 20 a technique in out-patient care centres, as the anti¬ biotic discs due to their small size must be applied by using tweezers or a needle. Further there is a certain risk of infection when reading results of the suscepti¬ bility testing since it is necess ' ary to remove the dip- 25 -slide from the outer tube. The size of the inhibition zone has to be measured manually and compared to a set of different interpretive templates for different anti¬ biotics, which is a time consuming procedure. At the same time there are technical disadvantages associated * 30 with the porous antibiotic discs as diffusion of anti¬ biotics therefrom to the agar layer does not always take place uniformly due to variations m the porosity of the paper of the agar layer and differences in the physico-chemical properties of different an bacterial 35 agents . This is valied for all porous carriers and thus for all the above-mentioned means. The present invention relates to a device for sus¬ ceptibility testing of microorganisms comprising a transparent, sealable container, a restangular carrier coated with a medium suitable for the growth of microorganisms, means for sealing the container, to which means the carrier may be optionally attached, and a rectangular, transparent, non-porous, inert test strip which is to be applied to the surface of the medium on which the microorganisms grow, with one side of the test strip having two or more antimicrobial substances applied in such a manner that one substance is present in a concentration gradient having a maximum at one end of the test strip and the other substance in a concentration gradient having a maximum at the opposite end, and that there is a zone between the gradients in which there is no substance, and that the concentration gradients of the two substances exhibit their minima at the respective part on the test strip next to the above-mentioned substance-free zone, and on the other side of the test strip there is a scale for direct reading of the susceptibility in which the predefined concentration gradient has been adapted to the reading scale. The test strip is optionally pro¬ vided with a grip. Figure 1 shows one embodiment of the device ac¬ cording to the invention, and Figures 2 and 3 show in more detail one embodiment of a test strip, which is a part of the device. Figure 1 shows one embodiment of the device according to the invention comprising a transparent tube 1 , a rectangular carrier 3 in the form of a dip- -siide on which there is an agar layer, and a lid 2, which is connected to the dip-slide. The dip-slide shown in the figure has been dipped for example in a urine specimen, whereafter a test strip 4 having an antimicrobial substance has been applied to the agar surface and the device has been sealed. The test strip is for example of the type illustrated in more detail in Figures 2 and 3. The whole device is thereafter incubated over night at about 37°C . Growth of bacteria is shown at 5, while an inhibition of bacterial growth is shown at 6 , where the antibiotic concentration present is enough to inhibit bacterial growth. As is evident it is simple to read the result directly, without having to remove the dip-slide from the tube 1. In the embodiment of test strip 4 shown in Figures 2 and 3 the test strip is provided with a grip tab 7 which is an angular bending of one end of the test strip. Two antimicrobial substances are applied o one side of the test strip in such a way that one of the substances exhibits a concentration gradient having a maximum at the end of the test strip integral with the grip tab, while the other substance exhibits a concen¬ tration gradient having a maximum at the other end of the test strip. Between these two gradients is a zone 8 where there is no substance present. The other side of the test strip is graded with a scale. Figure 2 shows the side of the test strip having a scale. The letters R, I and S indicates resistant, intermediate and sensi- tive categories of susceptibilities to the antibiotic in question. Squally exact concentrations of the sub¬ stances can be shown (9 in Figure 2) . The code for the antibiotic used can be applied on the space indicated with 10. In Figure 3, the side of the test strip on which the antimicrobial substances are applied is shown. Two an imicrobial substances are indicated by 11 and 12, and the concentration maxima located in the respective end of the carrier and the minima at respec¬ tive borders to the zone 8. In the embodiment shown the container is round, but it can also have an another shape, e.g. oval or square . Materials suitable for the test strip and contain¬ er according to the present invention are transparent, inert polymeric materials of a natural or synthetic origin, for example acrylic plastics, styrene plastics, vinyl chloride plastic or