30 THE ANTIMICROBIC NEWSLETTER, VOLUME 7, NUMBER 4, APRIL 1990

M 2 - A 4

TABLE 2 Zone D/ame/er/nferpre/~ Standards and E(FJ/va/enf Mrdnx~ ~

E q u ~ Zone Olametm', neamll whole mm MIC B r e a l ~

A n l J n d c t o b i a l A g e n t D i s k C o n t e n t R e ~ M a n t I n t a f m e d l a ~ n S u m : e p t l ) l e o S u s c q ~ b l e R u i M a n l S u s c e p t i b l e

A m ~ c i n " 30 #.g _< 14 15-16 - - :> 17 -> 32 -< 16

Amox ic l l l l n /¢ lavu~ lc aclo ~ when ~ staphylococci c 20/10 #g -< 18 - - - - ->20 -> 8/4 -< 4/2

when testing other Organl~ns d 20/10 #g <13 - - 14-17 ->18 ->16/6 -< 8/4

Ampicil l in" when testing gram-negative enteric o ~ i s m s 10 #g -< 13 - - 14-16 -> 17 -> 32 -< 8

when testing staphylococci c 10/~g -<28 - - - - ->29 ~-Iactamese c -< 0.25

w ~ tesUng enterococcl r 10pg <16 - - >-17 r - - -> 16 - -

when teMklg n o n - e n t e ~ streptococci I 10/~g -<21 - - 22-29 ->30 -> 4 -< 0.12

when testing L/st~/a ~ 10#g -<19 - - - - ->20 -> 4 -< 2

Ampici l l~/sulbectam when teot~O ~ estedcs and staphylococci ~ 10/10 #g -<13 - - 14-16 ->17 ->32/18 -< 8/4

A z l o c i l l i n w h e n t e s t i n g P ~ c.s 75pg -<17 - - - - ->18 -> 128 -< 64

Aztreonam 3 0 # g -<15 - - 16-21 ->22 -> 32 -< 8

Carpenicill ln c

whefltestingPseudornotms lOOpg <13 - - 14-16 ->17 -> 512 -< 128

when testing other gram-negatlve Organisms 100 #g -< 19 - - 20-22 ->23 -> 64 -< 16

