Panel update 5.pdf

Adult Therapy Guide Legend Panel Update 5 International 9020-7493 Rev. B

SMN 10714735

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Adult Therapy Guide Legend No part of this work covered by the copyrights herein may be reproduced or copied in any form or by any means-graphic, electronic, or mechanical; including photocopying, recording, typing, or information storage and retrieval systems without written permission of the publisher. MicroScan, MICroSTREP plus, Synergies plus and WalkAway systems are trademarks of Siemens Healthcare Diagnostics. 9020-7493, Rev. B May 2013 Siemens Healthcare Diagnostics Inc. 1584 Enterprise Blvd. West Sacramento, CA 95691 USA www.siemens.com/diagnosics (916) 372-1900 (800) 677-7226 2013 Siemens Healthcare Diagnostics Inc. All rights reserved. Spec: 9900-3651

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Table of Contents

Revision Record ........................................................................................................................................................ 5

General Notes for Reporting Results: ..................................................................................................................... 6 DEFINITIONS: ............................................................................................................................................................. 6 INTERPRETIVE GUIDELINES ......................................................................................................................................... 6 SYNERGIES PLUS GRAM NEGATIVE PANELS: .............................................................................................................. 6 SYNERGIES PLUS GRAM POSITIVE PANELS: ............................................................................................................... 6 REFERENCED FROM THE CLSI M100-S22: ................................................................................................................. 6 MISCELLANEOUS NOTES: ........................................................................................................................................... 7 URINE/SYSTEMIC THERAPY INTERPRETATION RULES: .................................................................................................. 7 ADDITIONAL RULES: ................................................................................................................................................... 7

Warning From the CLSI M100-S22: ......................................................................................................................... 7

Extreme Caution from the CLSI M100-S22: ........................................................................................................... 8

Use of Inducible Beta-Lactamase Flag:................................................................................................................... 8

Cefoxitin Screen: ....................................................................................................................................................... 9

Inducible Clindamycin: ............................................................................................................................................. 9

Streptococci Reporting (Viridans, Beta-hemolytic and S. pneumoniae): .......................................................... 10

Streptococci Limitations: ....................................................................................................................................... 10

Miscellaneous Fastidious Organism Limitation: .................................................................................................. 10

Miscellaneous Organism Recommendation: ........................................................................................................ 10

Synergies Screen Reporting: ................................................................................................................................. 10

Predicted Susceptibility Rules for Synergies plus Pos Panels: ......................................................................... 11

Extended Spectrum Beta-Lactamase (ESBL) Interpretations: ........................................................................... 12

ANTIMICROBIAL AGENT THERAPY GUIDE TABLES .......................................................................................... 15 DRIED OVERNIGHT AND RAPID (FLUOROGENIC) GRAM-NEGATIVE PANELS ............................................. 15 DRIED OVERNIGHT GRAM-POSITIVE PANELS ........................................................................... 64 SYNERGIES PLUS GRAM-NEGATIVE PANELS .............................................................................................. 112 SYNERGIES PLUS GRAM-POSITIVE PANELS ................................................................................................ 126 FASTIDIOUS PANELS - STREPTOCOCCI ......................................................................................................... 130 FASTIDIOUS PANELS - HAEMOPHILUS ........................................................................................................... 145

Species Classifications for Organism Groups ................................................................................................... 153 ACINETOBACTER GROUP ................................................................................................................................ 153 ENTEROBACTER GROUP ................................................................................................................................. 153 CITROBACTER GROUP ..................................................................................................................................... 153 CITROBACTER FREUNDII GROUP ................................................................................................................... 153 ESBL GROUP- SCREENING .............................................................................................................................. 153 ESBL GROUP- CONFIRMATION ........................................................................................................................ 153 CITROBACTER AMALONATICUS/KOSERI GROUP ......................................................................................... 153 PROTEUS/PROVIDENCIA GROUP .................................................................................................................... 153 KLEBSIELLA GROUP .......................................................................................................................................... 153 PROVIDENCIA GROUP ...................................................................................................................................... 154 SALMONELLA/SHIGELLA GROUP .................................................................................................................... 154 SERRATIA GROUP ............................................................................................................................................. 154

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SHIGELLA GROUP.............................................................................................................................................. 154 VIBRIO SPP other than V. cholerae ..................................................................................................................... 154 MISCELLANEOUS FASTIDIOUS GROUP-NEG ................................................................................................. 154 MISCELLANEOUS FASTIDIOUS GROUP-POS ................................................................................................. 154 PROTEUS GROUP .............................................................................................................................................. 154 AEROMONAS SPP. GROUP .. .... 154 OTHER SPECIES GROUP .................................................................................................................................. 155 VIRIDANS STREPTOCOCCI GROUP ................................................................................................................. 156 MISCELLANEOUS STREPTOCOCCI GROUP ................................................................................................... 156 BETA-HEMOLYTIC STREPTOCOCCUS GROUP .............................................................................................. 156 GROUP A STREPTOCOCCUS GROUP ............................................................................................................. 156 ENTEROCOCCUS GROUP (for DRIED-OVERNIGHT GRAM-POSITIVE PANELS) ......................................... 156 ENTEROCOCCUS GROUP (for SYNERGIES PLUS GRAM-POSITIVE PANELS) ........................................... 156 COAGULASE NEGATIVE STAPHYLOCOCCI GROUP ..................................................................................... 157

Specific Classifications for Panel Groups .......................................................................................................... 158

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Revision Record Rev. Date Affected Sections A March

2013 Initial revision.

B May 2013

Add NC54 panel to Note 2 of Fosfomycin Table with 16, 32 and 64 dilutions in the Dried Overnight and Rapid (Fluorogenic) Gram-Negative Panels section

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General Notes for Reporting Results: Definitions: Minimum inhibitory concentration (MIC) dilutions are a sequence of 3 or more dilutions. Breakpoint dilutions are a 1 or 2 dilution sequence. For therapy reporting, Enterobacteriaceae includes all fermenters (except V. cholerae and Y. pestis) in the

LabPro Information Manager database unless otherwise noted. For therapy reporting, Non-Enterobacteriaceae includes all non-fermenters unless otherwise noted. For therapy reporting, EUCAST and CLSI reports for Haemophilus influenzae and Haemophilus

parainfluenzae. INTERPRETIVE GUIDELINES The Interpretive Guidelines were based on the following references, unless otherwise noted. Reference Revision EUCAST Clinical Breakpoint Tables

2013-02-11 (Version 3.1) 2013-01-01 (Version 3.0) 2012-01-01 (Version 2.0) January 2011 (version 1.3) December 2009 (Version 1.0)

CLSI M45-A2; Methods for Antimicrobial Dilution and Disk Susceptibility Testing of Infrequently Isolated or Fastidious Bacteria, 2nd edition

August 2010

CLSI M100-S9, S14, S17, S19, S21 and S22; Performance Standards for Antimicrobial Susceptibility Testing; Informational Supplements

January 1999, 2004, 2007, 2009, 2011 and 2012

ANVISA Guidelines Nota Technica No. 1/2010 (2010-10-25)

SFM January 2008, 2009 and 2012 MENSURA An Clin 2001; 26 (4) 109-126

Synergies plus Gram Negative panels: The Synergies plus Gram Negative panels contain antimicrobial agents that will report-when-ready together

with dried overnight antimicrobial agents. The report-when-ready antimicrobial agents may report rapid results (4.5 - 12 hrs) or overnight results (16 - 20

hrs) and the dried overnight antimicrobial agents will report overnight results (16 - 20 hrs). The report-when-ready antimicrobial agents can only be read rapidly (4.5 - 12 hrs) by the WalkAway SI or

WalkAway plus System. Manual reading of all antimicrobial agents must be performed at 16 20 hrs. Synergies plus Gram Positive panels: The Synergies plus Gram Positive panels contain antimicrobial agents that will report-when-ready. The report-when-ready antimicrobial agents may report rapid results (4.5 - 12 hrs) or overnight results (16 - 18 hrs). The report-when-ready antimicrobial agents can only be read rapidly (4.5 - 12 hrs) by the WalkAway SI or

WalkAway plus System. Manual reading of all antimicrobial agents must be performed at 16 - 20 hrs. For all Beta-lactam antimicrobial agents, the predicted interpretation for staphylococci will be based on the

penicillin and/or Oxacillin MICs. MICs will only be reported for staphylococci and/or enterococci. MICs will not be reported for streptococci. Referenced from the CLSI M100-S22 For some organism groups excluded from Tables 2A through 2J, the CLSI guideline M45 Methods for Antimicrobial Dilution and Disk Susceptibility Testing of Infrequently Isolated or Fastidious Bacteria provides suggestions for standardized methods for susceptibility testing, including information about drug selection, interpretation and QC. The organism groups covered in that document are Abiotrophia and Granulicatella spp. (formerly known as nutritionally deficient or nutritionally variant streptococci); Aeromonas spp.; Bacillus spp. (not B. anthracis), Campylobacter jejuni/coli, Corynebacterium spp. (including C. diptheriae); Erysipelothrix rhusiopathiae, the HACEK group: Aggregatibacter spp. (formerly Haemophilus aphrophilus, H. paraphrophilus,

