STAPHYLOCOCCI: KEY AST CHALLENGES
|
|
- Scarlett Neal
- 6 years ago
- Views:
Transcription
1 Romney Humphries, PhD D(ABMM) Section Chief, UCLA Clinical Microbiology Los Angeles CA STAPHYLOCOCCI: KEY AST CHALLENGES
2 THE CHALLENGES detection of penicillin resistance detection of MRSA vancomycin and S. aureus including VISA inducible clindamycin resistance in staphylococci
3 Penicillin and Staphylococcus spp. - -lactamase testing
4 SPECIMEN: BONE DIAGNOSIS: OSTEOMYELITIS STAPHYLOCOCCUS AUREUS MIC ( g/ml) clindamycin 0.5 S erythromycin 0.5 S oxacillin 0.25 S penicillin 0.06 S?? vancomycin 0.5 S Should we do anything about penicillin?
5 STAPHYLOCOCCUS SPP. PENICILLIN > 90% of staphylococci are penicillin R Penicillin rarely considered for treatment of staphylococcal infections but might be considered for infections requiring lengthy therapy (e.g., endocarditis, osteomyelitis) IF penicillin S Some Staphylococcus spp. that test S by MIC or disk diffusion may possess a β- lactamase and may fail penicillin therapy Agent MIC (µg/ml) Zone (mm) S I R S I R Penicillin
6 S. aureus S. aureus and CoNS (including S. lugdunensis) CLSI M100-S25. Table 3D.
7 INDUCED ß-LACTAMASE TEST Oxacillin (inducer) -Sub isolate to agar (e.g., BAP, MHA) -Drop ß-lactam disk (e.g., oxacillin, cefoxitin) -Incubate overnight -Test cells from periphery of zone -If β-lactamase positive (with or without induction), report penicillin R Pos Neg
8 STAPHYLOCOCCUS AUREUS DISK ZONE EDGE TEST (10 U PENICILLIN DISK AND STANDARD DISK DIFFUSION METHOD NOT VALIDATED FOR MIC PURIT Y PLATES) Fuzzy beach = β-lactamase negative Penicillin - S Sharp cliff = β-lactamase positive Penicillin - R S. aureus QC: Neg - ATCC Pos - ATCC (supplemental QC) CLSI M100-S25. Table 3D.
9 STAPHYLOCOCCUS SPP. PENICILLIN STRATEGY Organism Action S. aureus Report PEN if R; Suppress PEN if S If PEN needed, perform nitrocefin β-lactamase test If nitrocefin β-lactamase test negative, perform PEN disk zone edge test (next day) CoNS (except Report PEN if R; Suppress PEN if S S. If PEN needed, perform nitrocefin β-lactamase test lugdunensis) If nitrocefin β-lactamase test negative, perform induced nitrocefin β-lactamase test All Continue to test subsequent isolates from patient
10 SPECIMEN: BONE DIAGNOSIS: OSTEOMYELITIS STAPHYLOCOCCUS AUREUS clindamycin MIC ( g/ml) 0.5 S erythromycin 0.5 S oxacillin 0.25 S vancomycin 0.5 S Contact laboratory if penicillin results needed
11 WHAT ABOUT S. LUGDUNENSIS? Usually very susceptible to antimicrobial agents including penicillin-s Only 5-25% penicillin-r, -lactamase positive Frank et al Clin Microbiol Rev. 21:111. UCLA 40-50% R Recommended Rx: oxacillin / nafcillin or penicillin (if β-lactamase negative) Sanford Guide, 45th ed Do not suppress penicillin results!
12 S. lugdunensis and Penicillin S. lugdunensis Report PEN if R Perform nitrocefin β-lactamase test If nitrocefin β-lactamase test negative, perform induced nitrocefin β-lactamase test Up to 50% are PEN S CLSI M100-S25. Table 3D.
13 MRSA methicillin-resistant S. aureus - Oxacillin vs. cefoxitin tests - BORSA
14 ANTIMICROBIAL AGENT OPTIONS FOR MSSA INFECTIONS Betalactams Predictable activity dicloxacillin / nafcillin cephalexin / cefazolin amoxicillin-clav ampicillin-sulbactam carbapenem vancomycin dalbavacin, oritavancin, televancin daptomycin linezolid ceftaroline (β-lactam) tigecycline Need AST clindamycin trimethoprim-sulfa macrolide (e.g. clarithromycin) tetracycline fluoroquinolone (e.g. ciprofloxacin) (gentamicin) (rifampin)
15 ANTIMICROBIAL AGENT OPTIONS FOR MSSA INFECTIONS Betalactams Predictable activity dicloxacillin / nafcillin cephalexin / cefazolin amoxicillin-clav ampicillin-sulbactam carbapenem vancomycin dalbavacin, oritavancin, televancin daptomycin linezolid ceftaroline (β-lactam) tigecycline Need AST clindamycin trimethoprim-sulfa macrolide (e.g. clarithromycin) tetracycline fluoroquinolone (e.g. ciprofloxacin) (gentamicin) (rifampin)
16 TESTS FOR meca-mediated OXACILLIN RESISTANCE IN S. AUREUS Phenotypic tests - Disk diffusion or MIC Cefoxitin as a surrogate Report results for OXACILLIN, not cefoxitin Oxacillin MIC (+ 2% NaCl) Oxacillin-salt agar screen for S. aureus Detection of gene or gene product meca PBP2a Why use cefoxitin to detect MRSA? Sensitivity Specificity Oxacillin 86 % 74 % Cefoxitin 100 % 100 % Swenson et al JCM :
17 Heteroresistant MRSA Cefoxitin (R) 10 mm zone Cefoxitin detects heteroresistant meca-mediated MRSA better than oxacillin Colonies in zone (heteroresistant) Staphylococcus aureus / S. lugdunensis Agent MIC (µg/ml) Zone (mm) S I R S I R Cefoxitin 4* - 8** 22* - 21** Oxacillin 2-4 NA * Report as oxacillin susceptible ** Report as oxacillin resistant
18 DEFINITION OF MRSA (2) MRSA are those strains of S. aureus that express meca or another mechanism of methicillin resistance, such as changes in affinity of penicillin binding proteins for oxacillin (modified S. aureus [MOD-SA] strains) MRSA = S. aureus with meca and/or oxacillin MIC >2 µg/ml and/or cefoxitin R CLSI M100-S25. Table 2C.
