History and development of antimicrobial susceptibility testing methodology

Antimicrobial susceptibility testing (AST) is performed daily on bacterial isolates in clinical laboratories. The techniques employed are often taken for granted. This paper traces the history and development of some methods still in common use for routine AST, e.g. disc diffusion and agar dilution. It was quickly recognized by early investigators that there were many variables affecting the results of these tests. Consequently, there was recognition (as early as the late 1950s) that standardization of these techniques was required. This need has led to many organizations producing standardized AST methodologies. Although some disc diffusion techniques that generated results within 4-6 h were described, most relied on 18-24 h incubation before a result was available. The clinical and economic pressures for rapid methods with low labour input led to the development of semi-automated and automated AST methodologies in the 1970s. Until 10 years ago, AST techniques relied on phenotypically testing the bacteria isolated. However, to increase the speed and reliability of resistance testing, the use of a genotypic approach has been advocated. The limitations and benefits of this new approach are discussed.