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Diffusion tensor imaging in children and adolescents: reproducibility, hemispheric, and age-related differences.

UNLABELLED: We evaluated intra-rater, inter-rater, and between-scan reproducibility, hemispheric differences, and the effect of age on apparent diffusion coefficient (ADC) and fractional anisotropy (FA) in healthy children (age range 5.5-19.1 years) examined with a clinical diffusion tensor imaging (DTI) protocol at 1.5 T, using a region of interest (ROI) methodology. Measures of reliability and precision were assessed in six ROIs using two different ROI shapes (polygonal and ellipsoidal). RESULTS: Highly reproducible values of ADC and FA were obtained with the polygonal method on intra-rater (coefficients of variation<or=2.7%) and inter-rater (coefficients of variation<or=4.8%) reproducibility. For between-scan reproducibility, the coefficients of variation were <or=5.0%. Mean asymmetry indices were in the range from -4% to 9% for FA and from -6% to 3% for ADC. ADC showed significant negative correlation with age in 13 of 15 examined fiber tracts and FA increased significantly in three fiber tracts. Our results show that the evaluated DTI protocol is suitable for clinical application in pediatric population.

Adolescent↗

Operator learning effect and interoperator reproducibility of the scanning laser polarimeter with variable corneal compensation.

PURPOSE: To ascertain operator learning effect, and to quantify the interoperator reproducibility, using the newly introduced GDx VCC (variable corneal compensator) scanning laser polarimeter. DESIGN: Prospective instrument validation study. PARTICIPANTS: Three operators with no prior experience in operating the GDx VCC examined one randomly chosen eye of each of 30 randomly ordered subjects (15 glaucoma patients and 15 normal subjects). METHODS: Each study eye was scanned by the 3 operators in a random sequence during a single session. Five GDx parameters were analyzed: TSNIT (temporal, superior, nasal, inferior, temporal) Average, TSNIT Standard Deviation (SD), Superior Average, Inferior Average, and Nerve Fiber Indicator (NFI). MAIN OUTCOME MEASURES: Retinal nerve fiber layer (RNFL) thickness GDx parameters across operators. RESULTS: A learning effect was not found for any of the operators for any of the 5 GDx parameters studied. Reproducibility for each GDx parameter was measured as the mean SD value of the measurements taken by the 3 operators. Interoperator reproducibilities for normal and glaucomatous eyes, respectively, were 0.8 and 1.6 microm (TSNIT Average), 1.7 and 2.2 microm (Superior Average), 1.6 and 2.7 microm (Inferior Average), 1.3 and 1.7 microm (TSNIT SD), and 1.4 and 4.6 microm (NFI). The data obtained by each operator were highly correlated with those of the other 2 operators. CONCLUSIONS: With the commercially available GDx VCC, a learning effect was not found for 3 novice operators. In addition, RNFL measurements seem highly reproducible across operators.

Adult↗

Development and reproducibility of a brief food frequency questionnaire for assessing the fat, fiber, and fruit and vegetable intakes of rural adolescents.

OBJECTIVE: To describe the systematic development and reproducibility of a food frequency questionnaire (FFQ) designed to meet the specific research requirements of the Goals for Health cancer prevention intervention program for rural middle school children. DESIGN: A 4-step process was used to develop a brief FFQ for scoring intakes of total fat, fiber, and fruits and vegetables. The resulting questionnaire consisted of 25 food frequency items and 10 supplemental questions. Reproducibility of the questionnaire was determined by comparing responses at the beginning and end of a 4-month interval. SUBJECTS: Study subjects were sixth- and seventh-grade students attending middle schools in rural areas of Virginia and upstate New York. Seventh-grade students participated in the pilot study, and sixth-grade students participated in the reproducibility study. The final version of the FFQ was completed twice by 539 sixth graders. After exclusions for missing and unreliable data, the usable sample size was 415. Boys were somewhat more likely than girls to be excluded for missing data. African-American students comprised 32% of the population. STATISTICAL ANALYSES PERFORMED: Each food frequency item was associated with 3 scores--a fat score, a fiber score, and a combined score for the number of servings of fruits and vegetables. Means and standard deviations were determined for nutrient variables, differences between repeat administrations were tested for significance by paired t test, and Pearson correlation coefficients were calculated for nutrients and for individual food items. RESULTS: Correlation coefficients for nutrient scores were 0.58 for fat, 0.49 for fiber, and 0.51 for fruits and vegetables. For individual food items, correlations ranged from 0.24 to 0.59 (mean=0.41). APPLICATIONS/CONCLUSIONS: Using a systematic approach to developing a study-specific FFQ for rural adolescents is feasible. Further, the reproducibility of the Goals for Health questionnaire was demonstrated for the 3 nutrient scores it was designed to measure. This developmental approach may be readily adapted to other populations, study designs, and nutrients of interest. The validity of the questionnaire remains to be tested.