19 OX S. AUREUS OR S. LUGDUNENSIS TESTING BOTH OX AND CX CX Resistance mechanism Relative Prevalence Report as OX: S S None Common S R R meca Common R S R meca (low level expression) Uncommon R* R S PBP changes or hyperproduction of β-lactamase (borderline MRSA) Rare R* *most commercial system software expertise to R (3) Isolates that test resistant by oxacillin minimal inhibitory concentration (MIC), cefoxitin MIC, or cefoxitin disk test should be reported as oxacillin resistant. CLSI M100-S25. Table 2C.
20 WHAT ABOUT BORDERLINE MRSA? Oxacillin MIC slightly above R breakpoint Cefoxitin S meca negative Mechanisms: Modifications in penicillin-binding proteins (PBPs) 1,2,4 (MOD-SA) Hyperproduction of blaz-encoded penicillinase Methicillinase Infrequently encountered Limited clinical information in literature re: therapy Chambers Clin Microbiol Rev. 10:781. Skinner et al J Clin Microbiol. 47:859. Croes et al Clin Microbiol Infection. 16:979. Maalej et al J Clin Microbiol. 50:3345.
21 WHY IS IT IMPORTANT TO CORRECTLY AND QUICKLY IDENTIFY MRSA AND MSSA? MRSA infections - β-lactams (except ceftaroline) ineffective MSSA infections β-lactams better than vancomycin For bacteremia Vancomycin associated with 2 3 times the risk of morbidity and mortality vs β-lactam (e.g., oxacillin and nafcillin, cefazolin) Switching from vancomycin to β-lactam inferior to starting with β-lactam McConeghy et al Clin Infect Dis. 57:1760. If you focus on ONE thing focus on getting this right!
22 WHAT S MECC? mecc 1 Human and bovine MRSA were reported in 2011 that carry a new meca homologue, mecc Human cases retrospectively identified in 1975, 1992 but most since Harbors ~68-70% genetic similarity to meca Mostly found in veterinary isolates, all in Europe, but some human cases to date in Denmark, Germany, France, UK and Spain Currently only detected by cefoxitin resistance - Typically have low oxacillin MICs - meca PCR, PBP2a tests do not work for these 1. Additional reading for mecc: Laurent et al 2012 EID 18:1465; Garcia-Alvarez et al 2011 Lancet Infect Dis 11: Petersen et al CMI :E16 3. Cartwright et al J Clin Microbiol. 51:
23 WHAT ARE CLSI RULES FOR DETECTING MRCONS? Species Rule S. lugdunensis Use oxacillin and cefoxitin breakpoints as for S. aureus S. saprophyticus Don t test; add comment to report re: appropriate therapy for S. saprophyticus UTI S. epidermidis Use CoNS oxacillin MIC and/or cefoxitin DD breakpoints - work well Other CoNS Use caution for oxacillin MICs µg/ml; cefoxitin DD testing is better! CoNS oxacillin-r more heterogeneous than S. aureus; lower breakpoint
24 REPORTING STRATEGY OXACILLIN MIC RESULTS FOR CONS* * For testing non-s. epidermidis isolates from sterile sites where CoNS is causing an infection Oxacillin MIC (µg/ml) S I R 0.25 Report Oxacillin S Negative Oxacillin MIC (µg/ml) Do meca or PBP2a or Cefoxitin disk Positive 4 Report Oxacillin R Report Oxacillin S Report Oxacillin R
25 Vancomycin and S. aureus See.. Howden et al Clin Microbiol Rev. 23:99.
26 SPECIMEN: BLOOD DIAGNOSIS: BACTEREMIA STAPHYLOCOCCUS AUREUS oxacillin penicillin vancomycin vancomycin MIC ( g/ml) >16 R R 1 S (automated) 1.5 S (Etest) What about vancomycin MIC?
27 S. AUREUS - VANCOMYCIN MIC INTERPRETIVE CRITERIA ( G/ML) Susceptible Intermediat e Resistant VSSA 1 vs 2 µg/ml VISA VRSA Vancomycin released 1950s; first resistance (VISA) 1990s! CLSI M100-S25. Table 2C.
28 CONTEMPORARY THOUGHTS ON TREATING MRSA BACTEREMIA WITH VANCOMYCIN Based on PK/PD, clinical outcome may vary if vancomycin treatment for isolates with susceptible MICs of 1 vs. 2 µg/ml Maintain trough serum concentration of mg/l Liu et al Clin Infect Dis. 52:285. Some say if vancomycin S MIC (µg/ml): <1.5 use vancomycin use alternative Recent study: No differences if MIC <1.5 or 1.5 µg/ml in risk of death; can t exclude increased mortality risk Kalil et al JAMA. 312:1552. Reproducibility of MIC = +/- 1 two-fold dilution!!!!
29 IDSA GUIDELINES SUGGEST USING VANCOMYCIN MICS TO GUIDE THERAPY AS FOLLOWS.. MIC (µg/ml) 2 (Susceptible) >2 (e.g., VISA or VRSA) IDSA Guidelines Recommendation The patient s clinical response should determine the continued use of vancomycin, independent of the MIC An alternative to vancomycin should be used Liu et al Clin Infect Dis. 52:1.
30 Vancomycin MIC (N=101 MRSA) Etest MICs > Reference Broth Microdilution and Agar Dilution MICs Prakash et al Antimicrob Agents Chemother. 52:4528. See also Hsu et al Intl J Antimicrob Agents. 32:378. Sader et al Antimicrob Agents Chemother. 53:3162.
31 48 hour growth on blood agar plate MRSA VISA VSSA VISA VSSA Marlowe, et al J Clin Microbiol. 39:2637. Howden et al CMR. 23:99.
32 CHARACTERISTICS SOMETIMES OBSERVED FOR VISA Colony morphology may be atypical for S. aureus (some pinpoint) Delayed growth in broth (e.g., blood culture) Weak / delayed coagulase reaction After several subcultures: Colony morphology becomes typical for S. aureus Vancomycin MIC decreases and isolate becomes vancomycin susceptible MICs for daptomycin increase MICs for -lactams decrease
33 PERSISTENT MRSA BACTEREMIA PATIENT #1 DAPTOMYCIN MIC STORY Patient receives 49 days daptomycin for MRSA Presents to ED with sepsis: MRSA in blood MRSA only tested every 5 days for AST from blood Daptomycin NS MRSA recognized on hospital day 8 Daptomycin NS isolate was found in blood bottle collected in ED (but not tested because it took longer to grow) Giltner et al J Clin Microbiol. 52:357.