Cefaclor 30/~g -<14 - - 15-17 ->18 -> 32 -< 8

Cefamandole ~ 30/~g -<14 - - 15-17 ->18 -> 32 -< 8

Cefazolin h 30/~g -< 14 - - 15-17 -> 18 -> 32 -< 8

Ceflxlme 5 # g -<15 - - 1 6 - 1 8 _>19 -> 4 -< 1

Cefonicid h 30/zg -< 14 - - 15-17 -> 18 -> 32 -< 5

Cefoperazorm h 75 #g -< 15 - - 16-20 ->21 -> 64 -< 16

Cefotaxime h 30/~g -< 14 - - 15-22 -> 23 -> 64 -< 8

Cefotetan h 30~g -<12 - - 13-15 ->16 -> 64 < 16

Cefoxittn h 30 #g < 14 - - 15-17 ->_ 18 -> 32 -< 8

Ceftazidime h 30pg -<14 - - 15-17 ->18 -> 32 -< 8

Ceftizoxime 30 pg -< 14 - - t 5 -19 ->20 -> 32 -< 8

Ceftriaxone h 30/zg -< 13 - - 14-20 -> 21 -> 64 < 8

Cefuroxirne axetil (oral) d 30 #g _< 14 - - 15-22 >_23 -> 32 < 4

Ceforoxime sodium ( par r u l e r al ) 3 0 # g _<14 - - 15-17 ->18 -> 32 -< 8

Cephalothin h 30 # g < 14 - - 15-17 -> 18 -> 32 _< 8

C h l o r a ~ i c o l 30/zg _<12 13-17 - - ->18 -> 32 < 8

CIprofloxacin 5 # g -<15 - - 15-20 ->21 -> 4 _< 1

Clindamycln' 2 #g _< 14 15-20 - - ->21 -> 4 -< 0.5

DoxycyclineJ 30~g -<12 13-15 - - ->16 -> 16 < 4

Enoxacin 10 #g _< 14 - - 15-17 -> 18 -> 8 < 2

Erythromycin 15 #g < 13 14-22 - - >-23 >- 8 -< 0,5

Gentamicin a 10pg -<12 13-14 - - ->15 -> 8 _< 4

lmipenem h 10#g -<13 - - 14-15 ->16 -> 16 -< 4

Kanamycin 3 0 # g _<13 14-17 - - ->18 -> 25 _< 6

Methicillin when testing staphylOCocci k 5 #g -< 9 10-13 - - -> 14 >_ 16 _< 8

Mezlocillin c when testing ~ s g 75 #g -<17 - - - - >_18 -> 128 -< 64

when testing other gram-negative organisms 75 #g < 17 - - 18-20 ->21 >-- 128 -< 16

Minocycline I 30pg -<14 15-18 - - ->19 -> 16 _< 4

Moxalactam h 3 0 # g <14 - - 15-22 ->23 -> 64 -< 8

Nafcillin when testing staphylococci* 1 #g -< 10 11-12 - - -> 13 - - -%< 1

Netllmicin a 30 #g < 12 13-14 - - -> 15 >- 32 _< 12

Ofloxacln 5 / ~ g _<12 - - 1 3 - 1 5 ->18 -> 8 -< 2

Oxacillin when testing staphylococci* 1 pg <10 11-12 - - ->13 >- 4 < 2

when testing prleumococci for penicill in G susceptibility 1 #g -< 19 - - - - ->20 - - _< 0.06

Penicillin G when testing staphylococci c 10 units _<28 - - - - >_29 /~-Iactarnase c < 0.1

when testing enterococci r 10 units _< 14 - - -> 15 ~ - - -> 16 - -

when testing L. rnonocytogenes 10 units _< 19 - - - - -> 20 -> 4 -< 2

when testing norHmterococcal streptococci 10 units < 19 - - 20-27 > 28 -> 4 < 0.12

Piperacillin c when testing Pseudomorms a 100#g < t 7 - - - - >--18 > 128 --- 64

when testing other gram-negative organisms 100 #g -< 17 - - 18-20 >_21 >- 128 --< 16

Rifampin 5 #g -< 16 17-19 - - >_20 >- 4 _< 1

Streptomycin 10 # g < 11 12-14 - - -> 15 - - - -

TetracyclirteJ 30pg <14 15-18 - - > -19 -> 16 < 4

© 1990 BY ELSEVIER SCIENCE PUBLISHING CO., INC. 0738-1751/90/$0.00 + 2.20

THE ANTIMICROBIC NEWSLETrER, V O L U M E 7, NUMBER 4, APRIL 1990 31

T~clII~ ¢ when testing _ p ~ . _ _ ~ o 75/~g -<14

w ~ testing other ~ t i v e organisms 75 #g -< 14

T i c a r c i l l i n / c l a ~ i c acid when testing _ P ' J ~ _ _ ~ 75/10 p.g -< 14

when testing other g~am-negative organisms 75/10/zg -< 14 Tobramycin* 10/~g -< 12

Trlmethoprlrn/su ffac-lelf~, v~ ~nis ~ 1.25123.75 p.g -< 10

Vancomycin ~ ,oi~_-c-_-c-_~! 30 pg -< 9

Lirinary Tract SpecifiC Antlmk~'obial Ag~fltS m

Cinoxacln 100/zg _< 14

Na,dlxk; acid 30/4G -<13

Nltrofunmtoin 300/~g -< 14

Norfloxacin 10 #g -< 12

SuHonm'nides ~ 250 or 300/~1 -< 12

Trime~Oprlm ~ 5 Pg -< 10

NOTE: ~ In boidtece type Is ~x~ldered tmlathm for one year.

a. The zone sizes Obtained with aminoglycosldes, particularly when tasting P, ~ are wlr /medium ( ~ e p e ~ because of varklflOn~ In divalent cation c041teld. ~ I n t ~ t l v e s t e n d l ~ i re to be used only wlth Idu~W-HInto~ medium that has yielded zone diameters wilNn the correct rlmge shown in Table 3 when pedonnlmce tests were done with P. aeru j~m~ ATCC e 27853. Ol~lnlams in the interrnedlete categow may be either susceptible or reslsterd when tested by dlikltiorl flrlelhods and should therefore mor o prOll:~e¢ly be classified as "kldetermk~lte" in their Susceptibility.