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H. segnis and Actinobacillus actinomycetemcomitans), Cardiobacterium spp., Eikenella corrodens, and Kingella spp.; Helicobacter pylori; Lactobacillus spp.; Leuconostoc spp.; Listeria monocytogenes; Moraxella catarrhalis; Pasteurella spp.; Pediococcus spp.; potential agents of bioterrorism; and Vibrio spp., including V. cholerae. For organisms other than those in the groups mentioned above, studies are not yet adequate to develop reproducible, definitive standards to interpret results. These organisms may require different media or different atmospheres of incubation, or they may show marked strain-to-strain variation in growth rate. For these microorganisms, consultation with an infectious disease specialist is recommended for guidance in determining the need for susceptibility testing and in the interpretation of results. Published reports in the medical literature and current consensus recommendations for therapy of uncommon microorganisms may obviate the need for testing. If necessary, a dilution method usually is the most appropriate testing method, and this may require submitting the organism to a reference laboratory. Physicians should be informed of the limitations of results and advised to interpret results with caution. Miscellaneous Notes: S = Susceptible Blac = Beta-lactamase positive I = Intermediate TFG = Thymidine dependent strain R = Resistant Blank = Data not available, or drug not advisable or tested R* = Extrapolated Resistance N/R = Not reported S* = Extrapolated susceptible result NS = Nonsusceptible MIC values are reported in g/ml or mg/l. If the MIC was not reported, N/R will be printed in the MIC area. If a column under an organism group is blank, interpretations are not available. The following antimicrobial agents can be reported for V. cholerae with CLSI interpretations: Ampicillin,

Chloramphenicol, Tetracycline and Trimethoprim/Sulfamethoxazole. Urine/Systemic Therapy Interpretation Rules: 1. For all panels (dried overnight, rapid fluorogenic; Gram-positive or Gram-negative) therapy interpretation will be driven by source of specimen. 2. In the LabPro System, if the specimen source is systemic (non-urine), only the systemic therapy will be reported, when available. 3. In the LabPro System, if the specimen source is urine, only urine therapies will be reported, when available. Additional Rules: 1. If a Haemophilus or Neisseria from the HNID database is stored as the organism for a non-HNID panel, the

therapies will not be printed. 2. If a panel has not been tested, or the panel has not been interpreted, the phrase results to follow will be

printed in the therapy area. 3. Additional antimicrobial agent MIC results will print after the panel MIC results. 4. Therapy results for one isolate may require two or more successive pages. 5. Only results of testing with penicillin, vancomycin, cefotaxime, ceftriaxone or meropenem should be reported

routinely for CSF isolates of S. pneumoniae. 6. For Y. pestis, studies have demonstrated that although beta-lactam antimicrobial agents may appear active in

vitro they lack efficacy in animal models of infection. These antimicrobial agents should not be reported as susceptible.

Warning from the CLSI M100-S22: The following antimicrobial agents should not be routinely reported for bacteria isolated from the CSF that are included in this document. These antimicrobial agents are not the drugs of choice and may not be effective for treating CSF infections caused by these organisms (ie, the bacteria included in Tables 2A through 2J):

agents administered by oral route only

1st- and 2nd-generation cephalosporins (except cefuroxime parenteral) and cephamycins

clindamycin macrolides

tetracyclines fluoroquinolones

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Extreme Caution from the CLSI M45-A2: Public health officials should be notified about all isolates presumptively identified as B. anthracis, Brucella spp., Y. pestis, B. mallei, B. pseudomallei or F. tularensis. Confirmation of isolates of these bacteria may require specialized testing only available in reference or public health laboratories. Use of Inducible Beta-Lactamase Flag: There is an option to utilize a flag to note possible inducible beta-lactamase isolates on the Long Format Patient Report. If customization is to be used, the therapies for the organisms and antimicrobial agents listed below will NOT utilize the attached pages of this document. The flag will perform as follows: Possible inducible beta-lactamase producing organisms:

Aeromonas caviae Citrobacter braakii/freundii/sedlakii Aeromonas hydrophila Citrobacter werkmanii/youngae Aeromonas hydrophila group Enterobacter aerogenes Aeromonas hydrophila/trota/veronii Enterobacter cloacae Aeromonas jandaei Hafnia alvei Aeromonas schubertii Morganella morganii Aeromonas species Providencia alcalifaciens Aeromonas sobria Providencia alcalifaciens/rustigianii Aeromonas trota Providencia rettgeri Aeromonas veronii Providencia rustigianii Citrobacter braakii Providencia stuartii Citrobacter freundii complex Pseudomonas aeruginosa Citrobacter sedlakii Serratia liquefaciens Citrobacter werkmanii Serratia marcescens Citrobacter youngae

Beta-lactam antimicrobial agents for inducible beta-lactamase flag:

Amoxicillin Cefotetan Amoxicillin/K Clavulanate Cefoxitin Ampicillin Cefpodoxime Ampicillin/Sulbactam Cefsulodin Azlocillin Ceftazidime Aztreonam Ceftizoxime Carbenicillin Ceftriaxone Cefaclor Cefuroxime Cefamandole Cephalothin Cefazolin Loracarbef Cefdinir Mecillinam Cefixime Mezlocillin Cefmetazole Piperacillin Cefonicid Piperacillin/Tazobactam Cefoperazone Ticarcillin Cefoperazone/Sulbactam Ticarcillin/K Clavulanate Cefotaxime

If the inducible beta-lactamase flag is customized, an IB flag will appear on the Long Format Patient Report for all the above listed organism-drug combinations in place of the Susceptible (S) therapy result.

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Cefoxitin Screen

The Dried Cefoxitin Screen is intended to determine the susceptibility of staphylococci to the penicillinase-stable beta-lactams, using the Cefoxitin Screen Well (CfxS) and the Oxacillin MIC result at 16/18 hours. The CfxS result and Oxacillin MIC are read independently at 16/18 hours and then processed through the LabPro software or interpreted manually to determine the final interpretation to the penicillinase-stable beta-lactams (i.e., Oxacillin). The interpretation rules are shown in the following table:

Oxacillin Interpretation

CfxS Oxacillin MIC S. aureus or S. lugdunensis Other CNS

4 Neg

0.25 S S 0.5 S S*

1 or 2 S R Check mecA (see comment)

> 2 R R

> 4 Pos

0.25 R* R* 0.5 R* R

1 or 2 R* R > 2 R R

Comment: CNS with CfxS 4 and Oxacillin MICs of 1 or 2 give variable mecA results. Perform mecA testing if beta-lactam therapy is critical for patient care.

Interpretations of S* or R* are used by the LabPro software when the Cefoxitin Screen result changes the interpretation of the Oxacillin MIC result. The LabPro software will flag CNS isolates when CfxS is negative and Oxacillin MICs are 1 or 2 g/ml. The default interpretation will be R, however, mecA status is variable and must be checked before these isolates are reported as Oxacillin susceptible (mecA negative only). These criteria should also be followed when interpreting the results manually; however, the asterisk is not required.

For panels containing Oxacillin only: Staphylococci should be reported as resistant to Ampicillin, Amoxicillin/K Clavulanate, Ampicillin/Sulbactam, Ertapenem, Imipenem, Meropenem, Penicillin, Piperacillin/Tazobactam, Ticarcillin/K Clavulanate and the Cephalosporin antimicrobics (regardless of the MIC) when Oxacillin MICs are >2 g/ml for S. aureus and S. lugdunensis and 0.5 g/ml for coagulase negative staphylococci other than S. lugdunensis.

For panels containing both Oxacillin and the Cefoxitin Screen Well (CfxS): Staphylococci should be reported as resistant to Ampicillin, Amoxicillin/K Clavulanate, Ampicillin/Sulbactam, Ertapenem, Imipenem, Meropenem, Penicillin, Piperacillin/Tazobactam, Ticarcillin/K Clavulanate and the Cephalosporin antimicrobics (regardless of the MIC) when CfxS is > 4 g/ml for all staphylococci or Oxacillin MICs are >2 g/ml for S. aureus and S. lugdunensis or > 0.5 g/ml for other coagulase negative staphylococci. Based on MicroScan clinical studies, for coagulase negative staphylococci other than S. lugdunensis when CfxS is 4 g/ml and Oxacillin MIC is 0.5, the mecA status has been shown to be negative and the Oxacillin interpretation will be reported as S*. For coagulase negative staphylococci other than S. lugdunensis when CfxS is 4 g/ml and Oxacillin MIC is 1 or 2, mecA status is variable and must be checked before reporting these antimicrobial agents as susceptible.

Inducible Clindamycin

The Inducible Clindamycin test (ICd) is intended to detect inducible clindamycin resistance in staphylococci intermediate or resistant to erythromycin and susceptible or intermediate to clindamycin. Expression of resistance due to the erm gene may require induction by erythromycin. Results of ICd are equivalent to the D-zone disk approximation test. Reported for systemic sources only.

Tests Negative Positive

Inducible Clindamycin Test - Staphylococci

4/0.5 > 4/0.5

When ICd is reported as Positive (>4/0.5) the clindamycin result will be reported as resistant (R*) regardless of the MIC.

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Streptococci Reporting (Viridans, Beta-hemolytic and S. pneumoniae): 1. MICroSTREP plus panels can report antimicrobial agent results for all streptococci: S. pneumoniae, beta-

hemolytic streptococci, viridans streptococci and viridans streptococci (S. bovis group). 2. The Dried Overnight Gram-Positive panels can report antimicrobial agent results for beta-hemolytic

streptococci (S. agalactiae) and viridans streptococci (S. bovis) only. 3. Antimicrobial agent results for viridans streptococci (S. bovis) will be reported using viridans streptococci

breakpoints (CLSI and EUCAST). 4. Antimicrobial agent results for beta-hemolytic streptococci (S. agalactiae) will be reported using beta-hemolytic

streptococci breakpoints (CLSI) or Streptococcus groups A, B, C and G breakpoints (EUCAST). 5. Antimicrobial agent results for viridans streptococci (S. bovis) and beta-hemolytic streptococci (S.

agalactiae) will be reported using other streptococci breakpoints when using SFM interpretive guidelines. Streptococci Limitations: 1. S. pneumoniae is contraindicated for use on the Antimicrobial Susceptibility Test (AST) portion of MicroScan

Dried Overnight Gram positive panels. 2. All streptococci, except beta-hemolytic streptococci (S. agalactiae) and viridans streptococci (S. bovis) are

contraindicated on MicroScan Dried Overnight Gram positive panels. 3. All streptococci are contraindicated on Synergies plus Positive panels. Miscellaneous Fastidious Organism Limitation: 1. MICs for Actinobacillus actinomycetemcomitans, Bordetella pertussis, Bordetella parapertussis, CDC groups

EO-2, HB-5, EF-4A and EF-4B, Eikenella corrodens, Kingella species, Moraxella atlantae, Moraxella lacunata, Moraxella non-liquifaciens, Moraxella osloensis, Moraxella species/Psychrobacter species, Psychrobacter (M.) phenylpyruvicus, Oligella urethralis, Oligella ureolytica, Pasteurella species, Mannheimia (P.) haemolytica, Myroides species, Roseomonas species, Neisseria elongata and Neisseria weaveri are contraindicated for use and should not be reported on MicroScan Dried Overnight panels, and Rapid (fluorogenic)/Synergies plus panels. An ID may be obtained on the Rapid (fluorogenic) panel. An ID may be obtained on the rapid (fluorogenic)/Synergies plus panels with the exception of Bordetella pertussis and Bordetella parapertussis. Refer to back of therapy guide (Miscellaneous Fastidious Organism Group).