34 PERSISTENT MRSA BACTEREMIA PATIENT #1 DAPTOMYCIN MIC STORY Day of Hospitalization on Which Blood Culture Drawn Routine AST done on S. aureus at time of isolation? Why? 1 Yes First S. aureus isolated from this hospitalization 0 No Recovered after MRSA from Day 1 was isolated 8 Yes More than 5 days elapsed since previous AST done No Less than 5 days elapsed since previous AST done 15 Yes More than 5 days elapsed since previous AST done Daptomycin MIC (µg/ml) 0.5 S 4 NS* 2 NS 0.5 S, 1S 2 NS* 8 NS *results obtained from retrospective testing Giltner et al J Clin Microbiol. 52:357.
35 WHAT SHOULD WE DO ABOUT TESTING VANCOMYCIN (& DAPTOMYCIN) FOR MRSA? Use MIC method verified in your laboratory; report according to your SOP Will be some differences by method Avoid repeated subcultures If use multiple methods and get conflicting results must review patient response to vancomycin! Test all isolates from blood, especially if they have atypical morphotype or take a long time to grow If MIC 3 µg/ml by any method, report VISA Most likely in patients previously treated with vancomycin Physicians should be informed about issues with vancomycin MIC testing and need to continually monitor patient response to vancomycin therapy Some refs Howden et al Clin Microbiol Rev. 23:99. Liu et al Clin Infect Dis. 52:1. Van Hal et al Clin Infect Dis. 54:755. Kalil et al JAMA 312:1552.
36 CAN CONS SHOW DECREASED SUSCEPTIBILITY TO VANCOMYCIN? May show increase in MICs following exposure to vancomycin Most common in S. haemolyticus and S. epidermidis Some suggest use alternative to vancomycin for S. haemolyticus Falcone et al Diagn Microbiol Infect Dis. 57:325. Method - Organism MIC - S. aureus MIC (µg/ml) S I R 2 * MIC - CoNS CLSI M100-S25. Table 2C.
37 Drug OTHER ANTIMICROBIAL AGENTS FOR MRSA Route PO IM IV Comments ceftaroline x FDA indications for complicated skin infxns, communityacquired pneumonia β-lactam with activity against MRSA FDA indications for complicated skin infxns, bacteremia daptomycin x Disk diffusion does not work; must do MIC S breakpoint only NOT for respiratory infxns (lung surfactant inhibits drug); do not report on respiratory specimens linezolid x x FDA indications for nosocomial pneumonia, complicated skin infxns, uncomplicated skin infxns (MSSA); communityacquired pneumonia (MSSA) For disk diffusion, examine with transmitted light
38 Measure linezolid zones with transmitted light (any growth is significant) Linezolid Measuring Endpoints Light Ignore MIC trailing endpoints CLSI M07-A10. p
39 NEWER ANTIMICROBIAL AGENTS MRSA Drug Route PO IM IV Comments dalbavancin oritavancin telavancin x x x FDA indications for complicated skin infxns; S only breakpoint (FDA no CLSI). Once/week dose FDA indications for complicated skin infxns; S only breakpoint (FDA no CLSI). One dose FDA indications for complicated skin infxns; community-acquired / hospital-associated pneumonia; S only breakpoint (FDA no CLSI). Once/day dose tedizolid x x FDA indications for complicated skin infxns; S/R breakpoint for S. aureus (FDA no CLSI). Once/day dose
40 Staphylococcus spp. -Inducible clindamycin resistance
41 SPECIMEN: PUS (L BUTTOCK LESION) DIAGNOSIS: LOCALIZED ABSCESS MANY STAPHYLOCOCCUS AUREUS clindamycin S??? erythromycin R oxacillin R penicillin R vancomycin S What should we do about clindamycin results?
42 STAPHYLOCOCCUS SPP. ERYTHROMYCIN / CLINDAMYCIN Mechanism Determinant Erythro Clinda Efflux msra R S Ribosome modification erm R S* Ribosome modification erm R R constitutive msra = macrolide streptogramin resistance erm = erythromycin ribosome methylase *requires induction to show resistance
43 S. AUREUS D ZONE TEST D zone test is only for staphylococci that are: Erythromycin R and Clindamycin S or I Photo 1: inducible clindamycin R Photos 2 and 3: erythromycin R and clindamycin R (D zone test NOT needed) 1 2 3
44 SPECIMEN: PUS (L BUTTOCK LESION) DIAGNOSIS: LOCALIZED ABSCESS MANY STAPHYLOCOCCUS AUREUS clindamycin erythromycin oxacillin penicillin vancomycin R R R R S Final Report with Optional Comment This S. aureus is presumed to be clindamycin resistant based on detection of inducible clindamycin resistance. Clindamycin may still be effective in some patients.
45 ERYTHROMYCIN-R, CLINDAMYCIN-S STAPHYLOCOCCI TESTS FOR INDUCIBLE CLINDAMYCIN RESISTANCE Notes: Test applies to S. aureus and CoNS (OX-S and OX-R) Test not routinely done on CoNS as clindamycin rarely used for CoNS Clindamycin can be give orally; good option for outpatients if S
46 SUMMARY (1) An induced -lactamase test usually, but not always detects staphylococci capable of producing -lactamase; for -lactamase negative staphylococci with penicillin MICs 0.12 µg/ml or zones 29 mm, subsequent isolates on a patient should be subjected to AST. Penicillin disk zone edge test is used to detect β- lactamase in S. aureus whereas induced nitrocefin β- lactamase test is used for CoNS. Cefoxitin disk diffusion and cefoxitin MIC tests are more sensitive in detecting meca-mediated resistance in S. aureus than tests using oxacillin. If both oxacillin and cefoxitin are tested against S. aureus or S. lugdunensis and either is resistant, the isolate should be reported as oxacillin resistant.