Adolescent↗

Measurement of parasympathetic activity from 24-hour ambulatory electrocardiograms and its reproducibility and sensitivity in normal subjects, patients with symptomatic myocardial ischemia, and patients with diabetes mellitus.

The parasympathetic nervous system plays a major role in the pathophysiology of many cardiovascular disease, particularly in modulating myocardial electrical stability. Measurements of heart rate variability have been widely used to assess parasympathetic activity. The reproducibility of measurements obtained from 24-hour ambulatory electrocardiograms has not been well documented. We have developed a technique for measuring parasympathetic activity from clinical quality 24-hour ambulatory electrocardiograms by counting beat-to-beat increases in RR interval that are > 50 ms. To determine the reproducibility and sensitivity of our technique, we analyzed repeated 24-hour electrocardiograms of 173 subjects (19 normal subjects, 67 patients with ischemic heart disease, and 87 diabetics) followed up over periods of 2 to 16 weeks. In all subject groups, mean values for repeated measurements were virtually identical. Measurements were stable in all 3 groups throughout the course of the study, as assessed by intraclass correlation coefficients. This technique is sensitive enough to detect relatively small changes in parasympathetic activity in subjects, as demonstrated by the calculated Bland and Altman coefficients of repeatability. Reproducibility and sensitivity of our technique are particularly good in normal subjects and in patients with ischemic heart disease. The results obtained with this technique imply that other related measurements of parasympathetic activity will show similar excellent short- and long-term reproducibility and sensitivity.

Adult↗

Comparison and reproducibility of visual echocardiographic and quantitative radionuclide left ventricular ejection fractions.

Left ventricular (LV) ejection fraction (EF) is commonly assessed by equilibrium radionuclide angiography and echocardiography. These methods are presumed to be interchangeable for this purpose. This study (1) compares quantification of LVEF by equilibrium radionuclide angiography with visual estimation of LVEF by echocardiography, (2) determines the reproducibility of both methods, and (3) evaluates whether differences in determinations of LVEF are of clinical relevance. Seventy-three clinically stable patients had both equilibrium radionuclide angiography and echocardiography performed within a 4-day period. LVEF by both techniques was compared after blinded analysis by 3 echocardiographers and 3 nuclear technologists. Reproducibility was assessed by blinded repeat analysis after a 1-week interval. The frequency of differences in repeat assessments of EF that the authors considered to be of potential clinical relevance (i.e., difference > or = 10% EF units) was assessed for both techniques. Correlation of LVEF determined by both methods was good (r = 0.81, SEE = 3.5) but with substantial differences in individual patients (limits of agreement, 23.6%). Intra- and inter-observer reproducibility was good for both methods, but better for radionuclide LVEF than for echocardiographic LVEF. Limits of agreement were substantially better for radionuclide LVEF than for echocardiographic LVEF (1.8% to 3.6% versus 13.4% to 17.4%, respectively). Clinically relevant differences did not occur on repeat processing of equilibrium radionuclide angiography. In contrast, potentially clinically relevant differences occurred in 8% to 26% of studies on repeat analysis of echocardiography. Thus, LVEF determined by equilibrium radionuclide angiography and echocardiography show good agreement. Both methods provide clinically valuable measurements for LV function. However, when a precisely reproducible measurement is required for patient management decisions, equilibrium radionuclide angiography is the method of choice.

Adult↗

The Ocular Hypertension Treatment Study: reproducibility of cup/disk ratio measurements over time at an optic disc reading center.