glass. They do not have to be of the same material. Different types of interpretive scales can be used in accordance with the invention, for example a nume¬ rical scale. Growth media containing a gelling agent such as agar-agar and the like c n be applied on the rectangu¬ lar carrier. Nutritive supplements necessary for the growth of the microorganisms can in a manner known per se be added to this medium. The term "microorganisms" comprise bacteria, such as enterobacteriaceae , staphylococci , streptococci, hemophilus, neisseriaceae-, bacteroides, and clostridia, virus and fungi-, such as moulds, yeasts, e.g. Candida. The term "antimicrobial substance" refers to one or a combination of more than one antimicrobial sub¬ stances. Antimicrobial substances comprise antibiot cs, for example ammoglycosides , β-lactam antibiotics, macrolide antibiotics, poiymyxms, polypeptides and other chemotherapeutics such as sulfonamides , antimyco- tics, such as polyene antibiotics, for example amphote- ricin, griseofulvin , 5-f luorocytosine and imidazoles, antiviral agents, such as a antadme and mterferon. The concentration gradient of the antimicrobial substance on the test strip can be applied in a manner known per se, for example by precision micrcpipetting . With the device according to the present invention it is easier to carry out susceptibility testing in out-patient care centres. It is much easier to apply a strip with the helpt of grip tab, on the agar surface of a dip-slide than to apply antibiotic discs using tweezers or the like. Further the risk of infection for the staff working with the test is eliminated, as the reading of the result can be carried out directly with¬ out having to remove the dip-slide from the tube as the interpretive scale marked on the test strip gives an immediate answer. This gives accurate and reproducible results and is time-saving, as it does not require, like in other methods, the use of templates which are based on approximations derived from comparisons of inhibition zone sizes and MIC (Minimum Inhibitory Concentration) values. Further, an instantaneous diffusion of antimicrobial substance from the strip to the agar is achieved with a non-porous test strip, which in accordance with the invention results m a stable and continuous concentration gradient in the reaction layer, thus eliminating the interference that may arise when using porous carriers. An exact amount of the substance in a well defined gradient along the strip, is transferred to the test surface,, thereby giving with good reproducibilitv an exact and accurate measure of the susceptibility of the microorganism for the antimicrobial substance being tested.

Claims: CLAI S 1. A device for susceptibility testing of microor¬ ganisms, c h a r a c t e r i z e d in that it com- prises a transparent, sealable container (1) , a rectan¬ gular carrier (3) coated with a medium suitable for the growth of microorganisms, means (2) for sealing the container (1), to which means the carrier (3) may be optionally attached, and a rectangular, transparent, non-porous, inert test strip (4) , which is to be applied to the surface of the medium on which the microorganisms grow, that on one side of the test strip two or more antimicrobial substances are applied in such a manner that one substance exhibits a concentra- tion gradient having a maximum at one end of the test strip and the other substance exhibits a concentration gradient having a maximum at the other end, that there is a zone (8) between the two gradients m which there is no substance present, that the concentration gradi- ents of the two substances exhibit their minima at the respective parts of the test strip next to the above- -mentioned zone (8), that on the other side of the test strip there is a scale provided for direct reading of the susceptibility that the conceritration gradient is pre-defined and adapted to the reading scale, and that the test strip may be optionally extended with a grip (7) . 2. The device of claim 1, c h a r a c t e r i z e d in that the antimicrobial substance is an antibiotic, a chemotherapeutic , an antimycotic or an antiviral agent. 3. The device of any of claims 1-2, c h r a c t e ¬ i z e d in that the test strip (4) is of a transparent, inert polymer material of natural or synthetic origin, or of glass . 4. The device of claim 3, c h a r a c t e r i z e d m that the test strip (4) is of an acrylic plastic, a styrene plastic, a vinyl chloride plastic or glass. 5. The means of any of claims 1-4, c h a r a c¬ t e r i z e d in that the grip of the test strip is a grip tab integral with the test strip and angular to the strip by a bending.

Inventors: BOLMSTROEM ANNE, ERICSSON MAGNUS, BOLMSTROEM, ANNE, ERICSSON, MAGNUS
Applicants: BIODISK AB, AB BIODISK
Application year: 1986
Main classification: C12M1
IPC codes: C12M1