47 SUMMARY (2) MRSA are strains that have meca and/or oxacillin MICs >2 µg/ml and/or cefoxitin resistance. Testing for S. aureus as MR or MS should be done as quickly as possible, especially on isolates from serious infections. MRSA with mecc have not yet been reported in the USA. Some suggest serious infections caused by MRSA with vancomycin susceptible MICs of 2 µg/ml may not respond as well to vancomycin therapy as MRSA with vancomycin MICs of 1 µg/ml. When considering alternative therapy to vancomycin for MRSA, patient clinical response and vancomycin MIC must be examined.
48 SUMMARY (3) Different methods may result in different vancomycin MICs for vancomycin-s S. aureus. Etest produces higher vancomycin MICs than CLSI broth microdilution reference method. Reproducibility of MIC tests is +/- 1 two-fold dilution. VISA are often slow growing and may yield a variety of colony morphologies. Tests for inducible clindamycin resistance should be done before reporting clindamycin S in erythromycin-r and clindamycin-s or I staphylococci. Oxacillin MIC tests work well for S. epidermidis but can overcall oxacillin-r in other CoNS that lack meca. The cefoxitin disk diffusion test is better.
STAPHYLOCOCCI: KEY AST CHALLENGES
Romney Humphries, PhD D(ABMM) Section Chief, UCLA Clinical Microbiology Los Angeles CA rhumphries@mednet.ucla.edu STAPHYLOCOCCI: KEY AST CHALLENGES THE CHALLENGES detection of penicillin resistance detection
More informationSTAPHYLOCOCCI: KEY AST CHALLENGES
Romney Humphries, PhD D(ABMM) Section Chief, UCLA Clinical Microbiology Los Angeles CA rhumphries@mednet.ucla.edu STAPHYLOCOCCI: KEY AST CHALLENGES THE CHALLENGES detection of penicillin resistance detection
More information56 Clinical and Laboratory Standards Institute. All rights reserved.
Table 2C 56 Clinical and Laboratory Standards Institute. All rights reserved. Table 2C. Zone Diameter and Minimal Inhibitory Concentration Breakpoints for Testing Conditions Medium: Inoculum: diffusion:
More informationJanuary 2014 Vol. 34 No. 1
January 2014 Vol. 34 No. 1. and Minimum Inhibitory Concentration (MIC) Interpretive Standards for Testing Conditions Medium: diffusion: Mueller-Hinton agar (MHA) Broth dilution: cation-adjusted Mueller-Hinton
More informationEDUCATIONAL COMMENTARY - Methicillin-Resistant Staphylococcus aureus: An Update
EDUCATIONAL COMMENTARY - Methicillin-Resistant Staphylococcus aureus: An Update Educational commentary is provided through our affiliation with the American Society for Clinical Pathology (ASCP). To obtain
More informationEUCAST Expert Rules for Staphylococcus spp IF resistant to isoxazolylpenicillins
EUAST Expert Rules for 2018 Organisms Agents tested Agents affected Rule aureus Oxacillin efoxitin (disk diffusion), detection of meca or mec gene or of PBP2a All β-lactams except those specifically licensed
More informationInt.J.Curr.Microbiol.App.Sci (2018) 7(8):
International Journal of Current Microbiology and Applied Sciences ISSN: 2319-7706 Volume 7 Number 08 (2018) Journal homepage: http://www.ijcmas.com Original Research Article https://doi.org/10.20546/ijcmas.2018.708.378
More informationThis document is protected by international copyright laws.
Table 2C Table 2C. and s for Product Name: Infobase 2010 - Release Date: February 2010 60 Clinical and Laboratory Standards Institute. All rights reserved. Testing Conditions Medium: diffusion: MHA Broth
More informationEducating Clinical and Public Health Laboratories About Antimicrobial Resistance Challenges
Educating Clinical and Public Health Laboratories About Antimicrobial Resistance Challenges Janet Hindler, MCLS MT(ASCP) UCLA Medical Center jhindler@ucla.edu also working as a consultant with the Association
More informationThe Basics: Using CLSI Antimicrobial Susceptibility Testing Standards
The Basics: Using CLSI Antimicrobial Susceptibility Testing Standards Janet A. Hindler, MCLS, MT(ASCP) UCLA Health System Los Angeles, California, USA jhindler@ucla.edu 1 Learning Objectives Describe information
More informationStaph Cases. Case #1
Staph Cases Lisa Winston University of California, San Francisco San Francisco General Hospital Case #1 A 60 y.o. man with well controlled HIV and DM presents to clinic with ten days of redness and swelling
More informationEuropean Committee on Antimicrobial Susceptibility Testing
European Committee on Antimicrobial Susceptibility Testing Routine and extended internal quality control as recommended by EUCAST Version 5.0, valid from 015-01-09 This document should be cited as "The
More informationEuropean Committee on Antimicrobial Susceptibility Testing
European Committee on Antimicrobial Susceptibility Testing Routine and extended internal quality control for MIC determination and disk diffusion as recommended by EUCAST Version 8.0, valid from 018-01-01
More informationAntimicrobial Susceptibility Testing: The Basics
Antimicrobial Susceptibility Testing: The Basics Susan E. Sharp, Ph.D., DABMM, FAAM Director, Airport Way Regional Laboratory Director, Regional Microbiology and Molecular Infectious Diseases Laboratories
More informationBackground and Plan of Analysis
ENTEROCOCCI Background and Plan of Analysis UR-11 (2017) was sent to API participants as a simulated urine culture for recognition of a significant pathogen colony count, to perform the identification
More informationجداول میکروارگانیسم های بیماریزای اولویت دار و آنتی بیوتیک های تعیین شده برای آزمایش تعیین حساسیت ضد میکروبی در برنامه مهار مقاومت میکروبی
جداول میکروارگانیسم های بیماریزای اولویت دار و آنتی بیوتیک های تعیین شده برای آزمایش تعیین حساسیت ضد میکروبی در برنامه مهار مقاومت میکروبی ویرایش دوم بر اساس ed., 2017 CLSI M100 27 th تابستان ۶۹۳۱ تهیه
More informationThe Very Latest from the CLSI AST Subcommittee.
2 0 1 4 The Very Latest from the CLSI AST Subcommittee. Susan E. Sharp, Ph.D., DABMM, FAAM Director - Regional Laboratory Director - Regional Microbiology/Molecular Infectious Diseases Diagnostics Laboratory
More information2016 Antibiotic Susceptibility Report
Fairview Northland Medical Center and Elk River, Milaca, Princeton and Zimmerman Clinics 2016 Antibiotic Susceptibility Report GRAM-NEGATIVE ORGANISMS 2016 Gram-Negative Non-Urine The number of isolates
More informationa. 379 laboratories provided quantitative results, e.g (DD method) to 35.4% (MIC method) of all participants; see Table 2.