PURPOSE: To determine the reproducibility over time of visual estimates of the horizontal cup/disk ratio by trained technicians from optic disk stereophotographs. METHODS: Baseline optic disk stereophotographs are graded at entry and regraded annually in a masked fashion. The 1,636 participants in the Ocular Hypertension Treatment Study (OHTS) undergo stereoscopic optic disk photography at study entry and annually thereafter. Stereophotographs are graded independently by two technicians at the Optic Disc Reading Center. If the readers' estimates of horizontal cup/disk ratio differ by more than 0.2 disk diameters (DD), they attempt to reach a consensus; if they cannot, the horizontal cup/disk ratio is adjudicated by a glaucoma specialist. RESULTS: The percent of regradings differing by 0.2 DD or more from the estimate of horizontal cup/disk ratio made at entry was 4%, 6%, and 7%, respectively at years 1, 2, and 3. The percent differing by more than 0.2 DD was 1% or less at all years. Intraclass correlation coefficients were 0.93, 0.92, and 0.92, respectively. Estimates of horizontal cup/disk ratio from sequential full-frame photographs and simultaneous split-frame photographs appeared comparable and equally reproducible. Gradings by technicians were comparable to gradings by glaucoma specialists. CONCLUSIONS: High reproducibility between repeated gradings of baseline horizontal cup/disk ratio was achieved by trained technicians adhering to a rigorous protocol. Horizontal cup/disk ratio measurements in OHTS are sufficiently reproducible to provide information about the relationship of cup/disk ratio to the prognosis of individuals with ocular hypertension.

Certification↗

Reproducibility of digital image analysis for measuring corneal haze after myopic photorefractive keratectomy.

PURPOSE: To evaluate the usefulness of digital image analysis for quantifying corneal haze by determining the reproducibility of its measurements at the corneal plane. METHODS: In a prospective study, 20 randomly selected eyes that had undergone myopic photorefractive keratectomy were photographed focusing the slit beam on their anterior corneal surface. Each photograph was examined using computer image analysis techniques that detect the edge of the reticular pattern of the image. Quantification of the difference between two areas, treated and adjacent untreated cornea, each containing 3,750 pixels with a resolution of 256 gray levels, was performed. Intra-analyzer variation was determined by evaluating the photographs obtained by two analyzers under standard conditions on four separate visits. Interanalyzer variation was calculated using one measurement and the mean of the four measurements. RESULTS: The pooled standard deviation of the measurements for the analyzers was 0.63 and 0.62 gray levels (coefficient of variation, 4.1% and 3.3%). An association between less severe haze measurements and higher reproducibility scores was found (r = .42; P = .007). The mean interanalyzer variation was smaller for the average of four measurements, 0.55 +/- 0.37 gray levels, than for one measurement, 0.94 +/- 0.73 gray levels (P = .014). CONCLUSIONS: Good reproducibility for haze measurements by digital image analysis of the differences between the treated and adjacent untreated corneal areas was obtained. When the average of four measurements was used instead of a single measurement, interanalyzer reproducibility increased significantly. This new technique may be used to quantify and analyze corneal haze after myopic photorefractive keratectomy.

Adult↗

Reproducibility of postural changes in intraocular pressure with the Tono-Pen and Pulsair tonometers.

Reproducibility of measurements of postural changes in intraocular pressure was determined by using the Tono-Pen (Mentor O & O, Inc., Norwell, Massachusetts) and Pulsair (Keeler Instruments, Inc., Broomhall, Pennsylvania) tonometers. Thirty subjects had three repeated sitting and reclining measurements performed on three separate visit days. Reproducibility coefficients of 3.3% for the Tono-Pen and 6.3% for the Pulsair were obtained for the within-visit postural change measurements. Across-visit reproducibility coefficients were 7.9% and 26.2% for the Tono-Pen and Pulsair, respectively. The estimated standard deviations for both the within-visit and across-visit postural change measurements were high for both instruments. These results indicate poor reproducibility of measurements of postural changes in intraocular pressure.

Adult↗

Origin of reproducibility in the responses of retinal rods to single photons.

The single photon responses of retinal rod cells are remarkably reproducible, allowing the number and timing of photon absorptions to be encoded accurately. This reproducibility is surprising because the elementary response arises from a single rhodopsin molecule, and typically signals from single molecules display large intertrial variations. We have investigated the mechanisms that make the rod's elementary response reproducible. Our experiments indicate that reproducibility cannot be explained by saturation within the transduction cascade, by Ca2+ feedback, or by feedback control of rhodopsin shutoff by any known element of the cascade. We suggest instead that deactivation through a series of previously unidentified transitions allows the catalytic activity of a single rhodopsin molecule to decay with low variability. Two observations are consistent with this view. First, the time course of rhodopsin's catalytic activity could not be accounted for by the time required for the known steps in rhodopsin deactivation-phosphorylation and arrestin binding. Second, the variability of the elementary response increased when phosphorylation was made rate-limiting for rhodopsin shutoff.

