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Antibiotic sensitivity testing - Report of an International Collaborative Study

- Commentary

Article  in  Apmis · May 2007

DOI: 10.1111/j.1600-0463.2007.apm_684.x

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APMIS 115: 619–620, 2007
Printed in Denmark . All rights reserved
COMMENTARY
Göran Kronvall
Ericsson HM, Sherris JC. Antibiotic sensitivity testing. Report of an international collaborative study. Acta
path microbiol immunol scand Sect B 1971;217(Suppl 217):1–90.
Initially, Professor Hans Ericsson’s scientific in-
terest focused on immunoprophylaxis against
diphtheria, but the major impact of his work
on clinical microbiology was in another field:
antimicrobial susceptibility testing of bacterial
pathogens using the disc diffusion method.
The Hygiene and Bacteriology Section of the
Swedish Medical Association set up a commit-
tee in 1949 (R. Frisk, G. Olin, O. Sievers, G.
Tunevall and S. Winblad) to look into ways of
determining antibiotic resistance. The sugges-
tions of the committee (among others: four sus-
ceptibility categories) and the responses from
referees led to the formation of another com-
mittee (H. Ericsson, P. Erlanson, G. Tunevall
and G. Wallmark) with the object of finalizing a
report (1). Several methodological options were
available.
Hans Ericsson picked up the suggestion of
using paper discs very early on and published
his standardization of the disc diffusion method
in 1954 (2). Another Swedish physician, Dr. Per
Erlanson, had earlier written a thesis on suscep-
tibility testing using the agar cup method (Acta
path microbiol scand (Suppl 85)). The simple
and relatively inexpensive disc method de-
scribed by Hans Ericsson was quickly adopted
by clinical bacteriology laboratories all over
Scandinavia.
Hans Ericsson soon had to provide other lab-
oratories with antibiotic discs. Discs were first
produced in the clinical laboratory at Karolin-
ska Hospital, but this grew to a scale which re-
quired an independent economy, separate from
C 2007 The Authors
Journal Compilation C 2007 APMIS
ISSN 0903-4641
Hans Ericsson
the hospital though still in the laboratory, an
enterprise known as ‘‘Lappverket’’. The discs
produced were of the highest quality. Hans Er-
icsson also arranged training courses in suscep-
tibility testing, gave stipends to young microbio-
logists, and set up quality control procedures
that enabled the individual laboratories to en-
sure a high quality of testing.
In those days, private enterprises of phys-
icians were not appreciated by colleagues and
others, and in the 1960s Hans Ericsson moved
the disc production outside the hospital. He
created AB Biodisk, a company that nowadays
has an impact on antimicrobial susceptibility
testing beyond the Scandinavian sphere. The
widely read supplement by H. Ericsson & J.
Sherris on results from an International Colla-
borative Study group with 20 members was an
important factor in promoting the ICS standard
supported by AB Biodisk.
When the FDA (Food and Drug Administra-
tion) in the USA, sent Drs. Richard Norton and
Thomas O’Brien on a tour of Europe in 1976
to check antibiotic susceptibility testing pro-
cedures, they concluded when visiting Sweden
that the quality of testing here was truly out-
standing. This is a fitting tribute to the high
standards maintained by Hans Ericsson in his
relentless efforts to improve the disc test.
The AB Biodisk company has continued its
pioneering work in susceptibility testing with
the introduction of the E-test, the basic prin-
ciples of which were invented by Professor Olof
Vesterberg (1977) and later developed and com-
619
 GÖRAN KRONVALL
mercialized with great success by Hans Er-
icsson’s son Magnus Ericsson, together with
Anne Bolmström, now President and CEO.
Further developments in Sweden in recent
years have expanded the field further with the
application of species-related interpretative
breakpoints, a concept which has now also been
adopted on the European scene by Gunnar
Kahlmeter as the chairman of EUCAST. But
that is another story (3).
REFERENCES
1. Ericsson H, Erlanson P, Tunevall G, Wallmark
G. Bestämning av bakteriers kemoresistens. Prin-
cipiella synpunkter på dess utförande och
bedömande [Determination of chemoresistance
620
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of bacteria; principles of technic and evaluation].
Svenska Läkartidningen 1953;50:476–81.
2. Ericsson H, Högman C, Wickman K. A paper
disk method for determination of bacterial sensi-
tivity to chemotherapeutic and antibiotic agents.
Scand J Clin Lab Invest 1954;6:23–36.
3. Kronvall G, Runehagen A. Förbättrad känsligh-
etsbedömning av bakterier medelst artrelaterat
SIR-system [Improved determination of anti-
biotic susceptibility of bacteria using species-re-
lated SIR interpretation]. Läkartidningen
1981;78:3483–5.
Göran Kronvall
Professor Emeritus
Karolinska Institutet
Stockholm
Sweden
goran.kronvall/telia.com