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Chapter 5.13 : Quality Assurance Measures for Antimicrobial Susceptibility Testing

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Abstract:

QC is performed to ensure proper performance of antimicrobial susceptibility tests in order to provide accurate, reproducible, and timely results. The basic QC procedure used in clinical laboratories involves testing reference strains that have defined characteristics of susceptibility to the antimicrobial agent(s) tested. These strains must be properly maintained in order to ensure their reliable performance. Testing the QC strains controls many parameters of the antimicrobial susceptibility test; however, testing the reference strains alone does not always ensure reliable results when testing patients' isolates. Inclusion of supplemental control strains (particularly if recommended in the manufacturer's instructions when using a commercial test system), evaluation of susceptibility profiles on patients' isolates, verifying technologist competency, and review of cumulative susceptibility statistics are some of the additional measures that can be taken to further QC antimicrobial susceptibility tests.

Citation: Garcia L. 2010. Quality Assurance Measures for Antimicrobial Susceptibility Testing, p 163-180. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch5.13
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Citation: Garcia L. 2010. Quality Assurance Measures for Antimicrobial Susceptibility Testing, p 163-180. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch5.13
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Citation: Garcia L. 2010. Quality Assurance Measures for Antimicrobial Susceptibility Testing, p 163-180. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch5.13
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Citation: Garcia L. 2010. Quality Assurance Measures for Antimicrobial Susceptibility Testing, p 163-180. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch5.13
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References

/content/book/10.1128/9781555817435.chap5.13
1.College of American Pathologists. 2001. CAP Accreditation Checklist, Microbiology, College of American Pathologists, Northfield, Ill.
2.Joint Commissionon Accreditation of Health care Organizations. 2002-2003. Section 2: technical functions, quality control, specialty-bacteriology, mycobacteriology, and mycology, p. QC-6. In Comprehensive Accreditation Manual for Pathology and Clinical Laboratory Services. Joint Commission on Accreditation of Healthcare Organizations, Chicago, Ill.
3.NCCLS.2003.Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically, 6th ed. Approved standard M7-A6. NCCLS, Wayne, Pa.
4.NCCLS.2003. Performance Standards for Antimicrobial Disk Susceptibility, 8th ed. Approved standard M2-A8. NCCLS, Wayne, Pa.
5.NCCLS.2002. Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test Data. Approved guideline M39-A. NCCLS, Wayne, Pa.
6.U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, and Centers for Disease Control and Prevention. 2003. Medicare, Medicaid, and CLIA programs. Fed. Regist. 68:3708. (42CFR493.1261.)
7. Hindler, J. A. 1990. Nontraditional approaches to quality control of antimicrobial susceptibility tests. Clin. Microbiol. Newsl. 12:6569.
8. Livermore, D. M.,, T. G. Winstanley,, and K. P. Shannon. 2001. Interpretative reading: recognizing the unusual and inferring resistance mechanisms from resistance phenotypes. J. Antimicrob. Chemother. 48:87102.
9. Von Graevenitz, A., 1991. Use of antimicrobial agents as tools in epidemiology, identification, and selection of microorganisms, p. 723738. In V. Lorian (ed.), Antibiotics in Laboratory Medicine, 3rd ed. The Williams & Wilkins Co., Baltimore, Md.
1.NCCLS. 2002. Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test Data. Approved guideline M39-A. NCCLS, Wayne, Pa.

Tables

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Suggested QC strains for antimicrobial susceptibility tests

BLNAR, beta-lactamase negative, ampicillin resistant; CMRNG, chromosomally mediated (penicillin) resistant .

Citation: Garcia L. 2010. Quality Assurance Measures for Antimicrobial Susceptibility Testing, p 163-180. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch5.13
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Off-scale endpoint.

On-scale endpoint.

Citation: Garcia L. 2010. Quality Assurance Measures for Antimicrobial Susceptibility Testing, p 163-180. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch5.13
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Primary variables that must be controlled when performing routine disk diffusion and broth microdilution MIC tests

J. A. Hindler and L. M. Mann. 1992. Principles and practices for the laboratory guidance of antimicrobial therapy, p. 548. R. Tilton (ed.), . The C. V. Mosby Co., St. Louis, Mo. Reprinted with permission of Elsevier. Abbreviations: HLR, high-level resistance; VISA, vancomycin-intermediate ; MHA, Mueller-Hinton agar.

Includes all penicillinase-stable penicillins (oxacillin, methicillin, nafcillin).

