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For detecting pneumococcal and enterococcal resistance, strictly adhere to CLSI recommended methods.6  d n b d p og n p n n on m n n pu qu m oo g n m un m n n b

 BBL™ Sensi-Disc™ Antimicrobial Susceptibility


HTM. The zone margin should be considered as the area showing no obvious growth visible with the unaided eye. Faint growth of tiny colonies that g n n D on ou n n ou h d d qu h un Un X u d n d qu d h qu ou h d n d n p on on ou n d n d h h ph m u qu d p d m o og ou d u d pp on d w d n B mon und h g pp önn n Am nog o d ow C ph o po n und C ph m n d n und w nG n on
4. Antimicrobial agents other than those listed in the Chart may be in current use. Susceptibility tests employing these agents should be interpreted
Zone Diameter Interpretive Chart † may appear to fade from the more obvious zone should be ignored in the measurement. When testing Haemophilus with amoxicillin/clavulanic acid nd qu qu u on n m d m n od ou h do n u d n d bu u n D BB p n n C n ou h d g p u n ou o donn d u n m d d p n n n o h n n nd b n hn h w m und o o nn h mp nd h do um n w d n
nou n ou ou h qu donn d u n m d ou n do n o un bo o d n pou
on the basis of presence or absence of a definite zone of inhibition and should be considered as only qualitative until such time as interpretive on HTM, include E. coli ATCC 35218 as the control strain. The acceptable limits for E. coli ATCC 35218 are 17-22 mm for amoxicillin/clavulanic acid when p u u mod d d bu u un d bu u d d qu un qu un d bu u d d qu pou bo d on m on g n p n n o un du u p d Mo g n o u o d n n ob C ob und önn n w h nd ng h p m C ph o po n n d d nG n on n w d n
Test Discs zones have been established. All zone diameters should be recorded.
5. ESBL confirmatory testing is only valid when the four discs (cefotaxime, cefotaxime/clavulanic acid, ceftazidime, ceftazidime/clavulanic acid) are



Zone Diameter
Interpretive Standards (mm)
E. S. P.
Control Zone
Diameter Limits (mm)
H. H. N. S.
incubated in ambient air.
d These zone diameter standards and quality control limits are applicable only to tests performed using GC agar base and 1% defined growth supple- d
mm d d
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English: pages 1 – 4 Deutsch: Seiten 7 – 9 Español: páginas 11 – 13 8840621 used simultaneously. Individual usage of these discs is not recommended by CLSI.6,7 ment (e.g., BBL™ GC II Agar with IsoVitaleX™ Enrichment) incubated in 5% CO2 (20 – 24 h). A m n p u on ou d gno n o m hop m g o Mu H n on do on n mo n po b d h m d n pou u md ou m hop m ou
coli aureus aeruginosa influenzae influenzae gonorrhoeae pneumoniae M D A M HOD B p um m n B nd on g mn g n g n p odu n m d du h Mu on n G n n ü no m
Français : pages 4 – 7 Italiano: pagine 9 – 11 Português páginas 13 – 16 2011/07 Antimicrobial Disc Resis- Inter- Suscep- ATCC ATCC ATCC ATCC ATCC ATCC ATCC d mn g o Mu H n on d n u u mm n b d h mn d h m d n on p u ou h d n o o u
6. Accurate results are a function of the correct storage and maintenance of quality control organisms. This is especially true for E. coli ATCC 35218 e These zone diameter standards and quality control limits are applicable only to tests performed using Mueller Hinton agar supplemented with 5% u mod d mp o p om n d d qu d p nd n non u m n d d d qu m g m n d pp qu n m n u b ob o n pd ou b g n ou H n u n N p md m m n n h n mm on K b pp und o d B p odu n nd mög h w o
o n m po n m n up po no BD Kon d n o BD p æ n n o n u on K u u uh uh and K. pneumoniae ATCC 700603, because spontaneous loss of the plasmid encoding the β-lactamase has been documented. Refer to CLSI stan- Agent Code Potency tant mediate a tible b 25922 25923 27853 49247 c 49766 c 49226 d 49619 e defibrinated sheep blood incubated in 5% CO2 (20 – 24 h). Interpretive standards apply to S. pneumoniae and other streptococci as indicated. d u on d u u d on ô d h n on d qu d bo d on onn p d un gono ho pn umon u p o oqu on u do um n M N m n ng d ou M non u p un A CC ou A CC d d qu d m hop m u m ho o o Un on d nh b on mm qu h nb n o mp nd h g g n ng d ub n n h p n M n h d mm g n H mm on n d
on ug om oh u BD nd g Åð ï ù Þó ï ïð ü á ðñüóùðï ç BD á ï ç Ah n u dard M2 for recommendations on the correct storage and maintenance of quality control organisms.6 Results may be inaccurate if specified criteria are applied to organisms other than those listed. Interpretive criteria for streptococci other than S. pneu- mp u d o g d qu d u u n m n d pou u d p o on nd qu un n u u mm n b d h mn d h mdn un h b d G öß ü n no m mp nd h opu on do h ob h b d no m n G n w ü b mm B p um
Ertapenemh,i ETP-10 10 µg 29 – 36 24 – 31 13 – 21 28 – 35 m hod d d u on u on d n ob qu d p o du p
BD h p õ N udo mo n u ø u o BD g o o o o o Kon dn o BD p n n o m 7. The ability to detect vancomycin-resistant Staphylococcus aureus (VRSA) with this product is unknown. Additional testing methods as recom- moniae are proposed based on population distributions of various species, pharmacokinetics of the antimicrobial agents, previously published literature R p hn qu d p p nd p u on n gu u on d ng m ob o og qu Ap u g uu  gono oqu donn n d d m d on mm u ou d un d qu d n µg o pond n n g n un o d C ph o po n od A on m g n o h mm o n un Anw ndung d B G n w u po n B odu on
Enterobacteriaceae and Staphylococcus spp.j ≤15 16 – 18 ≥19 on R n n m d n b n u m n d un m m qu o pond un m g d u ou n
n o m on Ab u n u u ow n on u o n mp d w w m BD n u um n ho mended by the Centers for Disease Control and Prevention (CDC) should be used when performing susceptibility testing on S. aureus isolates, and the clinical experience of certain members of the CLSI subcommittee. Systematically collected clinical data were not available for review with u u p n ou m on m n N gono ho n n RNG don n m d on p m d qu C ou h d n on m g w d n b o g bn ü n n B p um C ph o po n od A on m ng g b n w d n And mm
Haemophilus spp.c — — ≥19 20 – 28 27 – 33 n bo o C n u u p u n donn un d on d m n on ou n ou bo o p d
up u po o no BD Kon o B on D n on p n n ö n n ng Свърж м ни пр д ви л н BD particularly methicillin-resistant S. aureus (MRSA). These tests include nonautomated MIC methods (e.g., broth microdilution or agar dilution) and many of the compounds in the group.7 Despite the lack of reliable disc diffusion interpretive criteria for S. pneumoniae with certain β-lactams, S. n u on pou on on p un d d u on CM µg m ou n o un bo o pub pou nqu p d m o og qu w n hg g b n n m m H d no m n G n w n m d od n g g n n od m h d
Erythromycin E-15 15 µg — 22 – 30 — u u m n
ин р ии Con p n n u dumn o o BD p n u n u un T m n BD m n d n n a vancomycin agar screen test (Brain Heart Infusion Agar with 6 µg/mL of vancomycin). These methods require a full 24 h of incubation to detect pneumoniae ATCC 49619 is the strain designated for quality control of all disc diffusion tests with all Streptococcus spp.  ou o d ph o oqu o d d m d on pou n om n d mm ou mo n do n p un ub n n B n B p odu nd n mm n o nd on ndu hm ü n od m h d B p um C ph o po n
D p on on d qu n + C g u du bo o qu mm n ou qu ou d on d n h pn umo oqu n o oqu u upu u m n p o du omm nd p
Ob om o nom p d n u omp n BD upu Дл пол ни ин р ций в ж ь м ным пр д ви л м VRSA. For additional information, refer to the CDC web site.12 Staphylococcus spp. r and enterococci r,yy ≤13 14 – 22ii ≥23ii f FDA-approved zone size recommendations from drug manufacturers not included in CLSI M100-S21 (M2-A10).7 m hod d CM d n p o du d d u on u d qu n pou d n ou h p n n un n b du od ü A on m n G g nw on C u n u m ph no p h n B gung g öß w d n B nb g n B
mp u p on n p u n p qu qu n d d qu u n pou un m n C n C
омп нии BD Ө ң д ң ж р л БД ө л н ж н п н лыңы Kon o nog p d n BD upu S. pneumoniae and other streptococci e,r,s ≤15 16 – 20 ≥21 25 – 30e n om n CM d µg m d ou h n b CM omp n µg m m m p h d n ub on D p u p odu nd n mm n o d n p on n g g n n n C ph o po n und A on m ng g b n w d n
REFERENCES g Another E. coli (ATCC 35218) has been designated for quality control of discs containing combinations of β-lactams and β-lactamase inhibitors. This d qu p mn do n on d p n u ong u C D u g n n m ob n qu u d n b u on p o u d n b g n do n h ußno ü B u h und B gung D n h dung ob B u h b nU n o n du hg üh w d n
R o p odu b o C m b n om o do upno n C n d n n ob u odu gæng g 1. Bauer, A.W., W.M.M. Kirby, J.C. Sherris, and M. Turck. 1966. Antibiotic susceptibility testing by a standardized single disk method. Am. J. Clin. Fosfomycin z FOS-200 200 µg 22 – 30ii 25 – 33 — strain produces a β-lactamase which should be inactivated by the inhibitor. When used in conjunction with ATCC 25922, both components of the ou h d u u n n om n VR A CM µg m p u n o u m n d m n ub u ou d un d qu
ou h h u u qu nd mp u mb n n d ou R m d qu n p n b n u p n ou b n d un on d nh b on n on d un qu m n omm qu n o u bo n n B g o n w d n wob n h p und n on on o p ub ü h g n nd ü d
h C mæ n ng n nd p n oo d u d m on o g C m g o m o u ou m Pathol. 45:493-496. E. coli and E. faecalis only ≤12 13 – 15 ≥16 combination discs can be monitored. Control limits with this strain for amoxicillin/clavulanic acid are 17-22 mm, for ampicillin is 6 mm (i.e., no zone), n om n d d p g u g o pou n om n d pou n o oqu g o œu µg m d
nu u g u un o po d d qu mn Un o ou d qu do n on d n nd n qu on d n p on o n b ou d m d on do n Un u hung on o u m b u B odu on h M
qu g C du p odu qu h odu ü d V ügb C m odu Ôï ðñï ü á áè ó ï Gatifloxacin 30 – 37 27 – 33 20 – 28mm for ampicillin/sulbactam are 13-19 mm, for piperacillin are 12-18 mm, for piperacillin/tazobactam are 24-30 mm, for ticarcillin is 6 mm (i.e., no zone) n om n p u u pou m o n b d d on d ou h n n m d n om n d
2. Ryan, K.J., F.D. Schoenknecht, and W.M.M. Kirby. 1970. Disc sensitivity testing. Hospital Practice 5:91-100. GAT-5 5 µg un p n n m n n h d on m on d B n d qu o qu qu d qu o m o m d u n qu dm
Ü ç áö ñ ç óÞ á óç CE d m m n őC m g odo o d pon b h m hoC u u n n ub n g o p nd n h omp C u on d un ou h d on ô d qu n b qu N h n ob N h n ob uß ug no und A n ob pp B p und m oph o n
3. Federal Register. 1972. Rules and regulations. Antibiotic susceptibility discs. Fed. Regist. 37:20525-20529. Erratum, 38:2756, 1973. Enterobacteriaceaeddd and Staphylococcus spp.aa ≤14 15 – 17 ≥18 and for ticarcillin/clavulanic acid are 21-25 mm. The E. coli ATCC 35218 control strain contains a plasmid-encoded β-lactamase (non-ESBL); therefore, the U d qu mo n n np m dm d u n qu on u mu n m n C n omm nd p u on nd du d d qu
C m o n p odu o p p odu m ng n om d h C m O do pno p odu u n o mu n C A CC n pou u p ou h A CC p u u omm on ô po d m d V dünnung m hod g w d n h M ü B p und m oph nd d n p on nd d ü d
4. Ericsson, H.M., and J.C. Sherris. 1971. Antibiotic sensitivity testing. Report of an international collaborative study. Acta Pathol. Microbiol. Scand. Sec. P. aeruginosa, Acinetobacter spp. and enterococciz ≤14ii 15 – 17ii ≥18ii organism is resistant to many penicillinase-labile drugs, but susceptible to β-lactam/ β-lactamase inhibitor combinations. The plasmid must be present in d qu don d d p mp on d p g m n ou h don on qu mm n p
n V d pon b d d do p odu o p m C no ó u o on o u p omno C n n h dn do ob n on d u d p nd d ond on pp op d on on d m n nd ou h d on ô d qu C n n qu d n o m on omp m n u p n ou gn on n qu d o n on p d pon b H mm on ndu hm und ü d Qu on o nC M u nd n
B. Suppl. 217:1-90. H. influenzaec and H. parainfluenzaec — — ≥18 33 – 41c — the control strain for the quality control test to be valid; however, the plasmid may be lost during storage at refrigerator or freezer temperatures. See d qu du n m n ou d qu mp u mb n p nd n ou un nu ou n
ob u V d pon b d d d m do C n qu d p odu o odu n nn g ng g om d C m Виж p u m n pou o A CC K pn umon A CC p qu p pon n du p m d od n bo o p u n ug bon d mn ou h MR A pu d n on n d d d CM pou n om n ug no nn b ng h p g g n An b o n w d n o d n ng mp nd h nd önn n nn h b on
N. gonorrhoeaed ≤33 34 – 37 ≥38 45 – 56d “Limitations of the Procedure” and M2 for additional details. n u p b d p om n n d on nu u
и н прод н ли но н н СЕ V p n m uu C p h p odu u u CE g o ü ün 5. World Health Organization Expert Committee on Biological Standardization. 1977. Technical report series 610. W.H.O., Geneva. m on m po no m M du C pou p nd onn n d ond on pp op omm nd d A h u u n p d donn pou p m d omm nd u on d d d p g u g o pou b g nn h h p b g nn n w d n D w d ho Un u hung on o n nn no w nd g w d n
n b u un Po o n u CE n n pn p o od Пров рь н ли и н CE н и прод Po CE S. pneumoniae and other streptococci ≤17ii 18 – 20ii ≥21ii 24 – 31e h Isolates of pneumococci with oxacillin zone sizes of ≥ 20 mm are susceptible (MIC ≤ 0.06 µg/mL) to penicillin and can be considered susceptible on d nh b on o m p d qu m oo g n m d on ô on n on p on o m on on m n nd ou h d on ô d qu
6. Clinical and Laboratory Standards Institute. 2009. Approved standard M2-A10. Performance standards for antimicrobial disk susceptibility tests, 10th ed. ph o oqu o gu n g n o ou ph o oqu un CM d n om n µg m un bo o D mp nd h on udomon ug no d b n nm h bo o wu d n h du h d
o n u n n pn p o od mo p o od C o n om do upn u u u op (non-S. pneumoniae, b-hemolytic only) e to ampicillin, amoxicillin, amoxicillin/clavulanic acid, ampicillin/sulbactam, cefaclor, cefdinir, cefepime, cefetamet, cefixime, cefotaxime, cefprozil, p o du do d n o u p u du u d qu n m n m n p p on ou
CLSI, Wayne, Pa. p du p odu d d ph o o u u u n n om n VR A n p onnu D p o du d d n B h nm hod u g m n nn b n ng n ub on on b u h od n b o d g bn
ceftibuten, ceftriaxone, cefuroxime, cefpodoxime, ceftizoxime, ertapenem, imipenem, loracarbef, and meropenem for approved indications, p o ond u n on mm du m u ou n o d u u
7. Clinical and Laboratory Standards Institute. 2011. M100-S21 (M2). Disk Diffusion Supplemental Tables, CLSI, Wayne Pa. Gemifloxacin GEM-5 5 µg 29 – 36 27 – 33ii 19 – 25mm,ii dd onn qu omm nd p CDC C n o D Con o nd n on do n u o d u on ww  o qu on on d n om n on d n o oqu g o d n on p nd n h omp mp nd h ng g b n w d n nn
INTENDED USE – These discs are used for semi-quantitative in vitro susceptibility testing by the agar disc diffusion test procedure of com- and these agents need not be tested. Penicillin and cefotaxime or ceftriaxone or meropenem MICs should be determined for those isolates with
mon, rapidly growing and certain fastidious bacterial pathogens. These include the Enterobacteriaceae, Staphylococcus spp., Pseudomonas 8. Baker, C.N., C. Thornsberry, and R.W. Hawkinson. 1983. Inoculum standardization in antimicrobial susceptibility testing: evaluation of overnight Enterobacteriaceaell,ddd ≤15 16 – 19 ≥20 d d p mp on pp qu un qu m n u d qu on nu d n d ou h n on on o m m n d d n b u d o d u u np u d u u n m n MR A C omp nn n mn p np n um p n d un o ou d ou u om d o n n u d on d nh b on
oxacillin zone sizes ≤ 19 mm because zones of ≤ 19 mm occur with penicillin-resistant, intermediate, or certain susceptible strains. Isolates should ph o o u pp ph o o u pp önn n w h nd n ng n h p m Ch no on n n w d n D h b önn n n ng
agar cultures and the rapid inoculum standardization system. J. Clin. Microbiol. 17:450-457.
