ETEST APPLICATION SHEET - mediline

EAS 004
ETEST
APPLICATION
SHEET
© AB BIODISK 2005-05, M0000140-MF0044
Etest ® is a registered trademark of AB BIODISK and is patented in all major markets.
Gram Negative
Aerobes
Enterobacteriaceae,
Pseudomonas, Burkholderia, Acinetobacter
and Stenotrophomonas spp.
SPECIMEN Blood, CSF, sterile sites (joint, fluids, tissues), wounds, respiratory (sputum, transtracheal aspirate) and urines
PROCEDURE
ESBL
Extended Spectrum
β-Lactamases
Agar
Inoculum
Incubation
Mueller Hinton
Suspension in saline to 0.5 McFarland (1 McFarland for mucoid strains)
35°C/ ambient/ 16-20h (non-fermenters/ 48h, if poor growth at 24 h)
Materials and procedure as above.
Test ICU and critical isolates directly with Etest TZ/TZL and CT/CTL strips.
For other isolates, review aztreonam, cefotaxime, ceftazidime, ceftriaxone and cefpodoxime susceptibility results
and use the interpretation criteria in the latest CLSI M100-S document. Confirm ESBL suspects using both Etest
CT/CTL and TZ/TZL. Etest PM/PML 5) strips may be used to test strains with non determinable CT/CTL and
TZ/TZL results.
LITERATURE Package insert, product labels, Etest Technical Guide, Media/Inoculum/Incubation, CIS 007 and CIS 012,
Reading & Trouble Shooting charts and Etest reference list
QUALITY CONTROL
(MIC µg/mL)
E. coli
ATCC ® P. aeruginosa
25922 ATCC ® E. coli
27853
ATCC ® 35218
Amikacin AK 0.5-4 1-4 Amp/sulbactam 2/1 1)
AB 4-16
Amp/sulbactam 2/1 1) AB 2-8 - Pip/tazobactam 4 1) PTc 0.25-2
Aztreonam AT 0.064-0.25 1-4 Ticar/clav. acid 2 1)
TLc 4-16
Cefepime PM 0.016-0.064 1-4 E. coli
Cefotaxime CT 0.032-0.125 4-16 ESBL negative QC strain ATCC ® 35218
Ceftazidime TZ 0.064-0.5 0.5-2 Ceftazidime (TZ)/ 3) ≤0.5
Chloramphenicol 5) CL 2-8 - Ceftazidime + clav. acid (TZL) 3) ≤0.125
Ciprofloxacin CI 0.004-0.016 0.125-0.5 Cefotaxime (CT)/ 3)
≤0.25
Colistin 5) CO 0.125-0.5 1-4 Cefotaxime + clav. acid (CTL) 0.016-0.064
Gentamicin GM 0.25-1 0.5-2 Cefepime (PM) 5) ≤0.25
Imipenem IP 0.064-0.25 1-4 Cefepime + clav. acid (PML) 5) ≤0.064
Levofloxacin LE 0.008-0.064 0.5-4 K. pneumoniae
Meropenem MP 0.008-0.064 0.125-1 ESBL positive QC strain ATCC ® 700603
Minocycline 5) MC 0.25-1 - Ceftazidime (TZ)/ 8-32
Pip/tazobactam 4 1) PTc 1-4 1-8 Ceftazidime + clav. acid (TZL) 0.25-1
Polymyxin B 5)
PO 0.25-1 1-4 Cefotaxime (CT)/ 4)
1-4
Tetracycline 2) TC 0.5-2 - Cefotaxime + clav. acid (CTL) 0.125-1
Ticar/clav. acid2 1) TLc 2-8 8-32 Cefepime (PM) 4) 5) 0.125-1
Trim/sulfa 1/19 1)
TS 0.064-0.25 - Cefepime + clav. acid (PML) 5)
0.064-0.25
Notes:
1. Value on the MIC scale refers to the first component of the combination
2. Group representative for tetracyclines including doxycycline
3. MIC value below the strip range
4. Deformation of the ellipse is indicative of ESBL production even if the CT/CTL or PM/PML ratio is

Notes:
6. Polymyxin B MIC result can predict colistin MIC (CLSI M100-S15, 2005)
7. See CLSI tables for specific ESBL comments
8. See the Etest ESBL package insert and Etest PM/PML 5)
supplement
9. See the latest CLSI M100-S document for further details on species specific and clinical interpretations
READING PRECAUTIONS 1. For bactericidal drugs, read at complete inhibition of growth (microcolonies, hazes and isolated colonies)
2. For bacteriostatic drugs, read at 80% inhibition when trailing of growth is seen
ANTIBIOGRAMS Examples only, please use your own formulary.
REFERENCES
CI or
LE
CI or
LE
PM
or CT )
PTc
GM (256)
or AK
Enterobacteriaceae
GM
or AK
IP
MP or
IP
Pseudomonas spp.
Detection of ESBL
PTc
AT
AT
TZ or
PM
CI or
LE
CI or
LE
AB
or TLc
AK
GM
or AK
Acinetobacter spp. Burkholderia spp.
AB or
TLc
IP
or MP
Stenotrophomonas spp.
Strains with ND results by CT/CTL and TZ/TZL
AK
Mucoid organisms e.g. Klebsiella,
Enterobacter and P. aeruginosa
1. Bolmström et al. (2002) Cefepime • clavulanic acid (CA) in an Etest Configuration for Investigating Non-Determinable (ND) ESBL Results per
NCCLS criteria. ICCAC (Poster D527).
2. Stürenburg et al.(2004). Evaluation of a New Cefepime-clavulanate ESBL Etest to Detect Extended-Spectrum β-lactamases in an
Enterobacteriaceae Strain Collection. JAC. 54: 134- 138.
3. Lincott, A. and Brown, W. (2005). Evaluation of Four Commercially Available Extended-Spectrum Beta-Lactamase Phenotypic Confirmation
Tests. JCM. 43(3): 1081- 1085.
4. Yu, V et al. (2004). Antibiotic therapy for Klebsiella pneumoniae bacteremia: Implications of production of extended-spectrum β-lactamases.
CID. 39: 31- 37.
5. Mohr et al. (2004). Pharmacokinetic/ pharmacodynamic modeling can help guide targeted antimicrobial therapy for nosocomial Gram-negative
infections in critically ill patients. DMID. 48: 125- 130.
6. Shah, P. (2001). Determination of MICs in the routine laboratory. JAC. 48(6): 91.
7. Hanberger, H. et al. (1999). New species-related MIC breakpoints for early detection of development of resistance among Gram-negative
bacteria in Swedish intensive care units. JAC. 44: 611-619.
8. Tsakris et al. (2005). Heteroresistance to carbapenems in Acinetobacter baumannii. JAC. 55(6): 1055- 1056.
9. Walsh et al. (2002). Evaluation of a new Etest for detecting Metallo-β-lactamases in routine clinical testing. JCM. 40(8): 2755-2759.
Dalvägen 10, S-169 56 Solna, Sweden. Tel: +46-(0)8-730 07 60. Fax: +46-(0)8-83 81 58. etest@abbiodisk.se www.abbiodisk.com
TS
MC
MC
TZ or
PM
TZ or
PM
MC
LE
CI or
LE
PM
TS
IP
MP
PTc
TZ
TZ