AND QUANTITATIVE PRECISION (SAMPLE UR-01, 2017) Background and Plan of Analysis Sample UR-01 (2017) was sent to API participants as a simulated urine culture for recognition of a significant pathogen colony
More informationUpdate on the CLSI Standards for Antimicrobial Susceptibility Testing: What s New with the Gram Positive Organisms?
2 0 1 3 CASES (with answers!) Update on the CLSI Standards for Antimicrobial Susceptibility Testing: What s New with the Gram Positive Organisms? Susan E. Sharp, Ph.D., DABMM, FAAM Director - Regional
More informationAntibiotic Updates: Part I
Antibiotic Updates: Part I Fredrick M. Abrahamian, DO, FACEP, FIDSA Health Sciences Clinical Professor of Emergency Medicine David Geffen School of Medicine at UCLA Los Angeles, California Financial Disclosures
More information2015 Antibiotic Susceptibility Report
Citrobacter freundii Enterobacter aerogenes Enterobacter cloacae Escherichia coli Haemophilus influenzenza Klebsiella oxytoca Klebsiella pneumoniae Proteus mirabilis Pseudomonas aeruginosa Serratia marcescens
More informationAppropriate Antimicrobial Therapy for Treatment of
Appropriate Antimicrobial Therapy for Treatment of Staphylococcus aureus infections ( MRSA ) By : A. Bojdi MD Assistant Professor Inf. Dis. Dep. Imam Reza Hosp. MUMS Antibiotics Still Miracle Drugs Paul
More informationMICRONAUT MICRONAUT-S Detection of Resistance Mechanisms. Innovation with Integrity BMD MIC
MICRONAUT Detection of Resistance Mechanisms Innovation with Integrity BMD MIC Automated and Customized Susceptibility Testing For detection of resistance mechanisms and specific resistances of clinical
More informationChallenges Emerging resistance Fewer new drugs MRSA and other resistant pathogens are major problems
Micro 301 Antimicrobial Drugs 11/7/12 Significance of antimicrobial drugs Challenges Emerging resistance Fewer new drugs MRSA and other resistant pathogens are major problems Definitions Antibiotic Selective
More informationFailure of Cloxacillin in a Patient with BORSA Endocarditis ACCEPTED
JCM Accepts, published online ahead of print on 30 December 2008 J. Clin. Microbiol. doi:10.1128/jcm.00571-08 Copyright 2008, American Society for Microbiology and/or the Listed Authors/Institutions. All
More informationDetection of Methicillin Resistant Strains of Staphylococcus aureus Using Phenotypic and Genotypic Methods in a Tertiary Care Hospital
International Journal of Current Microbiology and Applied Sciences ISSN: 2319-7706 Volume 6 Number 7 (2017) pp. 4008-4014 Journal homepage: http://www.ijcmas.com Original Research Article https://doi.org/10.20546/ijcmas.2017.607.415
More informationThere are two international organisations that set up guidelines and interpretive breakpoints for bacteriology and susceptibility
ANTIMICROBIAL SUSCEPTIBILITY TESTING ON MILK SAMPLES Method and guidelines There are two international organisations that set up guidelines and interpretive breakpoints for bacteriology and susceptibility
More informationDetection of inducible clindamycin resistance among clinical isolates of Staphylococcus aureus in a tertiary care hospital
ISSN: 2319-7706 Volume 3 Number 9 (2014) pp. 689-694 http://www.ijcmas.com Original Research Article Detection of inducible clindamycin resistance among clinical isolates of Staphylococcus aureus in a
More informationVolume-7, Issue-2, April-June-2016 Coden IJABFP-CAS-USA Received: 5 th Mar 2016 Revised: 11 th April 2016 Accepted: 13 th April 2016 Research article
Volume-7, Issue-2, April-June-2016 Coden IJABFP-CAS-USA Copyrights@2016 Received: 5 th Mar 2016 Revised: 11 th April 2016 Accepted: 13 th April 2016 Research article A STUDY ON ANTIBIOTIC SUSCEPTIBILITY
More informationWhat s new in EUCAST methods?
What s new in EUCAST methods? Derek Brown EUCAST Scientific Secretary Interactive question 1 MIC determination MH-F broth for broth microdilution testing of fastidious microorganisms Gradient MIC tests
More informationESCMID Online Lecture Library. by author
Quality Assurance of antimicrobial susceptibility testing Derek Brown EUCAST Scientific Secretary ESCMID Postgraduate Education Course, Linz, 17 September 2014 Quality Assurance The total process by which
More informationShould we test Clostridium difficile for antimicrobial resistance? by author
Should we test Clostridium difficile for antimicrobial resistance? Paola Mastrantonio Department of Infectious Diseases Istituto Superiore di Sanità, Rome,Italy Clostridium difficile infection (CDI) (first
More informationRoutine internal quality control as recommended by EUCAST Version 3.1, valid from
Routine internal quality control as recommended by EUCAST Version.1, valid from 01-01-01 Escherichia coli Pseudomonas aeruginosa Staphylococcus aureus Enterococcus faecalis Streptococcus pneumoniae Haemophilus
More information2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Process
Quality ID #407: Appropriate Treatment of Methicillin-Susceptible Staphylococcus Aureus (MSSA) Bacteremia National Quality Strategy Domain: Effective Clinical Care 2018 OPTIONS FOR INDIVIDUAL MEASURES:
More informationPerformance Information. Vet use only
Performance Information Vet use only Performance of plates read manually was measured in three sites. Each centre tested Enterobacteriaceae, streptococci, staphylococci and pseudomonas-like organisms.