2. MICs for Abiotrophia/Granulicatella species, Aerococcus urinae, Aerococcus viridans, Erysipelothrix species,

Gemella haemolysans, Gemella morbillorum, Gemella species, Kytococcus sedentarius, Leuconostoc species, Listeria innocua/seeligeri, Pediococcus species, Rhodococcus equi, Rothia dentocariosa, Rothia mucilaginosa, and Rothia species are contraindicated for use and should not be reported on MicroScan Dried Overnight Gram positive panels, and Synergies plus Positive panels. An ID may be obtained on the Synergies plus Positive panels. Refer to the back of this therapy guide (Miscellaneous Fastidious Organism Group-Pos).

Miscellaneous Organism Recommendation: For the Synergies plus Gram-Negative Panels, sufficient strains of Vibrio cholerae were not tested to establish efficacy with Ampicillin, Chloramphenicol, Tetracycline and Trimethoprim/Sulfamethoxazole. Interpretive breakpoints should not be reported. Synergy Screen Reporting Gentamicin Synergy Screen

(GmS) Reporting1 Streptomycin Synergy

Screen (StS)

Reporting1

Kanamycin Synergy Screen (KSS )

Reporting2 Enterococci 500 = S, >500 = R 1000 = S, >1000 = R 1000 = S, >1000 = R Streptococci (S. agalactiae and S. bovis group)

Do not report, drug, therapy or MIC.

Do not report, drug, therapy or MIC.

1000 = S, >1000 = R

1 Based on CLSI M100-S22. 2 Based on French Market Center request in 1995.

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Predicted Susceptibility Rules for Synergies plus Pos Panels The predicted susceptibility results for staphylococci are based on the interpretive results for penicillin and/or Oxacillin. The following antimicrobial agents may have a predicted susceptibility result for the Synergies plus Pos panels. Antimicrobial

Class Antimicrobial

Subclass Antimicrobial Agent If

PenicillinS & Oxacillin-S

If Penicillin-R &

Oxacillin-S

If Penicillin-S or R & Oxacillin-R

Penicillins Aminopenicillin Amoxicillin S* R* R* Ampicillin S* R* R*

Ureidopenicillin Piperacillin S* R* R* Carboxypenicillin Ticarcillin S* R* R*

-lactam/ -lactamase inhibitor combinations

Amoxicillin-clavulanate (Aug)

S* S* R*

Ampicillin-sulbactam S* S* R* Piperacillin-tazobactam S* S* R* Ticarcillin-clavulanate (Tim)

S* S* R*

Cephems Cefaclor S* S* R* Cefazolin S* S* R* Cefdinir S* S* R* Cefepime S* S* R* Cefotaxime S* S* R* Cefpodoxime S* S* R* Ceftriaxone S* S* R* Cefuroxime S* S* R* Cephalothin S* S* R*

Carbapenems Ertapenem S* S* R* Imipenem S* S* R* Meropenem S* S* R*

An asterisk (*) will appear beside every predicted interpretation

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Extended Spectrum Beta-Lactamase (ESBL) Interpretations:

The software has two different sets of rules for Screen and confirmation testing for ESBL-producing organisms on Dried Overnight Gram-Negative Panels and Synergies plus Gram-Negative Panels. The SCREEN for suspected ESBL-producing organisms is for Escherichia coli, K. oxytoca, and K. pneumoniae only and utilizes cefpodoxime (1 or 4 g/ml, depending on panel type), aztreonam, cefotaxime, ceftazidime, ceftriaxone, ESBL-a (cefpodoxime at 1 or 4 g/ml depending on panel type) and ESBL-b (ceftazidime, 1 g/ml) as Screening agents. P. mirabilis utilizes cefotaxime, ceftazidime and cefpodoxime (1 g/ml) as screening agents. Some antimicrobials used as screening agents on the Dried Gram-Negative Panels are also present on the Synergies plus panels; however, only ESBL-a and ESBL-b are used as screening agents for Synergies plus panels. ESBL CONFIRMATION testing utilizes a comparison of MIC values obtained with ceftazidime to ceftazidime/ K. clavulanate (4 g/ml), or cefotaxime to cefotaxime/ K. clavulanate (4 g/ml). Some older panels compare ceftazidime to the BSE well (ceftazidime/ K. clavulanate (2 g/ml)). The MIC to the single antimicrobial must be 3 doubling dilutions greater than the MIC to the combination antimicrobial. If either comparison meets the criteria for a positive result, the confirmation test will be positive. ESBL confirmation rules take precedence over ESBL Screening rules in the software. ESBL confirmation rules apply to the following members of the Enterobacteriaceae: Citrobacter amalonaticus, C. koseri (diversus), C. farmeri, C. freundii complex, Citrobacter species, Enterobacter aerogenes, E. cloacae, Escherichia coli, K. oxytoca, K. pneumoniae, Morganella morganii, Proteus mirabilis, P. vulgaris, P. rettgeri, Salmonella species, and Serratia marcescens. The ESBL confirmation test is being applied to more organisms than are included in the CLSI ESBL confirmation test and should not be construed as being CLSI approved. If the ESBL Screen is activated, the report generated for a suspected ESBL-producing strain of E. coli, K. pneumoniae, K. oxytoca or P. mirabilis will report MIC values with normal SIR interpretations for all antimicrobial agents tested. However, if elevated MIC values are obtained for one or more of the screening antimicrobial agents, those agents giving the elevated MIC values will carry the interpretation EBL? The report generated for a CONFIRMED ESBL-producing strain will still report MIC values for all antimicrobial agents tested; however, the single or screening antimicrobial agents, including ESBL-a or ESBL-b, giving elevated MIC values will carry the interpretation ESBL, while all other cephalosporins, penicillins and aztreonam will have MIC values but will be given the interpretation R*. The footnotes on the patient report corresponding to these interpretations are as follows:

EBL? indicates that a particular strain is a suspected ESBL. Confirmatory tests are needed to differentiate ESBLs from other beta-lactamases.

ESBL indicates that a particular strain is a confirmed ESBL. R* indicates resistance to cephalosporins, penicillins and aztreonam is due to confirmed extended-spectrum

beta-lactamases (ESBL). These special interpretations will not appear if the laboratory chooses no when a suspected or confirmed ESBL-producer is flagged; normal SIR interpretative categories will be reported.

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Interpretations Reported as ESBL? or ESBL for the following ESBL Screening Antimicrobial Agents: Drug Panel Dilution Ranges MIC

Cefpodoxime 0.5-1 >1 CPD1,3 1 >1

1-4 >4 Aztreonam 1-4, 32 >2

AZT 1-16 >2 1, 4-8 >4 1, 4-16 >4 1, 8-16 >8 1,8 >8 2-16 >4 4-16 >8 4-32 >8 8-16 >16

Cefotaxime 0.5-2,16 >2 CFT 1-16 >2

1-32 >2 1-64 >2 1-2, 16 >2 1-2, 8-16 >2 1-2, 8-32 >2 2-32 >4

2-8, 32 >4 2, 8-32 8 2, 16 >16 4-32 >8 4-8, 32 >8 8-32 >16 8,32 >32

Ceftazidime 0.5-8 >2 CAZ 1-8 >2

1-16 >2 1-32 >2 1, 4-8 >4 1, 4-16 >4 1, 8-16 >8 1, 8 >8 1-128 >2 2-16 >4 4-32 >8 8-16 >16

Ceftriaxone 0.5-2 >2 CAX 1-8 >2

1-2, 8, 32 >2 2-32 >4 4-32 >8 4-8, 32 8 8-32 >16 8,32 >32

ESBL-a1,3 (Cefpodoxime)

4 >4

ESBL-b,3 (Ceftazidime)

1 >1

1. Panels containing a dilution of 4 g/ml Cefpodoxime will follow ESBL rules based on current CLSI documents. Panels with dilutions of 1 g/ml or 1-2 g/ml Cefpodoxime will follow CLSI/NCCLS M100-S9. 2. Rapid results ( 1 g/ml and Ceftazidime as screening agents.

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Interpretations Reported as R* for the following Antimicrobial Agents: When a confirmed ESBL is selected, the MIC interpretations for all other cephalosporins and penicillins report

as R* - Predicted resistance due to extended-spectrum beta-lactamase (ESBL).

Cephalosporins Penicillins Cefazolin CFZ Cefuroxime CRM Amoxicillin AMX Cefepime CPE Cephalothin CF Ampicillin AM Cefoperazone CFP Ceftizoxime CZ Mecillinam MEC Cefaclor CFR Ceftriaxone CAX Mezlocillin MZ Cefdinir CDN Piperacillin PI Cefixime CFE Ticarcillin TI

Interpretations Reported as S, I or R for the following Antimicrobial Agents: When a confirmed ESBL is selected, MIC interpretations for the following antimicrobial agents report as S, I or

R. The normal rules for interpreting the MICs for these antimicrobial agents do not change.

Beta-Lactam/ Beta-Lactamase Inhibitors

Carbapenems

Cephamycins

Amoxicillin-K Clavulanate AUG Imipenem IMP Cefotetan CTN Ampicillin-Sulbactam A/S Meropenem MER Cefoxitin CFX Cefoperazone-Sulbactam C/S Ertapenem ETP Piperacillin-Tazobactam P/T Doripenem DOR Ticarcillin-K. Clavulanate TIM

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ANTIMICROBIAL AGENT THERAPY GUIDE TABLES

DRIED OVERNIGHT AND RAPID (FLUOROGENIC) GRAM-NEGATIVE PANELS

Amikacin (Ak)

MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE

ACINETOBACTER SPP. PSEUDOMONAS SPP.