c
H. influenzae and H. parainfluenzae c — — ≥18 30 – 37 — u n u on m hod d CM non u om p m od u on n bou on ou d u on n g o d d p g u g o pou nd qu un n m oo g n m p n n d on n m d do n un m hod d CM omm d
spp., Acinetobacter spp., Enterococcus spp., Vibrio cholerae and, by modified procedures, Haemophilus influenzae, Neisseria gonorrhoeae, not be reported as penicillin resistant or intermediate based solely on an oxacillin zone ≤ 19 mm. Amoxicillin, ampicillin, cefepime, cefotaxime, mp nd h o nn h b on b g nn h h p b g nn n w d n W d ho o mü n gg du hg üh
S. pneumoniaee ≤19 20 – 22 ≥23 28 – 34 CHAN ON No m m n n do p pp qu d m n d h n on Vo ub qu n u on n om n g o œu µg m d n om n C d m nd n h u omp d n ub on pou d on d n do um n M du C Con u u d d p g u g o pou n om n d d n b u D d CM M
Streptococcus pneumoniae and other streptococci. NOTE: Special procedures are required for testing pneumococci, enterococci and methicil- 9. Clinical and Laboratory Standards Institute. 2010. Approved guideline M45-A2. Methods for antimicrobial dilution and disk susceptibility testing of ceftriaxone, cefuroxime, ertapenem, imipenem, and meropenem may be used to treat pneumococcal infections; however, reliable disc diffusion w d n
pou p p on d no u um D n m u du po b u u do n p p p d h n on d VR A ou p u mp n o m on po u n n du CDC On n m ob d ou h d pn umon donn n un d m d on d nh b on pou n om n < mm n o d
lin/oxacillin-resistant staphylococci, for performing β-lactamase tests and for screening and confirmatory tests for ESBLs; see the “RESULTS” infrequently isolated or fastidious bacteria. 2nd ed., CLSI, Wayne, Pa. Gentamicin susceptibility tests with these agents do not yet exist. Their in vitro activity is best determined using an MIC method. Penicillin and cefotaxime or u d n M hod n ü d n N hw on m h n n n ph o o n g hö n d O n und d C o n B h n
p n d bu d ou m n n b o qu m n d p du do um n M du C M D D u on upp m n b om n nd d o An m ob ou h un bo o d n
section. 10. Clinical and Laboratory Standards Institute. 2009. Approved standard M7-A8. Methods for dilution antimicrobial susceptibility tests for bacteria that Testing enterococci GM-120 120 µg 6 7 – 9 hh Ž≥10 — — — ceftriaxone or meropenem should be tested by a reliable MIC method (such as that described in CLSI document M79) and reported routinely with u m A od d du h m A od o n ow u d n n b nd nd o n B u h B b nn nd
CSF isolates of S. pneumoniae. Such isolates should also be tested against vancomycin using the MIC or disc method. With isolates from other M HOD u p b ng b u upp m n pou d u on u d qu No m d p o m n pou d n b n m ob nn  n on du nomb m d u po b h o mph n o h om n n ou do n ou m no n
For zone diameter interpretive criteria adopted in France, refer to the instructions in the French language section of this insert. grow aerobically, 8th ed. CLSI, Wayne, Pa. for high level resistance n,o,gg V g ng nh g b d Vo h nd n n on R n g g nüb nd n ub n n u h n n H nw u R n g g nM h n
sites, the oxacillin disc screening test may be used. If the oxacillin zone size is ≤ 19 mm, penicillin and cefotaxime or ceftriaxone MICs should be M ou n D qu n D pou n b og mm omm nd qu u qu uo on no m omp p u ob nu up du C n nd bo o nd d n u W V Ro d u W n A mp n p u n u pou n o oqu n n om n VR omm nd d on u un p d
11. Clinical and Laboratory Standards Institute. 2007. Approved standard M11-A7. Methods for antimicrobial susceptibility testing of anaerobic bacteria, Enterobacteriaceae, GM-10 10 µg 19 – 26 19 – 27 16 – 21 O n A d ng nd m n h m h n n n mm on u u MR A w b p w d ng n mm d b n n
SUMMARY AND EXPLANATION – Agar diffusion methods employing dried filter paper discs impregnated with specific concentrations of anti- determined. To determine susceptibility of streptococci other than S. pneumoniae to cefdinir, use the 10-unit penicillin disc; isolates with penicil- Un u non omp d n no m M on p qu d n u no nb d p g ou o on m d n u
7th ed. CLSI, Wayne, Pa. P. aeruginosa, Acinetobacter and staphylococci ≤12 13 – 14 ≥15 M u qu m non ou n M u d u u u m oo g n m d on ô d qu G m n h u nd n n on n g und n w d n n h mu n
microbial agents were developed in the 1940s. In order to eliminate or minimize variability in this testing, Bauer et al. developed a standard- lin zone sizes ≥ 2 Ž 8 mm are susceptible to penicillin and can be considered susceptible to cefdinir. pp op CM po no m M
h,i m d bo o n pou d n b og mm p m hod d d u on u d qu n g o on Au un n b n u d d n b o qu N gono ho p g d on ô donn un qu m n d n MR A und m h n n Ko gu n g ph o o n o n n g g n n n C b p n m C ph m
ized procedure in which Mueller Hinton Agar was selected as the test medium.1,2 12. Centers for Disease Control and Prevention. www.cdc.gov/ncidod/dhqp/ar_visavrsa_labFAQ.html Imipenem IPM-10 10 µg 26 – 32 — 20 – 28  n m d omp nd o don CM d g n n m ob n pp o h n n g n n u n d n ng
i A streptococcal isolate that is susceptible to penicillin can be considered susceptible to ampicillin, amoxicillin, amoxicillin/clavulanic acid, ampicillin/sul- p o du nd d p un nd d d u b d M nd n ou n m d B C M % d on ô d qu und Komb n on n u m m H mm p o o o od g n h b h w d n un bh ng g on d n m
Various regulatory agencies and standards-writing organizations subsequently published standardized reference procedures based on the 13. Bushby, S.R.M. 1973. Trimethoprim-sulfamethoxazole: in vitro microbiological aspects, p. 10-30. In M. Finland and E.H. Kass (ed.), Trimethoprim-sulfa- Enterobacteriaceae, P. aeruginosa, u pou qu u d pon p u n pu b qu pou o n b n m d ugg un
bactam, cefaclor, cefazolin, cefdinir, cefepime, cefprozil, cefotaxime, ceftibuten (group A streptococci only), ceftriaxone, cefuroxime, cefpodoxime, po d o B C H O m d H O % o o M N V d d un p opho om d m On n m ob d ou h d p o oqu h mo qu donn n un d m d on d nh b on d mo n d mm pou d n ub n n h n n n o g bn n D G und d ü d d m n on do um n n n on n du h
Bauer-Kirby method. Among the earliest and most widely accepted of these standardized procedures were those published by the U.S. Food methoxazole: microbiological, pharmacological, and clinical considerations. University of Chicago Press, Chicago. Acinetobacter and staphylococci j ≤13 14 – 15 ≥16 po b d pp on n qu u n ud n om qu où n b o qu on ph o og qu m n on n p mp
ceftizoxime, cephalothin, cephapirin, cephradine, imipenem, loracarbef, and meropenem for approved indications, and need not be tested against d p d u o pond n b o p on nm do omp n mp n pm o m on ou p n n n o d ou h un bo o d n m h n n ph o o n nu h h u m An b o ng p o h n h b n und b h n h üb ug nd D n
and Drug Administration (FDA)3 and the World Health Organization (WHO).4,5 The procedure was adopted as a consensus standard by the Haemophilus spp. c — — ≥16 21 – 29c — those agents. Viridans streptococci isolated from blood and normally sterile body sites (e.g., cerebrospinal fluid, blood, bone, etc.), should be tested for qu no on m n d n u n ou o qu d do d n b o qu p u qu no m p u n dm n p
Zone Diameter Interpretive Chart † n u on omp on ô p u u
mn n m d omp nd u un on mpon qu d mp h qu d u hn qu m n u non bbb  d o on du on nu d d qu d o n u d n m u ond on u u A CC un d m d on u Do um n on d n h nW m on m nb m n g g n MR h n ü o n mp nd h u u und
Clinical and Laboratory Standards Institute (CLSI, formerly NCCLS) and is periodically updated.6,7 The latest CLSI documents should be con- Kanamycin K-30 30 µg 17 – 25 19 – 26 — penicillin or ampicillin susceptibility using an MIC method. p on d no u um u u d on ô u u d h n on n p b d mm Ko gu n g ph o o n mü n d g bn ü p n und o b h C ph m Komb n on n u m
sulted for current recommendations. Zone Diameter Control Zone Enterobacteriaceae and staphylococci ≤13 14 – 17 ≥18 on ô u n d d od n m u d n p on n p u d n d n b o qu n un m g d ph m o o
j Penicillin-susceptible staphylococci are also susceptible to other penicillins, β-lactam/β-lactamase inhibitor combinations, cephems, and carbapenems un o o on d G m U un qu m n d u u pu  ou mp n pm o m on p n n p o oqu h mo qu un qu m n omp nn n m H mm und C b p n m g n p h nd d g bn d un V w ndung d Rou n n p on n
o
PRINCIPLES OF THE PROCEDURE – Discs containing a wide variety of antimicrobial agents are applied to the surface of Mueller Hinton Agar Interpretive Standards (mm) Diameter Limits (mm) Levofloxacin LVX–5 5 µg 29 – 37 25 – 30 19 – 26 approved for use by the FDA for staphylococcal infections. Penicillin-resistant, oxacillin-susceptible strains are resistant to penicillinase-labile penicillins ou h d p o oqu p og n qu om d g nd o on n g n d g oup A p og n C ou G ou h wu d n b h w d n ü o n n u u und Ko gu n g ph o o n MR h n n mög h w
b onn d o nq o on mb b n un n m n u d o ou n d n m b D po qu p odu on d n b og mm umu d n d n n od d m d n u
plates (or Haemophilus Test Medium Agar for H. influenzae, GC II Agar with IsoVitaleX™ Enrichment for N. gonorrhoeae or Mueller Hinton E. S. P. H. H. N. S. Enterobacteriaceaeddd, P. aeruginosa, but susceptible to other penicillinase-stable penicillins, β-lactam/β-lactamase inhibitor combinations, relevant cephems, and carbapenems. Oxacillin-resis- n g n d g oup B g ou pm o m on p o oqu V d n omp nn n ou h nd m An b o w B n n Komb n on n u m m H mm C ph m und C b p n m n o
d bou on d qu omm du bou on d p o ou d Mu H n on pou m oo g n m g n p onn ng g d n p n on d n on om d ph m o og d h p u qu D n p up d pou n g
Agar with 5% Sheep Blood for S. pneumoniae, β-hemolytic and viridans group streptococci) that have been inoculated with pure cultures of coli aureus aeruginosa influenzae influenzae gonorrhoeae pneumoniae Acinetobacter, staphylococci aa and enterococci ≤13 14 – 16 ≥17 tant staphylococci are resistant to all currently available β-lactam antibiotics. Thus, susceptibility or resistance to a wide array of β-lactam antibiotics may h mo qu om d p o on n g n du g oup A C ou G ng no u n nn m n pp m n qu u n n h nd d ng n h w m D g bn ü d A n m o n d nn m n poo o od
clinical isolates. Following incubation, the plates are examined and the zones of inhibition surrounding the discs are measured and compared be deduced from testing only penicillin and oxacillin. Routine testing of other penicillins, β-lactam/β-lactamase inhibitor combinations, cephems, and n ub u u n bou on C p nd n h n u qu ob n un u b d qu n un d u n b n m d n d n p omb n d n un m m donn qu g n h b h w d n D U h h ü g d n d d m n do um n MR n on n h h u m
Antimicrobial Disc Resis- Inter- Suscep- ATCC ATCC ATCC ATCC ATCC ATCC ATCC Haemophilus spp. c — — ≥17 32 – 40c — nd d d u b d M nd n on U Cm g m n po b d p p d m n m o ngu u n m du on u mu n bo
with established zone size ranges for individual antimicrobial agents in order to determine the agent(s) most suitable for use in antimicrobial carbapenems is not advised.7 For oxacillin-resistant staphylococci, report as resistant or do not report. C no m d d m d on m du on ô d qu pp qu n u m n u pou p d H moph u u n h p np h nb w d b h no h n üb ug nd n n h n D n o g n d d n h W m d ub n n
Agent Code Potency tant mediate a tible b 25922 25923 27853 49247 c 49766 c 49226 d 49619 e S. pneumoniae and other streptococci ≤13 14 – 16 ≥17 20 – 25e ddd  ou h d mon n b u uo oqu no on n d n d qu p u n o un h h p u qu
therapy. un u p n on b d bou on ou d um ph o og qu d o on p u un g o n bo d m u pou d d n on d H moph u M H n ub on ou % d CO h H n u n A CC omm nd b g n wü d n n Rou n ung on U n o n on p oph u w d n h mp oh n d n on n u Kon n on n
(non-S. pneumoniae, b-hemolytic only) e k Rare, β-lactamase-negative, ampicillin-resistant (BLNAR) strains of Haemophilus influenzae should be considered resistant to amoxicillin/clavulanic acid, ou un pon d h p n p ou oqu no on pou un mon o n n o n n n u d
REAGENTS – Sensi-Disc™ brand discs are 6-mm discs prepared by impregnating high quality absorbent paper with accurately determined Amdinocillin f AMD-10 10 µg 23 – 29 — — p un nu d n ub on u un m u non omm un g o u ng ou un g o u ho o pou omm ou h d on ô d qu omp m n pou p op d u d o n du M H m d on do g n d on d n h ömm h w u B h nd ung u un omp H nw g n on n w nd n An b o B
ampicillin/sulbactam, cefaclor, cefetamet, cefonicid, cefprozil, cefuroxime, and loracarbef despite apparent in vitro susceptibility of some BLNAR strains mon do n g m n pou n d n d qu ou o qu on n b u uo oqu no on
amounts of antibiotic or other chemotherapeutic agents. Discs are clearly marked on both sides with letters and numbers designating the Enterobacteriaceae ≤15 — ≥16 Linezolid LZD-30 30 µg — — 25 – 32ii H n u n N gono ho m hod d p p on d un u p n on d d o on p b on d omm g on n mon n u un o n m n b œ nu Un o n p u b d o on m nu u n N o u n on m hop m u m ho o od n uo h no on m U n w d n
to these agents. n d n d qu u ommun qu u m d n qu o n p u p d qu p un m n uo oqu no on
Staphylococcus spp. — — ≥21 pou p d ph o o u pn umon u p o oqu p d H moph u nd n nu d on p u pp n n do p p n omp o d m u o d d H moph u d
agent and the drug content. (See chart giving concentrations of reactive ingredients.) The drug content of discs is assayed by the methods Amikacin AN-30 30 µg 19 – 26 20 – 26 18 – 26 l Class representative for ampicillin and amoxicillin. omm nd d on u un p d m d n u ü n o m on n u Vo u g on m A m R n n ph o o u pp b m n on C o n µg h C M
Enterococcus spp. ≤20 21 – 22 ≥23 N gono ho o on mo n d u n qu u g o H M n u o A CC omm ou h d on ô m p b pou
established by the FDA or by methods similar or comparable to those published in the United States Federal Register. Enterobacteriaceae, P. aeruginosa, m For V. cholerae, the results of disc diffusion tests for ampicillin, tetracycline, trimethoprim/sulfamethoxazole and sulfonamides (i.e., percentage of sus- d D u n pou ob n un u b d qu n un nd d d u b d M nd Comm d u n o A CC on mm pou o on mo n d u n qu o qu n ub d n mb n Au un n b n u d d n b o qu u u p g d on ô donn un qu m n d n d
Sensi-Disc agents are furnished in cartridges containing 50 discs each. The last disc in each cartridge is marked “X” and contains the drug as Acinetobacter and staphylococci ≤14 15 – 16 ≥17 S. pneumoniae and other streptococci e — — ≥21 25 – 34e,ii ü n o m on n u ung on ph o o u pp u ndu b C nd m n R n h u hM
ceptible, intermediate, and resistant) correlate well with results determined by broth microdilution. Tetracycline results can be used to predict the likely u du bou on ou du um ph o og qu On p u g m n nd d no u um p pho om on ô d qu
coded. Cartridges are for use in BBL™ Sensi-Disc™ Dispensers; these include a Single Disc Dispenser, an 8-Place Dispenser for 100 mm-style Lomefloxacin LOM-10 10 µg 27 – 33 23 – 29 22 – 28 d C no m d d m d on m du on ô d qu pp qu n u m n u u n un g o GC dd onn d %
Amoxicillin/ susceptibility of isolates to doxycycline; do not use disc test for doxycycline or erythromycin because there is poor correlation with MIC results. pou op on m oo g n m o n pd po b u omp no u on R R NC Vo ub qu R n du ng n o o u pp Au g und d B dung on n n b nd nd n o n n B m n d g A n od d B dung on m
Petri dishes, 6- and 8-Place Self-Tamping Dispensers for 100 mm-style dishes and a Self-Tamping 12-Place Dispenser for 150 mm-style plates. Enterobacteriaceaeddd, P. aeruginosa, d un upp m n d o n d mn p g o BB GC n h d oV X n ub on ou % d CO h
Clavulanic Acid g,h,i AmC-30 20/10 µg 18 – 24g,ii 28 – 36 — n Ampicillin is the class representative for ampicillin and amoxicillin. Ampicillin results may be used to predict susceptibility to amoxicillin/clavulanic m m d n m n m n omp m d p p on o um qu d no u um önn n n o o n n g g n n n und Amp n n M d mB h n D u on önn n o m bw h nd n
Warnings and Precautions: For in vitro Diagnostic Use. Acinetobacter and staphylococci ≤18 19 – 21 ≥22 C no m d d m d on m du on ô d qu pp qu n u m n u u n un g o Mu H n on n h n n b nd nd n o n n g n u b m p odu nd mm nu un u g n hg w nw d n D n
Enterobacteriaceae ≤13 14 – 17 ≥18 acid, ampicillin/sulbactam, piperacillin and piperacillin/tazobactam among non-β-lactamase-producing enterococci. Enterococci susceptible to
 BBL Sensi-Disc Antimicrobial Susceptibility Test Discs
u u n bou on n ub p nd n nu n do n p u omm ou d no u um d %d ng d mou on d b n n ub on ou % d CO h no m d n p on pp qu n pn umon
Follow directions for use; disc performance depends not only on disc potency, but on use of proper inoculum and control cultures, functional j
Staphylococcus spp. ≤19 — ≥20 Haemophilus spp. c — — ≥22 33 – 41c — penicillin are predictably susceptible to ampicillin, amoxicillin, ampicillin/sulbactam, amoxicillin/clavulanic acid, piperacillin, and piperacillin/ mm w d n m b nm n md n m n hg w n B m C n N o n b h n od m
n m n m n u u p o oqu omm nd qu u p u n n p on pp qu d m oo g n m u
pretested plates, proper storage temperature and other factors. Haemophilus spp. c,k ≤19 — ≥20 15 –23c N. gonorrhoeae d ≤26 27 – 37 ≥38 45 – 54d tazobactam for non-β-lactamase-producing enterococci. However, enterococci susceptible to ampicillin cannot be assumed to be susceptible to h omog n n C ph o po n b h n
(Testb ättchen zur ant m krob e en Empf nd chke tsprüfung)
— qu u qu on m n onn d n p on pou p o oqu u qu pn umon on p opo u b d
penicillin. If penicillin results are needed, testing of penicillin is required. Because ampicillin or penicillin resistance among enterococci due to β- D n m n qu u n p p on mp un ou on d n no u um o m n d u
Observe aseptic techniques and established precautions against microbiological hazards throughout all procedures. Sterilize cultures, contain- Ampicillin h,l AM-10 10 µg 16 – 22 27 – 35 — Loracarbef h,i LOR-30 30 µg 23 – 29 23 – 31 — d bu on d popu on d d p ph m o n qu d g n n m ob n ud d pub p n
ü n o o u pp önn n C ph o po n Am nog o d uß ü ho hg d g R n R h n C nd m n und m hop m
lactamase production is not reliably detected using routine disc or dilution methods, a direct, nitrocefin-based β-lactamase test is recommended ou n p u u o n p n m m n on p o n n du h u du ub pou n d u m ho o n o h n n nd b n hn h w m und o o nn h mp nd h do um n w d n
ers and other contaminated materials after use. Enterobacteriaceaeii and V. cholerae m ≤13 14 – 16 ≥17 Enterobacteriaceae u,kk and staphylococci j ≤14 15 – 17 ≥18 n qu d n m mb du ou om du C D donn n qu m qu m n p n n p d pon b pou d
for blood and cerebrospinal fluid isolates. A positive β-lactamase test predicts resistance to penicillin, as well as amino-, carboxy- and ureido-peni- bou on Deu h
Storage Instructions: Staphylococci j,ii ≤28 — ≥29 Haemophilus spp. c,k ≤15 16 – 18 ≥19 — 26 – 32c nomb u ompo du g oup n d p du m nqu d d n p on b d d u on u d qu pou pn umon H moph u pp Nu d g bn m Amp n n m C ph o po n d d nG n on Ch o mph n o und M op n m
cillins. Certain penicillin- or ampicillin-resistant enterococci may possess high-level resistance (i.e., penicillin MICs ≥ 128 µg/mL or ampicillin b no u o o ou u d un g o Mu H n on ou d un u g o d qu n bo d n V RW NDUNG W CK D B h n nd u h bqu n n n o mp nd h p ü ung on h u g o omm nd n hn
1. On receipt, store discs at -20 – +8°C. If the laboratory refrigerator is frequently opened and closed, and a suitable temperature is not main- Enterococcus spp. n,o,ii ≤16 — ≥17 Meropenem h,i MEM-10 10 µg 28 – 34 29 – 37ii 27 – 33 n mn pn umon A CC ou h nu pou on ô d qu d ou d d u on u d qu o n ou n m ß g ü o on H n u n u b o pn ü g poo o w d n
MICs ≥ 64 µg/mL). The disc test will not differentiate those with normal resistance from this high-level resistance. For enterococci recovered from ou n n h qu o bo d d on u un n m n m n un o m w h nd n und b mm n n p u h o n b n g nm H d Ag B h n D u on h n b mm ud n
tained, place there a supply sufficient only for use within a week. Some discs (e.g., β-lactams) should preferably be kept frozen at -20°C. Listeria monocytogenes f ≤19 — ≥20 Enterobacteriaceae, P. aeruginosa, p d poo u Amo nC u n u A h om n C h om n C o C po o b C dn C m C podo m und C u o m A
blood and CSF, the laboratory should consider determining the actual MIC for penicillin or ampicillin since enterococcal strains with normal ou d bo p u ou p nd n mn n d p m n pou qu ou hum d g n g hö n n ob ph o o u pp udomon pp A n ob pp n o o u pp V b o ho und m
2. Allow containers to come to room temperature before opening. Return unused discs to the refrigerator when application of discs has Haemophilus spp. c,k,p ≤18 19 – 21 ≥22 13 – 21c
— Acinetobacter and staphylococci j ≤13 14 – 15 ≥16 D m d on omm nd p b n d n b o qu pp ou p DA non n u d n do um n M du C ow h om n nd o A n m d mp h g g n H moph u pp u h p on A mw g n on n ng w d n
lower level resistance (penicillin MICs ≤ 64 µg/mL and ampicillin MICs ≤ 32 µg/mL) should be considered potentially susceptible to synergy with p n n u o ob n po d d qu mp gn d g n n b o qu bg w nd nV h n H moph u n u n N gono ho p o o u pn umon und nd po o n H NW
been completed. Once opened, discs should be placed in a tightly sealed, desiccated container for storage. Haemophilus spp. c 20 – 28c M A önn n D g bn d mp nd h m d n An b o nd o on g ng m Nu n u h p nd du n n
Streptococci (non-S. pneumoniae, b-hemolytic — — ≥24ii 30 – 36e — — ≥20 — an aminoglycoside (in the absence of high-level aminoglycoside resistance) whereas strains with higher level resistance may be resistant to such onn d qu pp op omm omm nd d n n b u A Bd M M p V h n nd no w nd g um n umo o n n o o n und m h n o n n ph o o n n h uw n Um
3. Use the oldest discs first. D Üb p ü ung d mp nd h on H moph u pp ü d ub n n nn do h b Üb h ud n od p d m o og h n
only) e,i,aaa,ccc Mezlocillin ii MZ-75 75 µg 23 – 29 — 19 – 25 synergy.6 D po d qu un d bu u BB n p n p u on d p h b u d qu d
g Un u ou h d o A CC d gn pou on ô d qu d d qu on n n d o on d mn m ow u h und B gung ü B p um m n B nd d p um m du h u üh n
d nh b u d m C ou h p odu un m qu d n p nh b u o qu u ud n ng b h n
4. Discard expired discs. Also, cartridges from which discs have been frequently removed during a week and discs left out overnight in the Ampicillin/ Enterobacteriaceae and Acinetobacter ≤17 18 – 20 ≥21 o Synergy between ampicillin, penicillin or vancomycin and an aminoglycoside can be predicted for enterococci by using a high-level aminoglycoside o qu u n o n d n d u mo n mm p b d d po d qu d p n n h Ab hn RG BN
laboratory should be discarded, or else the discs should be tested for acceptable performance prior to continued use. on o n m n ou h A CC d u ompo n d d qu m p u n u m d on ô p o o u pp uß pn umon Von d U ood nd D ug Adm n on ug n mp nd h m n n n und