More informationUNDERSTANDING YOUR DATA: THE ANTIBIOGRAM
UNDERSTANDING YOUR DATA: THE ANTIBIOGRAM April Abbott, PhD, D(ABMM) Deaconess Health System Evansville, IN April.Abbott@Deaconess.com Special thanks to Dr. Shelley Miller for UCLA data WHAT WE WILL COVER
More informationEUCAST recommended strains for internal quality control
EUCAST recommended strains for internal quality control Escherichia coli Pseudomonas aeruginosa Staphylococcus aureus Enterococcus faecalis Streptococcus pneumoniae Haemophilus influenzae ATCC 59 ATCC
More informationCompliance of manufacturers of AST materials and devices with EUCAST guidelines
Compliance of manufacturers of AST materials and devices with EUCAST guidelines Data are based on questionnaires to manufacturers of materials and devices for antimicrobial susceptibility testing. The
More informationENTEROCOCCI. April Abbott Deaconess Health System Evansville, IN
ENTEROCOCCI April Abbott Deaconess Health System Evansville, IN OBJECTIVES Discuss basic antimicrobial susceptibility principles and resistance mechanisms for Enterococcus Describe issues surrounding AST
More informationANTIMICROBIAL SUSCEPTIBILITY DETECTION OF ELEVATED MICs TO PENICILLINS IN β- HAEMOLYTIC STREPTOCOCCI
HAEMOLYTIC STREPTOCOCCI This specimen was designated as a sample from a skin wound that was to be cultured, identified to species level and susceptibility tested [1-3]. The culture contained a Streptococcus
More informationAntibiotic Abyss. Discussion Points. MRSA Treatment Guidelines
Antibiotic Abyss Fredrick M. Abrahamian, D.O., FACEP, FIDSA Professor of Medicine UCLA School of Medicine Director of Education Department of Emergency Medicine Olive View-UCLA Medical Center Sylmar, California
More informationAntimicrobial Resistance and Molecular Epidemiology of Staphylococcus aureus in Ghana
Antimicrobial Resistance and Molecular Epidemiology of Staphylococcus aureus in Ghana Beverly Egyir, PhD Noguchi Memorial Institute for Medical Research Bacteriology Department, University of Ghana Background
More informationSuggestions for appropriate agents to include in routine antimicrobial susceptibility testing
Suggestions for appropriate agents to include in routine antimicrobial susceptibility testing These suggestions are intended to indicate minimum sets of agents to test routinely in a diagnostic laboratory
More informationSaxena Sonal*, Singh Trishla* and Dutta Renu* (Received for publication January 2012)
J. Commun. Dis. 44(2) 2012 : 97-102 Practical disk diffusion method for detection of inducible clindamycin resistance in Staphylococcus aureus at a tertiary care hospital: Implications for clinical therapy
More informationAntimicrobial Susceptibility Testing: Advanced Course
Antimicrobial Susceptibility Testing: Advanced Course Cascade Reporting Cascade Reporting I. Selecting Antimicrobial Agents for Testing and Reporting Selection of the most appropriate antimicrobials to
More informationMercy Medical Center Des Moines, Iowa Department of Pathology. Microbiology Department Antibiotic Susceptibility January December 2016
Mercy Medical Center Des Moines, Iowa Department of Pathology Microbiology Department Antibiotic Susceptibility January December 2016 These statistics are intended solely as a GUIDE to choosing appropriate
More informationIntrinsic, implied and default resistance
Appendix A Intrinsic, implied and default resistance Magiorakos et al. [1] and CLSI [2] are our primary sources of information on intrinsic resistance. Sanford et al. [3] and Gilbert et al. [4] have been
More informationChemotherapy of bacterial infections. Part II. Mechanisms of Resistance. evolution of antimicrobial resistance
Chemotherapy of bacterial infections. Part II. Mechanisms of Resistance evolution of antimicrobial resistance Mechanism of bacterial genetic variability Point mutations may occur in a nucleotide base pair,
More informationMethicillin and Clindamycin resistance in biofilm producing staphylococcus aureus isolated from clinical specimens
Original article Methicillin and Clindamycin resistance in biofilm producing staphylococcus aureus isolated from clinical specimens Pankaj A. Joshi, Dhruv K.Mamtora,. Neeta PJangale., Meena N.Ramteerthakar,
More informationTel: Fax:
CONCISE COMMUNICATION Bactericidal activity and synergy studies of BAL,a novel pyrrolidinone--ylidenemethyl cephem,tested against streptococci, enterococci and methicillin-resistant staphylococci L. M.
More informationHelp with moving disc diffusion methods from BSAC to EUCAST. Media BSAC EUCAST
Help with moving disc diffusion methods from BSAC to EUCAST This document sets out the main differences between the BSAC and EUCAST disc diffusion methods with specific emphasis on preparation prior to
More informationUNDERSTANDING THE ANTIBIOGRAM
UNDERSTANDING THE ANTIBIOGRAM April Abbott, PhD, D(ABMM) Deaconess Health System Indiana University School of Medicine - Evansville Evansville, IN April.Abbott@Deaconess.com WHAT WE WILL COVER Describe
More informationWhy we perform susceptibility testing
22 nd June 2015 Why we perform susceptibility testing Robin A Howe Antimicrobial use in Primary Care Why do we perform AST? Clinical Clinical Prediction Prediction of of Efficacy Efficacy Why do we perform
More information2019 COLLECTION TYPE: MIPS CLINICAL QUALITY MEASURES (CQMS) MEASURE TYPE: Process High Priority
Quality ID #407: Appropriate Treatment of Methicillin-Susceptible Staphylococcus Aureus (MSSA) Bacteremia National Quality Strategy Domain: Effective Clinical Care Meaningful Measure Area: Healthcare Associated
More informationThe Impact of meca Gene Testing and Infectious Diseases Pharmacists. Intervention on the Time to Optimal Antimicrobial Therapy for ACCEPTED
JCM Accepts, published online ahead of print on 7 May 2008 J. Clin. Microbiol. doi:10.1128/jcm.00801-08 Copyright 2008, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights
More informationEvaluation of MicroScan MIC Panels for Detection of
JOURNAL OF CLINICAL MICROBIOLOGY, May 1988, p. 816-820 Vol. 26, No. 5 0095-1137/88/050816-05$02.00/0 Copyright 1988, American Society for Microbiology Evaluation of MicroScan MIC Panels for Detection of
More informationAntibiotic Resistances Profile in Iran, Clinical Implication and Prospect for Antibiotic Stewardship Jafar Soltani
Antibiotic Resistances Profile in Iran, Clinical Implication and Prospect for Antibiotic Stewardship Jafar Soltani Pediatrics Department, Faculty of Medicine, Kurdistan University of Medical Sciences,
More informationESBL Producers An Increasing Problem: An Overview Of An Underrated Threat
ESBL Producers An Increasing Problem: An Overview Of An Underrated Threat Hicham Ezzat Professor of Microbiology and Immunology Cairo University Introduction 1 Since the 1980s there have been dramatic
More informationMethicillin-Resistant Staphylococcus aureus
Methicillin-Resistant Staphylococcus aureus By Karla Givens Means of Transmission and Usual Reservoirs Staphylococcus aureus is part of normal flora and can be found on the skin and in the noses of one
More informationSurveillance for Antimicrobial Resistance and Preparation of an Enhanced Antibiogram at the Local Level. janet hindler
Surveillance for Antimicrobial Resistance and Preparation of an Enhanced Antibiogram at the Local Level janet hindler At the conclusion of this talk, you will be able to Describe CLSI M39-A3 recommendations
More informationInducible clindamycin resistance among Staphylococcus aureus isolates
Original article Inducible clindamycin resistance among Staphylococcus aureus isolates *Gade ND 1, Qazi MS 2 1Department of Microbiology, BJ Medical college, Pune, India 2Department of Microbiology, GMC,
More informationMRSA surveillance 2014: Poultry
Vicky Jasson MRSA surveillance 2014: Poultry 1. Introduction In the framework of the FASFC surveillance, a surveillance of MRSA in poultry has been executed in order to determine the prevalence and diversity
More informationEmpiric therapy for severe suspected Staphylococcus aureus infection
Empiric therapy for severe suspected Staphylococcus aureus infection Salman Qureshi, MD McGill University Faculty of Medicine Department of Critical Care Medicine McGill University Health Centre Relevant
More informationInfectious Disease: Drug Resistance Pattern in New Mexico
Infectious Disease: Drug Resistance Pattern in New Mexico Are these the world's sexiest accents? Obi C. Okoli, MD.,MPH. Clinic for Infectious Diseases Las Cruces, NM. Are these the world's sexiest accents?