> R R R R 32 R I R R 16 I S I I 8 S S S S 4 S S S S 2 S S S S NOTE: 1. Enterobacteriaceae, Acinetobacter spp. and Pseudomonas spp. therapies based on EUCAST V3.1.

2. Non-Enterobacteriaceae (except for Acinetobacter spp. and Pseudomonas spp.) therapy based on CLSI M100-S22.

3. Use for EUCAST Blended panel class, except for NBC45, NBC46, NBC49E, NM40, NUC56 and NUC69E panels.

4. For Dried Overnight panels, do not report therapy for Salmonella/Shigella group because dangerously misleading results can occur.

5. Do not report therapy for B. cepacia, B. pseudomallei, S. maltophilia and Y. pestis.

Amikacin (Ak)


ACINETOBACTER SPP. PSEUDOMONAS SPP.

> R R R R 16 I S I I 8 S S S S NOTE: 1. Enterobacteriaceae, Acinetobacter spp. and Pseudomonas spp. therapies based on EUCAST V3.1.

2. Non-Enterobacteriaceae (except for Acinetobacter spp. and Pseudomonas spp.) therapy based on CLSI M100-S22.

3. Use for NBC45, NBC46, NM40, NUC56 and NUC69E panels. 4. For Dried Overnight panels, do not report therapy for Salmonella/Shigella group because dangerously

misleading results can occur. 5. Do not report therapy for B. cepacia, B. pseudomallei, S. maltophilia and Y. pestis. 6. Based on CLSI M100-S22 interpretive guidelines for Non-Enterobacteriaceae, all MICs of >16 will report

as R, since these dilutions do not differentiate between I and R (S16, I=32, R64).

Amikacin (Ak) MIC ENTEROBACTERIACEAE ACINETOBACTER SPP. PSEUDOMONASSPP.

> R R R 32 R R R 16 I I I 8 S S S 4 S S S 2 S S S NOTE: 1. Therapy based on EUCAST V3.1.

2. Use for EUCAST panel class. 3. For Dried Overnight panels, do not report therapy for Salmonella/Shigella group because dangerously

misleading results can occur. 4. Do not report therapy for Y. pestis.


9020-7493B Page 16 of 158

Amikacin (Ak) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA

> R R R 32 I I I 16 S S S 8 S S S 4 S S S 2 S S S NOTE: 1. Therapy based on CLSI M100-S22.

2. For Dried Overnight panels, do not report therapy for Salmonella/Shigella group because dangerously misleading results can occur.

3. Do not report therapy for B. cepacia, B. pseudomallei, S. maltophilia and Y. pestis.

Amikacin (Ak) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA

> R R R 16 S S S 8 S S S NOTE: 1. Therapy based on CLSI M100-S22.

2. Use for NUC69C panel 3. For Dried Overnight panels, do not report therapy for Salmonella/Shigella group because dangerously

misleading results can occur. 4. Do not report therapy for B. cepacia, B. pseudomallei, S. maltophilia and Y. pestis. . 5. Based on CLSI M100-S22 interpretive guidelines for Enterobacteriaceae, Non-Enterobacteriaceae and

P. aeruginosa, all MICs of >16 will report as R, since these dilutions do not differentiate between I and R (S16, I=32, R64).

Amoxicillin (Amx) MIC ENTEROBACTERIACEAE ACINETOBACTER SPP. .

> R 8 S 4 S 2 S 1 S NOTE: 1. Therapy based on EUCAST V3.1.

2. Use for EUCAST panel class. 3. Do not report therapy for Y. pestis because dangerously misleading results can occur. 4. Do not report therapy for Aeromonas spp., Plesiomonas shigelloides and Vibrio spp.

Amoxicillin / K Clavulanate (Aug)

MIC ENTEROBACTERIACEAE ACINETOBACTER SPP. PSEUDOMONAS SPP.

> R 16/8 R 8/4 S 4/2 S 2/1 S NOTE: 1. Therapy based on EUCAST V3.1.

2. Use for EUCAST Blended and EUCAST panel classes. 3. Do not report therapy for Y. pestis because dangerously misleading results can occur. 4. Do not report drug, therapy or MIC for B. pseudomallei.


9020-7493B Page 17 of 158

Amoxicillin / K Clavulanate (Aug)

MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA

> R 16/8 I 8/4 S 4/2 S 2/1 S NOTE: 1. Therapy based on CLSI M100-S22.

2. Do not report therapy for Y. pestis because dangerously misleading results can occur. 3. Do not report drug, therapy or MIC for B. pseudomallei.

Ampicillin (Am) MIC ENTEROBACTERIACEAE ACINETOBACTER SPP. PSEUDOMONAS SPP. V. CHOLERAE

> R R 16 R I 8 S S NOTE: 1. Enterobacteriaceae therapy based on EUCAST V3.1.

2. V. cholerae therapy based on CLSI M45-A2. 3. Use for EUCAST Blended panel class except NBC46, NM40 and NUC56 panels. 4. Do not report therapy for Y. pestis because dangerously misleading results can occur. 5. Do not report therapy for Aeromonas spp., Plesiomonas shigelloides and Vibrio spp.

Ampicillin (Am) MIC ENTEROBACTERIACEAE ACINETOBACTER SPP. PSEUDOMONAS SPP. V. CHOLERAE

> R N/R 8 S S 4 S S 2 S S 1 S S 0.5 S S NOTE: 1. Enterobacteriaceae therapy based on EUCAST V3.1.

2. V. cholerae therapy based on CLSI M45-A2. 3. Use for NBC46, NM40 and NUC56 panels 4. Do not report therapy for Y. pestis because dangerously misleading results can occur. 5. Do not report therapy for Aeromonas spp., Plesiomonas shigelloides and Vibrio spp. 6. Based on CLSI interpretive guidelines for V. cholerae, all MICs of >8 will report

as N/R, since these dilutions do not differentiate between I and R (S8, I=16, R32).

Ampicillin (Am) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE

P. AERUGINOSA V. CHOLERAE

> R R 16 I I 8 S S 4 S S 2 S S NOTE: 1. Enterobacteriaceae therapy based on CLSI M100-S22 and V. cholerae therapy based on CLSI M45-

A2. 2. For Rapid fluorogenic panel MIC format, do not report drug, therapy or MIC for C. braakii/C. freundii/C.

sedlakii, C. werkmanii/C. youngae, C. amalonaticus/koseri group, Citrobacter species, Proteus/Providencia group (except P. mirabilis) or Other Species group. See back of therapy guide for species names.

3. Do not report therapy for Y. pestis because dangerously misleading results can occur. 4. Do not report therapy for Aeromonas spp. and Plesiomonas shigelloides.


9020-7493B Page 18 of 158

Ampicillin (Am)

MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA V. CHOLERAE

> R R 16 I I 8 S S NOTE: 1. Enterobacteriaceae therapy based on CLSI M100-S22 and V. cholerae therapy based on CLSI M45-A2.

2. Use for panels with breakpoint format. 3. For Rapid fluorogenic panel breakpoint format, do not report drug, therapy or MIC for C. braakii/C.

freundii/C. sedlakii, C. werkmanii/C. youngae, C. amalonaticus/koseri group, Citrobacter species, P. mirabilis or M. morganii. See back of therapy guide for species names.

4. Do not report therapy for Y. pestis because dangerously misleading results can occur. 5. Do not report therapy for Aeromonas spp. and Plesiomonas shigelloides.

Ampicillin-Sulbactam (A/S)

MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE (Acinetobacter spp. only).

PSEUDOMONAS SPP.

> R R 16/8 R I 8/4 S S 4/2 S S NOTE: 1. Enterobacteriaceae therapy based on EUCAST V3.1.

2. Non-Enterobacteriaceae (Acinetobacter spp. only) therapy based on CLSI M100-S22. 3. Use for EUCAST Blended therapy panel class, except for NM40 panel. 4. Do not report drug, therapy or MIC for C. freundii group (See back of therapy guide for species names),

E. aerogenes, and E. cloacae. 5. Do not report therapy for Y. pestis because dangerously misleading results can occur.


MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE (Acinetobacter spp. only).

PSEUDOMONAS SPP.

> R R 8/4 S S 4/2 S S 2/1 S S 1/0.5 S S NOTE: 1. Enterobacteriaceae therapy based on EUCAST V3.1.

2. Non-Enterobacteriaceae (Acinetobacter spp. only) therapy based on CLSI M100-S22. 3. Use for NM40 panel. 4. Do not report drug, therapy or MIC for C. freundii group (See back of therapy guide for species names),

E. aerogenes, and E. cloacae. 5. Do not report therapy for Y. pestis because dangerously misleading results can occur. 6. Based on CLSI M100-S22 interpretive guidelines for Non-Enterobacteriaceae, all MICs of >8/4 will

report as R, since these dilutions do not differentiate between I and R (S8, I=16, R32).


MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE (Acinetobacter spp. only)

P. AERUGINOSA

> R R 16/8 I I 8/4 S S 4/2 S S 2/1 S S

NOTE: 1. Therapy based on CLSI M100-S22. 2. Report CLSI therapy for Enterobacteriaceae and Acinetobacter spp. See back of therapy guide for

species names. 3. Do not report therapy for Y. pestis because dangerously misleading results can occur.


9020-7493B Page 19 of 158

Aztreonam (Azt) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE. PSEUDOMONAS SPP.