Citation: Garcia L. 2010. Quality Assurance Measures for Antimicrobial Susceptibility Testing, p 163-180. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch5.13
Generic image for table

Primary variables that must be controlled when performing routine disk diffusion and broth microdilution MIC tests

J. A. Hindler and L. M. Mann. 1992. Principles and practices for the laboratory guidance of antimicrobial therapy, p. 548. R. Tilton (ed.), . The C. V. Mosby Co., St. Louis, Mo. Reprinted with permission of Elsevier. Abbreviations: HLR, high-level resistance; VISA, vancomycin-intermediate ; MHA, Mueller-Hinton agar.

Includes all penicillinase-stable penicillins (oxacillin, methicillin, nafcillin).

Citation: Garcia L. 2010. Quality Assurance Measures for Antimicrobial Susceptibility Testing, p 163-180. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch5.13
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antibiograms

These antibiograms should serve as guidelines only; exceptions will occur. Although some agents listed here are no longer available in the United States, they may be used in other countries. Abbreviations: AMP, ampicillin; AMPSULB, ampicillin-sulbactam; CHLOR, chloramphenicol; TETRA, tetracycline; TMP-SMZ, trimethoprim-sulfamethoxazole; NITROFURAN, nitrofurantoin; POLY B, polymyxin B; 1ST CEFS, cefazolin, cephalothin; AMINO GRP, amikacin, gentamicin, netilmicin, tobramycin; CARB GRP, carbenicillin, ticarcillin; CARBAP GRP, imipenem, meropenem; CEFOT, cefotetan; CEFOX, cefoxitin; CFMDL GRP, cefamandole, cefonicid, cefuroxime;CFTAX GRP, aztreonam, cefepime, cefoperazone, cefotaxime, ceftazidime, ceftizoxime, ceftriaxone; MEZLO GRP, mezlocillin, piperacillin; NALID GRP, nalidixic acid, cinoxacin; PIP-TAZO, piperacillin-tazobactam; QUIN GRP, ciprofloxacin, levofloxacin, norfloxacin; TICAR-CA, ticarcillin-clavulanic acid. *, it is very unusual to encounter an isolate susceptible to this drug.

Member of .

Can produce ESBLs that confer resistance to all penicillins, cephalosporins, and aztreonam.

Citation: Garcia L. 2010. Quality Assurance Measures for Antimicrobial Susceptibility Testing, p 163-180. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch5.13
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antibiograms

These antibiograms should serve as guidelines only; exceptions will occur. Although some agents listed here are no longer available in the United States, they may be used in other countries. Abbreviations: 1ST, 2ND CEFS, narrow- and extended-spectrum cephalosporins; AZTRE, aztreonam; CFTAX GRP, cefoperazone, cefotaxime, ceftizoxime, ceftriaxone; CFTAZ GRP, cefepime, ceftazidime; NRFLX, norfloxacin. For other abbreviations, see footnote a of Table 5.13-4a . *, it is very unusual to encounter an isolate susceptible to this drug.

Citation: Garcia L. 2010. Quality Assurance Measures for Antimicrobial Susceptibility Testing, p 163-180. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch5.13
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Gram-positive bacterium antibiograms

These antibiograms should serve as guidelines only; exceptions will occur. Abbreviations: AMP, ampicillin; AMP-SULB, ampicillin-sulbactam; PEN, penicillin; OXA, oxacillin; CEFS, cephems (including cephalosporins); CHLOR, chloramphenicol; CLIND, clindamycin; ERY, erythromycin; GENT, gentamicin; TETRA, tetracycline; TMP-SMZ, trimethoprim-sulfamethoxazole; VAN, vancomycin; Q/D, quinupristin-dalfopristin; LZD, linezolid. Symbol: (R), result often susceptible in vitro, but drug clinically ineffective against noted species. *, it is very unusual to encounter an isolate susceptible to this drug.

Standard NCCLS interpretive criteria not available; data based on various publications.

JK and D2 are usually resistant to these (some organisms ERY-S and/or TETRA-S).

Citation: Garcia L. 2010. Quality Assurance Measures for Antimicrobial Susceptibility Testing, p 163-180. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch5.13
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Miscellaneous gram-negative bacterium antibiograms

These antibiograms should serve as guidelines only; exceptions will occur. Abbreviations: CEFS, narrow-, extended-, and broad-spectrum cephems (including cephalosporins); β-LAC, beta-lactamase; AMOX-CLAV, amoxicillin-clavulanic acid. For other abbreviations, see Table 5.13-4a , footnote . Symbols: +, positive; −, negative.

Standard NCCLS interpretive criteria not available; data based on various publications.

Also resistant to oxacillin and clindamycin and susceptible to aminoglycosides.

Also resistant to clindamycin.

Also resistant to oxacillin and aminoglycosides.

Citation: Garcia L. 2010. Quality Assurance Measures for Antimicrobial Susceptibility Testing, p 163-180. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch5.13

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