Animals↗

Reproducibility of prompts in computer-aided detection (CAD) of breast cancer.

AIM: We evaluated the reproducibility of prompts using the R2 ImageChecker M2000 computer-aided detection (CAD) system. MATERIALS AND METHODS: Forty selected two-view mammograms of women with breast cancer were digitized and analysed using the ImageChecker on 10 separate occasions. The mammograms were chosen to provide both straightforward and subtle signs of malignancy. Data analysed included mammographic abnormality, pathology, and whether the cancer was prompted or given an emphasized prompt. RESULTS: Correct prompts were generated in 86 out of 100 occasions for screen-detected cancers. Reproducibility was less in the other categories of more subtle cancers: 21% for cancers previously missed by CAD, a group that contained more grade 1 and small (<10 mm) tumours. Prompts for calcifications were more reproducible than those for masses (76% versus 53%) and these cancers were more likely to have an emphasized prompt. CONCLUSIONS: Probably the most important cause of variability of prompts is shifts in film position between sequential digitizations. Consequently subtle lesions that are only just above the threshold for display may not be prompted on repeat scanning. However, users of CAD should be aware that even emphasized prompts are not consistently reproducible.

Breast Neoplasms↗

Reproducibility and diagnostic sensitivity of ultrasonometry of the phalanges to assess osteoporosis.

OBJECTIVE: The present study was designed to assess the reproducibility and the diagnostic sensitivity of the amplitude-dependent speed of sound (SoS) at the distal metaphysis of the proximal phalanges. METHOD: Fourteen presumably healthy volunteers were repeatedly measured every 6 weeks for approximately 6 months in order to assess the reproducibility of the SoS of the phalanges. We recruited 91 post-menopausal women, aged 55-75 years, who were divided in three groups according to their lumbar bone mineral density (BMD) and the existence of prevalent vertebral fractures. The objective was to evaluate the diagnostic sensitivity of SoS measurements. We used DBM Sonic 1200 equipment, and assessed the velocity at which US cross the phalanx in a lateral-medial direction. In post-menopausal women, BMD was measured by dual energy X-ray absorptiometry (DXA) at the level of the lumbar spine, the total zone of the non-dominant hip and the femoral neck zone of the non-dominant hip. RESULTS: The precision of the SoS measurements was 0.71+/-0.05% (mean+/-S.E.M) whereas the reproducibility was 0.95+/-0.06%. Subjects with low BMD or prevalent fractures had significantly lower values of SoS (P < 0.001) than the controls. ROC curve analysis applied to the study population confirmed that SoS was able to discriminate between the controls and osteoporotic subjects (area under the ROC curves were 0.82 (low bone mineral density) and 0.85 (prevalent fractures), respectively). Hip BMD was found to be the most significant variable when comparing the controls and the low density patients by stepwise discrimination and SoS significantly improved the discrimination between the groups when added to the hip BMD. The hip BMD was again the most discriminant variable when applying the same techniques to controls and patients with prevalent fractures, followed by SoS and lumbar BMD. A cut-off value of 1881 m/s is defined for SoS by logistic discrimination and likelihood ratio function. With this value, the sensitivity and the specificity for SoS used in the diagnosis of established osteoporosis were, 81.5% and 79.3%, respectively. Sensitivity and specificity were significantly improved when combining ultrasonometry and densitometry. CONCLUSION: Measurement of ultrasound velocity at the phalanges appears to be a precise and reproducible technique. SoS discriminates between normal post-menopausal women and patients with either low lumbar BMD or prevalent fractures to the same extent as BMD measurements.

Absorptiometry, Photon↗

Reproducibility of visual activation during checkerboard stimulation in functional magnetic resonance imaging at 4 Tesla.

PURPOSE: To investigate the reproducibility of visual activation by checkerboard stimulation, we used functional magnetic resonance imaging (fMRI) at 4 Tesla (T). METHODS: Four subjects were studied with fMRI at 4 T during checkerboard visual stimulation. The functional images were realigned and spatially normalized to the standard brain. For each subject, statistical parametric maps were made for each study, and the reproducibility was determined based on the number of supra-threshold voxels (Z > 3.5, 4.5, and 5.5). RESULTS: The mean ratio for the number of supra-threshold (Z > 4.5) voxels was 0.75, and the mean ratio for the overlapping voxels was 0.61. Restricting the region of interest within the posterior half of the brain improved reproducibility values at the low threshold (Z > 3.5), but did not improve the values at the higher thresholds. CONCLUSIONS: Despite the fact that more than half of the supra-threshold voxels were found to be active for the repeated scans, visual activation with checkerboard stimulation seems to be less reproducible than that by flash stimulation.

