Chapter 5.13 : Quality Assurance Measures for Antimicrobial Susceptibility Testing

Suggested QC strains for antimicrobial susceptibility tests a

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

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a Off-scale endpoint.

b On-scale endpoint.

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

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

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

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

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

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

Enterobacteriaceae antibiograms a

a 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.

b Member of Vibrionaceae.

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

Pseudomonas-Acinetobacter-Stenotrophomonas antibiograms a

a 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.

Gram-positive bacterium antibiograms a

a 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.

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

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

Miscellaneous gram-negative bacterium antibiograms a

a 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 a. Symbols: +, positive; −, negative.

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

c Also resistant to oxacillin and clindamycin and susceptible to aminoglycosides.

d Also resistant to clindamycin.

e Also resistant to oxacillin and aminoglycosides.