Sulbactam g,h,i SAM-20 10/10 µg 19 – 24g,ii 29 – 37 — P. aeruginosa ≤15 — ≥16 (gentamicin and streptomycin) screening test. Other aminoglycosides need not be tested because their activities against enterococci are not superior to d ph o po n un d n d u mo n mm du bo d d bo d d o qu u n D n n h ng nomm n n n p on n ü d on ndu hm nd n d n n ö h n An ung n d
5. If the discs form incorrect zones with the recommended control organisms, the entire procedure should be checked; faulty zone size may ou h on mm pou o on mo n d u n qu mm pou mp n o p d on mm pou o on nd n m An b o ü d B h nd ung on p og n od g nd ü n h w n h od h und mü n
Enterobacteriaceae, P. aeruginosa, Minocycline ee MI-30 30 µg 19 – 25 25 – 30 — gentamicin and streptomycin. o n d n d u mo n mm d d po d qu un ô d u A p H n u n
mp n ub m mm pou pp n mm pou o on p p n ob m mm pou n o p ung b g u g üh n h ou n m ß g du hg üh w d n d w b V n om n n mm n h b nn nd ü ph m u h nw ung n
be due to the disc, the inoculation, the preparation or depth (about 4 mm) of medium, or other factors. Acinetobacter q and staphylococci j ≤11 12 – 14ii ≥15ii aa p The results of ampicillin susceptibility tests should be used to predict the activity of amoxicillin. The majority of isolates of H. influenzae that are N gono ho pn umon n p u p u d n u d qu p bo d mm qu d qu p bo
Enterobacteriaceae , P. aeruginosa, d on mm pou o on n d u n qu ou h d on ô o A CC on n un m od p d m o og h w od u Üb w hung u h nw nd R n nw d n n p on n u V ügung g
The expiration date applies only to discs in intact containers, stored as directed. Haemophilus spp. c,k 14 –22c resistant to ampicillin and amoxicillin produce a TEM-type-β-lactamase. In most cases, a direct β-lactamase test can provide a rapid means of detecting d mm d qu on d po u g o n u un d bu u u o pp u ppu u d qu U AMM N A UNG UND RK ÄRUNG Ag D u on h n un V w ndung on g o n n p p b h n d
≤19 — ≥20 — Acinetobacteraa, staphylococci and enterococci yy ≤14 15 – 18 ≥19 p un p m d non B p on qu n o g n m n d u nomb u n b o qu b p n n m n b n n m d od n b w mm o u B gung n n R n bo w g g b nw d n
SPECIMENS – Specimens should not ordinarily be employed in this test. See Directions, which include preparation of inoculum. If possible, ampicillin and amoxicillin resistance. un gu ou un p n pou u on u d g o m b mm n Kon n on n on n m ob n ub n n mp gn nd wu d n n d n h n nw Um d
Azithromycin AZM-15 15 µg — 21 – 26 — Moxalactam MOX-30 30 µg 28 – 35 18 – 24 17 – 25 u o on m n nh b u d m p m d do p n d n ou h d on ô pou qu d on ô d ü n o m on n u ung on h mo h n po o n u ndu b C nd m n R n h M
cultures should be derived from specimens obtained from patients prior to the initiation of antimicrobial therapy. q May be reported for Acinetobacter spp. resistant to other agents. D n m n qu u n p bo d ô g o ou n h u d n un n ub u ± C b umnm n od u u h n nw nB u n nd d h n b d m Mu H n on Ag
Staphylococcus spp. r ≤13 14 – 17 ≥18 Enterobacteriaceae, P. aeruginosa, qu o d p md p u p nd n p du p nd n on on u mp u du g u omm du ong u
m d um w nd w d V R AHR N B CHRÄNKUNG N
r Not routinely reported on isolates from the urinary tract. pou p d ph o o u d d mp u up u Cp u n n p p m d
PROCEDURE Haemophilus spp. c — — ≥12 13 – 21c — Acinetobacter and staphylococci j ≤14 15 – 22 ≥23 po u m d m hod u do um n M pou p u mp n o m on D h b h b n g h up h h ü hn w h nd ob g ü npu h o B n uß H n u n
s Susceptibility and resistance to azithromycin, clarithromycin and dirithromycin can be predicted by using erythromycin. d ph o oqu n m n MR pou N gono ho n ub ± C n p d p m An h u d n ö n h nm h Au üh ung b hö d n und O g n on n u gung on No m n nd d
Material Provided: Sensi-Disc™ susceptibility test discs as labeled. S. pneumoniae and other streptococci e,r,s ≤13 14 – 17 ≥18 19 – 25e Moxifloxacin MXF-5 5 µg 28 – 35 28 – 35 —aa h  o d pn umo oqu donn n pou o n d d m d on mm on n b CM µg m p n n
R n h n u d G und g d B u K b M hod u d n üh n und g b u h h n d nd d h n g hö n N gono ho pn umon und nd po o n h M N m n ng d od M An on n o nd m d m
C p d H moph u N gono ho pn umon u p o oqu do n n ub d n
Materials Required But Not Provided: Ancillary culture media, reagents, quality control organisms and laboratory equipment required to t See discussion of ESBLs under “RESULTS.” For screening and confirmatory tests for ESBLs in Klebsiella pneumoniae, K. oxytoca and E. coli, see p u n on d omm n b mp n mo n u o on mo n d u n qu mp n ub m V dünnung h ng w d n An ob mü n m p h ng w d n
Azlocillin AZ-75 75 µg — — 24 – 30 Enterobacteriaceaef,ddd and Staphylococcus spp.aa ≤15 16 – 18 ≥19 un mo ph n h % d CO d on d U ood nd D ug Adm n on DA und d W g undh og n on WHO ö n h n M hod n D
perform disc diffusion susceptibility testing by the standardized procedure. Prepare a 0.5 McFarland turbidity standard by adding 0.5 mL of "RESULTS" section and reference 7. Screening breakpoints (Mueller Hinton agar, standard disc diffusion procedure, 35 ± 2ºC, ambient air, u o u dn u pm u m m u o m u po u bu n on u uo m
P. aeruginosa ≤17 — ≥18 H. influenzaec and H. parainfluenzaec — — ≥18 31 – 39c — mn bo d p h d n ub on h pou N gono ho pn umon u V h n n h B u K b wu d on d m C n nd bo o nd d n u C om NCC g m n m nd d D n ung n n n m d und mp nd h B n un h d h nu du h n n M m w nn h b d
0.048 M BaCl2 [1.175% (wt/vol) BaCl2•2H2O] to 99.5 mL of 0.18 M [0.36N] H2SO4 [1% (vol/vol)]. Verify by using a spectrophotometer with a 16 – 18 h) are: aztreonam (≤ 27 mm), ceftazidime (≤ 22 mm), cefotaxime (≤ 27 mm), cefpodoxime (≤ 17 mm) and ceftriaxone (≤ 25 mm). Quality control podo m u o m p n m mp n m u o b u m op n m p p on n nd qu g n no m n bo h b h g B n g n Ku u n h m n H mm on n m G n b h d on g u g od bo u bo
Aztreonam ATM-30 30 µg 28 – 36 — 23 – 29 S. pneumoniaee ≤14 15 – 17 ≥18 25 – 31e p o oqu Un n ub on d h omp omm nd pou p d ph o o u nd m n n nn und w d g m ß g u ü d u n mp h ung n w d u d üng n C Do um n w n
1-cm light path and matched cuvette; absorbance at 625 nm should be 0.08 – 0.13. recommendations are E. coli ATCC 25922 (as listed in the chart); K. pneumoniae ATCC 700603 (aztreonam 9 – 17 mm), ceftazidime (10 – 18 mm), cefo- n on p b o n d CM d p n n du o m ou d on ou du m op n m do n d mn nd u n önn n A d ng nd o h Ku u n n
Enterobacteriaceae, t P. aeruginosa & Acinetobacter ≤15 16 – 21 ≥22 Nafcillin NF-1 1 µg — 16 – 22 — taxime (17 – 25 mm), cefpodoxime (9 – 16 mm) and ceftriaxone (16 – 24 mm).7 The use of more than one antimicrobial agent for screening improves d n ph o oqu n m n n n o n n om n pou p d n o o u pou o p n n pou o n d d m d on mm p qu d d m d on mm on ob nu d V R AHR N GRUND AG N B h nm h d n n n m ob n ub n n w d n u d Ob h on Mu H n on
Directions, Including User Controls:6 Ag p n od H moph u m d um g um N hw on H n u n GC Ag m oV X An h ung m d um ü um R n n hw on n umo o n und n o o n mü n d om C mp oh n n M hod n b og w d n
Haemophilus spp. c — — ≥26 30 – 38c — Staphylococcus aureus j,nn ≤10 11 – 12 ≥13 the sensitivity of detection. Phenotypic confirmatory testing requires the use of both cefotaxime and ceftazidime, alone and in combination with clavu- nd m n d n n o oqu n n om n d m d on d nh b on o on ou h n p n n d ou h n m d ou n ou h n b o n do n p on d omm
1. Preparation of inoculum with test and control cultures. m u u b d un n p on u m u on ond um m pu p o h ou p u N gono ho od Mu H n on Ag m % h bu ü pn umon h mo h po o n und po o nd Un Um nd n w d n d g nd d nd b u g üh n n m ob n ub n n w nd D g bn d
Bacitracin f B-10 10 U ≤ 8 9 – 12 ≥13 — 12 – 22 — Nalidixic Acid NA-30 30 µg 22 – 28 — — lanic acid. A ≥ 5 mm zone diameter for either antimicrobial agent tested in combination with clavulanic acid versus its zone when tested alone = ESBL. n p n n ou n m d un qu m n u b d un on mm pou o n mo n mp n pm
a. Perform a Gram stain. Use only pure cultures. Quality Control recommendations are: negative strain E. coli ATCC 25922 which produces a ≤ 2 mm increase in zone diameter for antimicrobial agent d n o m on u m u d on d nh b on po n on ob un qu m n o n d o m on uo m p n m mp n m m op n m p u n u pou n on V d n G upp g b h d m R n u u n n h o b mp wu d n N h d n ub on w d n d n un u h d mp nd h p ü ung o h ub n n mü n u d G und g d Anw nh od d h n n d n n H mm on
Carbenicillin CB-100 100 µg 23 – 29 — 18 – 24 Enterobacteriaceae z ≤13 14 – 18 ≥19 H mm on n um d B h ng m n und d nn m g g n H mm on ng öß n ü n n n m ob ub n n g h n
b. Select three to five similar colonies and transfer with inoculation needle or loop into 4 – 5 mL of a suitable broth such as Trypticase™ Soy tested alone versus its zone diameter when tested in combination with clavulanic acid; positive strain K. pneumoniae ATCC 700603 which produces a o on o no u um n p d n do p on u u ou d d qu on n n pn umo oqu m d d n b b p m hod d d u on u d qu n g o n n p n o pou g n u n p w d n Auß d m mü n d g bn o ng qu ng h nw d n b n H mm on n n p on
Enterobacteriaceae and Acinetobacter ≤19ii 20 – 22ii ≥23 Neomycin f N-30 30 µg ≤12 13 – 16 ≥17 17 – 23 18 – 26 — d n g n n m ob n n do n p u d n d omp on d d g n Con u um d ub n n u b mm n d ü n An b o h p mb n g gn nd b wu d A H mm on ndu hm mü n h h g h nw d n
Broth (or Mueller Hinton Broth for fastidious organisms). ≥ 3 mm increase in cefotaxime zone diameter and a ≥ 5 mm increase in ceftazidime zone diameter. See "Limitations of the Procedure." See reference 7 n o m u d mn u mo n d un m hod CM p n n o m ou on ou m op n m do n
P. aeruginosa ≤13 14 – 16 ≥17 Netilmicin NET-30 30 µg 22 – 30 22 – 31 17 – 23 b ud n p on du d m d on pou ob n u ndu pou ob ou n m u R AG N N n D b h n nd mm g oß B h n d h g w d n nd m qu ho hw g ug h g
c. Incubate the broth cultures at 35°C for 2 – 6 h, if necessary, to develop a turbidity equivalent to the 0.5 McFarland turbidity standard for details of the procedure. p un m hod CM b qu d d n do um n M du C ppo n ou n pou d o ngu n B B gung nd nu gü g w nn d B h n C o m C o mC u n u C dm C dm C u n u
(approximately 1 to 2 x 108 CFU/mL). Alternatively, make a direct broth or saline suspension of colonies selected from an agar plate incu- Cefaclor h,i CEC-30 30 µg 23 – 27 27 – 31 — Enterobacteriaceae, P. aeruginosa, d on p u mp g u on du b d n p on d on n D BB d CR d pn umon D o do n u n om n u mo n d un m hod CM ou d d u on u p m g n ub m n n M ng n on An b o od nd n h mo h p u hw m n ub n n mp gn w d D g h g ng w d n n n n n d B h n w d om C n h mp oh n
u Cephalothin can be used to predict activity of cephalothin, cephapirin, cephradine, cephalexin, cefaclor and cefadroxil. Cefazolin, cefuroxime, cefpo-
bated overnight (a nonselective medium such as blood agar, or chocolate agar for H. influenzae and N. gonorrhoeae, should be used). Enterobacteriaceae u and staphylococci j ≤14 15 – 17 ≥18 Acinetobacter and staphylococci ≤12 13 – 14 ≥15 doxime, cefprozil, and loracarbef (urinary isolates only) may be tested individually because some isolates may be susceptible to these agents when D d on ô u n u u p do n n u h qu ou où un n b og mm ou d qu A d o po n n d u d d p g u d qu o n p u u CM d p n n du B h nb n u b d n n nd u g nnb Bu h b n und n u d n ung d An b o um und u Ang b G n u g bn nd n un on d o n g ung und d h ung on O g n m n u Qu on o D g
The direct colony suspension method is preferred for Staphylococcus spp., S. pneumoniae and other streptococci, Haemophilus spp. and Haemophilus spp. c,k ≤16 17 – 19 ≥20 — 25 – 31c un o p m n p om n on n on o m m n no m C p qu d on o m ou d on do n d mn o qu d m d on mm pou o n ou d mn n b d w nd nW o m ng Vg d b m d n Kon n on n d nB nd D nd nB h n nh n
Nitrofurantoin F/M-300 300 µg 20 – 25 18 – 22 — resistant to cephalothin. n b ond ü o A CC und K pn umon A CC d pon n V u d md w h ü d m
N. gonorrhoeae.6 Cefamandole MA-30 30 µg 26 – 32 26 – 34 — pou o A CC u u A CC ug no A CC H n u n A CC H n u n A CC d p o oqu u qu pn umon u dn u d qu un d p n n o donn n d d m d on A n m m ng w d m on d DA g g n M hod n od m M hod n d d n n m U Bund g Un d d od do um n wu d B üg h d mp h ung n u o n g ung und d h ung on O g n m n ü d
Enterobacteriaceae, staphylococci and v Not applicable for testing Morganella spp.
N gono ho A CC pn umon A CC o A CC ou h p odu d m mm on n b p n n p u n on d omm n b u dn R g hn h nd od g h n b mm Qu on o h C nd d M
d. Dilute, if required, to obtain turbidity equivalent to the 0.5 McFarland turbidity standard. For diluent, use sterile broth or saline. Enterobacteriaceae and staphylococci j ≤14 15 – 17 ≥18 enterococci ≤14 15 – 16 ≥17 w For N. gonorrhoeae, an intermediate result for an antimicrobial agent indicates either a technical problem that should be resolved by repeat testing or
Alternatively, standardize the inoculum photometrically; to facilitate inoculum adjustment of rapidly growing organisms, the Prompt™ A CC pou d d on ô d qu d d qu d g n m n µg p om n Un o d p o oqu qu n b p n n p u on d omm n n b mp n mo n mo n D n D W o w d n nK u h n u w B h ng D B h n n d K u h m n m X n h b nn ob n om n n mm on ph o o u u u VR A m d m odu d w d n
Cefazolin CZ-30 30 µg 21 – 27ii 29 – 35 — Norfloxacin ii NOR-10 10 µg 28 – 35 17 – 28 22 – 29 a lack of clinical experience in treating organisms with these zones. The latter seems to be the case for cefmetazole, cefotetan, cefoxitin, and spectino- µg K b pn umon A CC pou d d p g d on m on d B on donn g nn hn und n h d du h d n Cod u g w n An b o um D K u h n w d n n
Inoculation System (volumetric inoculum preparation device) may be used.8 Enterobacteriaceae u and staphylococci j ≤14 15 – 17 ≥18 ddd mycin. Strains with intermediate zones with the other agents have a documented lower clinical cure rate (85 - 95%) compared to >95% for susceptible d u n qu mp n ub m u o u dn u pm u po u o m u bu n p o oqu önn n B mp nd h on o n on u u n b ond m h n n n mm n on u u MR A nd
Enterobacteriaceae , P. aeruginosa, d n b u ou no nb d p g o qu u on ob mo gn n d un p o m n BB n D D p n n w nd nd d n B h nD p n n B h nD p n ü h n on mm und
Overnight broth cultures should not be used as inoculum. strains. du g oup A u m n on u uo m podo m u o m o n p n dn u h m hod n g m ß d n mp h ung n d C n o D Con o nd n on CDC d U m n h n
Cefdinir h CDR-5 5 µg 24 – 28 25 – 32 — Acinetobacter, staphylococci and enterococci ≤12 13 – 16 ≥17 n d n mb d p o du n ou ou h A CC ou omm nd pou mp n m u o b u m op n m p p on n nd qu n p b ond d g n b w B h nD p n m u om h And u o h ung ü h n on mm und n
2. Inoculation. u h n hu b hö d n u n ud n g hö n n h u om MHK M hod n B Bou on M o dünnung od
Enterobacteriaceaekk and Novobiocin f NB-30 30 µg ≤17 18 – 21 ≥ 22 — 22 – 31 — x Cefotaxime, ceftizoxime or ceftriaxone should be tested and reported on isolates from CSF in place of cephalothin and cefazolin. d mn o n u d g o Mu H n on on d n u u mm n b n h mn h mdn o B h nD p n m u om h And u o h ung ü h n on mm
p o oqu d n omp u o p du ng d n om qu no m m n p qu d ph o h d n ng Ag V dünnung und n V n om n Ag H nH n u on Ag m µg m V n om n ü d n o h
a. Within 15 min, dip a sterile cotton swab into the properly adjusted inoculum and rotate it firmly several times against the upper inside methicillin-susceptible staphylococci j ≤16 17 – 19 ≥20 y Because certain strains of Providencia spp. have been reported to give false-susceptible results with cefprozil discs, strains of this genus should not be no nb d p g ou h H n u n A CC omm nd omm on ô d qu upp m n W nung n und Vo h m ßn hm n n o D gno um
(Mueller Hinton agar with sheep blood o do n u mo n d un m hod CM qu n u n b p n n ou mp n n ub on p od od h um VR A u d n W n o m on n h n üb d W b on CDC
wall of the tube to express excess fluid. Haemophilus spp. c — — ≥20 — 24 – 31c tested and reported with this disc. pou p op d u d o n d g o pou d d n on d H moph u
for veterinary use) ≤14 15 – 16 ≥17  ph o oqu n b p n n on u n b d u p n n o on m n nh b u d m D G b u h n ung b o g n D ung h g d B h n h ng n h nu on d ub n on n on u d n B h n M G n hm gung w üb nomm n u und ng p n p h nd C Do um n M M D D u on upp m n b
b. Streak the entire agar surface of a Mueller Hinton Agar (or other appropriate agar) plate three times, turning the plate 60° between z Indicated for urine isolates only. In addition to testing urine isolates, nalidixic acid may be used to test for reduced fluoroquinolone susceptibility in R U A R MARQU d n p on omm nd on b u h m po o og qu o
Cefepime h,i FEP-30 30 µg 31 –37ii 23 – 29 24 – 30 Ofloxacin OFX-5 5 µg 29 – 33 24 – 28 17 – 21 ph m b p n m don mp o pp ou p DA pou n on ph o oqu ou h n ond n u h on d V w ndung n g gn n no u um und g gn Kon o u u n un on h g og n om n nd d o An m ob u p b ng D o nd g No m nw h h om C n nd bo o nd d
streakings to obtain even inoculation. isolates from patients with extraintestinal Salmonella infections. See footnote ddd. d dm n on h b u u Un o h m ßg g ung mp u und nd n o n b
Enterobacteriaceae, P. aeruginosa, Enterobacteriaceaeddd, P. aeruginosa, p n n n b o n on n u p n n n b u p n n m n b u u p n n n n u W V Ro d u W n A U A N h m Do um n M u g üh W w d n n nd n
c. The lid may be left ajar for 3 – 5 min, but no more than 15 min, to allow for any surface moisture to be absorbed before applying the aa FDA-approved zone diameters for interpretive and/or quality control criteria that differ from CLSI recommendations. Ap d C b d p g d n p on d d m d on pou N m n ng d Bu ho d
Acinetobacter and staphylococci j ≤14 15 – 17 ≥18 aa
Acinetobacter and staphylococci ≤12 13 – 15 ≥16 u p n n u o on m n nh b u d m u ph m pp op u b p n m ph o oqu D Umg ng m m ob o og h m M o b nV h n un nh ung p h Ab w und d g m n üb h n ußno n u h M ü n p h nd MHK Ko
drug-impregnated discs. bb For V. cholerae, use with caution as the disc diffusion test may misclassify many organisms (higher minor error rate). p no ophomon m oph ou p nd onn n d p g on u do um n M du n o n on n ou n b o qu d m d mn u m n d pon b An n b
Haemophilus spp. c — — ≥26 25 –31c — Haemophilus spp. c — — ≥16 31 – 40c — Vo h m ßn hm n o g n N h G b u h Ku u n B h und nd on m n M n n D K go n m d b nh o m MHK on n m ob n ub n n D MHK W ü d o n h n hd n
3. Select appropriate discs (such as recommended in reference 7, Tables 1A and 1B of M100 [M2]). C ou p u n upp m n M d pon b n ou on p u on u d M du C M hod o ou n un g g mm d n b o qu d m d mn p u d d u d p n n
N. gonorrhoeae d — — ≥31 37 – 46d,ii N. gonorrhoeae d ≤24 25 – 30w Ž≥31 43 – 51d cc No criteria have been established to support testing of this drug with Streptococcus pneumoniae. The control range is listed for quality control pur- Au b w h ung no m w hb n B u und G w b p g n und d R n nd mög h w g ng b mp nd h n o n
4. Apply the discs by means of a BBL™ dispenser, using aseptic precautions. Deposit discs so that the centers are at least 24 mm apart. It is poses only. An m ob D u on nd D u p b ng o n qu n o do d ou B pou ob n d o n D d ou n d u p n n d o on d m n nh b u d m d ph m d D K go n m d b d u n h Anw ndb n Kö p n nd n nd A n m ph o og h on n nd
Viridans Streptococci (non-S. pneumoniae) e,ccc ≤ 21ii 22 – 23ii ≥24ii 28 – 35e S. pneumoniae e and other streptococci B h nn h h b + C ub w h n W dd bo üh h n h u g g ö n und g h o n und d h g
preferable to deposit penicillin and cephalosporin discs so that they are no less than 10 mm from the edge of the Petri dish, and their cen- n o m on u d un d o g n m don C mp ob Co n b um pp B u pp b p n m on d on ou ph o oqu n o n ppo omm n ou n p ppo B Ch no on und m m U n od w nn n höh no m g nd Do d A n m w nd w d n nn B
Streptococci (non-S. pneumoniae, β-hemolytic — — ≥24ii (non-S. pneumoniae, b-hemolytic only) e ≤ 12 13 – 15 ≥16 16 – 21e dd Colistin and polymyxin B diffuse poorly in agar and the accuracy of the diffusion method is thus less than with other antibiotics. Resistance is always
ou o g n m non m n onn d n b u o n ou d n n ud on n u n pou mp u nn n h u h h n w d n nu d ü n Wo h u h nd M ng B h n nd m Küh h n g n
ters are at least 30 mm apart. Avoid placing such discs adjacent to one another. With H. influenzae, N. gonorrhoeae and S. pneumoniae, use significant, but when treatment of systemic infections due to susceptible strains is considered, it is wise to confirm the results of a diffusion test with a  ou h d H moph u n u n m n g n mp n B NAR d n on d omm m D K go n m d b nh uh n u on d h nd n o d n un on o hn h o n
only)aaa,ccc Oxacillin OX-1 1 µg — 18 – 24 — mom n n p m n p d b d no m d n p odu b pou n p on d u ng B h n B o h d m nh n nd o ug w b C g üh u ub w h n
no more than nine discs per 150 mm plate or four discs per 100 mm plate. If discs have been placed on the agar with other than the Self- dilution method. n u o on mo n d u n qu mp n ub m u o u m u on d u po u g öß D p n nb d n p on u h n b ond b A n m nm n m n n ph m o o h n h h b h
Cefixime h CFM-5 5 µg 23 – 27 — — Staphylococcus aureus j,nn,oo ≤10 11 – 12 ≥13 n un m hod d d u on ng n m hod d m u pp op qu p u n B h o d m Ö n n u R um mp u w m n n N hd mD p n n d unb nu nB h nw d m Küh h n
Tamping Dispensers, press them down with a sterile needle or forceps to make contact with the surface. uo m u o b m g pp n n b n od n ou h B NAR n g n b R h n n b üg h d ung on umu n An b og mm n o n n u mm n b m d ü n on n h n u nd g n
ee Organisms that are susceptible to tetracycline are also considered susceptible to doxycycline and minocycline. However, some organisms that are inter- ub w h n B h nn hd mÖ n n n n m g n o n nB h ub w h n
5. Within 15 min, place the plates agar side up in a 35 ± 2°C incubator (for Staphylococcus spp., testing at temperatures above 35°C may not Enterobacteriaceae v ≤15 16 –18 ≥19 Staphylococci, coagulase-negative j,nn ≤17 — ≥18 d n o m oo g n m un bo o d n
mediate or resistant to tetracycline may be susceptible to doxycycline or minocycline or both. C p n pou mp n mo n B hö d d m u h nb mp ung p on und d m h m und h p u hu b w d n nd nm n n o d
c
Haemophilus spp. — — ≥21 25 – 33c — D n n C m n œu d nou p g d d m d on pou d d n p on D nB h n u w nd n
detect methicillin-resistant staphylococci (MRS); for N. gonorrhoeae, incubate at 36 ± 1°C [do not exceed 37°C]). Haemophilus spp., N. gon- S. pneumoniae (for
m  ou V ho u d d d u on u d qu n g o d mp n n du m hop m po nu An on mp nd h n und n m d n g bn n n h n d n b n n u mm ng w d n
ff FDA-approved for S. saprophyticus and S. epidermidis (not S. aureus).