More informationCompliance of manufacturers of AST materials and devices with EUCAST guidelines
Compliance of manufacturers of AST materials and devices with EUCAST guidelines Data are based on questionnaires to manufacturers of materials and devices for antimicrobial susceptibility testing. The
More informationJasmine M. Chaitram, 1,2 * Laura A. Jevitt, 1,2 Sara Lary, 1,2 Fred C. Tenover, 1,2 and The WHO Antimicrobial Resistance Group 3,4
JOURNAL OF CLINICAL MICROBIOLOGY, June 2003, p. 2372 2377 Vol. 41, No. 6 0095-1137/03/$08.00 0 DOI: 10.1128/JCM.41.6.2372 2377.2003 The World Health Organization s External Quality Assurance System Proficiency
More informationContinued in vitro cefazolin susceptibility in methicillin susceptible Staphylococcus aureus
https://doi.org/10.1186/s12941-018-0257-x Annals of Clinical Microbiology and Antimicrobials SHORT REPORT Open Access Continued in vitro cefazolin susceptibility in methicillin susceptible Staphylococcus
More informationAntimicrobial stewardship: Quick, don t just do something! Stand there!
Antimicrobial stewardship: Quick, don t just do something! Stand there! Stanley I. Martin, MD, FACP, FIDSA Director, Division of Infectious Diseases Director, Antimicrobial Stewardship Program Geisinger
More informationBest Antimicrobials for Staphylococcus aureus Bacteremia
Best Antimicrobials for Staphylococcus aureus Bacteremia I. Methicillin Susceptible Staph aureus (MSSA) A. In vitro - Anti-Staphylococcal β-lactams (Oxacillin, Nafcillin, Cefazolin) are more active B.
More informationANTIMICROBIAL SUSCEPTIBILITY CHARACTERIZING SUSCEPTIBILITY PATTERNS OF MSSA ASSOCIATED WITH SURGICAL WOUND INFECTIONS
ASSOCIATED WITH SURGICAL WOUND INFECTIONS Specimen ES-02 was designated as a "surgical wound culture" to be identified to the species level and tested for antimicrobial susceptibility. 1-4 The culture
More informationThe β- Lactam Antibiotics. Munir Gharaibeh MD, PhD, MHPE School of Medicine, The University of Jordan November 2018
The β- Lactam Antibiotics Munir Gharaibeh MD, PhD, MHPE School of Medicine, The University of Jordan November 2018 Penicillins. Cephalosporins. Carbapenems. Monobactams. The β- Lactam Antibiotics 2 3 How
More informationInterpreting Microbiology reports for better Clinical Decisions Interpreting Antibiogrammes
Interpreting Microbiology reports for better Clinical Decisions Interpreting Antibiogrammes Prof C. Wattal Hon. Sr. Consultant & Chairman Dept. of Clinical Microbiology Sir Ganga Ram Hospital New Delhi
More informationmicrobiologists. In this article, we will discuss some of the challenges the laboratory faces with antimicrobial susceptibility
CE Update [microbiology and virology] Challenges in Antimicrobial Susceptibility Testing and Reporting Melinda D. Poulter, PhD, MT(ASCP), Janet F. Hindler, MT(ASCP) UCLA Medical Center, Department of Pathology
More informationIntroduction to Pharmacokinetics and Pharmacodynamics
Introduction to Pharmacokinetics and Pharmacodynamics Diane M. Cappelletty, Pharm.D. Assistant Professor of Pharmacy Practice Wayne State University August, 2001 Vocabulary Clearance Renal elimination:
More informationAntimicrobial Therapy
Antimicrobial Therapy David H. Spach, MD Professor of Medicine Division of Infectious Diseases University of Washington, Seattle Disclosure: Dr. Spach has no significant financial interest in any of the
More informationAntimicrobials. Antimicrobials
Antimicrobials For more than 50 years, antibiotics have come to the rescue by routinely producing rapid and long-lasting miracle cures. However, from the beginning antibiotics have selected for resistance
More informationResistance Among Streptococcus pneumoniae: Patterns, Mechanisms, Interpreting the Breakpoints
...PRESENTATIONS... Resistance Among Streptococcus pneumoniae: Patterns, Mechanisms, Interpreting the Breakpoints Angela B. Brueggemann, MS; and Gary V. Doern, PhD Presentation Summary Streptococcus pneumoniae
More informationCefazolin vs. Antistaphyloccal Penicillins: The Great Debate
Cefazolin vs. Antistaphyloccal Penicillins: The Great Debate Annie Heble, PharmD PGY2 Pediatric Pharmacy Resident Children s Hospital Colorado Microbiology Rounds March 22, 2017 Image Source: Buck cartoons
More informationStreptococcus pneumoniae. Oxacillin 1 µg as screen for beta-lactam resistance
Streptococcus pneumoniae Oxacillin µg as screen for beta-lactam resistance Version 6. June Streptococcus pneumoniae and zone diameter correlates The following histograms present inhibition zone diameter
More informationDetecting / Reporting Resistance in Nonfastidious GNR Part #2. Janet A. Hindler, MCLS MT(ASCP)
Detecting / Reporting Resistance in Nonfastidious GNR Part #2 Janet A. Hindler, MCLS MT(ASCP) Methods Described in CLSI M100-S21 for Testing non-enterobacteriaceae Organism Disk Diffusion MIC P. aeruginosa
More informationConsequences of Antimicrobial Resistant Bacteria. Antimicrobial Resistance. Molecular Genetics of Antimicrobial Resistance. Topics to be Covered