/~ 11W ImWlWell~ cffmrla f ~ mnMct l l t ~ m ~ l ~ be used Ior I m l q m d J * m of amll lcal~/ mdlNotent a~d ~lll@Xlldlll~daVlllll~m~ ~ ~ t~ltMg Imtefo¢o(~l, non- lmler ( l ( :~ l l ~ . oral olhw ~am padUvas.

C. Reslatents~alrtsof S. aore(Bproduce ~-.iectsm~me andthe testing of the lO.UnHpeniclllinG d/ok/s prefmT~ed. Penk;lllin G should be used to te~ the s .us~t.. Ibillty of all penlclllinas~)- so.drive penlcltlles, linch as ampiclllin, amoxlcillin, azlOClllin, bacarn~icillln, hetscllfln, carbenidlllin, mezloclllle, plperactllin, and ticarcillin Results may also be al~011ed to phenoxymethyl p~micillin or pt~ne~icinln,

d. ~ ImIK;®ptlble m~ie ~ to Gram-negative ent~'lc bacilli isolated from the urinary ~r~ct.

aml ~ i p F i ~ a l m I~ c l l a m m ~ Mlecl imL AmmdcIM al Idglt dmme ( -SO0 roll J wm be mq~Ved ~ ¢~vwqle ~ mmepUMe ( -< I ~ l / r~ . ) ~ ' a m - n e O ~ b . o i L

O. CteSlr, ~ ~or ~ h , lITlox~oi~in, b~K:~plciRin, cyc~o~ln, ~ hetoGi~tkl. t Fm entorococcl, asrococcl, mid notl-ent~oo~ccal streptococci, the designotion "moderately

SUSCe I~ " Implies th~ need foe hlgh-dooe plmiClllin or amplcillin f(x eodocarl~is and s~icus invasIve t lllM.~l IflfecUOllS lf~tel nley foquire (olwsy~ for MItet'oc(x:~'l) corflblned Ihlltr&Py wllh an

shonld be~e an MIC determlned In case of e~docardltls. U r m isoletes shoukl be cor~idered to be s u ~ to ampicillin or penk:illin alone.

h. ~ l n / l u l b e c t e m . Iztmer,~n, c~;c,~;.n, c~ltozldlme, ol~rlaxone, and Imlponem are

~ to 0 m v ~ apOrov~ ceph;;ca~c.-;r~ ~ach ~ c ~ N n . 11w ~ 0 - ~ 1 C ~ a ~ te~ ~ may Mt t a m e l y , ~ wamepUM~/ to other find gas~ratl~