orrhoeae, S. pneumoniae and other streptococci should be incubated in an atmosphere enriched with 5% CO2. N. gonorrhoeae d — — ≥31 37 – 45d penicillin G susceptibility) e,h — — ≥20 ≤12 e,bbb ou d on ô d qu D n d un no d p g ou nd qu qu d m d on V n B h n n o g n Auß d m o n K u h n u d n n w h nd n Wo h h u g B h n n nomm n wu d n
gg For control limits of gentamicin 120 µg and streptomycin 300 µg discs, use E. faecalis ATCC 29212 (gentamicin: 16 - 23ii mm; streptomycin: u m ho o d u md o pou n g d n b n m d n on o m n o u d d D on ndu hm und Qu on o g n n g n nu ü m H moph u pp m H moph u m d um H M b
pp ou p DA donn d n d omm nd on u du C ow B h n d üb N h n h m Küh h n u b w h wu d n n o g w d n um nd o nd B h n o n
6. Examine the plates after 16 – 18 h of incubation (20 – 24 h for N. gonorrhoeae, S. pneumoniae and other streptococci). A full 24 h of incu- Cefmetazole CMZ-30 30 µg 26 – 32 25 – 34 — Oxolinic Acid f OA-2 2 µg ≤10 — ≥11 20 – 24 10 – 13 — m od u on n bou on u ob nu pou n p u n p d n b p ob b d o do n n n ub on n n A mo ph m % CO h H n u n A CC w d n u h nü h Qu on o mm
14 - 20ii mm). Comp d m d on ob u donn d n b u pou un m oo g n m donn o w n V w ndung u p b ung h g hng w d n
bation is recommended for Staphylococcus spp. to detect methicillin/nafcillin/oxacillin/vancomycin-resistant staphylococci and Enterococcus Enterobacteriaceae and staphylococci j ≤12 13 – 15 ≥16 Penicillin h P-10 10 U — 26 – 37 — p u m hod d d u on u d qu pou do n ou h om n o on u d CM b mp oh n um d w h um ö d nd n g n h n on H M u üb p ü n D on n nd o d B hb h w d n n
hh If the zone is 7 - 9 mm, the test is inconclusive and an agar dilution or broth microdilution screen test should be performed to confirm resistance. on on po b R n n m d n b ou n omb n on d g n n m ob n d d B h n m d n mp oh n n Kon o o g n m n h H mm on n g b n mu d g m V h n üb p ü w d n
spp. for vancomycin resistance. The diameters of the zones of complete inhibition are measured, as determined by gross visual inspection. N. gonorrhoeae d ≤27 28 – 32w ≥33 31 – 36d Staphylococcus spp. j,pp ≤28 — ≥29 n  mp n p n n d mo u mp n mo n u d d mp n p u n p d d m m d m b oß n Aug n W h um u n hw h W h um n w n g n Ko on n d u d o n h h n on
Zones are measured to the nearest whole millimeter. For further details in measuring zones of inhibition, consult the reference.6 If only ii CLSI-recommended zone sizes that differ from FDA-approved zone size recommendations. m oo g n m b n d ou h n ou u o u n mp h d d n d u qu n b D U h n h n H mm on ng öß nn u d n B h n d no u on d Vo b ung od ung h mm d
Cefonicid CID-30 30 µg 25 – 29 22 – 28 — Enterococcus spp. n,o ≤14 — ≥15 n b d n o oqu n p odu n p d m u o on mo n d u n qu mp n ub m h u hn hw h w d o n d n M ung n gno w d n B ung on H moph u m Amo nC u n u u H M
isolated colonies grow, the inoculum is too light and the test should be repeated. Zones around discs containing different drugs are not jj No criteria have been established to support testing of this drug with H. influenzae. The control range is listed for quality control purposes only. ou ou h donn n d u ugg n un non n b u d d d n on M d um und nd n o n b uh n
Enterobacteriaceae and staphylococci j ≤14 15 – 17 ≥18 L. monocytogenes f ≤19 20 – 27 ≥28 pp n pp n ob m D n o oqu n b p n n p u n p d n b d n o oqu Kon o mm o A CC m n u h ß n ü Amo nC u n u b g nd p b nG n n ü o A CC
comparable for the purpose of comparing activity of drugs. See the Zone Diameter Interpretive Chart, which gives expected values from kk Because certain strains of Citrobacter, Providencia, and Enterobacter spp. have been reported to give false susceptible results with cefdinir and loracar- du m oo g n m d n b u n m ob n n d on m on o do p n o un D ng g b n V d um g nu ü n ung ö n n ung n u b w h B h n und b B h ung d n p h nd n b n ub on n Umg bung u mm
Haemoph — N. gonorrhoeae d,qq,ii ≤26 27 – 46 w ≥47 26 – 34d n p odu n p d m mp n mo n u o on mp n ub m mo n d u n qu
testing common aerobes. Zone measurement may be simplified by using a BBL™ Sensi-Disc™ Zone Interpretation Set. bef discs, strains of these genera should not be tested and reported with these discs. bo o d n qu on m u nu n un m hod d d u on d n C g o h n
pp n o on p p n ob m ou o n o oqu n b mp n n p u n p uppo d D on ndu hm und Qu on o g n n g n nu ü d un V w ndung on GC Ag b und % d n m
C op on Streptococci (non-S. pneumoniae, — — ≥24ii 24 – 30e Un pd d m p nu n d d qu C n p u ou n d u n qu m n mpo n K N CH MA R A No m w o n h M b d m n h d w nd w d n h d An ung m
7. Control tests using prescribed cultures should be included each day susceptibility testing is performed or weekly if satisfactory performance can ll FDA-approved for K. pneumoniae. g m n n b p n n d u d p n n on n p n n do D n W h um upp m n B BB GC Ag m oV X An h ung m d um und n ub on n n A mo ph m % CO h
be documented according to the CLSI standard.6 Typical zone sizes of E. coli ATCC™ 25922, S. aureus ATCC 25923, P. aeruginosa ATCC 27853, b-hemolytic only) e,i,rr,aaa,ccc n qu u d n b og mm p d u on u d qu n g o n o n ob nu pou p Anw ung n u ub ung d no u um mög h o n d Ku u n u n h mM ng g w d n d d n n n
mm No criteria have been established to support testing of this drug with Pseudomonas aeruginosa. The control range is listed for quality control purposes d n o oqu n mp n ou p n n n p d b du d p odu on d m p du hg üh wu d n
A Piperacillin 24 – 30g d H moph u N gono ho Mo h u b pou d on d n o oqu o B g nn n An b o h p n nomm n wu d
H. influenzae ATCC 49247, H. influenzae ATCC 49766, N. gonorrhoeae ATCC 49226, S. pneumoniae ATCC 49619, E. coli ATCC 35218 (β-lactamase- PIP-100 100 µg — 25 – 33
only. m hod d ou n d d u on u d qu n g o ou d d u on un d d m b u n o n don D on ndu hm und Qu on o g n n g n nu ü d un V w ndung on Mu H n on Ag m %
producing strain), E. faecalis ATCC 29212 (for quality control testing of gentamicin 120 µg and streptomycin 300 µg discs) and Klebsiella pneu- C o m X Enterobacteriaceae and Acinetobacter ≤17 18 – 20 ≥21 p odu u d m Un u po pou m p d un n p n n mp n omm nd pou o ngu n ou d qu d ph o h d n Un po pou m p d n p n n n V R AHR N
nn If a penicillinase-stable penicillin is tested, oxacillin is the preferred agent and results can be applied to the other penicillinase-stable penicillins, cloxacil- d b n m h b u du hg üh und n % g CO A mo ph h n ub wu d n R h n n d n p on g n ü
moniae ATCC 700603 (for screening and confirmatory tests for ESBLs) are given in the chart (or footnotes) and indicate the correct performance of P. aeruginosa ≤17 — ≥18 mo n h p d H moph u N gono ho M h un n p n n qu u m no bo u do p n n C n n o oqu n p n n ou mp n p u n p n un n
lin, dicloxacillin, flucloxacillin, methicillin and nafcillin. Oxacillin is preferred because it is more resistant to degradation in storage, and because it is M g Ab m n D b h n u mp nd h p ü ung n h K nn hnung pn umon und ü nd po o nw ng g b n B Anw ndung d p h nK n u nd d h ng g b n n
the entire procedure. E. faecalis ATCC 29212 (or 33186) is also recommended for evaluating new lots of Mueller Hinton Agar for low thymine and A omp m no bo u do p n n h ph o oqu n o oqu Un u n g pou
Piperacillin/ more likely to detect heteroresistant staphylococcal strains. Cloxacillin discs should not be used because they may not detect oxacillin-resistant S. aureus. d h u n u p mp CM d p n n µg m ou CM d mp n µg m d d qu n pou d n B nö g do h n h m g Ab m u h Ku u m d n R g n n B n mm u Qu on o und O g n m n nn u h n g bn n omm n D og h g n n n p on n ü po o n uß pn umon
thymidine content (see footnote tt). H. influenzae ATCC 10211 is recommended as a useful additional quality control strain to verify the growth H m — — — m n mn p po b d un n du d u m n m N p p d g n
Tazobactam g TZP-110 100/10 µg 24 – 30g 27 – 36 25 – 33ii Cefoxitin may be tested instead of oxacillin (see M100-S21). After incubation for a full 24 h, examine for light growth within the zone of inhibition of u don n no m d u p n n un n d h u n u ou n o oqu up d n ng CR od h bo g u Du h üh ung n B h n mp nd h p ü ung m d m D u on n hd m nd d h n b uh n u d n opu on ung n h d n p d h m o n n m ob Ag n n üh ö n h
N — — n ob udomon n u b ob G mn g u p u n n p p d
promotion properties of Haemophilus Test Medium Agar.7 bo o do n g d d mn CM d p n n ou d mp n n donn qu ou h d n o oqu p n n
V m Enterobacteriaceae and Acinetobacter ii ≤17 18 – 20 ≥21 the oxacillin disc using transmitted light (plate held up to light). Any discernable growth within the zone of inhibition is indicative of oxacillin resis- u n b u mn p u ou n u n m n Un m n d n d m h n n M nd übung nd d h n nd m m MB C % G w Vo B C H O u m M N u und d n h n h ung b mm M g d d C Un u hu m h g wonn n n h D n ü
RESULTS 6,7 – NOTE: Recommended interpretive criteria are based on usual dosage regimens and routes of administration in the U.S. un n no m d pu b n u CM d p n n µg m d mp n µg m do n on d omm H O % Vo Vo ug g b n w d n D n übung nd d m H n p pho om m V g h ü b n V b ndung n n d G upp nd n u Üb p ü ung n h u V ügung o d h n on u g n n p on n
m m — — Staphylococcus spp. j,ii and P. aeruginosa ii ≤17 — ≥18 tance. ph o oqu p u n ndu on d u n m n ub on u qu h d un b u n o n
Beginning in 2006, CLSI established zone diameter interpretive ranges for Neisseria meningitidis, Burkholderia cepacia and Stenotrophomonas po n m n n b un n g un m nog o d n b n d un n m nog o d d h u n u nd qu h hd on m üb p ü n d n on b nm mu w h n und g n ü pn umon m b mm n m n pn umon A CC ü p o o u pp d u Qu on o
Polymyxin B aa,dd PB-300 300 U ≤8 9 – 11 ≥12 12 – 16 — — oo If oxacillin intermediate results are obtained for S. aureus, perform testing for mecA or PBP 2a, the cefoxitin disc test, an oxacillin MIC test or the oxacil- ndu on p u m n omp n n o n d n on m g n n ou n d qu d o n
maltophilia. For these ranges, consult CLSI M100-S217 or the latest M100 supplement available. In addition, CLSI guideline M45 – Methods for C o m X A ou h p n n un n d pu h u n up u n n un n g D u on d gn mm
lin-salt agar screening test. Report the result of the alternative test rather than the intermediate result. o d o n pou g n ud d u n d ou h d on ô po n g onnu An ung n n h ß h Qu h ung du h d n Anw nd
Antimicrobial Dilution and Disk Susceptibility Testing of Infrequently Isolated or Fastidious Bacteria – can be consulted to obtain information for test- C u n A d Quinupristin/Dalfopristin SYN-15 4.5/10.5 µg — 21 – 28ii — o D n d n o oqu n g n mp n p n n ou n om n un m nog o d p u p d u
pp Penicillin-resistant, oxacillin-susceptible strains of Staphylococcus aureus produce β-lactamase and the testing of the 10-unit penicillin disc instead of the do n nm m mp qu o n qu ub ung d no u um m und Kon o u u n Von d DA ug n mp h ung n d A n m h b üg h d H mm on ng öß nd n C M M A n h
ing a variety of organisms including Campylobacter, Corynebacterium spp., Bacillus spp., etc.9 For organisms not found in the accompanying table, or Staphylococcus spp., ≤15 16 – 18 ≥19 mo n d un d d p g d m nog o d g n m n p om n d h u n u n p n d u
C o n — ampicillin disc is preferred. Penicillin should be used to test the susceptibility of all β-lactamase-labile penicillins, such as ampicillin, amoxicillin, azlocil- n G m bung n g n Nu R n u u n w nd n nh n
the references mentioned, studies are not yet adequate to develop reproducible definitive standards for interpretation of results. If necessary, a dilu- Enterococcus faecium and n ob ou o u d p d mon hg u mp n un qu no on m nog o d u d n o oqu n u d g n m n d p om n
lin, carbenicillin, mezlocillin, piperacillin, and ticarcillin. Likewise, a positive β-lactamase test predicts resistance to these agents.6 For oxacillin-resistant m hop m u m ho o do n ppo n ou n n ou u h o mph n o un b D b ün hn h Ko on n u w h n und m no u on n d od ö n m n g gn n Bou on w B g  u Qu on o on B h n d Komb n on n on m n und m H mm n n h n n nd mm on o
tion method usually will be the most appropriate testing method, which may require submitting the organism to a reference laboratory. w S. pyogenese only 19 – 24e,ii,cc p  u d d n b mp n do n p d d mo n m o d o d H n u n qu
N staphylococci, report as resistant or do not report. ph o po n d o m g n on pou o n n u d p d mon ou p d p o Bou on od Mu H n on Bou on ü n p u h o O g n m n üb üh n A CC b mm wo d n D mm p odu n m d du h d n H mm o n w d n o B V w ndung
In some instances, CLSI has implemented new zone diameter ranges for interpretive or quality control criteria. When this has occurred, footnote Rifampin RA-5 5 µg 8 – 10 26 – 34 — on n mp n mo n p odu n d m d p M D n p up d un d d m n V b ndung m A CC önn n b d Kompon n n d Komb n on b h n üb w h w d n D Kon o g n n m d m
C o n OX — qq A positive β-lactamase test predicts resistance to penicillin, ampicillin, and amoxacillin. A β-lactamase test will detect one form of penicillin resistance mon hg d m nog o d d ph o po n d p m d u m g n on d nö g d Ku u n n d Bou on b C h ng n ub n b n übung h d n m übung nd d on
“aa” has been added indicating that the FDA-approved zone diameters provided differ from the current CLSI recommendations. Staphylococcus spp. and Enterococcus spp. yy ≤16 17 – 19 ≥20 p u o un mo n p d d d n mp n mo n mm ü Amo nC u n u b g n mm ü Amp n mm d h n on ü Amp n ub m mm
in N. gonorrhoeae and also may be used to provide epidemiologic information. Strains with chromosomally-mediated resistance can be detected only ph m n p u n n o m n on u un n qu o n do n don p M nd n p h ung h b KB m nn u h A n n d Bou on od Ko h u p n on m
Compare recorded zone diameters with those in the chart; results with a specific organism may be reported as Resistant, Intermediate or Susceptible. c
Haemophilus spp. ≤16 17 – 19 ≥20 22 – 30c — q u ppo pou p d A n ob n u u g n ü p n mm ü p n ob m mm ü n mm d h n on und ü nC u n u
N w by additional susceptibility testing, such as the disc diffusion method or the agar dilution MIC method. Gonococci with 10-unit penicillin disc zone ppo omm n b Ko on n on n Ag p d üb N h n ub wu d h g w d n o nn h M d um w B u g
For some organism/antimicrobial agent combinations, the absence or rare occurrence of resistant strains precludes defining any results categories S. pneumoniae e ≤16 17 – 18 Ž≥19 25 – 30 e diameters of ≤19 mm are likely to be β-lactamase-producing strains. However, the β-lactamase test remains preferable to other susceptibility methods N p ppo n ou n pou o p d h n on du m u n mm D Kon o mm o A CC nh n p m d od m Non B D h d O g n mu n
C podo m D — n ob C ob p u n d opp un n u ou d un m n p o ong d od ho o d n g ü H n u n und N gono ho w nd w d n D d Ko on u p n on m hod b
other than “Susceptible.” For strains yielding results suggestive of a “nonsusceptible” category, organism identification and antimicrobial susceptibil- g g nüb np n n b nA n m n g do h mp nd h u Komb n on n u m m H mm
Sparfloxacin SPX–5 5 µg 30 – 38 27 – 33 21 – 29 ii for rapid, accurate recognition of this plasmid-mediated penicillin resistance. ph o po n d o m g n on C pou quo o qu on n m n n b p u n d n n n b n h om n h om n d h om n p u n p d p d h om n ph o o u pp pn umon und nd n po o n H moph u pp und N gono ho o u h n
ity test results should be confirmed. Subsequently, the isolates should be saved and submitted to a reference laboratory that will confirm results D m d Qu on o gü g mu d m d n d m Kon o mm n h n n A d ng nn d m d w h nd d
Staphylococcus spp. ≤15 16 – 18 ≥19 rr Susceptibility tests on S. pyogenes to penicillin are seldom necessary since this microorganism has continued to be universally susceptible to penicillin. u bou d ou d m n R p u d o p u ud u Vo d u on d B ub qu R U A ou d d p g d on m on d B h K b pn umon d nö g dünn n b d übung d m M nd übung nd d n p h A V dünnung m w d Bou on
using a CLSI reference dilution method.6 H m — — — g ung m Küh h n od b m n n o ng h n ü w n h n h V h n b h n ung n und M
S. pneumoniae e ≤15ii 16 – 18 ii ≥19 21 – 27 e However, some strains of S. agalactiae may give penicillin-intermediate results.7 m p g B on d n m p odu p b G mn g qu p o nn n d K o o o po on R U A n u d d p g p o du nd d d d u on u od Ko h ö ung w nd A A n m hod nn d no u um pho om h nd d w d n Um d n ung
A rapid b-lactamase test (e.g., using Cefinase™ discs) may yield clinically relevant information earlier than results of a disc diffusion test with N — — h  o on n umo o nm O n H mm on n on mm G öß nd mp nd h MHK µg m g g n n n und önn n
Spectinomycin SPT-100 100 µg — — — ss Tigecycline has decreased in vitro activity against Morganella spp., Proteus spp. and Providencia spp. mu on d g n on ô n m ommun m d on p m d qu D ou h d p d K b d qu n g o Mu H n on ± C mb n h on on m mm dm mm o m mm d no u um on hn w h nd n O g n m n u h n nn d omp no u on m o um h Vo h ung u
Haemophilus spp., N. gonorrhoeae and Moraxella catarrhalis; it is the only reliable test for detecting b-lactamase-producing Enterococcus spp. A C p o — podo m mm on mm on omm nd pou on ô d qu o A CC qu m n onn d n ü ug n nd on n mp nd h g g n Amp n Amo n Amo n C u n u Amp n ub m C o C dn
N. gonorrhoeae d ≤14 15 – 17w ≥18 23 – 29d tt The sulfisoxazole disc can be used to represent any of the currently available sulfonamides. Blood-containing media (except for lysed horse blood) are d o p odu d B p u n n qu m n n u m n p p n n ph o po n ub ung d no u um w nd w d n
positive b-lactamase test predicts resistance to penicillin, ampicillin and amoxicillin among Haemophilus spp., N. gonorrhoeae and M. catarrhalis and K pn umon A CC on m mm dm mm o m mm podo m mm C pm C m C m C o m C p o C bu n C on C u o m C podo m C o m p n m mp n m
generally not suitable for testing sulfonamides or trimethoprim. Mueller Hinton agar should be as thymidine-free as possible for sulfonamide and/or ou on m m g u n b pp n n o n d g n C n d ou h p n on Üb N h u b w h Bou on u u n o nn h no u um w nd w d n
resistance to penicillin, including amino-, carboxy- and ureido-penicillins among staphylococci and enterococci. A negative b-lactamase test does not H m —
Streptomycin on mm u on d p u d un g n n m ob n pou d p g m o n b d d on o b und M op n m ng h n w d n d ub n n mü n n h g p ü w d n B o nm O n on ng öß n on
trimethoprim testing. To determine whether the Mueller Hinton agar has sufficiently low levels of thymine and thymidine, Enterococcus faecalis ATCC un on d nh b on p u du qu d popu on no m n b m pu ndu qu u u
rule out resistance due to other mechanisms. Do not test members of the Enterobacteriaceae, Pseudomonas spp. and other aerobic gram-negative Testing enterococci S-300 300 µg 6 7 – 9 hh ≥10 — — — d on m on du ph no p n u on du o m n qu d dm u omb n d u n qu Un no u on mm o n d MHK ü n n C o m od C on b mm w d n d on n on mm G öß b p n n n n
C dm A 29212 or ATCC 33186 may be tested with the trimethoprim-sulfamethoxazole disc (see ref. 13). An inhibition zone of ≥ 20 mm that is essentially free of nd d d n ph o po n p ndu ou d on m m n d n d p odu on d B
bacilli because the results may not be predictive of susceptibility to the b-lactams most often used for therapy. Accurate detection of b-lactamase in for high level resistance n,o,gg d m d on mm pou un ou u d g n n m ob n n o on d u n qu p ppo ud m nn h b on mn n n nW up nd o ng no u um u h n und g g n d ob nn nw nd d od n m d n mm n od b b mm n p n n mp nd h n mm n u n o o nn h n u g und n
fine colonies indicates a sufficiently low level of thymine and thymidine.6 p d ou h p u u mo n d u d d p g pp op n d ppo u pou
staphylococci may require induction of the enzyme and incubation of a nitrocefin-based test for up to 1 h. Induction can be easily accomplished by Enterobacteriaceae S-10 10 µg ≤11 12 – 14 ≥15 12 – 20 14 – 22 — d on d g n n m ob n u nd qu d B omm nd on u du on ô d qu on u n un ou h Röh h n m h m h n und h d h n um üb hü g ü g u ud ü n O nh mm on on mm p n n n od n m d poo o w d n Amo n Amp n C pm C o m
uu Gonococci with 30-µg tetracycline disc zone diameters of ≤ 19 mm usually indicate a plasmid-mediated tetracycline-resistant N. gonorrhoeae (TRNG) p n n ph o po n p g ou on m on u u nd d d u ou h p u n
testing the growth from the zone margin surrounding an oxacillin disc test. Care must be exercised to ensure accurate results, including testing of A C on C u o m p n m m p n m und M op n m önn n u B h nd ung on n umo o n n on n ng w d n
Sulfisoxazole tt G-.25 250 µg 15 – 23 24 – 34 — isolate. These strains should be confirmed by a dilution test (MIC ≥ 16 µg/mL) and/or referred to a public health laboratory for epidemiologic investiga- pp n m d ou n un ou p u u d g n ou ou ou h B d m d n g d o A CC qu p odu un ugm n on mm du d m d on d g n n m ob n u p ppo u b D g m Ob h n Mu H n on Ag p od n nd n g gn n Ag p d m u h n wob d
known positive and negative control strains at the time clinical isolates are examined.6 H m — — — d m d on o pond n n o on d u n qu un ou h po d K pn umon A CC qu p odu w h n d m Au h n um G d g d h w d um n g hm ß g no u on u n gb d do h n u g nB h nd u on mp nd h ü d ub n n h n oA w d mb n
Enterobacteriaceae, P. aeruginosa, tion. on d nh b on u ou d d qu on n n n ph o po n p g ou on m d ugm n
Enterobacteriaceae: When fecal isolates of Salmonella and Shigella spp. are tested, only ampicillin, a quinolone and trimethoprim/sulfamethoxazole N — — un ugm n on mm du d m d on du o m un ugm n on mm du d m d on d d m Vo m H n MHK M hod b mm n n C o m od C on und M op n m o n m n u g n MHK M hod
Acinetobacter, staphylococci and V. cholerae m ≤12 13 – 16 ≥17 np n d d u n qu omm mon d on m on ph no p qu ou h p odu D D nn mn b n h ng mng ö n b b n d m nu ob h h u h g o d m
should be reported routinely. In addition, chloramphenicol and a third generation cephalosporin should be tested and reported for extraintestinal vv All staphylococcal isolates with vancomycin zone diameters of 14 mm or less should be tested by a reference MIC method. The disc diffusion procedure m d m hod Vo n pou d d p o du B m d m C Do um n M b h b n n g p ü und ou n m ß g m o n on pn umon u b o pn ü g
C dm A A d B d n donn d u d n p omm n pou ou p n n ph o po n Au b ng n d m A n m mp gn nB h n bob w d
isolates of Salmonella spp. For Salmonella and Shigella spp., aminoglycosides and first and second generation cephalosporins and cephamycins may Telavancin TLV-30 30 µg — 16 – 20 — 17 – 24 will not differentiate strains with reduced susceptibility to vancomycin (MICs 4 to 8 µg/mL) from susceptible strains (MICs 0.5 to 2 µg/mL) even when poo o w d n o h o o n m d MHK M hod od n mB h n b n g g n V n om n g w d n
C u n A d on m Vo no nb d p g pou d d p g d on m on d B d on d u u  o n p u p d d o n d p n d ph d n d n du o du do G gn B h n uw h n h mp h ung n n u ng b b n A und B on M M
appear active in vitro but are not effective clinically and should not be reported as susceptible.7 Staphylococcus aureus incubated 24 h. Additionally, vancomycin-resistant S. aureus (VRSA) strains (MICs ≥ 16 µg/mL) may produce only subtle growth around a vancomycin B o n on nd n Kö p n nn d O nB h nuh w nd w d n W nn d O n on mm o n
C bu n — — d d d p g d B u ou o d u n do p un ud b m n n on d n o n uo m podo m po o b o u n u m n p u n nd du m n D B h nm n m BB D p n un B h ung p h Vo h m ßn hm n u g n D b d B h n o b n d
Enterobacter, Citrobacter, and Serratia may develop resistance during prolonged therapy with third generation cephalosporins. Therefore, isolates (including methicillin-resistant isolates) f — — ≥15 disc. The vancomycin agar screen test described for enterococci (Brain Heart Infusion Agar with 6 µg/mL Vancomycin) may be used to enhance the d MHK ü n n und C o m od C on b mm w d n u B mmung d mp nd h on nd n po o n
p n m n p n on d n on ou d p o u m b p odu u d B po u p u n o qu o n n p d n n n m nd n mm u n nd g n n n und C ph o po n b h n o ug w m nd n mm om
that are initially susceptible may become resistant within 3 to 4 days after initiation of therapy. Testing of repeat isolates may be warranted.7 Streptococcus pyogenes, Streptococcus agalactiae, sensitivity of detecting vancomycin-intermediate and vancomycin-resistant strains of S. aureus incubating the plates for a full 24 h at 35°C.6 Use of a sus- pn umon g g nC dn w dd nh n n nb h n w nd o m G öß n d n n on on mm nd
H m — — — do um n M pp b u d p d Mo g n R nd d h und m n m Ab nd on m nd n mm w h n d n B h n n np n D B h nn h
Streptococcus anginosus group (S. anginosus, ceptible quality control strain, such as E. faecalis ATCC 29212 is critical to ensure specificity. E. faecalis ATCC 51299 may be used as a positive (i.e., resis- p n n mp nd h und önn n u h mp nd h g g n C d n b h w d n
Extended-spectrum b-lactamases (ESBLs) are enzymes produced by gram-negative bacilli that arise by mutation in genes for common plasmid-medi- Non n ob non n ob u qu ug no p d A n ob B p w  ou N gono ho ob n on d un u n m d un g n n m ob n nd qu o un p ob m hn qu qu d n b n n nd p n B H n u n N gono ho und pn umon n h m h n un B h npo mm b w
C o m OX S. constellatus and S. intermedius)e,f — — ≥15 tant) control. Until further data on the prevalence or clinical significance of these isolates is known, laboratories may choose to examine MRSA strains  n g g n n n mp nd h po o n o nn ü ug n nd on n mp nd h g g n Amp n Amo n
ated b-lactamases. Strains of Klebsiella spp. and E. coli that produce ESBLs may be clinically resistant to therapy with penicillins, cephalosporins, or m oph do n p m hod d d u on o do um n M ou B p m oph oud n p n o un m nqu d p n n qu d n m n d m oo g n m donn n d u d n B h npo mm w nd n Wu d n d B h nn h m D p n nm u om h And ü o h ung u d m
more carefully for elevated MICs to vancomycin.6 Currently, there are insufficient data to recommend using this agar screen test for coagulase-negative Amo n C u n u Amp n ub m C o C o n C dn C pm C p o C o m C bu n nu po o n
aztreonam, despite apparent in vitro susceptibility to some of these agents. Some of these strains will show zones of inhibition below the normal Enterococcus faecalis
on u do um n M du C pou p nd onn n d no m d n p on d d m d on h po h mb pou m o o n o n p nom n ou h p n n d on n m d Ag p B h n ü gu n Kon m d nob h m n n N d od n nd ü n
staphylococci. Send any staphylococci determined to have an elevated MIC to vancomycin (≥ 4 µg/mL) to a reference laboratory. d G upp A C on C u o m C podo m C o m C ph o h n C ph p n C ph d n m p n m o b und M op n m
susceptible population but above the standard breakpoints for certain extended-spectrum cephalosporins or aztreonam; such strains should be A (vancomycin-susceptible isolates only) f — — ≥15 on ô d qu u g n p n n un u d gu on n qu do um n n u % u > %d ou h n b
ww When testing vancomycin against enterococci, plates should be held a full 24 h and examined using transmitted light; the presence of a haze or any D n m d m Ag no h ob n nn h b on m n n n n n ub o on ± C nb ng n ü ph o o u pp önn n b ng h n w d n und mu g g n d ub n n n h g p ü w d n Au B u und no m w n Kö p g w b n
screened for potential ESBL production by using the ESBL screening breakpoints before reporting results for penicillins, extended-spectrum cepha- H m — — — Telithromycin TEL-15 15 µg — 24 – 30 —
growth within the zone of inhibition indicates resistance. Organisms with intermediate zones should be tested by an MIC method as described in CLSI ug no p u d n n u d un m n p o ong ou n b o qu o n m n D n d o u d CR u ppo u du o m o m ou d on p d m mp u n üb C mög h w m h n n ph o o n MR n h n hg w n w d n N gono ho B b o pn ü g Kno h n u w o V d n po o n o nm n MHK M hod u n n od
losporins or aztreonam. Other strains may test intermediate or resistant by standard breakpoints to one or more of these agents. In all strains with N — — S. aureus —aa —aa ≥22
document M7. See also the vancomycin agar screen test described in the MIC Table 2D (M100-S21).9 n b p u n d n n u bou d ou d m n p u ud u d p u o n o n b ± C n ub n C n h üb h n H moph u pp N gono ho pn umon und nd po o n o n Amp n mp nd h g pü w d n
ESBLs the zone diameters for one or more of the extended-spectrum cephalosporins or aztreonam should increase in the presence of clavulanic acid Haemophilus spp.c ≤11 12 – 14 ≥15 17 – 23 —
C on O
xx No S. pneumoniae strain with a vancomycin zone diameter of inhibition <17 mm has been observed; submit such strains to a reference laboratory.7 pu u o Comm n ou h du g n o d n on donn d u u m n n b d qu d po on n d n p n n m % CO ng h n A mo ph n ub w d n  n n mp nd h ph o o n nd u h g g n nd n n n Komb n on n u m m H mm C ph m
as determined in phenotypic confirmatory testing. For all confirmed ESBL-producing strains, the test interpretation should be reported as resistant S. pneumoniaee ≤15 16 – 18 ≥19 27 – 33
for all penicillins, cephalosporins, and aztreonam. See footnote t for ESBL screening and confirmatory tests. The decision to perform ESBL screening yy Because of limited alternatives, chloramphenicol, erythromycin, tetracycline (or doxycyline or minocycline) and rifampin may be used for vancomycin- n b d udomon ug no o p d h n on p u d p n ou n d mu o do ou h pp n n g n d qu n d ppo u o pond n D nn h n n ub on on h h ü N gono ho pn umon und nd po o n und C b p n m mp nd h d on d DA ü n on n m ph o o n g n hm g nd n n n o n mp nd h
A Tetracycline ee Te-30 30 µg 18 – 25 24 – 30 — p u u b p m hod d d qu m m hod p u g un du d n ub on n  pou o u n u m n npu d u o u n d n d qu p u u pou n b un u h n ü ph o o u pp w d d o n ub on on h mp oh n um mm nd g g n p n n b n n n b mp nd h g g n nd p n n b n n Komb n on n u
tests on all urine isolates should be made on an institutional basis, considering prevalence, therapy and infection control issues.7 To screen Proteus resistant enterococci (VRE) and consultation with an infectious disease practitioner is recommended.7
mirabilis for ESBL production, see M100.7 H m — — — Enterobacteriaceaeaa, P. aeruginosa, u qu h n d pou o ppo un o omm n b du u uo oqu no on d o n n u d p d mon Vo no ddd n b d p g m h n n n o n n ph o o n n h uw n d G h g ü d n N hw on n om n n n m m H mm n C ph m und C b p n m O n n ph o o nw nR n g g n d
zz No criteria have been established to support testing of this drug with N. gonorrhoeae. The control range is listed for quality control purposes only.
