Minimum inhibitory concentration (MIC) is determined when a patient does not respond to treatment thought to be adequate, relapses while being treated or when there is immunosuppression.
Dilution methods can be carried out in 2 ways
A. Broth dilution
Broth dilution testing allows the option of providing both quantitative (MIC) and qualitative (category interpretation) results. MIC can be helpful in establishing the level of resistance of a particular bacterial strain and can substantially affect the decision to use certain antimicrobial agents.
Broth dilution can again be performed by 2 ways
- Macro dilution: Uses broth volume of 1 ml in standard test tubes .
- Microdilution: Uses about 0.05 to 0.1 ml total broth volume and can be performed in a microtiter plate or tray .
The procedure for both macro and microdilution are same except the volume of the broth.
B. Agar dilution
MIC of an antibiotic using broth dilution method is determined by using the following procedure
- Preparation of antibiotic stock solution
- Preparation of antibiotic dilution range
- Preparation of agar dilution plates
- Preparation of inoculum
- Reading and interpreting results
Preparation of antibiotic Stock solution.
Antibiotic stock solution can be prepared by commercially available antimicrobial powders (with given potency). The amount needed and the diluents in which it can be dissolved can be calculated by using either of the following formulas to determine the amount of antimicrobial powder (1) or diluent (2) needed for a standard solution:
Prepare antimicrobial agent stock solutions at concentrations of at least 1000 μg/mL (example: 1280 μg/mL) or 10 times the highest concentration to be tested, whichever is greater.
Because microbial contamination is extremely rare, solutions that have been prepared aseptically but not filter sterilized are generally acceptable. If desired, however, solutions may be sterilized by membrane filtration. Dispense small volumes of the sterile stock solutions into sterile glass, polypropylene, polystyrene, or polyethylene vials; carefully seal; and store (preferably at −60 °C or below, but never at a temperature warmer than −20 °C and never in a self-defrosting freezer). Vials may be thawed as needed and used the same day.
Preparation of antibiotic dilution range
- Use sterile 13- x 100-mm test tubes to conduct the test. If the tubes are to be saved for later use, be sure they can be frozen.
- Close the tubes with loose screw-caps, plastic or metal closure caps, or cotton plugs.
- Prepare the final two fold (or other) dilutions of antimicrobial agent volumetrically in the broth. A minimum final volume of 1 mL of each dilution is needed for the test.
Note: For, microdilution,only 0.1 ml is dispensed into each of the 96 wells of a standard tray.
Preparation of inoculum
- Prepare the inoculum by making a direct broth suspension of isolated colonies selected from an 18- to 24-hour agar plate (use a non-selective medium, such as blood agar).
- Adjust the suspension to achieve a turbidity equivalent to a 0.5 McFarland turbidity standard. This results in a suspension containing approximately 1 to 2 x 10^8 colony forming units (CFU)/mL for Escherichia coli ATCC®a 25922.
- Compare the inoculum tube and the 0.5 McFarland standard against a card with a white background and contrasting black lines.
- Optimally within 15 minutes of preparation, dilute the adjusted inoculum suspension in broth so, after inoculation, each tube contains approximately 5 x 10^5 CFU/mL.
Note: This can be accomplished by diluting the 0.5 McFarland suspension 1:150, resulting in a tube containing approximately 1 x 10^6 CFU/mL. The subsequent 1:2 dilution in step 3 brings the final inoculum to 5 x 10^5 CFU/mL.
Within 15 minutes after the inoculum has been standardized as described above, add 1 mL of the adjusted inoculum to each tube containing 1 mL of antimicrobial agent in the dilution series (and a positive control tube containing only broth), and mix.
This results in a 1:2 dilution of each antimicrobial concentration and a 1:2 dilution of the inoculums.
Incubate the inoculated tubes at 35 ± 2 ºC for 16 to 20 hours in an ambient air incubator. To maintain the same incubation temperature for all cultures, do not stack microdilution trays more than four high.
Compare the amount of growth in the wells or tubes containing the antimicrobial agent with the amount of growth in the growth-control wells or tubes (no antimicrobial agent) used in each set of tests when determining the growth end points. For a test to be considered valid, acceptable growth (≥ 2 mm button or definite turbidity) must occur in the growth-control well.
The lowest concentration at which the isolate is completely inhibited (as evidenced by the absence of visible bacterial growth) is recorded as the minimal inhibitory concentration or MIC.