During high-impact events involving Bacillus anthracis, such as the Amerithrax incident of 2001 or the anthrax outbreaks in Russia and Sweden in 2016, critical decisions to reduce morbidity and mortality include rapid selection and distribution of effective antimicrobial agents for treatment and postexposure prophylaxis. Detection of antimicrobial resistance currently relies on a conventional broth microdilution method that requires a 16-to 20-h incubation time for B. anthracis. Advances in high-resolution optical screening offer a new technology to more rapidly evaluate antimicrobial susceptibility and to simultaneously assess the growth characteristics of an isolate. Herein, we describe a new method developed and evaluated as a rapid antimicrobial susceptibility test for B. anthracis. This method is based on automated digital time-lapse microscopy to observe the growth and morphological effects of relevant antibiotics with an optical screening instrument, the oCelloScope. B. anthracis strains were monitored over time in the presence or absence of penicillin, ciprofloxacin, or doxycycline. Susceptibility to each antibiotic was determined in Յ4 h, 75 to 80% less than the time required for conventional methods. Time-lapse video imaging compiled from the optical screening images revealed unexpected differences in growth characteristics among strains of B. anthracis, which is considered to be a clonal organism. This technology provides a new approach for rapidly detecting phenotypic antimicrobial resistance and for documenting growth attributes that may be beneficial in the further characterization of individual strains.
KEYWORDS Bacillus anthracis, morphological differentiation, multidrug resistance, optical screening technology
Bacillus anthracis is the etiological agent of anthrax and has been designated a tier 1 select agent by the United States Federal Select Agent Program, as it presents a high risk of deliberate misuse as a biological threat agent. In 2001, spores of B. anthracis were maliciously distributed in letters sent through the U.S. postal system. The epidemiologic investigation identified 22 cases of anthrax (cutaneous and inhalation) in seven states (New York, New Jersey, Florida, Pennsylvania, Virginia, Maryland, and Connecticut) that ultimately resulted in five deaths (1). Globally, there are also naturally occurring outbreaks of anthrax in animals, and these may include infection of humans associated with their care.B. anthracis is a member of the Bacillus cereus group, which is composed of six species, including B. cereus, B. thuringiensis, B. anthracis, B. weihenstephanensis, B. mycoides, and B. pseudomycoides. B. anthracis has remarkably low genetic diversity across strains compared to other species of the B. cereus group (2). This species is one