N — — Acinetobacteraa, staphylococci, ph o o u pp p d ph o o u p u n d opp un n o d un n b o h p p o ong D m d on pp ou p DA pou d n p on ou on ô d qu qu d n d omm nd on du C n o o u pp D Du hm d H mm on n d b u Üb p ü ung n o nd g H mmung u w n w d n h h n m An b o u D h b nn mp nd h od R n g g n n R h on m An b o n h n m
Non-Enterobacteriaceae: Non-Enterobacteriaceae other than P. aeruginosa, Acinetobacter spp., B. cepacia and S. maltophilia should be tested by the aaa Strains of β-hemolytic streptococci with ampicillin, cefepime, cefotaxime, ceftriaxone or penicillin zone diameters of less than 24 mm have not been
V m enterococci yy and V. cholerae m ≤14 15 – 18 ≥19 d qu no on C pou quo o qu on n m n n b p u n d n n u bou d g m n D on ndu hm w d n u d nn h nM m g und W n h n u M ung d H mm on n mp nd h nu g g n n n und O n bg w d n D ou n m ß g n nd n n Komb n on n u
dilution method (see M710). For B. cepacia and S. maltophilia, consult CLSI M100-S21 for zone diameter interpretative standards and quality control. observed; submit such strains to a reference laboratory. bb D n d V ho u on p on m hod d d u on u d qu n g o p u d nomb u
m m — — Haemophilus spp. c ≤25 26 – 28 ≥29 14 – 22c — ou d m n R p u d o p u ud u nd d u u n n hm n W nn nu n n h nd Ko on n g w h n nd w d no u um u dünn und d mu m m H mm C ph m und C b p n m w d n h mp oh n O n n ph o o n o n n
P. aeruginosa may develop resistance during prolonged therapy with all antibiotics. Isolates that are initially susceptible may become resistant within bbb Deterioration in oxacillin disc content is best assessed with S. aureus ATCC 25923, with an acceptable zone diameter of 18 - 24 mm. m oo g n m d on on u d u ond pu
N. gonorrhoeae d,uu ≤30 31 – 37w ≥38 30 – 42d m hod d d on d ph o oqu n m n omp nn n p d qu d o n w d ho w d n H mm on n um h nm h d n nA n m n nd n h um V g hd A n m w m poo o od g n h b h w d n
3 to 4 days after initiation of therapy and testing of repeat isolates may be warranted.7 ccc For ampicillin, cefepime, cefotaxime, ceftriaxone and penicillin, Streptococci, b β -hemolytic only includes the large-colony-forming pyogenic strains of Au un n b n u du d m d m n p o o u pn umon ndu d on ô n num qu g gn h d b u n p on d H mm on n d u w nd W u m h u g o omm nd n A ob n
S. pneumoniae and other streptococci e ≤18 19 – 22 ≥23 27 – 31e u d qu o n d d on du g n m A ou d p o n od p m A po n d pou d on d on ô d qu  n m n g mp n n B NAR mm on H moph u n u n o n n g g n Amo n
The susceptibility of Pseudomonas aeruginosa isolated from patients with cystic fibrosis can be reliably determined by the disc method, but may C u o m m XM — streptococci with group A (S. pyogenes), C or G antigens and strains with group B (S. agalactiae) antigen. For cefepime, cefotaxime and ceftriaxone, nh D V w ndung n BB n D on n p on nn d H mm on nm ung n h n
Ticarcillin TIC-75 75 µg 24 – 30 — 21 – 27ii on p n n B u pp B p p n d un n d u d g n C u n u Amp n ub m C o C m C on d C p o C u o m und o b ng h n w d n obwoh n g
require extended incubation up to 24 h before reporting as susceptible.7 Viridans Streptococci includes small-colony-forming β-hemolytic strains with group A, C, F or G antigens (S. anginosus, previously termed S. milleri) as dd  o n po m n B d u n m d n g o p on qu n ud d m hod d d u on n u Kon o m o g h b n n Ku u n o n n d m g n d m mp nd h p ü ung n du hg üh w d n m u n
≤14 15 – 19 ≥20 n m ob n gn d n m n o n ou o n u u n m n B NAR mm n h nb n o mp nd h g g nüb d n Ag n n u w n
Staphylococcus spp.: Staphylococcus spp. may develop resistance during prolonged therapy with quinolones. Therefore, isolates that are initially Enterobacteriaceae and Acinetobacter well as S. mitis, S. oralis, S. sanguis, S. salivarius, S. intermedius, S. constellatus, S. mutans and S. bovis. ob nu d u n b o qu Un n ou ou gn m o qu m n d n on m qu u n u C nd d u d n nd ung do um n w d n nn önn n d Kon o wö h n h
MR A u n on d n n on ommun u n on p d n mu p G upp n p n ü Amp n und Amo n
susceptible may become resistant within 3 to 4 days after initiation of therapy. Testing of repeat isolates may be warranted.7 H m — P. aeruginosa ≤14 — ≥15 ddd Fluoroquinolone-susceptible strains of Salmonella that test resistant to nalidixic acid may be associated with clinical failure or delayed response in p d ou h n b n g p ud n d on m u d un n b og mm p d u on u d qu n g o p un du hg üh w d n p h H mm on ng öß n ü o A CC u u A CC ug no A CC H n u n
MR A u ph o oqu n m n o gu n g do n ndu omm n m hod d d u on m B V ho mm n d g bn d B h n D u on u mp nd h g g n Amp n n m hop m
Methods for the detection of methicillin-resistant staphylococci include the oxacillin disc test, the cefoxitin disc test and tests for mecA or the protein N w Ticarcillin/ fluoroquinolone-treated patients with extraintestinal salmonellosis. Extraintestinal isolates of Salmonella should also be tested for resistance to nalidixic A CC H n u n A CC N gono ho A CC pn umon A CC o A CC m
ou non ppo ou u p n n ou b p n m ph m o on m n nh b u d u m ho o und u on m d B o n on mp nd h n m d und n m d n g bn n d m d Bou on
encoded by mecA, the penicillin-binding protein 2a (PBP 2a, also called PBP 2′). In the past, the presence of resistance to other classes of agents was Clavulanic Acid g TIM-85 75/10 µg 24 –30g,ii 29 – 37 20 – 28 acid. For isolates that test susceptible to fluoroquinolones and resistant to nalidixic acid, the physician should be informed that the isolate may not be C n m oo g n m n b n p u n g m n on d omm n b m no n do n p odu nd mm und A CC u Qu on o on B h nm µg G n m n und µg p om n
C ph o h n — m qu qu o n u d n o g n u d gn n p qu p up d M o dünnung b mm wu d n gu üb n n g bn önn n d u b nu w d n um d w h h n h mp nd h
an indication of methicillin (oxacillin) resistance. However, some methicillin-resistant S. aureus (MRSA), such as those found in community-associated Enterobacteriaceae and Acinetobacter ≤14 15 - 19 ≥20 eradicated by fluoroquinolone treatment. A consultation with an infectious disease practitioner is recommended. C p nd n n m oo g n m n m d ou n n p u n pu n b do n ou m no n und K b pn umon A CC u Du h üh ung on u h und B gung ü B nd n d b od d n
on m d n on n m n on p u n b un m n p un mn qu on o n g g n Do n oh u g n B h n o n ü Do n od h om n n h b nu w d n d n gu
infections, are not multiply-resistant.6 P. aeruginosa ≤14 — ≥15 eee No criteria have been established to support testing of this drug with S. aureus. The control range is listed for quality control purposes only. ou d u ußno n u g üh und g nd nw nd ung h g d g m nV h n n A CC od
Ch o mph n o — n pou mom n u un donn n qu on n n d mon n n qu d mn g d Üb n mmung m MHK g bn n o g
MRSA and methicillin-resistant, coagulase-negative staphylococci should be reported as resistant (or not reported) to all other penicillins, carbapen- Staphylococcus spp. j ≤22 — ≥23 d MR ou u u n b o n ph o oqu o gu n g u pou ph m App ou p DA pou p oph u pd md m p u u w d u h u Üb p ü ung n n d g n h m n und h m d ng h n n u n Ch g n on Mu H n on Ag mp oh n
n Amp n g upp n p n ü Amp n und Amo n D g bn d Amp n önn n u Vo h g d mp nd h

 BBL Sensi-Disc Antimicrobial Susceptibility Test Discs


ems, cephems, and b-lactam/b-lactamase inhibitor combinations, regardless of in vitro test results with those agents. This is because most cases of gg  ou m d on ô d d m d on p odu p d qu d g n m n µg d p om n µg u h ußno H n u n A CC w d nü h B n mm u u h n Qu on o mp oh n um d
A Tigecycline TGC-15 15 µg 20 – 27 20 – 25 9 – 13mm 23 – 31jj — 30 – 40zz p n u o u o on g g n Amo n C u n u Amp n ub m p n und p n ob m un n h m p odu nd n
documented methicillin-resistant infections have responded poorly to b-lactam therapy, and convincing clinical data have yet to be presented that m n nh b u d m b p n m on do n ndu on o m m n u u A CC g n m n mm p om n mm w h um mu nd n g n h n on H moph u m d um g u üb p ü n
V Enterobacteriaceaef,ss ≤14 15 - 18 ≥19 n o o n w nd w d n D n n mp nd h on n o o n nn u h ü d Vo h g d mp nd h
document clinical efficacy for b-lactams versus MRS. For oxacillin-susceptible S. aureus and coagulase-negative staphylococci, results for parenteral hh  on d mm n p on u n un d d p g p d u on n g o ou p m od u on n bou on do RG BN H NW D mp oh n n n p on nb n u g b u h h n Do ung n und V b hung w g n n
and oral cephems, b-lactam/b-lactamase inhibitor combinations, and carbapenems, if tested, should be reported according to the results generated H m


f
S. aureus (including MRSA) —
E. faecalis (vancomycin-susceptible isolates only)f —


≥19
≥19
(D sques Sens -D sc BBL pour ant b ogramme) an a
ob nu n pp qu n d
o gu n g MR u
d n p
mn
on d ou n
d
ou
p n
u u
n
n
o
o
on
n ph o oqu
m n nh b u d pou on m n d nU A
d
ü n h
n o o
m
n ü Amp
p odu
n Amo
nd n o o
n Amp
n
n ub m Amo
w nd w d n A d ng
nC u n u p
nn n h ng nomm n w d n d
n und p n
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using routine interpretive criteria. For oxacillin-resistant S. aureus and coagulase-negative staphylococci (MRS), other b-lactam agents; i.e., penicillins, m — m ph m b p n m p u n pp n om on n qu m n n D m d on omm nd p C qu d n d omm nd on pp ou p DA Ab d m h üh d C n p on b h ü H mm on ndu hm ü N m n ng d Bu ho d p nd
b-lactam/b-lactamase inhibitor combinations, cephems, and carbapenems, may appear active in vitro, but are not effective clinically. Results for these m Streptococcus spp. (other than S. pneumoniae)e,f — — ≥19 23 – 29cc APPLICATION – Ces disques sont utilisés pour une évaluation semi-quantitative in vitro de la sensibilité aux antibiotiques des agents pathogènes d mp nd h u Amp n g n u h mp nd h ü n n nd d g bn ü n n b nö g w d n mu n
u pou g n n m ob n do n ndu omm n ou n do n p ppo p qu Au un n b n u d d n b o qu H n u n p g d on ô donn un qu m n d n d no ophomon m oph n D B h nd C M od d u nM g n ung u n n hm n u h n p h nd m n n du hg üh w d n D n Amp n od n n n b n o o n n og d odu on
drugs should be reported as resistant or should not be reported. This is because most cases of documented MRS infections have responded poorly Tobramycin NN-10 10 µg 18 – 26 19 – 29 19 – 25 bactériens courants à croissance rapide ainsi que de certaines espèces exigeantes, par un antibiogramme par diffusion sur disque en gélose.