> R R R 16 R I I 8 R S I 4 I S I 2 I S I 1 S S S NOTE: 1. Enterobacteriaceae and Pseudomonas spp. therapies based on EUCAST V3.1.

2. Non-Enterobacteriaceae (except Pseudomonas spp.) therapy based on CLSI M100-S22. 3. Use for EUCAST Blended panel class, except for NBC45, NC53, NM40 and NUC56 panels. 4. Aztreonam is a screening antimicrobial for extended-spectrum beta-lactamases (ESBL) on Dried Overnight

panels with E. coli, K. pneumoniae, and K. oxytoca. See ESBL information in front of guide. 5. Do not report therapy for Y. pestis because dangerously misleading results can occur. 6. Do not report therapy for Acinetobacter spp., B. cepacia, B. pseudomallei, S. maltophilia and Vibrio spp.

Aztreonam (Azt) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE. PSEUDOMONAS SPP.

> R R R 16 R I I 8 R S I 1 S S S NOTE: 1. Enterobacteriaceae and Pseudomonas spp. therapies based on EUCAST V3.1.

2. Non-Enterobacteriaceae (except Pseudomonas spp.) therapy based on CLSI M100-S22. 3. Use for NC53, NM40 and NUC56 panels. 4. Aztreonam is a screening antimicrobial for extended-spectrum beta-lactamases (ESBL) on Dried Overnight

panels with E. coli, K. pneumoniae, and K. oxytoca. See ESBL information in front of guide. 5. Do not report therapy for Y. pestis because dangerously misleading results can occur. 6. Do not report therapy for Acinetobacter spp., B. cepacia, B. pseudomallei, S. maltophilia and Vibrio spp. 7. Based on EUCAST interpretive guidelines for Enterobacteriaceae, all MICs of >1 will report as R, since

these dilutions do not differentiate between I and R (S1, I=2-4, R>4).

Aztreonam (Azt) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE PSEUDOMONAS SPP.

> R R R 8 R S I 1 S S S NOTE: 1. Enterobacteriaceae and Pseudomonas spp. therapies based on EUCAST V3.1.

2. Non-Enterobacteriaceae (except Pseudomonas spp.) therapy based on CLSI M100-S22. 3. Use for NBC45 panel. 4. Aztreonam is a screening antimicrobial for extended-spectrum beta-lactamases (ESBL) on Dried Overnight

panels with E. coli, K. pneumoniae, and K. oxytoca. See ESBL information in front of guide. 5. Do not report therapy for Y. pestis because dangerously misleading results can occur. 6. Do not report therapy for Acinetobacter spp., B. cepacia, B. pseudomallei, S. maltophilia and Vibrio spp. 7. Based on EUCAST interpretive guidelines for Enterobacteriaceae, all MICs >1 will report as R, since

these dilutions do not differentiate between I and R (S1, I=2-4, R>4). 8. Based on CLSI interpretive guidelines for Non-Enterobacteriaceae (except Pseudomonas spp.), all MICs of

>8 will report as R, since these dilutions do not differentiate between I and R (S8, I=16, R32). 9. Based on EUCAST interpretive guidelines for Pseudomonas spp., all MICs of >8 will report as R, since these dilutions do not differentiate between I and R (S1, I=2-16, R>16).


9020-7493B Page 20 of 158

Aztreonam (Azt) MIC ENTEROBACTERIACEAE ACINETOBACTER SPP. PSEUDOMONAS SPP.

> R R 32 R R 16 R I 8 R I 4 I I 2 I I 1 S S NOTE: 1. Therapy based on EUCAST V3.1.

2. Use for EUCAST panel class, except for NUC57 panel. 3. Aztreonam is a screening antimicrobial for extended-spectrum beta-lactamases (ESBL) on Dried Overnight

panels with E. coli, K. pneumoniae, and K. oxytoca. See ESBL information in front of guide. 4. Do not report therapy for Y. pestis because dangerously misleading results can occur. 5. Do not report therapy for Vibrio spp.

Aztreonam (Azt) MIC ENTEROBACTERIACEAE ACINETOBACTER SPP. PSEUDOMONAS SPP.

> R R 16 R I 8 R I 1 S S NOTE: 1. Therapy based on EUCAST V3.1.

2. Use for NUC57 panel. 3. Aztreonam is a screening antimicrobial for extended-spectrum beta-lactamases (ESBL) on Dried Overnight

panels with E. coli, K. pneumoniae, and K. oxytoca. See ESBL information in front of guide. 4. Do not report therapy for Y. pestis because dangerously misleading results can occur. 5. Do not report therapy for Vibrio spp. 6. Based on EUCAST interpretive guidelines for Enterobacteriaceae, all MICs >1 will report as R, since

these dilutions do not differentiate between I and R (S1, I=2-4, R>4). Aztreonam (Azt) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA

> R R R 8 R S S 4 I S S 1 S S S NOTE: 1. Enterobacteriaceae therapy based on ANVISA.

2. Non-Enterobacteriaceae and P. aeruginosa therapy based on CLSI M100-S22. 3. Use for NC66 panel. 4. Aztreonam is a screening antimicrobial for extended-spectrum beta-lactamases (ESBL) on Dried Overnight

panels with E. coli, K. pneumoniae, and K. oxytoca. See ESBL information in front of guide. 5. Do not report therapy for Y. pestis because dangerously misleading results can occur. 6. Do not report therapy for Acinetobacter spp., B. cepacia, B. pseudomallei, S. maltophilia and Vibrio spp. 7. Based on CLSI interpretive guidelines for Non-Enterobacteriaceae and P. aeruginosa, all MICs of >8 will



9020-7493B Page 21 of 158

Aztreonam (Azt) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA

> R R R 32 R R R 16 R I I 8 I S S 4 S S S 2 S S S 1 S S S NOTE: 1. Therapy based on CLSI M100-S22.

2. Aztreonam is a screening antimicrobial for extended-spectrum beta-lactamases (ESBL) on Dried Overnight panels with E. coli, K. pneumoniae, and K. oxytoca. See ESBL information in front of guide.

3. Do not report therapy for Y. pestis because dangerously misleading results can occur. 4. Do not report therapy for Acinetobacter spp., B. cepacia, B. pseudomallei, S. maltophilia and Vibrio spp.


> R R R 16 R I I 8 N/R S S NOTE: 1. Therapy based on CLSI M100-S22.

2. Aztreonam is a screening antimicrobial for extended-spectrum beta-lactamases (ESBL) on Dried Overnight panels with E. coli, K. pneumoniae, and K. oxytoca. See ESBL information in front of guide.

3. Do not report therapy for Y. pestis because dangerously misleading results can occur. 4. Do not report therapy for Acinetobacter spp., B. cepacia, B. pseudomallei, S. maltophilia and Vibrio spp. 5. Based on CLSI interpretive guidelines for Enterobacteriaceae, all MICs of 8 will report as N/R, since these

dilutions do not differentiate between S and I (S4, I=8, R16).


> R R R 16 I I I 8 S S S NOTE: 1. Therapy based on CLSI M100-S19.

2. Use for RNBC3 and RNUC1 panels. 3. For Rapid fluorogenic panel breakpoint format, do not report drug, therapy or MIC for P. aeruginosa. 4. Aztreonam is a screening antimicrobial agent for extended-spectrum beta-lactamases (ESBL). For Dried

Overnight panels and E. coli, K. oxytoca and K. pneumoniae see ESBL information in front of guide. 5. Do not report therapy for Y. pestis because dangerously misleading results can occur. 6. Do not report therapy for Acinetobacter spp., B. cepacia, B. pseudomallei, S. maltophilia and Vibrio spp.

Cefazolin (Cfz) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA

> R 16 I 8 S 4 S 2 S NOTE: 1. Therapy based on CLSI M100-S19. 2. For Rapid fluorogenic panel MIC and breakpoint format, do not report drug, therapy or MIC for C.

braakii/C. freundii/C. sedlakii, C. werkmanii/C. youngae, Citrobacter species, Proteus/Providencia group (except P. mirabilis) or Other Species group. See back of therapy guide for species names.

3. Do not report therapy for Salmonella/Shigella group or Y. pestis because dangerously misleading results can occur.


9020-7493B Page 22 of 158

Cefazolin (Cfz) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA

> N/R 4 S 2 S NOTE: 1. Therapy based on CLSI M100-S19. 2. Use for NC63, NC68 and NC72 panels. 3. Do not report therapy for Salmonella/Shigella group or Y. pestis because dangerously misleading

results can occur. 4. Based on CLSI interpretive guidelines for Enterobacteriaceae, all MICs >4 will report as N/R, since these dilutions do not differentiate between S, I and R (S8, I=16, R32). Cefepime (Cpe) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE PSEUDOMONAS SPP.

> R R R 16 R I R 8 R S S 4 I S S 2 I S S 1 S S S NOTE: 1. Enterobacteriaceae and Pseudomonas spp. therapies based on EUCAST V3.1. 2. Non-Enterobacteriaceae (except Pseudomonas spp.) therapy based on CLSI M100-S22. 3. Use for NC58, NC70E, NC71E and NM44E panels. 4. Do not report therapy for Y. pestis because dangerously misleading results can occur.

5. Do not report therapy for B. cepacia, B. pseudomallei and S. maltophilia. Cefepime (Cpe)

MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE PSEUDOMONAS SPP.

> R R R 8 R S S 4 I S S 2 I S S 1 S S S 0.5 S S S NOTE: 1. Enterobacteriaceae and Pseudomonas spp. therapies based on EUCAST V3.1.

2. Non-Enterobacteriaceae (except Pseudomonas spp.) therapy based on CLSI M100-S22. 3. Use for NBC46 NM40, NUC56 panels. 4. Do not report therapy for Y. pestis because dangerously misleading results can occur. 5. Do not report therapy for B. cepacia, B. pseudomallei and S. maltophilia. 6. Based on CLSI interpretive guidelines for Non-Enterobacteriaceae, all MICs >8 will report as R, since these

dilutions do not differentiate between I and R (S8, I=16, R32). Cefepime (Cpe)


> R R R 16 R I R 8 R S S 1 S S S NOTE: 1. Enterobacteriaceae and Pseudomonas spp. therapies based on EUCAST V3.1.