Adolescent↗

Repeatability and reproducibility of retention data and band profiles on reversed-phase liquid chromatography columns. IV. Results obtained with Luna C18 (2) columns.

The reproducibility of retention data and band profile characteristics was investigated for a series of columns packed with Luna C18 (2), a silica-based, reversed-phase adsorbent. High precision data were obtained and statistically compared among five columns from the same batch (column-to-column reproducibility) and nine columns from as many different batches (batch-to-batch reproducibility). These data were acquired under five different sets of chromatographic conditions, for a group of 30 neutral, acidic, and basic compounds selected as probes following an experimental protocol previously described. This work is part of a study on the precision of chromatographic analyses. Its purpose is to illustrate the contribution of the stationary phase reproducibility to this precision.

Chromatography, Liquid↗

Reproducibility of computerized ECG measurements and coding in a nonhospitalized elderly population.

The standard 12-lead electrocardiogram (ECG) is used in many epidemiologic studies to diagnose and predict cardiovascular disease. In view of this, knowledge about the reproducibility of ECG measurements and coding is essential. Minute-to-minute, day-to-day, and year-to-year variability of ECG measurements, composite scores, and Minnesota Code classification were assessed by use of a computer program, in 101 nonhospitalized elderly men and women. Interval ECG measurements were more reproducible than amplitude measurements. The best reproducibility was found for the overall QTc interval (coefficient of variation 3.1%, 4.0%, and 5.2% for the minute-to-minute, day-to-day, and year-to-year groups, respectively) and the poorest was found for the Cardiac Infarction Injury Score (coefficient of variation 67.1%, 78.5%, and 94.3%, respectively). Minnesota Code discrepancies occurred in 16%, 19%, and 22% of the ECGs in the minute-to-minute, day-to-day, and year-to-year groups, respectively. Reproducibility within specific code categories was much better. Overall, variability tended to increase with time. In the routine setting, electrode positioning had relatively little effect on total variability.

Aged↗

Reproducibility of classification in non-squamous cell carcinomas of the uterine cervix.

OBJECTIVE: Reproducibility of histopathologic classification systems is of major importance for their utility in daily practice and in research. The reproducibility of histologic classification of non-squamous carcinomas (non-SCC) of the uterine cervix was evaluated, using population-based material from two 5-year periods in Norway. METHODS: Histologic slides from 388 tumors were reviewed by three experienced pathologists and analyzed for inter- and intraobserver agreement on histological subtypes and grade. RESULTS: Kappa values of inter- and intraobserver agreement were moderate to substantial for all major adenocarcinoma subgroups (endocervical, endometrioid, clear cell, or serous carcinoma), and fair to poor for mixed carcinomas and adenocarcinomas not otherwise specified (NOS). Interobserver agreement on villoglandular and adenosquamous carcinomas was poor, and the distinction of adenocarcinoma in situ from well-differentiated carcinoma proved difficult. Reproducibility of the high-risk subgroups of small cell and undifferentiated carcinomas was acceptable from a statistical point of view (kappa values >0.50). However, the authors agreed upon the diagnosis of small cell carcinomas and undifferentiated carcinomas only in 2/3 of these high-risk diagnoses. Patients with high-risk diagnoses showed significantly lower overall survival than patients with non-high-risk diagnoses (P < 0.001). This inferior survival was independent of whether the reviewers had agreed on the high-risk diagnosis or not. CONCLUSION: Clinicians should be aware of the potential inconsistencies of histopathologic diagnoses. No histopathological classification system will ever be perfectly reproducible. Future histopathologic classification of the uterine cervix should emphasize the distinction between groups of particularly low or high prognostic risks.

Adenocarcinoma↗

Reproducibility of topographic measurements of the macula with a scanning laser ophthalmoscope.