C no n N — — p up d on m d n on MR on m pondu u m n p m n ou p qu donn on ô d qu nn d C R h n M M hod o An m ob D u on nd D u p b ng o n qu n o do d ou on m m ou n m ß g n B h n od V dünnung m hod n n h u g nn w d n nn w d ü o u
to b-lactam therapy, or because convincing clinical data have yet to be presented that document clinical efficacy for those agents. Routine testing of Enterobacteriaceae, P. aeruginosa, Les microorganismes concernés incluent : les Enterobacteriaceae, les genres Staphylococcus, Pseudomonas, Acinetobacter, Enterococcus, Vibrio
n qu n n qu on g n p hog n on n u n n p omm nd d u B h ng og n w d n um n o m on n ü d n n b n p um on O g n m n n h ß h C mp ob B u und b o pn ü g nd u N o nb nd m mp oh n n po m g n
urine isolates of S. saprophyticus is not advised, because infections respond to concentrations achieved in urine of antimicrobial agents commonly cholerae et, avec des procédures modifiées, Haemophilus influenzae, Neisseria gonorrhoeae, Streptococcus pneumoniae et d’autres streptocoques. Comm n ou h d g n C ob o d n n ob on donn d u u m n n b d qu
Acinetobacter and staphylococci ≤12 13 – 14 ≥15 d d ou n d p oph u u d o u n p qu n on on n b u on n on Co n b um pp B u pp u w u h n ü Og n m n d nd b g nd n b od d ng g b n n u
Cp o o n REMARQUE : Des procédures particulières sont nécessaires pour tester les pneumocoques, les entérocoques et les staphylocoques résistants à d po d o b on n d n p ou h pp n n g n d qu n d ppo u R n g g n n n ow Am no C bo und U dop n n o u B mm p n n od mp n n n o o n
used to treat acute, uncomplicated urinary tract infections (e.g., nitrofurantoin, trimethoprim/sulfamethoxazole or a fluoroquinolone).6,7 Trimethoprim TMP-5 5 µg 21 – 28 19 – 26 — u n d g n n m ob n ou mm n u pou n on u n gu non omp qu p n h u g üh nd g nb ng no h n d qu n ud n o u d n n h p odu b nd d ü d n p on d
la méticilline/oxacilline et pour réaliser des tests des bβ-lactamases et des tests de dépistage et de confirmation pour les ESBL ; voir la section o pond n önn n n h hoh R n uw n d h n n MHK µg m od Amp n MHK µg m D B h n ub n
To obtain information on predicting mecA-mediated resistance in Staphylococcus spp. using cefoxitin (30 µg), consult CLSI M100-S21. Enterobacteriaceae and staphylococci ≤10 11 – 15 ≥16 n ou non m hop m u m ho o ou un uo oqu no on g bn nw n n no w nd g no m w n V dünnung m hod d mb n g gn m hod b d D n ung w h n no m R n und d h hoh n R n B u B u und b o pn ü g o n n o o n
A « Résultats ». App ou p DA pou K pn umon
Similarly, to obtain information on testing Staphylococcus spp. for inducible clindamycin resistance consult M100-S21. A n d ob n un n o m on on n n p d on d n m d on m A d n p d gg d O g n mu n n R n bo g h w d n mu o d bo n B mmung d g n h n MHK ü n n od Amp n nB h h n d n o o n mm m
H m — — — Trimethoprim/ SXT 1.25 µg mm Au un n b n u du d m d m n udomon ug no ndu d on ô n num qu pou
Enterococcus spp.: Enterococci may be resistant to penicillin and ampicillin because of the production of low-affinity, penicillin-binding proteins w Pour la France: Les résultats seront interprétés en fonction du dernier communiqué du Comité de l’antibiogramme de la Société Française de ph o o u n u n o n µg on u do um n M du C n ng n nh d C n u B h ü H mm on ndu hm ü n p on und Qu on o n no m w n d g R n n n MHK µg m und Amp n MHK µg m po n mp nd h ü n n g h
N Sulfamethoxazole tt 23.75 µg 23 – 29ii 24 – 32 — d on d on ô d qu
(PBPs), or the production of b-lactamase. The disc diffusion test can accurately detect isolates with altered PBPs, but it will not reliably detect b-lac- Microbiologie. Un guide d’interprétation conforme au communiqué du Comité de l’antibiogramme de la Société Française de Microbiologie pourra D m m pou un n o m on u p o du d d p d ph o o u pou n ndu b ng üh Au g und d Änd ung wu d ußno h n ug üg d d u h nw d d on d DA ug n n W ung m n m Am nog o d n Abw nh on hoh Am nog o d n ng h n w d n o n w h nd mm m n
C h om n — — Enterobacteriaceae, P. aeruginosa, être fourni sur simple demande à la société Becton Dickinson France S.A.S., Tel: 04 76 68 36 36. nn  un p n n n p n n o n g n p u p u n pp qu u u p n n H mm on ndu hm h on d n u nC mp h ung n un h d n
tamase producing strains. The latter strains are best detected by using a direct b-lactamase test;6 e.g., with Cefinase nitrocefin discs or chromogenic m nd m n on u do um n M höh n R n ü n o h n g un mp nd h n önn n
Acinetobacter, staphylococci and V. cholerae ≤10 11 – 15 ≥16 n p n n o n d o n u o n m n n n o n p p qu
cephalosporin discs. n o o u pp n o oqu p u n n p n n mp n du d p odu on d D g m n n on ndu hm w d nm d n n nd b g h n D g bn ü n n p h n O g n mu önn n o  n g mu w h n Amp n n n od V n om n und n m Am nog o d nn ü n o o n du h V w ndung n
H m — Haemophilus spp. c ≤10 11 – 15 ≥16 24 – 32c — RESUME ET EXPLICATION – Les méthodes de diffusion en gélose utilisant des disques en papier filtre séchés contenant des concentrations m u d g d on p nd n o g qu pu u p b d d ou h d ph o oqu h o n d qu
For Enterococcus spp., cephalosporins, aminoglycosides (except for high level resistance screening), clindamycin and trimethoprim/sulfamethoxazole po n d b n n p n n B ou d p odu on d m p o du p d u on u n n m d od mp nd h b w w d n ü m n h Komb n on n on O g n m n und An b o h ß d R h n m hoh n Kon n on n on Am nog o d n G n m n und p om n o h g g w d n And Am nog o d
S. pneumoniae e ≤15 16 – 18 ≥19 20 – 28e déterminées en agents antimicrobiens ont été mises au point au cours des années 40. Afin d’éliminer ou de minimiser la variabilité inhérente à ce d o n n do n p u p qu n p u n p d u u n o n o n p u
may appear active in vitro but are not effective clinically and isolates should not be reported as susceptible. m Abw nh od d Au n on n o omm nd n n n mm n d gung on g bn go n m Au n hm on mü n n h g w d n w h A g g n n o o nn h b d on G n m n und p om n
type de test, Bauer et al. ont mis au point une procédure standardisée dans laquelle la gélose Mueller Hinton était le milieu choisi pour le test.1,2 d qu n g o p u d p on o qu on d B m n pou p d b p d o n o do um n M Ap un n ub on d h omp h h p np n n n n bo
Haemophilus spp.: Only results of testing with ampicillin, one of the third-generation cephalosporins, chloramphenicol and meropenem should be C nd m n — — Vancomycin Va-3 0 30 µg — 17 – 21 — ou h qu p odu n un m m u m hod pou d d n ou h on u un mp nd h u B mm n m g bn n d u d K go Un mp nd h h nd u n o n O g n mu d n on p D g bn on Amp n mp nd h o n u Vo h g d Amo n w nd w d n D m n o on
Divers organismes de réglementation et de rédaction des normes ont ensuite publié des procédures standardisées de référence en se basant sur la d d n un ou um n u un g o n d n on d nh b on du d qu d o n ou o n d n b d n und n m ob mp nd h b g w d n D n h o nd o u b w h und n n R n bo g g b n w d n
reported routinely with cerebrospinal fluid isolates of H. influenzae. Staphylococcus spp. vv,ii — — ≥15 d d H n u n d g g n Amp n und Amo n n nd p odu n n m om p M n d n m n n nn n
méthode Bauer-Kirby. Les normes de la Food and Drug Administration (FDA)3 américaine et de l’Organisation mondiale de la santé (OMS)4,5 figurent on d nh b on gn d un n o n d d g bn m n C R n V dünnung m hod b g
Amoxicillin/clavulanic acid, azithromycin, clarithromycin, cefaclor, cefprozil, loracarbef, cefdinir, cefixime, cefpodoxime, cefuroxime axetil and telithro- m Enterococcus spp. n,o,ww ≤14 15 – 16 ≥17 parmi les procédures standardisées les plus anciennes et les plus suivies. La procédure a été adoptée comme norme consensuelle par le Clinical and m p mp d d qu C n n o n ou d d qu ph o po n h omog n d m Amp n und Amo n n hn n
oo  d u n m d o n on ob nu pou u u u d m A ou d B u d qu o n B H moph u pp N gono ho und Mo h nn n hn g nd m B m C n
mycin are oral agents that may be used as empiric therapy for respiratory tract infections due to Haemophilus spp. The results of susceptibility tests Co n — — S. pneumoniae xx and other streptococci e — — ≥17 20 – 27 e Laboratory Standards Institute (CLSI, anciennement NCCLS) et fait l’objet de mises à jour périodiques.6,7 Les documents du CLSI les plus récents ou p d n o o u ph o po n m nog o d u pou d d d p g d n q K nn ü A n ob pp n g g n nd Ag n n do um n w d n
un d CM d o n ou un d d p g u g o h p o n R ppo u du n p u ô qu b h n hn n h n g bn n nB h n D u on n m u hd n g
with these antimicrobial agents are often not useful for management of individual patients. However, susceptibility testing of Haemophilus spp. Do p n m DO — — doivent être consultés pour prendre connaissance des recommandations actuelles. d h u n u nd m n m hop m u m ho o p u n n o m on n u n m d B o n u d H n öh n h ou n m ß g do um n
† Adapted in part from CLSI Document M100-S21 (M2): Disk Diffusion Supplemental Tables, Performance Standards for Antimicrobial Susceptibility u g um N hw on m p odu nd n n o o u pp M n m po n m nn R n
with these compounds may be appropriate for surveillance or epidemiologic studies. PRINCIPES DE LA METHODE – Des disques contenant toute une gamme d’agents antimicrobiens sont déposés sur la surface de la gélose Mueller n qu p on qu n o n do n p ppo omm n b D V w ndung on h om n nn mp nd h und R n g g n A h om n C h om n und D h om n o h g n
— — Testing, with permission. The complete standard may be obtained from the Clinical and Laboratory Standards Institute, 940 West Valley Road, Suite pp  ou h d ph o o u u u n p n n n b o n p odu n d m p b du g g n n n Amp n und Amo n b H moph u p N gono ho und M h und R n g g n n n
Streptococcus spp. other than S. pneumoniae: Susceptibility testing of penicillins and other b-lactams approved by the U.S. Food and Drug 1400, Wayne, PA 19087-1898 USA. Values not in M100-S21 are explained in other footnotes. For appropriate MIC correlates, refer to M100-S21.6,7,9 Hinton (ou de la gélose du test d’identification d’Haemophilus pour H. influenzae, de la gélose GC II enrichie d’IsoVitaleX pour N. gonorrhoeae ou H moph u pp u u d pou mp n un ph o po n d o m g n on un d qu d un d p n n p d un d qu d mp n p n n d u pou n b d  h B p hung on B un RG BN H n h h u h und B gung ü B nK b pn umon K o o
m — — n h ß h Am no C bo und U dop n n b ph o o n und n o o n o ug g w d n nn g m
Administration for treatment of S. pyogenes or S. agalactiae is not necessary for clinical purposes and need not be done routinely, since as with van- de la gélose Mueller Hinton avec 5 % de sang de mouton pour S. pneumoniae, les streptocoques b hémolytiques et du groupe viridans) dans des h o mph n o m op n m do n ppo n ou n pou ou o d H n u n u d ou p n n n b u m qu mp n mo n o n b n n m o n pp n und o h d n Ab hn RG BN ow u ng b n ng G n w Mu H n on Ag nd d
A m — — a The “Intermediate” category includes isolates with antimicrobial agent MICs that approach usually attainable blood and tissue levels and for which h ß n R n u g und nd M h n m nn h u n ob und udomon pp ow nd ob
comycin, resistant strains have not been recognized. Interpretive criteria are provided for pharmaceutical development, epidemiology or monitoring boî tes de Pétri ensemencées avec des cultures pures d’isolats cliniques. Après incubation, les boî tes de Pétri sont examinées et les zones d’inhibition p m n d qu d ph o hd n n D m m un po m p d un n g n ou ph o oqu n o n B h nd u on h n ± C Umg bung u h nd A on m mm C dm mm C o m mm
response rates may be lower than for susceptible isolates. The “Intermediate” category implies clinical applicability in body sites where the drugs are g mn g g o nn h g w d n d d g bn n h Vo h g d mp nd h g g nd h p u h
for emerging resistance. Any strain found to be intermediate or resistant should be referred to a reference laboratory for confirmation. entourant les disques sont mesurées et comparées aux gammes de taille de zone établies pour les différents agents antimicrobiens afin de mo n d u n qu h om n h om n o po o b dn ppo omm n ou n p ppo C podo m mm und C on mm Qu on o mp h ung n nd o A CC w nd b u g üh
m — — physiologically concentrated (e.g., quinolones and β-lactams in urine), or when a higher than normal dosage of a drug can be used (e.g., β-lactams). mh u g n w nd n m An b o ub n um g n u n N hw on m b ph o o n u U n
To obtain information on testing β-hemolytic streptococci for inducible clindamycin resistance consult M100-S21.7 déterminer l’agent ou les agents les plus adéquats pour le traitement antimicrobien. m podo m uo m h om n on d g n o u qu p u n u pou qq Un po pou m p d n p n n mp n mo n Un d m p m d n m ndu on und n ub on n u N o nB b u h od h D h h h n nd m B n om K pn umon A CC A on m mm C dm mm C o m mm C podo m mm und C on
Do n D —
The “Intermediate” category also includes “buffer zone” which should prevent small uncontrolled technical factors from causing major discrepancies in
LIMITATIONS OF THE PROCEDURE interpretation, especially for drugs with narrow pharmacotoxicity margins. REACTIFS – Les disques Sensi-Disc sont des disques de 6 mm fabriqués à partir de papier absorbant de haute qualité imprégné d’antibiotiques ou m n mp qu d n on d o p o du d p d H moph u u d n b og mm d un d om d n u p n n h N gono ho u ob n un n o m on p d m o og qu R nd d H mm on n O nB h n g w d n Au d h ung g n u g bn mu o g gg h w d n mm D V w ndung on m h n m An b o um ü d n ng b d N hw mp nd h h no p h
1. The test as herein described applies primarily to rapidly growing aerobic pathogens. For fastidious bacteria other than H. influenzae, d’autres agents chimiothérapeutiques en quantités déterminées de manière précise. Les disques sont clairement identifiés des deux côtés par des pou g n n m ob n n on n g n p du pou p n h g d p n nd du C p nd n ou h don n m d on h omo om qu n p u n m n d n qu p d d n b upp m n H u g hö d nb nn po und n g Kon o mm u d Un u hung on n h n o n B gung o d n d Anw ndung on C o m und C d m u mm n n und n Komb n on m C u n u n
b Policies regarding generation of cumulative antibiograms should be developed in concert with the infectious disease service, infection control person-
N. gonorrhoeae, S. pneumoniae and other streptococci, consult M100 (N. meningitidis) or M45.7,13 Otherwise, test by the dilution method. A lettres et des chiffres désignant l’agent et sa concentration. (Voir le tableau des concentrations des composants actifs.) La teneur en agent des n b og mm d p d H moph u pou g n p u n u u u ou u ud p d m o og qu qu m hod d d u on u d qu ou d d u on CM n g o gono oqu p odu n d d m d on mm d H mm on ndu hm on mm ü n n d n m ob nW o d n V b ndung m C u n u g w d g h n
nel, and the pharmacy and therapeutics committee. Under most circumstances, the percentage of susceptible and intermediate results should not be n ob W nn o on mon und h g pp un u h w d n o n nu Amp n n Ch no on und
Testing of anaerobes requires special procedures.11 no n NX disques est mesurée par les méthodes définies par la FDA ou par des méthodes similaires ou comparables à celles publiées dans le Federal Register p d po o u u qu pn umon d n b u p n n u mn pp ou d qu d un d p n n on p ob b m n d ou h p odu d m ou o d m d m u m d H mm on w nn d W o ng w d = B Qu on o mp h ung n nd n g mm o A CC
combined into the same statistics. m hop m u m ho o ou n m ß g g und do um n w d n D üb h n u o n n n o on
2. The classifications of Resistant, Intermediate and Susceptible vary only by one millimeter, which is within normal laboratory error. Some américain. p ood nd D ug Adm n on DA m n pou m n d p og n ou g n on p p b u u m hod d n b pou un d n on p d d n p n n m d on p m d qu d n V g öß ung d H mm on ndu hm um mm b n m n g p ü n n m ob nW o b w
c These zone diameter standards and quality control limits apply only to tests with Haemophilus spp. using Haemophilus Test Medium (HTM) incubated in mon pp u mp nd h g g n Ch o mph n o und n C ph o po n d d nG n on g und do um n
cultures may give a borderline zone that varies from day to day or from laboratory to laboratory; such cultures are relatively uncommon. N du n qu on don up u n ou n pu qu omm pou n om n u un ou h n n g g nüb n H mm on b n ü ung n Komb n on m C u n u po mm K pn umon A CC d n
5% CO2 (16♣-18 h). H. influenzae ATCC 10211 is recommended as a useful additional quality control strain to verify the growth promotion properties of
2 4 5 6 7 8
3
3. For detecting pneumococcal and enterococcal resistance, strictly adhere to CLSI recommended methods.6  d n b d p og n p n n on m n n pu qu m oo g n m un m n n b

 BBL™ Sensi-Disc™ Antimicrobial Susceptibility


HTM. The zone margin should be considered as the area showing no obvious growth visible with the unaided eye. Faint growth of tiny colonies that g n n D on ou n n ou h d d qu h un Un X u d n d qu d h qu ou h d n d n p on on ou n d n d h h ph m u qu d p d m o og ou d u d pp on d w d n B mon und h g pp önn n Am nog o d ow C ph o po n und C ph m n d n und w nG n on
4. Antimicrobial agents other than those listed in the Chart may be in current use. Susceptibility tests employing these agents should be interpreted
Zone Diameter Interpretive Chart † may appear to fade from the more obvious zone should be ignored in the measurement. When testing Haemophilus with amoxicillin/clavulanic acid nd qu qu u on n m d m n od ou h do n u d n d bu u n D BB p n n C n ou h d g p u n ou o donn d u n m d d p n n n o h n n nd b n hn h w m und o o nn h mp nd h do um n w d n
nou n ou ou h qu donn d u n m d ou n do n o un bo o d n pou
on the basis of presence or absence of a definite zone of inhibition and should be considered as only qualitative until such time as interpretive on HTM, include E. coli ATCC 35218 as the control strain. The acceptable limits for E. coli ATCC 35218 are 17-22 mm for amoxicillin/clavulanic acid when p u u mod d d bu u un d bu u d d qu un qu un d bu u d d qu pou bo d on m on g n p n n o un du u p d Mo g n o u o d n n ob C ob und önn n w h nd ng h p m C ph o po n n d d nG n on n w d n
Test Discs zones have been established. All zone diameters should be recorded.
5. ESBL confirmatory testing is only valid when the four discs (cefotaxime, cefotaxime/clavulanic acid, ceftazidime, ceftazidime/clavulanic acid) are



Zone Diameter
Interpretive Standards (mm)
E. S. P.
Control Zone
Diameter Limits (mm)
H. H. N. S.
incubated in ambient air.
d These zone diameter standards and quality control limits are applicable only to tests performed using GC agar base and 1% defined growth supple- d
mm d d
d qu pou
bu u
bo
u o pp
mm
u d d qu pou bo mm un d bu u u o pp u D m m pou un n o m on
nd m n on u do um n M
u p o du d d p o oqu h mo qu pou n ndu b  d qu d u o o p u
on n n du ng p on d
u omm p
u on n n du ng d h
n n d n mpo qu u m d
n on nn n g n
u m n omm
m n p pou
m u
u m d ou
D h b önn n n ng mp nd h
mü n gg du hg üh w d n
o nn h b on b g nn h h p b g nn n w d n W d ho o

English: pages 1 – 4 Deutsch: Seiten 7 – 9 Español: páginas 11 – 13 8840621 used simultaneously. Individual usage of these discs is not recommended by CLSI.6,7 ment (e.g., BBL™ GC II Agar with IsoVitaleX™ Enrichment) incubated in 5% CO2 (20 – 24 h). A m n p u on ou d gno n o m hop m g o Mu H n on do on n mo n po b d h m d n pou u md ou m hop m ou
coli aureus aeruginosa influenzae influenzae gonorrhoeae pneumoniae M D A M HOD B p um m n B nd on g mn g n g n p odu n m d du h Mu on n G n n ü no m
Français : pages 4 – 7 Italiano: pagine 9 – 11 Português páginas 13 – 16 2011/07 Antimicrobial Disc Resis- Inter- Suscep- ATCC ATCC ATCC ATCC ATCC ATCC ATCC d mn g o Mu H n on d n u u mm n b d h mn d h m d n on p u ou h d n o o u
6. Accurate results are a function of the correct storage and maintenance of quality control organisms. This is especially true for E. coli ATCC 35218 e These zone diameter standards and quality control limits are applicable only to tests performed using Mueller Hinton agar supplemented with 5% u mod d mp o p om n d d qu d p nd n non u m n d d d qu m g m n d pp qu n m n u b ob o n pd ou b g n ou H n u n N p md m m n n h n mm on K b pp und o d B p odu n nd mög h w o
o n m po n m n up po no BD Kon d n o BD p æ n n o n u on K u u uh uh and K. pneumoniae ATCC 700603, because spontaneous loss of the plasmid encoding the β-lactamase has been documented. Refer to CLSI stan- Agent Code Potency tant mediate a tible b 25922 25923 27853 49247 c 49766 c 49226 d 49619 e defibrinated sheep blood incubated in 5% CO2 (20 – 24 h). Interpretive standards apply to S. pneumoniae and other streptococci as indicated. d u on d u u d on ô d h n on d qu d bo d on onn p d un gono ho pn umon u p o oqu on u do um n M N m n ng d ou M non u p un A CC ou A CC d d qu d m hop m u m ho o o Un on d nh b on mm qu h nb n o mp nd h g g n ng d ub n n h p n M n h d mm g n H mm on n d
on ug om oh u BD nd g Åð ï ù Þó ï ïð ü á ðñüóùðï ç BD á ï ç Ah n u dard M2 for recommendations on the correct storage and maintenance of quality control organisms.6 Results may be inaccurate if specified criteria are applied to organisms other than those listed. Interpretive criteria for streptococci other than S. pneu- mp u d o g d qu d u u n m n d pou u d p o on nd qu un n u u mm n b d h mn d h mdn un h b d G öß ü n no m mp nd h opu on do h ob h b d no m n G n w ü b mm B p um
Ertapenemh,i ETP-10 10 µg 29 – 36 24 – 31 13 – 21 28 – 35 m hod d d u on u on d n ob qu d p o du p
BD h p õ N udo mo n u ø u o BD g o o o o o Kon dn o BD p n n o m 7. The ability to detect vancomycin-resistant Staphylococcus aureus (VRSA) with this product is unknown. Additional testing methods as recom- moniae are proposed based on population distributions of various species, pharmacokinetics of the antimicrobial agents, previously published literature R p hn qu d p p nd p u on n gu u on d ng m ob o og qu Ap u g uu  gono oqu donn n d d m d on mm u ou d un d qu d n µg o pond n n g n un o d C ph o po n od A on m g n o h mm o n un Anw ndung d B G n w u po n B odu on
Enterobacteriaceae and Staphylococcus spp.j ≤15 16 – 18 ≥19 on R n n m d n b n u m n d un m m qu o pond un m g d u ou n
n o m on Ab u n u u ow n on u o n mp d w w m BD n u um n ho mended by the Centers for Disease Control and Prevention (CDC) should be used when performing susceptibility testing on S. aureus isolates, and the clinical experience of certain members of the CLSI subcommittee. Systematically collected clinical data were not available for review with u u p n ou m on m n N gono ho n n RNG don n m d on p m d qu C ou h d n on m g w d n b o g bn ü n n B p um C ph o po n od A on m ng g b n w d n And mm
Haemophilus spp.c — — ≥19 20 – 28 27 – 33 n bo o C n u u p u n donn un d on d m n on ou n ou bo o p d
up u po o no BD Kon o B on D n on p n n ö n n ng Свърж м ни пр д ви л н BD particularly methicillin-resistant S. aureus (MRSA). These tests include nonautomated MIC methods (e.g., broth microdilution or agar dilution) and many of the compounds in the group.7 Despite the lack of reliable disc diffusion interpretive criteria for S. pneumoniae with certain β-lactams, S. n u on pou on on p un d d u on CM µg m ou n o un bo o pub pou nqu p d m o og qu w n hg g b n n m m H d no m n G n w n m d od n g g n n od m h d
Erythromycin E-15 15 µg — 22 – 30 — u u m n
ин р ии Con p n n u dumn o o BD p n u n u un T m n BD m n d n n a vancomycin agar screen test (Brain Heart Infusion Agar with 6 µg/mL of vancomycin). These methods require a full 24 h of incubation to detect pneumoniae ATCC 49619 is the strain designated for quality control of all disc diffusion tests with all Streptococcus spp.  ou o d ph o oqu o d d m d on pou n om n d mm ou mo n do n p un ub n n B n B p odu nd n mm n o nd on ndu hm ü n od m h d B p um C ph o po n
D p on on d qu n + C g u du bo o qu mm n ou qu ou d on d n h pn umo oqu n o oqu u upu u m n p o du omm nd p
Ob om o nom p d n u omp n BD upu Дл пол ни ин р ций в ж ь м ным пр д ви л м VRSA. For additional information, refer to the CDC web site.12 Staphylococcus spp. r and enterococci r,yy ≤13 14 – 22ii ≥23ii f FDA-approved zone size recommendations from drug manufacturers not included in CLSI M100-S21 (M2-A10).7 m hod d CM d n p o du d d u on u d qu n pou d n ou h p n n un n b du od ü A on m n G g nw on C u n u m ph no p h n B gung g öß w d n B nb g n B
mp u p on n p u n p qu qu n d d qu u n pou un m n C n C
омп нии BD Ө ң д ң ж р л БД ө л н ж н п н лыңы Kon o nog p d n BD upu S. pneumoniae and other streptococci e,r,s ≤15 16 – 20 ≥21 25 – 30e n om n CM d µg m d ou h n b CM omp n µg m m m p h d n ub on D p u p odu nd n mm n o d n p on n g g n n n C ph o po n und A on m ng g b n w d n
REFERENCES g Another E. coli (ATCC 35218) has been designated for quality control of discs containing combinations of β-lactams and β-lactamase inhibitors. This d qu p mn do n on d p n u ong u C D u g n n m ob n qu u d n b u on p o u d n b g n do n h ußno ü B u h und B gung D n h dung ob B u h b nU n o n du hg üh w d n
R o p odu b o C m b n om o do upno n C n d n n ob u odu gæng g 1. Bauer, A.W., W.M.M. Kirby, J.C. Sherris, and M. Turck. 1966. Antibiotic susceptibility testing by a standardized single disk method. Am. J. Clin. Fosfomycin z FOS-200 200 µg 22 – 30ii 25 – 33 — strain produces a β-lactamase which should be inactivated by the inhibitor. When used in conjunction with ATCC 25922, both components of the ou h d u u n n om n VR A CM µg m p u n o u m n d m n ub u ou d un d qu
ou h h u u qu nd mp u mb n n d ou R m d qu n p n b n u p n ou b n d un on d nh b on n on d un qu m n omm qu n o u bo n n B g o n w d n wob n h p und n on on o p ub ü h g n nd ü d
h C mæ n ng n nd p n oo d u d m on o g C m g o m o u ou m Pathol. 45:493-496. E. coli and E. faecalis only ≤12 13 – 15 ≥16 combination discs can be monitored. Control limits with this strain for amoxicillin/clavulanic acid are 17-22 mm, for ampicillin is 6 mm (i.e., no zone), n om n d d p g u g o pou n om n d pou n o oqu g o œu µg m d
nu u g u un o po d d qu mn Un o ou d qu do n on d n nd n qu on d n p on o n b ou d m d on do n Un u hung on o u m b u B odu on h M
qu g C du p odu qu h odu ü d V ügb C m odu Ôï ðñï ü á áè ó ï Gatifloxacin 30 – 37 27 – 33 20 – 28mm for ampicillin/sulbactam are 13-19 mm, for piperacillin are 12-18 mm, for piperacillin/tazobactam are 24-30 mm, for ticarcillin is 6 mm (i.e., no zone) n om n p u u pou m o n b d d on d ou h n n m d n om n d
2. Ryan, K.J., F.D. Schoenknecht, and W.M.M. Kirby. 1970. Disc sensitivity testing. Hospital Practice 5:91-100. GAT-5 5 µg un p n n m n n h d on m on d B n d qu o qu qu d qu o m o m d u n qu dm
Ü ç áö ñ ç óÞ á óç CE d m m n őC m g odo o d pon b h m hoC u u n n ub n g o p nd n h omp C u on d un ou h d on ô d qu n b qu N h n ob N h n ob uß ug no und A n ob pp B p und m oph o n
3. Federal Register. 1972. Rules and regulations. Antibiotic susceptibility discs. Fed. Regist. 37:20525-20529. Erratum, 38:2756, 1973. Enterobacteriaceaeddd and Staphylococcus spp.aa ≤14 15 – 17 ≥18 and for ticarcillin/clavulanic acid are 21-25 mm. The E. coli ATCC 35218 control strain contains a plasmid-encoded β-lactamase (non-ESBL); therefore, the U d qu mo n n np m dm d u n qu on u mu n m n C n omm nd p u on nd du d d qu
C m o n p odu o p p odu m ng n om d h C m O do pno p odu u n o mu n C A CC n pou u p ou h A CC p u u omm on ô po d m d V dünnung m hod g w d n h M ü B p und m oph nd d n p on nd d ü d
4. Ericsson, H.M., and J.C. Sherris. 1971. Antibiotic sensitivity testing. Report of an international collaborative study. Acta Pathol. Microbiol. Scand. Sec. P. aeruginosa, Acinetobacter spp. and enterococciz ≤14ii 15 – 17ii ≥18ii organism is resistant to many penicillinase-labile drugs, but susceptible to β-lactam/ β-lactamase inhibitor combinations. The plasmid must be present in d qu don d d p mp on d p g m n ou h don on qu mm n p
n V d pon b d d do p odu o p m C no ó u o on o u p omno C n n h dn do ob n on d u d p nd d ond on pp op d on on d m n nd ou h d on ô d qu C n n qu d n o m on omp m n u p n ou gn on n qu d o n on p d pon b H mm on ndu hm und ü d Qu on o nC M u nd n
B. Suppl. 217:1-90. H. influenzaec and H. parainfluenzaec — — ≥18 33 – 41c — the control strain for the quality control test to be valid; however, the plasmid may be lost during storage at refrigerator or freezer temperatures. See d qu du n m n ou d qu mp u mb n p nd n ou un nu ou n
ob u V d pon b d d d m do C n qu d p odu o odu n nn g ng g om d C m Виж p u m n pou o A CC K pn umon A CC p qu p pon n du p m d od n bo o p u n ug bon d mn ou h MR A pu d n on n d d d CM pou n om n ug no nn b ng h p g g n An b o n w d n o d n ng mp nd h nd önn n nn h b on
N. gonorrhoeaed ≤33 34 – 37 ≥38 45 – 56d “Limitations of the Procedure” and M2 for additional details. n u p b d p om n n d on nu u
и н прод н ли но н н СЕ V p n m uu C p h p odu u u CE g o ü ün 5. World Health Organization Expert Committee on Biological Standardization. 1977. Technical report series 610. W.H.O., Geneva. m on m po no m M du C pou p nd onn n d ond on pp op omm nd d A h u u n p d donn pou p m d omm nd u on d d d p g u g o pou b g nn h h p b g nn n w d n D w d ho Un u hung on o n nn no w nd g w d n
n b u un Po o n u CE n n pn p o od Пров рь н ли и н CE н и прод Po CE S. pneumoniae and other streptococci ≤17ii 18 – 20ii ≥21ii 24 – 31e h Isolates of pneumococci with oxacillin zone sizes of ≥ 20 mm are susceptible (MIC ≤ 0.06 µg/mL) to penicillin and can be considered susceptible on d nh b on o m p d qu m oo g n m d on ô on n on p on o m on on m n nd ou h d on ô d qu
6. Clinical and Laboratory Standards Institute. 2009. Approved standard M2-A10. Performance standards for antimicrobial disk susceptibility tests, 10th ed. ph o oqu o gu n g n o ou ph o oqu un CM d n om n µg m un bo o D mp nd h on udomon ug no d b n nm h bo o wu d n h du h d
o n u n n pn p o od mo p o od C o n om do upn u u u op (non-S. pneumoniae, b-hemolytic only) e to ampicillin, amoxicillin, amoxicillin/clavulanic acid, ampicillin/sulbactam, cefaclor, cefdinir, cefepime, cefetamet, cefixime, cefotaxime, cefprozil, p o du do d n o u p u du u d qu n m n m n p p on ou
CLSI, Wayne, Pa. p du p odu d d ph o o u u u n n om n VR A n p onnu D p o du d d n B h nm hod u g m n nn b n ng n ub on on b u h od n b o d g bn
ceftibuten, ceftriaxone, cefuroxime, cefpodoxime, ceftizoxime, ertapenem, imipenem, loracarbef, and meropenem for approved indications, p o ond u n on mm du m u ou n o d u u
7. Clinical and Laboratory Standards Institute. 2011. M100-S21 (M2). Disk Diffusion Supplemental Tables, CLSI, Wayne Pa. Gemifloxacin GEM-5 5 µg 29 – 36 27 – 33ii 19 – 25mm,ii dd onn qu omm nd p CDC C n o D Con o nd n on do n u o d u on ww  o qu on on d n om n on d n o oqu g o d n on p nd n h omp mp nd h ng g b n w d n nn
INTENDED USE – These discs are used for semi-quantitative in vitro susceptibility testing by the agar disc diffusion test procedure of com- and these agents need not be tested. Penicillin and cefotaxime or ceftriaxone or meropenem MICs should be determined for those isolates with
mon, rapidly growing and certain fastidious bacterial pathogens. These include the Enterobacteriaceae, Staphylococcus spp., Pseudomonas 8. Baker, C.N., C. Thornsberry, and R.W. Hawkinson. 1983. Inoculum standardization in antimicrobial susceptibility testing: evaluation of overnight Enterobacteriaceaell,ddd ≤15 16 – 19 ≥20 d d p mp on pp qu un qu m n u d qu on nu d n d ou h n on on o m m n d d n b u d o d u u np u d u u n m n MR A C omp nn n mn p np n um p n d un o ou d ou u om d o n n u d on d nh b on
oxacillin zone sizes ≤ 19 mm because zones of ≤ 19 mm occur with penicillin-resistant, intermediate, or certain susceptible strains. Isolates should ph o o u pp ph o o u pp önn n w h nd n ng n h p m Ch no on n n w d n D h b önn n n ng
agar cultures and the rapid inoculum standardization system. J. Clin. Microbiol. 17:450-457.