2. Non-Enterobacteriaceae (except Pseudomonas spp.) therapy based on CLSI M100-S22. 3. Use for NC53 and NUC59 panels. 4. Do not report therapy for Y. pestis because dangerously misleading results can occur. 5. Do not report therapy for B. cepacia, B. pseudomallei and S. maltophilia. 6. Based on EUCAST interpretive guidelines for Enterobacteriaceae, all MICs of >1 will report as R, since



9020-7493B Page 23 of 158

Cefepime (Cpe)


> R R R 8 R S S 1 S S S NOTE: 1. Enterobacteriaceae and Pseudomonas spp. therapies based on EUCAST V3.1.

2. Non-Enterobacteriaceae (except Pseudomonas spp.) therapy based on CLSI M100-S22. 3. Use for NBC45 panel. 4. Do not report therapy for Y. pestis because dangerously misleading results can occur. 5. Do not report therapy for B. cepacia, B. pseudomallei and S. maltophilia. 6. Based on EUCAST interpretive guidelines for Enterobacteriaceae, all MICs of >1 will report as R, since

these dilutions do not differentiate between I and R (S1, I=2-4, R>4). 7. Based on CLSI interpretive guidelines for Non-Enterobacteriaceae, all MICs >8 will report as R, since

these dilutions do not differentiate between I and R (S8, I=16, R32).

Cefepime (Cpe)


> R R 32 R R 8 R S 4 I S 2 N/R S NOTE: 1. Therapy based on EUCAST V3.1.

2. Use for NC48 panel. 3. Do not report therapy for Y. pestis because dangerously misleading results can occur. 4. Based on EUCAST interpretive guidelines for Enterobacteriaceae, all MICs of 2 will report as N/R,

since these dilutions do not differentiate between S and I (S1, I=2-4, R>4).

Cefepime (Cpe)


> R R 8 R S 4 I S 2 I S 1 S S 0.5 S S NOTE: 1. Therapy based on EUCAST V3.1. 2. Use for NM39 panel. 3. Do not report therapy for Y. pestis because dangerously misleading results can occur. Cefepime (Cpe)


> R R 8 R S 1 S S NOTE: 1. Therapy based on EUCAST V3.1.

2. Use for NUC57 panel. 3. Do not report therapy for Y. pestis because dangerously misleading results can occur. 4. Based on EUCAST interpretive guidelines for Enterobacteriaceae, all MICs of >1 will report as R, since



9020-7493B Page 24 of 158

Cefepime (Cpe)


> R R R 8 R S S 4 I S S 1 S S S NOTE: 1. Enterobacteriaceae therapy based on ANVISA.

2. Non-Enterobacteriaceae and P. aeruginosa therapies based on CLSI M100-S22. 3. Use for NC66 panel. 4. Do not report therapy for Y. pestis because dangerously misleading results can occur. 5. Do not report therapy for B. cepacia, B. pseudomallei and S. maltophilia. 6. Based on CLSI interpretive guidelines for Non-Enterobacteriaceae and P. aeruginosa, all MICs of >8 will


Cefepime (Cpe)


> R R R 32 R R R 16 I I I 8 S S S 4 S S S 2 S S S 1 S S S 0.5 S S S NOTE: 1. Therapy based on CLSI M100-S22. 2. Do not report therapy for Y. pestis because dangerously misleading results can occur.

3. Do not report therapy for B. cepacia, B. pseudomallei and S. maltophilia.

Cefixime (Cfe)


> R 2 R 1 S NOTE: 1. Therapy based on EUCAST V3.1.

2. Use for EUCAST panel class. 3. Do not report therapy for Y. pestis because dangerously misleading results can occur. 4. Do not report therapy for Aeromonas spp., Plesiomonas shigelloides and Vibrio spp.

Cefixime (Cfe)


> R 2 I 1 S NOTE: 1. Therapy based on CLSI M100-S22.

2. Do not report therapy for Y. pestis because dangerously misleading results can occur. 3. Do not report therapy for Aeromonas spp., Plesiomonas shigelloides and Vibrio spp.


9020-7493B Page 25 of 158

Cefoperazone/Sulbactam (C/S)

MIC ENTEROBACTERIACEAE ACINETOBACTER SPP. P. AERUGINOSA

> R R R 32 I I I 16 S S S NOTE: 1. Therapy based on Manufacturers Breakpoints.

2. For Dried Overnight panels, do not report drug, therapy or MIC for S. maltophilia. 3. Do not report therapy for Y. pestis because dangerously misleading results can occur. 4. For Dried Overnight panels, do not report therapy for Aeromonas spp, Plesiomonas shigelloides,

Vibrio spp. and Non-Enterobacteriaceae (except Acinetobacter spp. and P. aeruginosa).

Cefotaxime (Cft)


> R R 32 R I 16 R I 8 R S 4 R S 2 I S 1 S S NOTE: 1. Enterobacteriaceae therapy based on EUCAST V3.1.

2. Non-Enterobacteriaceae (including Acinetobacter spp. and Pseudomonas spp.) therapy based on CLSI M100-S22.

3. Use for EUCAST Blended panel class, except for NBC46, NC70E, NC71E, NM40, NUC56 and NUC69E panels.

4. Do not report drug, therapy or MIC for M. morganii and Serratia spp. 5. Cefotaxime is a screening antimicrobial for extended-spectrum beta-lactamases (ESBL) on Dried Overnight

panels with E. coli, K. pneumoniae, K. oxytoca and P. mirabilis. See ESBL information in front of guide. 6. Do not report therapy for Y. pestis because dangerously misleading results can occur. 7. Do not report therapy for B. cepacia, B. pseudomallei, and S. maltophilia. 8. Based on CLSI M100-S22, do not report therapy for P. aeruginosa.

Cefotaxime (Cft)


> R N/R 16 R I 8 R S 4 R S 2 I S 1 S S 0.5 S S NOTE: 1. Enterobacteriaceae therapy based on EUCAST V3.1.

2. Non-Enterobacteriaceae (including Acinetobacter spp. and Pseudomonas spp.) therapy based on CLSI M100-S22.

3. Use for NBC46, NC70E, NM40, NUC56 and NUC69E panels. 4. Do not report drug, therapy or MIC for M. morganii and Serratia spp. 5. Cefotaxime is a screening antimicrobial for extended-spectrum beta-lactamases (ESBL) on Dried Overnight

panels with E. coli, K. pneumoniae, K. oxytoca and P. mirabilis. See ESBL information in front of guide. 6. Do not report therapy for Y. pestis because dangerously misleading results can occur. 7. Do not report therapy for B. cepacia, B. pseudomallei, and S. maltophilia. 8. Based on CLSI M100-S22, do not report therapy for P. aeruginosa. 9. Based on CLSI interpretive guidelines for Non-Enterobacteriaceae, all MICs of >16 will report as N/R,

since these dilutions do not completely differentiate between I and R (S8, I=16-32, R64).


9020-7493B Page 26 of 158

Cefotaxime (Cft)


> R 16 R 2 I 1 S 0.5 S NOTE: 1. Therapy based on EUCAST V3.1.

2. Use for EUCAST panel class, except for NC48 panel. 3. Do not report drug, therapy or MIC for M. morganii and Serratia spp. 4. Cefotaxime is a screening antimicrobial for extended-spectrum beta-lactamases (ESBL) on Dried Overnight

panels with E. coli, K. pneumoniae, K. oxytoca and P. mirabilis. See ESBL information in front of guide. 5. Do not report therapy for Y. pestis because dangerously misleading results can occur.

Cefotaxime (Cft)


> R 32 R 8 R 4 R 2 N/R NOTE: 1. Therapy based on EUCAST V3.1.

2. Use for NC48 panel. 3. Do not report drug, therapy or MIC for M. morganii and Serratia spp. 4. Cefotaxime is a screening antimicrobial for extended-spectrum beta-lactamases (ESBL) on Dried Overnight

panels with E. coli, K. pneumoniae, K. oxytoca and P. mirabilis. See ESBL information in front of guide. 5. Do not report therapy for Y. pestis because dangerously misleading results can occur. 6. Based on EUCAST interpretive criteria for Enterobacteriaceae, all MICs of 2 will report as N/R, since

these dilutions do not differentiate between S and I (S1, I=2, R>2). Cefotaxime (Cft) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE

P. AERUGINOSA

> R R 32 R I 16 R I 8 N/R S NOTE: 1. Therapy based on CLSI M100-S22.

2. Cefotaxime is a screening antimicrobial for extended-spectrum beta-lactamases (ESBL) on Dried Overnight panels with E. coli, K. pneumoniae, K. oxytoca and P. mirabilis. See ESBL information in front of guide.

3. Use for NC71C and NC71E panels. 4. Do not report therapy for Y. pestis because dangerously misleading results can occur. 5. Do not report therapy for B. cepacia, B. pseudomallei, and S. maltophilia. 6. Do not report drug, therapy or MIC for M. morganii and Serratia spp. 7. Based on CLSI M100-S22, do not report therapy for P. aeruginosa. 8. Based on CLSI interpretive breakpoints for Enterobacteriaceae, all MICs of 8 will report as N/R, since

these dilutions do not differentiate between S, I and R (S1, I=2, R4).


9020-7493B Page 27 of 158

Cefotaxime (Cft) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE

P. AERUGINOSA

> R R 64 R R 32 R I 16 R I 8 R S 4 R S 2 I S 1 S S NOTE: 1. Therapy based on CLSI M100-S22.


3. Do not report therapy for Y. pestis because dangerously misleading results can occur. 4. Do not report therapy for B. cepacia, B. pseudomallei, and S. maltophilia. 5. Do not report drug, therapy or MIC for M. morganii and Serratia spp. 6. Based on CLSI M100-S22, do not report therapy for P. aeruginosa.