BACKGROUND: The Heidelberg retina tomograph, a scanning laser ophthalmoscope that uses confocal optics to provide high resolution of images, is able to scan the retina in three dimensions to obtain quantitative topographic measurements. The authors evaluated its usefulness for measuring macular lesions by determining the reproducibility of its topographic measurements at the macula. METHODS: For each of ten healthy patients, the authors took five images with the patient's right eye undilated and five with the eye cyclopleged and dilated. As a measure of reproducibility, the standard deviation of height measurements for the same location at the macula was calculated for each patient and then the pooled standard deviation for all patients was calculated. The authors performed similar calculations for the mean depth within a contour line. RESULTS: The pooled standard deviation for height measurements was 47.4 microns in undilated eyes and 36.0 microns in cyclopleged, dilated eyes. The authors obtained an extremely low standard deviation of 2.2 microns when the software calculated relative differences between measurements, such as the mean depth within a contour line. When the average of three height measurement values on 1 day was compared with the average of the three values on another day, the 95% confidence interval was +/- 58.7 microns for mean height values and +/- 3.7 microns for mean depth values within a contour line. CONCLUSIONS: The authors obtained good reproducibility for height measurements with the Heidelberg retina tomograph and excellent reproducibility when the instrument calculated relative differences in height measurements. The authors recommend that patients, especially young patients, be dilated and cyclopleged to obtain lower variability of measurements. The scanning laser ophthalmoscope could potentially be used to quantify small changes in retinal lesions.

Adult↗

Growing reproducible biofilms with respect to structure and viable cell counts.

We have developed a new method of growing 4-day-old biofilms that are reproducible, with respect to viable cell number and biofilm structure. To demonstrate the utility of the method, we grew biofilms composed of Pseudomonas aeruginosa (ATCC#700829), P. fluorescens (ATCC#700830) and Klebsiella pneumoniae (ATCC#700831), 18 times in flat-plate reactors under well-defined conditions of: flow rate, nutrient concentration, temperature, inoculum and growth rate. The resulting 4-day-old biofilms were approximately 200-300 microm thick and exhibited a high degree of reproducibility. The number of viable cells that accumulated per unit surface area and the biofilm areal porosity were reproduced within 10% error. We have also quantified other parameters characterizing biofilm structure using biofilm-imaging techniques: fractal dimension, textural entropy and diffusion distance as auxiliary parameters characterizing the reproducibility of biofilm accumulation. As a result of analysis, we have introduced a new parameter to better quantify and characterize the number of viable cells in biofilms, "specific number of viable cells" (SNVC). This parameter is the viable cell number normalized with respect to the surface area covered by the biofilm and with respect to the biomass of the biofilm. This new descriptor represents the dynamics of biofilm accumulation better than the traditionally used colony-forming unit (CFU) per surface area covered by the biofilm because it accounts not only for the surface coverage but also for the biofilm thickness.

Bacteriological Techniques↗

Intact cell mass spectrometry (ICMS) used to type methicillin-resistant Staphylococcus aureus: media effects and inter-laboratory reproducibility.

Intact cell mass spectrometry (ICMS) rapidly analyses the surface composition of microorganisms providing rapid, discriminatory fingerprints for identification and subtyping of important nosocomial pathogens such as methicillin resistant Staphylocccus aureus (MRSA). In this study, ICMS using matrix-assisted laser desorption ionisation time-of-flight mass spectrometry (MALDI TOF/MS) was assessed for the identification and subtyping of MRSA. An intra- and inter-laboratory reproducibility study was carried out and the effects of culture media (an important source of variation for ICMS) were also studied. Several media used for the cultural identification of MRSA were examined using a panel of well-characterised staphylococcal isolates (n=26). Six MRSA isolates were analysed over a 1-month period for intra-laboratory reproducibility on the same instrument and three different culture media. Spectra were consistent for each isolate between the four experiments on the same culture medium. Individual isolates produced different spectral profiles on different culture media. Spectra from organisms grown on Columbia blood agar contained more peaks (approximately 120) compared to Columbia agar (approximately 50) and methicillin mannitol salt agar (approximately 25). All 26 staphylococcal isolates were subjected to an inter-laboratory study on two MALDI instruments. For each isolate, the overall spectral profile was the same for each of the two instruments but the baseline threshold values was adjusted due to instrument differences in detector sensitivities. Differences between certain regions of the spectra reproducibly identified isolates belonging to the two major MRSA strains (EMRSA phage group 15 and 16). These results demonstrate ICMS with appropriate media selection is a rapid and reproducible technique for identification and discrimination of MRSA.

Culture Media↗