c
H. influenzae and H. parainfluenzae c — — ≥18 30 – 37 — u n u on m hod d CM non u om p m od u on n bou on ou d u on n g o d d p g u g o pou nd qu un n m oo g n m p n n d on n m d do n un m hod d CM omm d
spp., Acinetobacter spp., Enterococcus spp., Vibrio cholerae and, by modified procedures, Haemophilus influenzae, Neisseria gonorrhoeae, not be reported as penicillin resistant or intermediate based solely on an oxacillin zone ≤ 19 mm. Amoxicillin, ampicillin, cefepime, cefotaxime, mp nd h o nn h b on b g nn h h p b g nn n w d n W d ho o mü n gg du hg üh
S. pneumoniaee ≤19 20 – 22 ≥23 28 – 34 CHAN ON No m m n n do p pp qu d m n d h n on Vo ub qu n u on n om n g o œu µg m d n om n C d m nd n h u omp d n ub on pou d on d n do um n M du C Con u u d d p g u g o pou n om n d d n b u D d CM M
Streptococcus pneumoniae and other streptococci. NOTE: Special procedures are required for testing pneumococci, enterococci and methicil- 9. Clinical and Laboratory Standards Institute. 2010. Approved guideline M45-A2. Methods for antimicrobial dilution and disk susceptibility testing of ceftriaxone, cefuroxime, ertapenem, imipenem, and meropenem may be used to treat pneumococcal infections; however, reliable disc diffusion w d n
pou p p on d no u um D n m u du po b u u do n p p p d h n on d VR A ou p u mp n o m on po u n n du CDC On n m ob d ou h d pn umon donn n un d m d on d nh b on pou n om n < mm n o d
lin/oxacillin-resistant staphylococci, for performing β-lactamase tests and for screening and confirmatory tests for ESBLs; see the “RESULTS” infrequently isolated or fastidious bacteria. 2nd ed., CLSI, Wayne, Pa. Gentamicin susceptibility tests with these agents do not yet exist. Their in vitro activity is best determined using an MIC method. Penicillin and cefotaxime or u d n M hod n ü d n N hw on m h n n n ph o o n g hö n d O n und d C o n B h n
p n d bu d ou m n n b o qu m n d p du do um n M du C M D D u on upp m n b om n nd d o An m ob ou h un bo o d n
section. 10. Clinical and Laboratory Standards Institute. 2009. Approved standard M7-A8. Methods for dilution antimicrobial susceptibility tests for bacteria that Testing enterococci GM-120 120 µg 6 7 – 9 hh Ž≥10 — — — ceftriaxone or meropenem should be tested by a reliable MIC method (such as that described in CLSI document M79) and reported routinely with u m A od d du h m A od o n ow u d n n b nd nd o n B u h B b nn nd
CSF isolates of S. pneumoniae. Such isolates should also be tested against vancomycin using the MIC or disc method. With isolates from other M HOD u p b ng b u upp m n pou d u on u d qu No m d p o m n pou d n b n m ob nn  n on du nomb m d u po b h o mph n o h om n n ou do n ou m no n
For zone diameter interpretive criteria adopted in France, refer to the instructions in the French language section of this insert. grow aerobically, 8th ed. CLSI, Wayne, Pa. for high level resistance n,o,gg V g ng nh g b d Vo h nd n n on R n g g nüb nd n ub n n u h n n H nw u R n g g nM h n
sites, the oxacillin disc screening test may be used. If the oxacillin zone size is ≤ 19 mm, penicillin and cefotaxime or ceftriaxone MICs should be M ou n D qu n D pou n b og mm omm nd qu u qu uo on no m omp p u ob nu up du C n nd bo o nd d n u W V Ro d u W n A mp n p u n u pou n o oqu n n om n VR omm nd d on u un p d
11. Clinical and Laboratory Standards Institute. 2007. Approved standard M11-A7. Methods for antimicrobial susceptibility testing of anaerobic bacteria, Enterobacteriaceae, GM-10 10 µg 19 – 26 19 – 27 16 – 21 O n A d ng nd m n h m h n n n mm on u u MR A w b p w d ng n mm d b n n
SUMMARY AND EXPLANATION – Agar diffusion methods employing dried filter paper discs impregnated with specific concentrations of anti- determined. To determine susceptibility of streptococci other than S. pneumoniae to cefdinir, use the 10-unit penicillin disc; isolates with penicil- Un u non omp d n no m M on p qu d n u no nb d p g ou o on m d n u
7th ed. CLSI, Wayne, Pa. P. aeruginosa, Acinetobacter and staphylococci ≤12 13 – 14 ≥15 M u qu m non ou n M u d u u u m oo g n m d on ô d qu G m n h u nd n n on n g und n w d n n h mu n
microbial agents were developed in the 1940s. In order to eliminate or minimize variability in this testing, Bauer et al. developed a standard- lin zone sizes ≥ 2 Ž 8 mm are susceptible to penicillin and can be considered susceptible to cefdinir. pp op CM po no m M
h,i m d bo o n pou d n b og mm p m hod d d u on u d qu n g o on Au un n b n u d d n b o qu N gono ho p g d on ô donn un qu m n d n MR A und m h n n Ko gu n g ph o o n o n n g g n n n C b p n m C ph m
ized procedure in which Mueller Hinton Agar was selected as the test medium.1,2 12. Centers for Disease Control and Prevention. www.cdc.gov/ncidod/dhqp/ar_visavrsa_labFAQ.html Imipenem IPM-10 10 µg 26 – 32 — 20 – 28  n m d omp nd o don CM d g n n m ob n pp o h n n g n n u n d n ng
i A streptococcal isolate that is susceptible to penicillin can be considered susceptible to ampicillin, amoxicillin, amoxicillin/clavulanic acid, ampicillin/sul- p o du nd d p un nd d d u b d M nd n ou n m d B C M % d on ô d qu und Komb n on n u m m H mm p o o o od g n h b h w d n un bh ng g on d n m
Various regulatory agencies and standards-writing organizations subsequently published standardized reference procedures based on the 13. Bushby, S.R.M. 1973. Trimethoprim-sulfamethoxazole: in vitro microbiological aspects, p. 10-30. In M. Finland and E.H. Kass (ed.), Trimethoprim-sulfa- Enterobacteriaceae, P. aeruginosa, u pou qu u d pon p u n pu b qu pou o n b n m d ugg un
bactam, cefaclor, cefazolin, cefdinir, cefepime, cefprozil, cefotaxime, ceftibuten (group A streptococci only), ceftriaxone, cefuroxime, cefpodoxime, po d o B C H O m d H O % o o M N V d d un p opho om d m On n m ob d ou h d p o oqu h mo qu donn n un d m d on d nh b on d mo n d mm pou d n ub n n h n n n o g bn n D G und d ü d d m n on do um n n n on n du h
Bauer-Kirby method. Among the earliest and most widely accepted of these standardized procedures were those published by the U.S. Food methoxazole: microbiological, pharmacological, and clinical considerations. University of Chicago Press, Chicago. Acinetobacter and staphylococci j ≤13 14 – 15 ≥16 po b d pp on n qu u n ud n om qu où n b o qu on ph o og qu m n on n p mp
ceftizoxime, cephalothin, cephapirin, cephradine, imipenem, loracarbef, and meropenem for approved indications, and need not be tested against d p d u o pond n b o p on nm do omp n mp n pm o m on ou p n n n o d ou h un bo o d n m h n n ph o o n nu h h u m An b o ng p o h n h b n und b h n h üb ug nd D n
and Drug Administration (FDA)3 and the World Health Organization (WHO).4,5 The procedure was adopted as a consensus standard by the Haemophilus spp. c — — ≥16 21 – 29c — those agents. Viridans streptococci isolated from blood and normally sterile body sites (e.g., cerebrospinal fluid, blood, bone, etc.), should be tested for qu no on m n d n u n ou o qu d do d n b o qu p u qu no m p u n dm n p
Zone Diameter Interpretive Chart † n u on omp on ô p u u
mn n m d omp nd u un on mpon qu d mp h qu d u hn qu m n u non bbb  d o on du on nu d d qu d o n u d n m u ond on u u A CC un d m d on u Do um n on d n h nW m on m nb m n g g n MR h n ü o n mp nd h u u und
Clinical and Laboratory Standards Institute (CLSI, formerly NCCLS) and is periodically updated.6,7 The latest CLSI documents should be con- Kanamycin K-30 30 µg 17 – 25 19 – 26 — penicillin or ampicillin susceptibility using an MIC method. p on d no u um u u d on ô u u d h n on n p b d mm Ko gu n g ph o o n mü n d g bn ü p n und o b h C ph m Komb n on n u m
sulted for current recommendations. Zone Diameter Control Zone Enterobacteriaceae and staphylococci ≤13 14 – 17 ≥18 on ô u n d d od n m u d n p on n p u d n d n b o qu n un m g d ph m o o
j Penicillin-susceptible staphylococci are also susceptible to other penicillins, β-lactam/β-lactamase inhibitor combinations, cephems, and carbapenems un o o on d G m U un qu m n d u u pu  ou mp n pm o m on p n n p o oqu h mo qu un qu m n omp nn n m H mm und C b p n m g n p h nd d g bn d un V w ndung d Rou n n p on n
o
PRINCIPLES OF THE PROCEDURE – Discs containing a wide variety of antimicrobial agents are applied to the surface of Mueller Hinton Agar Interpretive Standards (mm) Diameter Limits (mm) Levofloxacin LVX–5 5 µg 29 – 37 25 – 30 19 – 26 approved for use by the FDA for staphylococcal infections. Penicillin-resistant, oxacillin-susceptible strains are resistant to penicillinase-labile penicillins ou h d p o oqu p og n qu om d g nd o on n g n d g oup A p og n C ou G ou h wu d n b h w d n ü o n n u u und Ko gu n g ph o o n MR h n n mög h w
b onn d o nq o on mb b n un n m n u d o ou n d n m b D po qu p odu on d n b og mm umu d n d n n od d m d n u
plates (or Haemophilus Test Medium Agar for H. influenzae, GC II Agar with IsoVitaleX™ Enrichment for N. gonorrhoeae or Mueller Hinton E. S. P. H. H. N. S. Enterobacteriaceaeddd, P. aeruginosa, but susceptible to other penicillinase-stable penicillins, β-lactam/β-lactamase inhibitor combinations, relevant cephems, and carbapenems. Oxacillin-resis- n g n d g oup B g ou pm o m on p o oqu V d n omp nn n ou h nd m An b o w B n n Komb n on n u m m H mm C ph m und C b p n m n o
d bou on d qu omm du bou on d p o ou d Mu H n on pou m oo g n m g n p onn ng g d n p n on d n on om d ph m o og d h p u qu D n p up d pou n g
Agar with 5% Sheep Blood for S. pneumoniae, β-hemolytic and viridans group streptococci) that have been inoculated with pure cultures of coli aureus aeruginosa influenzae influenzae gonorrhoeae pneumoniae Acinetobacter, staphylococci aa and enterococci ≤13 14 – 16 ≥17 tant staphylococci are resistant to all currently available β-lactam antibiotics. Thus, susceptibility or resistance to a wide array of β-lactam antibiotics may h mo qu om d p o on n g n du g oup A C ou G ng no u n nn m n pp m n qu u n n h nd d ng n h w m D g bn ü d A n m o n d nn m n poo o od
clinical isolates. Following incubation, the plates are examined and the zones of inhibition surrounding the discs are measured and compared be deduced from testing only penicillin and oxacillin. Routine testing of other penicillins, β-lactam/β-lactamase inhibitor combinations, cephems, and n ub u u n bou on C p nd n h n u qu ob n un u b d qu n un d u n b n m d n d n p omb n d n un m m donn qu g n h b h w d n D U h h ü g d n d d m n do um n MR n on n h h u m
Antimicrobial Disc Resis- Inter- Suscep- ATCC ATCC ATCC ATCC ATCC ATCC ATCC Haemophilus spp. c — — ≥17 32 – 40c — nd d d u b d M nd n on U Cm g m n po b d p p d m n m o ngu u n m du on u mu n bo
with established zone size ranges for individual antimicrobial agents in order to determine the agent(s) most suitable for use in antimicrobial carbapenems is not advised.7 For oxacillin-resistant staphylococci, report as resistant or do not report. C no m d d m d on m du on ô d qu pp qu n u m n u pou p d H moph u u n h p np h nb w d b h no h n üb ug nd n n h n D n o g n d d n h W m d ub n n
Agent Code Potency tant mediate a tible b 25922 25923 27853 49247 c 49766 c 49226 d 49619 e S. pneumoniae and other streptococci ≤13 14 – 16 ≥17 20 – 25e ddd  ou h d mon n b u uo oqu no on n d n d qu p u n o un h h p u qu
therapy. un u p n on b d bou on ou d um ph o og qu d o on p u un g o n bo d m u pou d d n on d H moph u M H n ub on ou % d CO h H n u n A CC omm nd b g n wü d n n Rou n ung on U n o n on p oph u w d n h mp oh n d n on n u Kon n on n
(non-S. pneumoniae, b-hemolytic only) e k Rare, β-lactamase-negative, ampicillin-resistant (BLNAR) strains of Haemophilus influenzae should be considered resistant to amoxicillin/clavulanic acid, ou un pon d h p n p ou oqu no on pou un mon o n n o n n n u d
REAGENTS – Sensi-Disc™ brand discs are 6-mm discs prepared by impregnating high quality absorbent paper with accurately determined Amdinocillin f AMD-10 10 µg 23 – 29 — — p un nu d n ub on u un m u non omm un g o u ng ou un g o u ho o pou omm ou h d on ô d qu omp m n pou p op d u d o n du M H m d on do g n d on d n h ömm h w u B h nd ung u un omp H nw g n on n w nd n An b o B
ampicillin/sulbactam, cefaclor, cefetamet, cefonicid, cefprozil, cefuroxime, and loracarbef despite apparent in vitro susceptibility of some BLNAR strains mon do n g m n pou n d n d qu ou o qu on n b u uo oqu no on
amounts of antibiotic or other chemotherapeutic agents. Discs are clearly marked on both sides with letters and numbers designating the Enterobacteriaceae ≤15 — ≥16 Linezolid LZD-30 30 µg — — 25 – 32ii H n u n N gono ho m hod d p p on d un u p n on d d o on p b on d omm g on n mon n u un o n m n b œ nu Un o n p u b d o on m nu u n N o u n on m hop m u m ho o od n uo h no on m U n w d n
to these agents. n d n d qu u ommun qu u m d n qu o n p u p d qu p un m n uo oqu no on
Staphylococcus spp. — — ≥21 pou p d ph o o u pn umon u p o oqu p d H moph u nd n nu d on p u pp n n do p p n omp o d m u o d d H moph u d
agent and the drug content. (See chart giving concentrations of reactive ingredients.) The drug content of discs is assayed by the methods Amikacin AN-30 30 µg 19 – 26 20 – 26 18 – 26 l Class representative for ampicillin and amoxicillin. omm nd d on u un p d m d n u ü n o m on n u Vo u g on m A m R n n ph o o u pp b m n on C o n µg h C M
Enterococcus spp. ≤20 21 – 22 ≥23 N gono ho o on mo n d u n qu u g o H M n u o A CC omm ou h d on ô m p b pou
established by the FDA or by methods similar or comparable to those published in the United States Federal Register. Enterobacteriaceae, P. aeruginosa, m For V. cholerae, the results of disc diffusion tests for ampicillin, tetracycline, trimethoprim/sulfamethoxazole and sulfonamides (i.e., percentage of sus- d D u n pou ob n un u b d qu n un nd d d u b d M nd Comm d u n o A CC on mm pou o on mo n d u n qu o qu n ub d n mb n Au un n b n u d d n b o qu u u p g d on ô donn un qu m n d n d
Sensi-Disc agents are furnished in cartridges containing 50 discs each. The last disc in each cartridge is marked “X” and contains the drug as Acinetobacter and staphylococci ≤14 15 – 16 ≥17 S. pneumoniae and other streptococci e — — ≥21 25 – 34e,ii ü n o m on n u ung on ph o o u pp u ndu b C nd m n R n h u hM
ceptible, intermediate, and resistant) correlate well with results determined by broth microdilution. Tetracycline results can be used to predict the likely u du bou on ou du um ph o og qu On p u g m n nd d no u um p pho om on ô d qu
coded. Cartridges are for use in BBL™ Sensi-Disc™ Dispensers; these include a Single Disc Dispenser, an 8-Place Dispenser for 100 mm-style Lomefloxacin LOM-10 10 µg 27 – 33 23 – 29 22 – 28 d C no m d d m d on m du on ô d qu pp qu n u m n u u n un g o GC dd onn d %
Amoxicillin/ susceptibility of isolates to doxycycline; do not use disc test for doxycycline or erythromycin because there is poor correlation with MIC results. pou op on m oo g n m o n pd po b u omp no u on R R NC Vo ub qu R n du ng n o o u pp Au g und d B dung on n n b nd nd n o n n B m n d g A n od d B dung on m
Petri dishes, 6- and 8-Place Self-Tamping Dispensers for 100 mm-style dishes and a Self-Tamping 12-Place Dispenser for 150 mm-style plates. Enterobacteriaceaeddd, P. aeruginosa, d un upp m n d o n d mn p g o BB GC n h d oV X n ub on ou % d CO h
Clavulanic Acid g,h,i AmC-30 20/10 µg 18 – 24g,ii 28 – 36 — n Ampicillin is the class representative for ampicillin and amoxicillin. Ampicillin results may be used to predict susceptibility to amoxicillin/clavulanic m m d n m n m n omp m d p p on o um qu d no u um önn n n o o n n g g n n n und Amp n n M d mB h n D u on önn n o m bw h nd n
Warnings and Precautions: For in vitro Diagnostic Use. Acinetobacter and staphylococci ≤18 19 – 21 ≥22 C no m d d m d on m du on ô d qu pp qu n u m n u u n un g o Mu H n on n h n n b nd nd n o n n g n u b m p odu nd mm nu un u g n hg w nw d n D n
Enterobacteriaceae ≤13 14 – 17 ≥18 acid, ampicillin/sulbactam, piperacillin and piperacillin/tazobactam among non-β-lactamase-producing enterococci. Enterococci susceptible to
 BBL Sensi-Disc Antimicrobial Susceptibility Test Discs
u u n bou on n ub p nd n nu n do n p u omm ou d no u um d %d ng d mou on d b n n ub on ou % d CO h no m d n p on pp qu n pn umon
Follow directions for use; disc performance depends not only on disc potency, but on use of proper inoculum and control cultures, functional j
Staphylococcus spp. ≤19 — ≥20 Haemophilus spp. c — — ≥22 33 – 41c — penicillin are predictably susceptible to ampicillin, amoxicillin, ampicillin/sulbactam, amoxicillin/clavulanic acid, piperacillin, and piperacillin/ mm w d n m b nm n md n m n hg w n B m C n N o n b h n od m
n m n m n u u p o oqu omm nd qu u p u n n p on pp qu d m oo g n m u
pretested plates, proper storage temperature and other factors. Haemophilus spp. c,k ≤19 — ≥20 15 –23c N. gonorrhoeae d ≤26 27 – 37 ≥38 45 – 54d tazobactam for non-β-lactamase-producing enterococci. However, enterococci susceptible to ampicillin cannot be assumed to be susceptible to h omog n n C ph o po n b h n
(Testb ättchen zur ant m krob e en Empf nd chke tsprüfung)
— qu u qu on m n onn d n p on pou p o oqu u qu pn umon on p opo u b d
penicillin. If penicillin results are needed, testing of penicillin is required. Because ampicillin or penicillin resistance among enterococci due to β- D n m n qu u n p p on mp un ou on d n no u um o m n d u
Observe aseptic techniques and established precautions against microbiological hazards throughout all procedures. Sterilize cultures, contain- Ampicillin h,l AM-10 10 µg 16 – 22 27 – 35 — Loracarbef h,i LOR-30 30 µg 23 – 29 23 – 31 — d bu on d popu on d d p ph m o n qu d g n n m ob n ud d pub p n
ü n o o u pp önn n C ph o po n Am nog o d uß ü ho hg d g R n R h n C nd m n und m hop m
lactamase production is not reliably detected using routine disc or dilution methods, a direct, nitrocefin-based β-lactamase test is recommended ou n p u u o n p n m m n on p o n n du h u du ub pou n d u m ho o n o h n n nd b n hn h w m und o o nn h mp nd h do um n w d n
ers and other contaminated materials after use. Enterobacteriaceaeii and V. cholerae m ≤13 14 – 16 ≥17 Enterobacteriaceae u,kk and staphylococci j ≤14 15 – 17 ≥18 n qu d n m mb du ou om du C D donn n qu m qu m n p n n p d pon b pou d
for blood and cerebrospinal fluid isolates. A positive β-lactamase test predicts resistance to penicillin, as well as amino-, carboxy- and ureido-peni- bou on Deu h
Storage Instructions: Staphylococci j,ii ≤28 — ≥29 Haemophilus spp. c,k ≤15 16 – 18 ≥19 — 26 – 32c nomb u ompo du g oup n d p du m nqu d d n p on b d d u on u d qu pou pn umon H moph u pp Nu d g bn m Amp n n m C ph o po n d d nG n on Ch o mph n o und M op n m
cillins. Certain penicillin- or ampicillin-resistant enterococci may possess high-level resistance (i.e., penicillin MICs ≥ 128 µg/mL or ampicillin b no u o o ou u d un g o Mu H n on ou d un u g o d qu n bo d n V RW NDUNG W CK D B h n nd u h bqu n n n o mp nd h p ü ung on h u g o omm nd n hn