Cefotaxime (Cft) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE

P. AERUGINOSA

> R N/R 16 R I 8 R S 4 R S 2 I S 1 S S NOTE: 1. Therapy based on CLSI M100-S22.


3. Use for NC66, NC70C and NUC69C panels 4. Do not report therapy for Y. pestis because dangerously misleading results can occur. 5. Do not report therapy for B. cepacia, B. pseudomallei, P. aeruginosa and S. maltophilia. 6. Do not report drug, therapy or MIC for M. morganii and Serratia spp. 7. Based on CLSI interpretive guidelines for Non-Enterobacteriaceae, all MICs of >16 will report as N/R, since

these dilutions do not completely differentiate between I and R (S8, I=16-32, R64).

Cefotaxime (Cft)


> R R 32 R I 16 R I 8 R S 4 R S 2 N/R S NOTE: 1. Therapy based on CLSI M100-S22.


3. Do not report therapy for Y. pestis because dangerously misleading results can occur. 4. Do not report therapy for B. cepacia, B. pseudomallei, P. aeruginosa and S. maltophilia. 5. Do not report drug, therapy or MIC for M. morganii and Serratia spp. 6. Based on CLSI interpretive guidelines for Enterobacteriaceae, all MICs of 2, will report as N/R, since these



9020-7493B Page 28 of 158

Cefotaxime (Cft)


> R R 32 R I 16 R I 8 R S 4 N/R S NOTE: 1. Therapy based on CLSI M100-S22.


3. Do not report therapy for Y. pestis because dangerously misleading results can occur. 4. Do not report therapy for B. cepacia, B. pseudomallei, P. aeruginosa and S. maltophilia. 5. Do not report drug, therapy or MIC for M. morganii and Serratia spp. 6. Based on CLSI interpretive guidelines for Enterobacteriaceae, all MICs of 4 will report as N/R, since these


Cefotaxime (Cft)


> R R 32 R I 8 N/R S NOTE: 1. Therapy based on CLSI M100-S22.


3. Do not report therapy for Y. pestis because dangerously misleading results can occur. 4. Do not report therapy for B. cepacia, B. pseudomallei, P. aeruginosa and S. maltophilia. 5. Do not report drug, therapy or MIC for M. morganii and Serratia spp. 6. Based on CLSI interpretive guidelines for Enterobacteriaceae, all MICs of 8 will report as N/R, since these


Cefotaxime (Cft)


> R R 32 I I 16 I I 8 S S 4 S S NOTE: 1. Therapy based on CLSI M100-S19.

2. Use for RNBC3 and RNUC1 panels. 3. Do not report therapy for Y. pestis because dangerously misleading results can occur. 4. Do not report therapy for B. cepacia, B. pseudomallei and S. maltophilia. 5. Based on CLSI M100-S22, do not report therapy for P. aeruginosa.

Cefotaxime (Cft)


> 16 2 NOTE: 1. Cefotaxime is a screening antimicrobial for extended-spectrum beta-lactamases (ESBL) on Dried Overnight

panels with E. coli, K. pneumoniae, K. oxytoca and P. mirabilis. See ESBL information in front of guide.


9020-7493B Page 29 of 158

Cefotaxime-K Clavulanate (Cft/CA)


> 16/4 8/4 4/4 2/4 1/4 0.5/4 0.25/4 NOTE: 1. Cefotaxime/4 K Clavulanate is a confirmation antimicrobial for extended-spectrum beta-

lactamases (ESBL) on Dried Overnight panels. See ESBL information in front of guide.

Cefotetan (Ctn)


> R 32 I 16 S 8 S 4 S NOTE: 1. Therapy based on CLSI M100-S22.


3. Do not report therapy for Aeromonas spp., Plesiomonas shigelloides and Vibrio spp.

Cefoxitin (Cfx)


> R 32 I 8 S 4 S 2 S NOTE: 1. Therapy based on SFM 2012. 2. Use for EUCAST panel class. Cefoxitin (Cfx)


> R 32 R 16 I 8 S 4 S 2 S NOTE: 1. Therapy based on CLSI M100-S22.



9020-7493B Page 30 of 158

Cefoxitin (Cfx)


> R 8 S NOTE: 1. Therapy based on CLSI M100-S22.

2. Use for NBC49C, NBC49E, NBC42, NBC46 and NUC56 panels. 3. Do not report therapy for Salmonella/Shigella group or Y. pestis because dangerously misleading results can

occur. 4. Based on CLSI interpretive guidelines for Enterobacteriaceae, all MICs of >8 will report as R, since these

dilutions do not differentiate between I and R (S8, I=16, R32).

Cefpodoxime (Cpd) MIC ENTEROBACTERIACEAE ACINETOBACTER SPP. PSEUDOMONAS

SPP.

> R 1 S 0.5 S NOTE: 1. Therapy based on EUCAST V3.1.

2. Use for EUCAST Blended panel class, except for NBC46 panel. 3. Do not report drug, therapy or MIC for S. marcescens. 4. Cefpodoxime is a screening antimicrobial for extended-spectrum beta-lactamases (ESBL) on Dried Overnight

panels with E. coli, K. oxytoca, K. pneumoniae, and P. mirabilis. See ESBL information in front of guide. 5. Do not report therapy for Y. pestis because dangerously misleading results can occur. 6. Do not report therapy for Aeromonas spp., Plesiomonas shigelloides and Vibrio spp.

Cefpodoxime (Cpd)


> R 4 I 2 S 1 S NOTE: 1. Therapy based on CLSI M100-S22.

2. Cefpodoxime is a screening antimicrobial for extended-spectrum beta-lactamases (ESBL) on Dried Overnight panels with E. coli, K. oxytoca, K. pneumoniae, and P. mirabilis. See ESBL information in front of guide.

3. Do not report therapy for Y. pestis because dangerously misleading results can occur. 4. Do not report therapy for Aeromonas spp., Plesiomonas shigelloides and Vibrio spp.

Cefpodoxime (Cpd)


> 1 NOTE: 1. Cefpodoxime is a screening antimicrobial for extended-spectrum beta-lactamases (ESBL) on Dried Overnight

panels with E. coli, K. pneumoniae, K. oxytoca, and P. mirabilis . See ESBL information in front of guide. 2. Use for NBC46 panel.

Cefsulodin (Cfs)


> 32 8 NOTE: 1. Therapy based on SFM 2012.


9020-7493B Page 31 of 158

Ceftazidime (Caz) MIC ENTEROBACTERIACEAE NON-

ENTEROBACTERIACEAE PSEUDOMONAS SPP. B. PSEUDOMALLEI

> R R R R 32 R R R R 16 R I R I 8 R S S S 4 I S S S 2 I S S S 1 S S S S NOTE: 1. Enterobacteriaceae and Pseudomonas spp. therapies based on EUCAST V3.1.

2. Non-Enterobacteriaceae (except Pseudomonas spp. and B. pseudomallei) including Acinetobacter spp. therapy based on CLSI M100-S22 and B. pseudomallei therapy based on CLSI M45-A2.

3. Use for EUCAST Blended panel class, except for NBC45, NBC46, NC70E, NM40 and NUC56 panels. 4. Ceftazidime is a screening antimicrobial for extended-spectrum beta-lactamases (ESBL) on Dried Overnight

panels with E. coli, K. oxytoca, K. pneumoniae, and P. mirabilis. See ESBL information in front of therapy guide. 5. Do not report therapy for Y. pestis because dangerously misleading results can occur.

Ceftazidime (Caz) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE PSEUDOMONAS SPP. B. PSEUDOMALLEI

> R R R N/R 8 R S S S 4 I S S S 2 I S S S 1 S S S S 0.5 S S S S NOTE: 1. Enterobacteriaceae and Pseudomonas spp. therapies based on EUCAST V3.1.


3. Use for NBC46, NC70E, NM40 and NUC56 panels. 4. Ceftazidime is a screening antimicrobial for extended-spectrum beta-lactamases (ESBL) on Dried Overnight

panels with E. coli, K. oxytoca, K. pneumoniae, and P. mirabilis. See ESBL information in front of guide. 5. Do not report therapy for Y. pestis because dangerously misleading results can occur. 6. Based on CLSI interpretive guidelines for Non-Enterobacteriaceae all MICs >8 will report as R, since these

dilutions do not differentiate between I and R (S8, I=16, R>32). 7. Based on CLSI interpretive guidelines for B. pseudomallei, all MICs >8 will report as N/R, since these dilutions

do not differentiate between I and R (S8, I=16, R32).

Ceftazidime (Caz) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE PSEUDOMONAS SPP. B. PSEUDOMALLEI

> N/R R R R 16 N/R I R I 8 N/R S S S 1 S S S S NOTE: 1. Enterobacteriaceae and Pseudomonas spp. therapies based on EUCAST V3.1.


3. Use for NBC45 panel. 4. Ceftazidime is a screening antimicrobial for extended-spectrum beta-lactamases (ESBL) on Dried Overnight

panels with E. coli, K. oxytoca, K. pneumoniae, and P. mirabilis. See ESBL information in front of therapy guide. 5. Do not report therapy for Y. pestis because dangerously misleading results can occur. 6. Based on EUCAST interpretive guidelines for Enterobacteriaceae, all MICs >1 will report as N/R, since



9020-7493B Page 32 of 158

Ceftazidime (Caz)


> R R 32 R R 16 R R 8 R S 4 I S 2 I S 1 S S 0.5 S S NOTE: 1. Therapy based on EUCAST V3.1.

2. Use for EUCAST panel class. 3. Ceftazidime is a screening antimicrobial for extended-spectrum beta-lactamases (ESBL) on Dried Overnight

panels with E. coli, K. oxytoca, K. pneumoniae, and P. mirabilis. See ESBL information in front of guide. 4. Do not report therapy for Y. pestis because dangerously misleading results can occur.

Ceftazidime (Caz)

MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE ACINETOBACTER SPP.