Antimicrobial Resistance Consequences of Antimicrobial Resistant Bacteria Change in the approach to the administration of empiric antimicrobial therapy Increased number of hospitalizations Increased length
More informationLe infezioni di cute e tessuti molli
Le infezioni di cute e tessuti molli SCELTE e STRATEGIE TERAPEUTICHE Pierluigi Viale Clinica di Malattie Infettive Policlinico S. Orsola Malpighi Treatment of complicated skin and skin structure infections
More informationTHE NAC CHALLENGE PANEL OF ISOLATES FOR VERIFICATION OF ANTIBIOTIC SUSCEPTIBILITY TESTING METHODS
THE NAC CHALLENGE PANEL OF ISOLATES FOR VERIFICATION OF ANTIBIOTIC SUSCEPTIBILITY TESTING METHODS Stefanie Desmet University Hospitals Leuven Laboratory medicine microbiology stefanie.desmet@uzleuven.be
More informationMID 23. Antimicrobial Resistance. Consequences of Antimicrobial Resistant Bacteria. Molecular Genetics of Antimicrobial Resistance
Antimicrobial Resistance Molecular Genetics of Antimicrobial Resistance Micro evolutionary change - point mutations Beta-lactamase mutation extends spectrum of the enzyme rpob gene (RNA polymerase) mutation
More informationUnderstanding the Hospital Antibiogram
Understanding the Hospital Antibiogram Sharon Erdman, PharmD Clinical Professor Purdue University College of Pharmacy Infectious Diseases Clinical Pharmacist Eskenazi Health 5 Understanding the Hospital
More informationJanuary 2014 Vol. 34 No. 1
January 2014 Vol. 34 No. 1. and Minimal Inhibitory Concentration (MIC) Interpretive Standards for Testing Conditions Medium: diffusion: Mueller-Hinton agar (MHA) roth dilution: cation-adjusted Mueller-Hinton
More informationAntimicrobial Resistance
Antimicrobial Resistance Consequences of Antimicrobial Resistant Bacteria Change in the approach to the administration of empiric antimicrobial therapy Increased number of hospitalizations Increased length
More informationAntimicrobial Resistance Acquisition of Foreign DNA
Antimicrobial Resistance Acquisition of Foreign DNA Levy, Scientific American Horizontal gene transfer is common, even between Gram positive and negative bacteria Plasmid - transfer of single or multiple
More informationPractical approach to Antimicrobial susceptibility testing (AST) and quality control
Practical approach to Antimicrobial susceptibility testing (AST) and quality control A/Professor John Ferguson, Microbiologist & Infectious Diseases Physician, Pathology North, University of Newcastle,
More informationMain objectives of the EURL EQAS s
EQAS Enterococci, Staphylococci and E. coli EURL workshop, April, 11 Lourdes García Migura Main objectives of the EURL EQAS s To improve the comparability of antimicrobial susceptibility testing (AST)
More informationQuality assurance of antimicrobial susceptibility testing
Quality assurance of antimicrobial susceptibility testing Derek Brown Routine quality control Repeated testing of controls in parallel with tests to ensure that the test system is performing reproducibly
More informationMechanism of antibiotic resistance
Mechanism of antibiotic resistance Dr.Siriwoot Sookkhee Ph.D (Biopharmaceutics) Department of Microbiology Faculty of Medicine, Chiang Mai University Antibiotic resistance Cross-resistance : resistance
More informationAntibiotics. Antimicrobial Drugs. Alexander Fleming 10/18/2017
Antibiotics Antimicrobial Drugs Chapter 20 BIO 220 Antibiotics are compounds produced by fungi or bacteria that inhibit or kill competing microbial species Antimicrobial drugs must display selective toxicity,
More informationAntimicrobial Resistance in the Intensive Care Unit: Mechanisms, Epidemiology, and Management of Specific Resistant Pathogens
Antimicrobial Resistance in the Intensive Care Unit: Mechanisms, Epidemiology, and Management of Specific Resistant Pathogens Henry S. Fraimow, MD a, *, Constantine Tsigrelis, MD b KEYWORDS Resistance
More informationAn Approach to Linezolid and Vancomycin against Methicillin Resistant Staphylococcus Aureus
Article ID: WMC00590 ISSN 2046-1690 An Approach to Linezolid and Vancomycin against Methicillin Resistant Staphylococcus Aureus Author(s):Dr. K P Ranjan, Dr. D R Arora, Dr. Neelima Ranjan Corresponding
More informationDefining Resistance and Susceptibility: What S, I, and R Mean to You
Defining Resistance and Susceptibility: What S, I, and R Mean to You Michael D. Apley, DVM, PhD, DACVCP Department of Clinical Sciences College of Veterinary Medicine Kansas State University Susceptible
More informationRise of Resistance: From MRSA to CRE
Rise of Resistance: From MRSA to CRE Paul D. Holtom, MD Professor of Medicine and Orthopaedics USC Keck School of Medicine SUPERBUGS (AKA MDROs) MRSA Methicillin-resistant S. aureus Evolution of Drug Resistance
More informationORIGINAL ARTICLE /j x
ORIGINAL ARTICLE 10.1111/j.1469-0691.2006.01550.x Antimicrobial susceptibility of Gram-positive bacteria isolated from European medical centres: results of the Daptomycin Surveillance Programme (2002 2004)
More information