1. On receipt, store discs at -20 – +8°C. If the laboratory refrigerator is frequently opened and closed, and a suitable temperature is not main- Enterococcus spp. n,o,ii ≤16 — ≥17 Meropenem h,i MEM-10 10 µg 28 – 34 29 – 37ii 27 – 33 n mn pn umon A CC ou h nu pou on ô d qu d ou d d u on u d qu o n ou n m ß g ü o on H n u n u b o pn ü g poo o w d n
MICs ≥ 64 µg/mL). The disc test will not differentiate those with normal resistance from this high-level resistance. For enterococci recovered from ou n n h qu o bo d d on u un n m n m n un o m w h nd n und b mm n n p u h o n b n g nm H d Ag B h n D u on h n b mm ud n
tained, place there a supply sufficient only for use within a week. Some discs (e.g., β-lactams) should preferably be kept frozen at -20°C. Listeria monocytogenes f ≤19 — ≥20 Enterobacteriaceae, P. aeruginosa, p d poo u Amo nC u n u A h om n C h om n C o C po o b C dn C m C podo m und C u o m A
blood and CSF, the laboratory should consider determining the actual MIC for penicillin or ampicillin since enterococcal strains with normal ou d bo p u ou p nd n mn n d p m n pou qu ou hum d g n g hö n n ob ph o o u pp udomon pp A n ob pp n o o u pp V b o ho und m
2. Allow containers to come to room temperature before opening. Return unused discs to the refrigerator when application of discs has Haemophilus spp. c,k,p ≤18 19 – 21 ≥22 13 – 21c
— Acinetobacter and staphylococci j ≤13 14 – 15 ≥16 D m d on omm nd p b n d n b o qu pp ou p DA non n u d n do um n M du C ow h om n nd o A n m d mp h g g n H moph u pp u h p on A mw g n on n ng w d n
lower level resistance (penicillin MICs ≤ 64 µg/mL and ampicillin MICs ≤ 32 µg/mL) should be considered potentially susceptible to synergy with p n n u o ob n po d d qu mp gn d g n n b o qu bg w nd nV h n H moph u n u n N gono ho p o o u pn umon und nd po o n H NW
been completed. Once opened, discs should be placed in a tightly sealed, desiccated container for storage. Haemophilus spp. c 20 – 28c M A önn n D g bn d mp nd h m d n An b o nd o on g ng m Nu n u h p nd du n n
Streptococci (non-S. pneumoniae, b-hemolytic — — ≥24ii 30 – 36e — — ≥20 — an aminoglycoside (in the absence of high-level aminoglycoside resistance) whereas strains with higher level resistance may be resistant to such onn d qu pp op omm omm nd d n n b u A Bd M M p V h n nd no w nd g um n umo o n n o o n und m h n o n n ph o o n n h uw n Um
3. Use the oldest discs first. D Üb p ü ung d mp nd h on H moph u pp ü d ub n n nn do h b Üb h ud n od p d m o og h n
only) e,i,aaa,ccc Mezlocillin ii MZ-75 75 µg 23 – 29 — 19 – 25 synergy.6 D po d qu un d bu u BB n p n p u on d p h b u d qu d
g Un u ou h d o A CC d gn pou on ô d qu d d qu on n n d o on d mn m ow u h und B gung ü B p um m n B nd d p um m du h u üh n
d nh b u d m C ou h p odu un m qu d n p nh b u o qu u ud n ng b h n
4. Discard expired discs. Also, cartridges from which discs have been frequently removed during a week and discs left out overnight in the Ampicillin/ Enterobacteriaceae and Acinetobacter ≤17 18 – 20 ≥21 o Synergy between ampicillin, penicillin or vancomycin and an aminoglycoside can be predicted for enterococci by using a high-level aminoglycoside o qu u n o n d n d u mo n mm p b d d po d qu d p n n h Ab hn RG BN
laboratory should be discarded, or else the discs should be tested for acceptable performance prior to continued use. on o n m n ou h A CC d u ompo n d d qu m p u n u m d on ô p o o u pp uß pn umon Von d U ood nd D ug Adm n on ug n mp nd h m n n n und
Sulbactam g,h,i SAM-20 10/10 µg 19 – 24g,ii 29 – 37 — P. aeruginosa ≤15 — ≥16 (gentamicin and streptomycin) screening test. Other aminoglycosides need not be tested because their activities against enterococci are not superior to d ph o po n un d n d u mo n mm du bo d d bo d d o qu u n D n n h ng nomm n n n p on n ü d on ndu hm nd n d n n ö h n An ung n d
5. If the discs form incorrect zones with the recommended control organisms, the entire procedure should be checked; faulty zone size may ou h on mm pou o on mo n d u n qu mm pou mp n o p d on mm pou o on nd n m An b o ü d B h nd ung on p og n od g nd ü n h w n h od h und mü n
Enterobacteriaceae, P. aeruginosa, Minocycline ee MI-30 30 µg 19 – 25 25 – 30 — gentamicin and streptomycin. o n d n d u mo n mm d d po d qu un ô d u A p H n u n
mp n ub m mm pou pp n mm pou o on p p n ob m mm pou n o p ung b g u g üh n h ou n m ß g du hg üh w d n d w b V n om n n mm n h b nn nd ü ph m u h nw ung n
be due to the disc, the inoculation, the preparation or depth (about 4 mm) of medium, or other factors. Acinetobacter q and staphylococci j ≤11 12 – 14ii ≥15ii aa p The results of ampicillin susceptibility tests should be used to predict the activity of amoxicillin. The majority of isolates of H. influenzae that are N gono ho pn umon n p u p u d n u d qu p bo d mm qu d qu p bo
Enterobacteriaceae , P. aeruginosa, d on mm pou o on n d u n qu ou h d on ô o A CC on n un m od p d m o og h w od u Üb w hung u h nw nd R n nw d n n p on n u V ügung g
The expiration date applies only to discs in intact containers, stored as directed. Haemophilus spp. c,k 14 –22c resistant to ampicillin and amoxicillin produce a TEM-type-β-lactamase. In most cases, a direct β-lactamase test can provide a rapid means of detecting d mm d qu on d po u g o n u un d bu u u o pp u ppu u d qu U AMM N A UNG UND RK ÄRUNG Ag D u on h n un V w ndung on g o n n p p b h n d
≤19 — ≥20 — Acinetobacteraa, staphylococci and enterococci yy ≤14 15 – 18 ≥19 p un p m d non B p on qu n o g n m n d u nomb u n b o qu b p n n m n b n n m d od n b w mm o u B gung n n R n bo w g g b nw d n
SPECIMENS – Specimens should not ordinarily be employed in this test. See Directions, which include preparation of inoculum. If possible, ampicillin and amoxicillin resistance. un gu ou un p n pou u on u d g o m b mm n Kon n on n on n m ob n ub n n mp gn nd wu d n n d n h n nw Um d
Azithromycin AZM-15 15 µg — 21 – 26 — Moxalactam MOX-30 30 µg 28 – 35 18 – 24 17 – 25 u o on m n nh b u d m p m d do p n d n ou h d on ô pou qu d on ô d ü n o m on n u ung on h mo h n po o n u ndu b C nd m n R n h M
cultures should be derived from specimens obtained from patients prior to the initiation of antimicrobial therapy. q May be reported for Acinetobacter spp. resistant to other agents. D n m n qu u n p bo d ô g o ou n h u d n un n ub u ± C b umnm n od u u h n nw nB u n nd d h n b d m Mu H n on Ag
Staphylococcus spp. r ≤13 14 – 17 ≥18 Enterobacteriaceae, P. aeruginosa, qu o d p md p u p nd n p du p nd n on on u mp u du g u omm du ong u
m d um w nd w d V R AHR N B CHRÄNKUNG N
r Not routinely reported on isolates from the urinary tract. pou p d ph o o u d d mp u up u Cp u n n p p m d
PROCEDURE Haemophilus spp. c — — ≥12 13 – 21c — Acinetobacter and staphylococci j ≤14 15 – 22 ≥23 po u m d m hod u do um n M pou p u mp n o m on D h b h b n g h up h h ü hn w h nd ob g ü npu h o B n uß H n u n
s Susceptibility and resistance to azithromycin, clarithromycin and dirithromycin can be predicted by using erythromycin. d ph o oqu n m n MR pou N gono ho n ub ± C n p d p m An h u d n ö n h nm h Au üh ung b hö d n und O g n on n u gung on No m n nd d
Material Provided: Sensi-Disc™ susceptibility test discs as labeled. S. pneumoniae and other streptococci e,r,s ≤13 14 – 17 ≥18 19 – 25e Moxifloxacin MXF-5 5 µg 28 – 35 28 – 35 —aa h  o d pn umo oqu donn n pou o n d d m d on mm on n b CM µg m p n n
R n h n u d G und g d B u K b M hod u d n üh n und g b u h h n d nd d h n g hö n N gono ho pn umon und nd po o n h M N m n ng d od M An on n o nd m d m
C p d H moph u N gono ho pn umon u p o oqu do n n ub d n
Materials Required But Not Provided: Ancillary culture media, reagents, quality control organisms and laboratory equipment required to t See discussion of ESBLs under “RESULTS.” For screening and confirmatory tests for ESBLs in Klebsiella pneumoniae, K. oxytoca and E. coli, see p u n on d omm n b mp n mo n u o on mo n d u n qu mp n ub m V dünnung h ng w d n An ob mü n m p h ng w d n
Azlocillin AZ-75 75 µg — — 24 – 30 Enterobacteriaceaef,ddd and Staphylococcus spp.aa ≤15 16 – 18 ≥19 un mo ph n h % d CO d on d U ood nd D ug Adm n on DA und d W g undh og n on WHO ö n h n M hod n D
perform disc diffusion susceptibility testing by the standardized procedure. Prepare a 0.5 McFarland turbidity standard by adding 0.5 mL of "RESULTS" section and reference 7. Screening breakpoints (Mueller Hinton agar, standard disc diffusion procedure, 35 ± 2ºC, ambient air, u o u dn u pm u m m u o m u po u bu n on u uo m
P. aeruginosa ≤17 — ≥18 H. influenzaec and H. parainfluenzaec — — ≥18 31 – 39c — mn bo d p h d n ub on h pou N gono ho pn umon u V h n n h B u K b wu d on d m C n nd bo o nd d n u C om NCC g m n m nd d D n ung n n n m d und mp nd h B n un h d h nu du h n n M m w nn h b d
0.048 M BaCl2 [1.175% (wt/vol) BaCl2•2H2O] to 99.5 mL of 0.18 M [0.36N] H2SO4 [1% (vol/vol)]. Verify by using a spectrophotometer with a 16 – 18 h) are: aztreonam (≤ 27 mm), ceftazidime (≤ 22 mm), cefotaxime (≤ 27 mm), cefpodoxime (≤ 17 mm) and ceftriaxone (≤ 25 mm). Quality control podo m u o m p n m mp n m u o b u m op n m p p on n nd qu g n no m n bo h b h g B n g n Ku u n h m n H mm on n m G n b h d on g u g od bo u bo
Aztreonam ATM-30 30 µg 28 – 36 — 23 – 29 S. pneumoniaee ≤14 15 – 17 ≥18 25 – 31e p o oqu Un n ub on d h omp omm nd pou p d ph o o u nd m n n nn und w d g m ß g u ü d u n mp h ung n w d u d üng n C Do um n w n
1-cm light path and matched cuvette; absorbance at 625 nm should be 0.08 – 0.13. recommendations are E. coli ATCC 25922 (as listed in the chart); K. pneumoniae ATCC 700603 (aztreonam 9 – 17 mm), ceftazidime (10 – 18 mm), cefo- n on p b o n d CM d p n n du o m ou d on ou du m op n m do n d mn nd u n önn n A d ng nd o h Ku u n n
Enterobacteriaceae, t P. aeruginosa & Acinetobacter ≤15 16 – 21 ≥22 Nafcillin NF-1 1 µg — 16 – 22 — taxime (17 – 25 mm), cefpodoxime (9 – 16 mm) and ceftriaxone (16 – 24 mm).7 The use of more than one antimicrobial agent for screening improves d n ph o oqu n m n n n o n n om n pou p d n o o u pou o p n n pou o n d d m d on mm p qu d d m d on mm on ob nu d V R AHR N GRUND AG N B h nm h d n n n m ob n ub n n w d n u d Ob h on Mu H n on
Directions, Including User Controls:6 Ag p n od H moph u m d um g um N hw on H n u n GC Ag m oV X An h ung m d um ü um R n n hw on n umo o n und n o o n mü n d om C mp oh n n M hod n b og w d n
Haemophilus spp. c — — ≥26 30 – 38c — Staphylococcus aureus j,nn ≤10 11 – 12 ≥13 the sensitivity of detection. Phenotypic confirmatory testing requires the use of both cefotaxime and ceftazidime, alone and in combination with clavu- nd m n d n n o oqu n n om n d m d on d nh b on o on ou h n p n n d ou h n m d ou n ou h n b o n do n p on d omm
1. Preparation of inoculum with test and control cultures. m u u b d un n p on u m u on ond um m pu p o h ou p u N gono ho od Mu H n on Ag m % h bu ü pn umon h mo h po o n und po o nd Un Um nd n w d n d g nd d nd b u g üh n n m ob n ub n n w nd D g bn d
Bacitracin f B-10 10 U ≤ 8 9 – 12 ≥13 — 12 – 22 — Nalidixic Acid NA-30 30 µg 22 – 28 — — lanic acid. A ≥ 5 mm zone diameter for either antimicrobial agent tested in combination with clavulanic acid versus its zone when tested alone = ESBL. n p n n ou n m d un qu m n u b d un on mm pou o n mo n mp n pm
a. Perform a Gram stain. Use only pure cultures. Quality Control recommendations are: negative strain E. coli ATCC 25922 which produces a ≤ 2 mm increase in zone diameter for antimicrobial agent d n o m on u m u d on d nh b on po n on ob un qu m n o n d o m on uo m p n m mp n m m op n m p u n u pou n on V d n G upp g b h d m R n u u n n h o b mp wu d n N h d n ub on w d n d n un u h d mp nd h p ü ung o h ub n n mü n u d G und g d Anw nh od d h n n d n n H mm on
Carbenicillin CB-100 100 µg 23 – 29 — 18 – 24 Enterobacteriaceae z ≤13 14 – 18 ≥19 H mm on n um d B h ng m n und d nn m g g n H mm on ng öß n ü n n n m ob ub n n g h n
b. Select three to five similar colonies and transfer with inoculation needle or loop into 4 – 5 mL of a suitable broth such as Trypticase™ Soy tested alone versus its zone diameter when tested in combination with clavulanic acid; positive strain K. pneumoniae ATCC 700603 which produces a o on o no u um n p d n do p on u u ou d d qu on n n pn umo oqu m d d n b b p m hod d d u on u d qu n g o n n p n o pou g n u n p w d n Auß d m mü n d g bn o ng qu ng h nw d n b n H mm on n n p on
Enterobacteriaceae and Acinetobacter ≤19ii 20 – 22ii ≥23 Neomycin f N-30 30 µg ≤12 13 – 16 ≥17 17 – 23 18 – 26 — d n g n n m ob n n do n p u d n d omp on d d g n Con u um d ub n n u b mm n d ü n An b o h p mb n g gn nd b wu d A H mm on ndu hm mü n h h g h nw d n
Broth (or Mueller Hinton Broth for fastidious organisms). ≥ 3 mm increase in cefotaxime zone diameter and a ≥ 5 mm increase in ceftazidime zone diameter. See "Limitations of the Procedure." See reference 7 n o m u d mn u mo n d un m hod CM p n n o m ou on ou m op n m do n
P. aeruginosa ≤13 14 – 16 ≥17 Netilmicin NET-30 30 µg 22 – 30 22 – 31 17 – 23 b ud n p on du d m d on pou ob n u ndu pou ob ou n m u R AG N N n D b h n nd mm g oß B h n d h g w d n nd m qu ho hw g ug h g
c. Incubate the broth cultures at 35°C for 2 – 6 h, if necessary, to develop a turbidity equivalent to the 0.5 McFarland turbidity standard for details of the procedure. p un m hod CM b qu d d n do um n M du C ppo n ou n pou d o ngu n B B gung nd nu gü g w nn d B h n C o m C o mC u n u C dm C dm C u n u
(approximately 1 to 2 x 108 CFU/mL). Alternatively, make a direct broth or saline suspension of colonies selected from an agar plate incu- Cefaclor h,i CEC-30 30 µg 23 – 27 27 – 31 — Enterobacteriaceae, P. aeruginosa, d on p u mp g u on du b d n p on d on n D BB d CR d pn umon D o do n u n om n u mo n d un m hod CM ou d d u on u p m g n ub m n n M ng n on An b o od nd n h mo h p u hw m n ub n n mp gn w d D g h g ng w d n n n n n d B h n w d om C n h mp oh n
u Cephalothin can be used to predict activity of cephalothin, cephapirin, cephradine, cephalexin, cefaclor and cefadroxil. Cefazolin, cefuroxime, cefpo-
bated overnight (a nonselective medium such as blood agar, or chocolate agar for H. influenzae and N. gonorrhoeae, should be used). Enterobacteriaceae u and staphylococci j ≤14 15 – 17 ≥18 Acinetobacter and staphylococci ≤12 13 – 14 ≥15 doxime, cefprozil, and loracarbef (urinary isolates only) may be tested individually because some isolates may be susceptible to these agents when D d on ô u n u u p do n n u h qu ou où un n b og mm ou d qu A d o po n n d u d d p g u d qu o n p u u CM d p n n du B h nb n u b d n n nd u g nnb Bu h b n und n u d n ung d An b o um und u Ang b G n u g bn nd n un on d o n g ung und d h ung on O g n m n u Qu on o D g
The direct colony suspension method is preferred for Staphylococcus spp., S. pneumoniae and other streptococci, Haemophilus spp. and Haemophilus spp. c,k ≤16 17 – 19 ≥20 — 25 – 31c un o p m n p om n on n on o m m n no m C p qu d on o m ou d on do n d mn o qu d m d on mm pou o n ou d mn n b d w nd nW o m ng Vg d b m d n Kon n on n d nB nd D nd nB h n nh n
Nitrofurantoin F/M-300 300 µg 20 – 25 18 – 22 — resistant to cephalothin. n b ond ü o A CC und K pn umon A CC d pon n V u d md w h ü d m
N. gonorrhoeae.6 Cefamandole MA-30 30 µg 26 – 32 26 – 34 — pou o A CC u u A CC ug no A CC H n u n A CC H n u n A CC d p o oqu u qu pn umon u dn u d qu un d p n n o donn n d d m d on A n m m ng w d m on d DA g g n M hod n od m M hod n d d n n m U Bund g Un d d od do um n wu d B üg h d mp h ung n u o n g ung und d h ung on O g n m n ü d
Enterobacteriaceae, staphylococci and v Not applicable for testing Morganella spp.
N gono ho A CC pn umon A CC o A CC ou h p odu d m mm on n b p n n p u n on d omm n b u dn R g hn h nd od g h n b mm Qu on o h C nd d M
d. Dilute, if required, to obtain turbidity equivalent to the 0.5 McFarland turbidity standard. For diluent, use sterile broth or saline. Enterobacteriaceae and staphylococci j ≤14 15 – 17 ≥18 enterococci ≤14 15 – 16 ≥17 w For N. gonorrhoeae, an intermediate result for an antimicrobial agent indicates either a technical problem that should be resolved by repeat testing or
Alternatively, standardize the inoculum photometrically; to facilitate inoculum adjustment of rapidly growing organisms, the Prompt™ A CC pou d d on ô d qu d d qu d g n m n µg p om n Un o d p o oqu qu n b p n n p u on d omm n n b mp n mo n mo n D n D W o w d n nK u h n u w B h ng D B h n n d K u h m n m X n h b nn ob n om n n mm on ph o o u u u VR A m d m odu d w d n
Cefazolin CZ-30 30 µg 21 – 27ii 29 – 35 — Norfloxacin ii NOR-10 10 µg 28 – 35 17 – 28 22 – 29 a lack of clinical experience in treating organisms with these zones. The latter seems to be the case for cefmetazole, cefotetan, cefoxitin, and spectino- µg K b pn umon A CC pou d d p g d on m on d B on donn g nn hn und n h d du h d n Cod u g w n An b o um D K u h n w d n n
Inoculation System (volumetric inoculum preparation device) may be used.8 Enterobacteriaceae u and staphylococci j ≤14 15 – 17 ≥18 ddd mycin. Strains with intermediate zones with the other agents have a documented lower clinical cure rate (85 - 95%) compared to >95% for susceptible d u n qu mp n ub m u o u dn u pm u po u o m u bu n p o oqu önn n B mp nd h on o n on u u n b ond m h n n n mm n on u u MR A nd
Enterobacteriaceae , P. aeruginosa, d n b u ou no nb d p g o qu u on ob mo gn n d un p o m n BB n D D p n n w nd nd d n B h nD p n n B h nD p n ü h n on mm und
Overnight broth cultures should not be used as inoculum. strains. du g oup A u m n on u uo m podo m u o m o n p n dn u h m hod n g m ß d n mp h ung n d C n o D Con o nd n on CDC d U m n h n
Cefdinir h CDR-5 5 µg 24 – 28 25 – 32 — Acinetobacter, staphylococci and enterococci ≤12 13 – 16 ≥17 n d n mb d p o du n ou ou h A CC ou omm nd pou mp n m u o b u m op n m p p on n nd qu n p b ond d g n b w B h nD p n m u om h And u o h ung ü h n on mm und n
2. Inoculation. u h n hu b hö d n u n ud n g hö n n h u om MHK M hod n B Bou on M o dünnung od
Enterobacteriaceaekk and Novobiocin f NB-30 30 µg ≤17 18 – 21 ≥ 22 — 22 – 31 — x Cefotaxime, ceftizoxime or ceftriaxone should be tested and reported on isolates from CSF in place of cephalothin and cefazolin. d mn o n u d g o Mu H n on on d n u u mm n b n h mn h mdn o B h nD p n m u om h And u o h ung ü h n on mm
p o oqu d n omp u o p du ng d n om qu no m m n p qu d ph o h d n ng Ag V dünnung und n V n om n Ag H nH n u on Ag m µg m V n om n ü d n o h
a. Within 15 min, dip a sterile cotton swab into the properly adjusted inoculum and rotate it firmly several times against the upper inside methicillin-susceptible staphylococci j ≤16 17 – 19 ≥20 y Because certain strains of Providencia spp. have been reported to give false-susceptible results with cefprozil discs, strains of this genus should not be no nb d p g ou h H n u n A CC omm nd omm on ô d qu upp m n W nung n und Vo h m ßn hm n n o D gno um
(Mueller Hinton agar with sheep blood