e. a range of 18 mm). In contrast, fully automated Sirscan readings had a range of 4 mm and only

4 out of 19 values were 1 mm out of the quality control range. Table 4 Examples of scattergrams of inhibition zone measurements with calliper, the Sirscan system adaped on-screen by the human eye and the Sirscan fully automated mode Nitrofurantoin, E. coli ATCC 25922   Diameter (mm) 15 16 17 18 19 20 21 22 23 24                        Sirscan fully automated     9 10                                    Sirscan on-screen adjusted   6 4 5 2 2                                Calliper 3 3 4 3 5 1                             Ertapenem, E. coli ATCC 25922   Diameter (mm) see more 28 29 30 31 32 33 34 35 36 37 38             MK-2206 manufacturer          Sirscan fully automated

          3 7 9                            Sirscan on-screen adjusted         1   4 6 2 3 3                      Calliper 1     1 1 4 3 1 5 3                     Trimethoprim-Sulfamethoxazole, S. aureus ATCC 29213   Diameter (mm) 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37    Sirscan fully automated                     4 6 7 2                Sirscan on-screen adjusted                     1 4 3 7 4              Calliper 2 1 1     1   1 2 3 2 1 2 1 1   1       Amikacin, S. aureus ATCC 29213   Diameter (mm) 17 18 19 20 21 22 23 24 25                          Sirscan fully automated           7 12                              Sirscan on-screen adjusted           1 6 8 4                          Calliper   1       5 3 7 3                       Measurements were done independently and double-blinded by 19 experienced persons (technicians and laboratory physicians)

with the same disk diffusion plates of EUCAST quality control strains of S. Carnitine dehydrogenase aureus ATCC 29213, and E. coli ATCC 25922. Measurements of the Sirscan fully automated mode comprise 19 independent measurements of the panels. EUCAST quality control ranges are indicated in italics. Discussion Automation of inhibition zone readings was developed to avoid disadvantages of disk diffusion AST such as high find more manual workload, laborious data documentation, and low speed of manual readings. Our results show excellent comparability of on-screen adjusted automated measurements using the Sirscan instrument compared with the manual calliper method for a broad range of species representing the most common isolates in a routine clinical microbiological laboratory (Table 1). The present results are in agreement with other studies that found a high correlation of Sirscan and manual measurements [12, 13]. Relative deviations of Sirscan and manual measurements were almost equally distributed pointing to random deviations rather than systematical errors (Table 2). Neither method tended to systematically higher or lower diameter measurements compared with the other with the exception of Enterococcus spp.