Advanced amperometric respiration assay for antimicrobial susceptibility testing.

A ferricyanide-based electrochemical cell respiration assay was adapted for use in broad-spectrum antimicrobial susceptibility testing (AST). Total bacterial respiration was converted into faradaic current by electro-oxidation of ferrocyanide, produced when ferricyanide is reduced by bacterial electron-transport. For Escherichia coli (E. coli), the signal was linear with 5-13 × 10(8) colony-forming units in measuring buffer. For AST, test cells were treated with drugs before ferricyanide addition; cell counts from the amperometric assay provided a measure of drug-induced cell death. Initial trials with six antimicrobial agents produced incorrect susceptibility classifications for drugs that were electroactive at the potential used to detect ferrocyanide or which affected cellular respiration rates. We therefore changed the procedure from drug-treatment and assay in the same buffer to sequential drug exposure in treatment buffer, centrifugal separation of surviving cells, cell resuspension, incubation in the presence of ferricyanide and finally ferrocyanide amperometry in drug-free buffer. Data analysis with E. coli led to an activity classification that agreed with cell culture-based ASTs, obtained by a quicker, more convenient procedure. The potential of this approach was confirmed by trials with the highly virulent bacterium Burkholderia pseudomallei, a particularly antimicrobial-resistant pathogen that is the cause of lethal melioidosis in tropical climates and is currently of concern as a potential bioterrorism agent.