P. AERUGINOSA B.PSEUDOMALLEI

> R R R R 16 R I I I 8 R S S S 4 I S S S 1 S S S S NOTE: 1. Enterobacteriaceae therapy based on ANVISA.

2. Non-Enterobacteriaceae and P. aeruginosa therapies based on CLSI M100-S22 and B. pseudomallei therapy based on CLSI M45-A2.

3. Use for NC66 panel. 4. Ceftazidime is a screening antimicrobial for extended-spectrum beta-lactamases (ESBL) on Dried Overnight

panels with E. coli, K. oxytoca, K. pneumoniae, and P. mirabilis. See ESBL information in front of guide. 5. Do not report therapy for Y. pestis because dangerously misleading results can occur.

Ceftazidime (Caz)

MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA B. PSEUDOMALLEI

> R R R R 128 R R R R 64 R R R R 32 R R R R 16 R I I I 8 I S S S 4 S S S S 2 S S S S 1 S S S S NOTE: 1. Therapy based on CLSI M100-S22 and B. pseudomallei therapy based on CLSI M45-A2.

2. Ceftazidime is a screening antimicrobial for extended-spectrum beta-lactamases (ESBL) on Dried Overnight panels with E. coli, K. oxytoca, K. pneumoniae, and P. mirabilis. See ESBL information in front of guide.

3. Do not report therapy for Y. pestis because dangerously misleading results can occur.


9020-7493B Page 33 of 158

Ceftazidime (Caz) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA B. PSEUDOMALLEI > R R R N/R 8 I S S S 4 S S S S 2 S S S S 1 S S S S NOTE: 1. Therapy based on CLSI M100-S22 and B. pseudomallei therapy based on CLSI M45-A2.

2. Use for NC70C panel. 3. Ceftazidime is a screening antimicrobial for extended-spectrum beta-lactamases (ESBL) on Dried Overnight

panels with E. coli, K. oxytoca, K. pneumoniae, and P. mirabilis. See ESBL information in front of guide. 4. Do not report therapy for Y. pestis because dangerously misleading results can occur. 5. Based on CLSI interpretive guidelines for Non-Enterobacteriaceae and P. aeruginosa, all MICs of >8

will report as R, since these dilutions do not differentiate between I and R (S8, I=16, R32). 6. Based on CLSI interpretive guidelines for B. pseudomallei, all MICs of >8 will report as N/R, since these

dilutions do not differentiate between I and R (S8, I=16, R32). Ceftazidime (Caz) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA B. PSEUDOMALLEI

> R R R R 16 R I I I 8 N/R S S S NOTE: 1. Therapy based on CLSI M100-S22 and B. pseudomallei therapy based on CLSI M45-A2.

2. Ceftazidime is a screening antimicrobial for extended-spectrum beta-lactamases (ESBL) on Dried Overnight panels with E. coli, K. oxytoca, K. pneumoniae, and P. mirabilis. See ESBL information in front of guide.

3. Do not report therapy for Y. pestis because dangerously misleading results can occur. 4. Based on CLSI interpretive guidelines for Enterobacteriaceae, all MICs of 8 will report as N/R, since

these dilutions do not differentiate between S and I (S4, I=8, R16).

Ceftazidime (Caz) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA B. PSEUDOMALLEI

> R R R R 16 I I I I 8 S S S S 4 S S S S 2 S S S S NOTE: 1. Therapy based on CLSI M100-S19 and B. pseudomallei therapy based on CLSI M45-A2.

2. Use for RNUC1 panel. 3. For Rapid fluorogenic panel MIC format, do not report drug, therapy or MIC for P. mirabilis and M.

morganii. 4. Do not report therapy for Y. pestis because dangerously misleading results can occur.


> R R R R 16 I I I I 8 S S S S NOTE: 1. Therapy based on CLSI M100-S19 and B. pseudomallei therapy based on CLSI M45-A2.

2. Use for RNBP3 panels. 3. Do not report therapy for Y. pestis because dangerously misleading results can occur.


9020-7493B Page 34 of 158


> 8 1 NOTE: 1. Ceftazidime is a screening antimicrobial for extended-spectrum beta-lactamases (ESBL) on Dried Overnight panels with E. coli, K. oxytoca, K. pneumoniae, and P. mirabilis. See ESBL information in front of guide.

2. Use for NC67 panel.

Ceftazidime-K Clavulanate (Caz/CA)


> 32/4 16/4 8/4 4/4 2/4 1/4 0.5/4 0.25/4 NOTE: 1. Ceftazidime/4 g/ml K Clavulanate is a confirmation antimicrobial for extended-spectrum beta-

lactamases (ESBL) on Dried Overnight panels. See ESBL information in front of therapy guide.

Ceftizoxime (Cz)


> R R 32 I I 8 S S NOTE: 1. Therapy based on CLSI M100-S19.

2. Do not report therapy for Y. pestis because dangerously misleading results can occur. 3. Do not report therapy for Acinetobacter spp., Aeromonas spp., B. cepacia, B. pseudomallei,

Plesiomonas shigelloides, S. maltophilia and Vibrio spp. 4. Do not report therapy for P. aeruginosa.

Ceftriaxone (Cax)


> R N/R 2 I S 1 S S 0.5 S S NOTE: 1. Enterobacteriaceae therapy based on EUCAST V3.1.

2. Non-Enterobacteriaceae therapy based on CLSI M100-S22. 3. Use for EUCAST Blended panel class. 4. Ceftriaxone is a screening antimicrobial for extended-spectrum beta-lactamases (ESBL) on Dried

Overnight panels with E. coli, K. oxytoca and K. pneumoniae. See ESBL information in front of therapy guide. 5. Do not report therapy for Y. pestis because dangerously misleading results can occur. 6. Do not report therapy for B. cepacia, B. pseudomallei, P. aeruginosa, S. maltophilia, and Vibrio spp. 7. Based on CLSI interpretive guidelines for Non-Enterobacteriaceae, all MICs >2 will report as N/R since

these dilutions do not differentiate between S, I and R (S8, I=16-32, R64).


9020-7493B Page 35 of 158

Ceftriaxone (Cax)


> R R 32 R I 8 R S 2 I S 1 S S NOTE: 1. Therapy based on CLSI M100-S22.

2. Ceftriaxone is a screening antimicrobial for extended-spectrum beta-lactamases (ESBL) on Dried Overnight panels with E. coli, K. oxytoca and K. pneumoniae. See ESBL information in front of therapy guide.

3. Do not report therapy for Y. pestis because dangerously misleading results can occur. 4. Do not report therapy for B. cepacia, B. pseudomallei, P. aeruginosa, S. maltophilia, and Vibrio spp.

Ceftriaxone (Cax)


> R N/R 8 R S 4 R S 2 I S 1 S S NOTE: 1. Therapy based on CLSI M100-S22.


3. Use for NC67 panel. 4. Do not report therapy for Y. pestis because dangerously misleading results can occur. 5. Do not report therapy for B. cepacia, B. pseudomallei, P. aeruginosa, S. maltophilia, and Vibrio spp. 6. Based on CLSI interpretive guidelines for Non-Enterobacteriaceae, all MICs of >8 will report as N/R,

since these dilutions do not differentiate between I and R (S8, I=16-32, R64). Ceftriaxone (Cax)


> R R 32 R I 16 R I 8 R S 4 R S 2 N/R S NOTE: 1. Therapy based on CLSI M100-S22.


3. Do not report therapy for Y. pestis because dangerously misleading results can occur. 4. Do not report therapy for B. cepacia, B. pseudomallei, P. aeruginosa, S. maltophilia, and Vibrio spp. 5. Based on CLSI interpretive guidelines for Enterobacteriaceae, all MICs of 2 will report as N/R, since

these dilutions do not differentiate between S and I (S1, I=2, R4).


9020-7493B Page 36 of 158

Ceftriaxone (Cax)


> R R 32 R I 16 R I 8 R S 4 N/R S NOTE: 1. Therapy based on CLSI M100-S22.



these dilutions do not differentiate between S and I (S1, I=2, R4). Ceftriaxone (Cax)


> R R 32 R I 16 R I 8 N/R S NOTE: 1. Therapy based on CLSI M100-S22.



these dilutions do not differentiate between S and I (S1, I=2, R4). Ceftriaxone (Cax) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA

> R R 32 I I 16 I I 8 S S 4 S S NOTE: 1. Therapy based on CLSI M100-S19.

2. Use for RNUC1 panel. 3. For Rapid fluorogenic panel MIC format, do not report drug, therapy or MIC for P. aeruginosa. 4. Do not report therapy for Y. pestis because dangerously misleading results can occur. 5. Do not report therapy for B. cepacia, B. pseudomallei, S. maltophilia, and Vibrio spp.

Ceftriaxone (Cax)


> R R 32 I I 8 S S NOTE: 1. Therapy based on CLSI M100-S19.

2. Use for RNBP3 panel. 3. Do not report therapy for Y. pestis because dangerously misleading results can occur. 4. Do not report therapy for B. cepacia, B. pseudomallei, S. maltophilia, and Vibrio spp. 5. Based on CLSI M100-S22, do not report therapy for P. aeruginosa.


9020-7493B Page 37 of 158

Cefuroxime (Crm)


> R 16 R 8 S 4 S 2 S 1 S NOTE: 1. Therapy based on EUCAST V3.1.

2. Use for EUCAST Blended and EUCAST panel classes. 3. Report therapy for E. coli, P. mirabilis, and Klebsiella spp. only. 4. Do not report therapy for Salmonella/Shigella group and Y. pestis because dangerously misleading

results can occur. Cefuroxime sodium (Crm) (parenteral)


> R 16 I 8 S 4 S 2 S 1 S NOTE: 1. Therapy based on CLSI M100-S22.

2. For Rapid fluorogenic panel MIC format, do not report drug, therapy or MIC for Proteus/Providencia group (except P. mirabilis) or Other Species groups. See back of therapy guide for species names.

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