N C C L S V O L . 10 NO. 7

Eq.iva~l 7.me ~ , hearst vd~ie mm M I C ~

Mo~at.~ (.~'mL) ~ m ~ l a t e " i o ~----~-,:~ R e . m r ~ _ q i ~

- - - - ->15 -> 128 -< 84

- - 1 5 - 1 9 >-20 >_ 128 -< 16

- - - - -> 15 > 1 2 8 / 2 -<64 /2

- - 1 5 - 1 9 ->20 > -128 /2 -<18 /2

1 3 - 1 4 - - >-15 >-- 8 -< 4

- - 1 1 - 1 5 -> 16 > -8 /152 -<2138

10-11 >-12 - - -> 32 -< 4

1 0 - 1 1 ~ >-12 >__ 32 -< 4

15-18 - - >19 >- 64 -< 18

14-18 - - ->19 -> 32 -< 8

15-16 - - ->17 -> 128 -< 32

13-16 - - ->17 -> 18 < 4

- - 13-16 ->17 >-- 350 < 100

- - 1 1 - 1 5 ->16 -> 16 -< 4

( exeqN let H ~ m e L ~ l ~ ) , e e l ~ l ~ , eq~radlee, eqDl~*~l . , ~ d ~ l * d r ~ . See Tabie 1 for othor d r ~ groupings wire o slmllor N :~ lnm l of *cUv~. S. m ' e u l I l ra /~ e*/Wb/l~ re~mnce to one ol Ihe ~ p ~ / c / t / ~ (MclSA) m ~ t be reported as ras/slant to cep/ i toeporm ~ o i w newer/~-/acmtm such as ~nox/c///kVc~vu~m/c ac/d, amv~. / su~acw~ ~ *¢~ t ; ca rc~/c~w~c *ck/. r ~ r a k m o¢ ~n vnro r~ats. This Is p.Inwily f ~ m e in m ~ cas~ of ~ MRSA letecUon, tbe pettsnt has r ~ i~orly to the cephlloq:x>'in t ~ or com'Mclng d lnk~l dote has yet te be dedved confirming clinical efficacy (clevutenic acid Or sulbactem combinations end imtpenem). MelNcll l le-r~lst~t, coegulase-negatlve Stophy/ococ¢~ spp. aieo appeer notto r ~ ~II~ ~ ~ o~ ~.

L The cll~c~ disk Is used ~ testing susceptibility 1o both cll~in and l~c~. J. Tetracycline is the ckms disk for all tetracyolines, and the re~JltS can be applied to

chlortetraoycllne, demeclocyollne, doxycycllne, methacycline, mlnocycline, l ind oxytetracycllne, However, clrtein o l ' gan lm may be more susceptible to ~li~ mlnocycllne ~ to tel~-yctlrm. (See toomote g, Tal0le 1.)

k. Of the antlstephylococcal, ~lactomllse-re61stent pefliclllil~, etthor oxaolllln or ~ l l l l e could be tested, l i l d re~dlts c4m be applied to the other two of theoe drtlgs and to cloxaclllln snd diclOXaCilllfl. OxaC///kl M preten'ed due tO more reslstenoe to degtlldation in storage and its application to pneumoo0o~l testing and be~uas it IS more likety to detect hetororelbtent S t a p ~ S/IIIns. DO not use r~fclllm Oll blood-contok~ media, Cloxacillln ~ should not be tmed ~ they may rtot d~l)ct ~ l l l n - ¢ e s i s t l t n t S. aureus. When lntmmsdlato results ale obteMed with ~aphyIococci, the S;=ltinS ~tould be furth~ irNestlgated tO detemllne If b~my are hetermeshsts~.

I, T b e s u l f l s o x a z o t e d i ~ c ~ n b e u r ~ d f o r a s y o f t b e o o m m e r c i e l t y a v s l l l b t e s u l t ~ . ~ corltolnlrlg medll, ex¢ept media o o 1 1 1 ~ ly~ld horse blood, ore not s l l t ~ tee testing suIfomlmide~. The Mlmlle¢-Hlnton ~ should be as b'lymldtne-free as possible foe suffonemlde and/or ~melhoprim teaks. (S~m NOTE for Table 3.)

m. Susceptlblltly ~ for clnoxacln, nldldlxic acid. nlVoftl'lUltoln, norfloxa¢in, imlfonlnddel, and ~r tme~oWtm ~ y only to o r g e n t m leoklted from urln~'~ 'o'act tntectlo~.

n. The category "leten'r, e d t m " #r, ouid be reported. ~t g~rwally Indicates that the test mm' t be consldm~ equivocal or indeterminate (see text, Inteqxetlve Categories, Sections 2.3.2.2 and 2.3.2.3).

O. The ~ ~ " m o d ~ IRIsce~llble" should be re(~-'tsd. R i m ~ l ~ ollnk~l apl~lc~b~my undor mlected o ~ " ~ , ~ c h as v ~ n hk~ do~,ae of drng can be uwd or wh~'e tbe dn~ n.~W ~ onncennted, asd the o~lenlem Is not ~ y ~ e ~ l b t e to ony o e w k m toxic drug. (See text, k~mqxetive Categories, Sections 2.3.2.2 and 2,3.2.3).

p. ~ values r ~ MIC b r ~ used in d ~ ~ o l # r o ~ zone size k~r~et lve ~,t~r~. ~ cetste to MCs ¢~erm~ned by ~ ~ . ~ dlscrel~ncles rosy exlst between M2 and M7 due to ~ llmitetions.

0738-1751/90/$0.00 + 2.20 © 1990 BY ELSEVIER SCIENCE PUBLISHING CO., INC.