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EUCAST
L i b
e ho
Frequently Asked r
Questions

I D ut Rafael Cantón

M a
Hospital Universitario Ramón y Cajal, Madrid, Spain
EUCAST Clinical Data Coordinator

S C b y Erika Matuschek

E
EUCAST Development Laboratory, Växjö Sweden

© Monday 24 April, ECCMID 2017, Vienna, Austria

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Objectives
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• To summarise the EUCAST frequently asked questions

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section on the EUCAST website.

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D ut
• To discuss questions frequently asked by laboratories

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regarding EUCAST breakpoints and the EUCAST disk

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diffusion method.

S C b y
• To highlight significant changes in EUCAST breakpoints

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and the EUCAST disk diffusion method over the past
year.
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www.eucast.org

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Sub-headings in the FAQ document

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• EUCAST Disk Diffusion Test
–
–
Medium
Disks L
e ho r
D ut
– Inoculum preparation
–
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Reading zones of inhibition

M a
– General methodology

C
• Breakpoints –general
•
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Breakpoints –zone diameter

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• Quality Control
•
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Other questions
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L i b
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I D ut Click on question
to read answer

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Frequently Askedib
L
e ho r
Questions

I D ut
Which methods can we use for antimicrobial

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susceptibility testing of colistin?

y
E S b
©
For more results, see poster P161
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AST of colistin – dilution methods
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• Broth microdilution (BMD)

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– International reference method (ISO 20776-1)

e ho
– Sulphate salts
– Standard polystyrene trays

I D ut
– No additives or pre-treatment of plates

M a
– In-house prepared or commercial plates

C y
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• Agar dilution For BMD, see EUCAST Guidance
– To be evaluated

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Documents

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www.eucast.org/guidance_documents/
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AST of colistin – diffusion methods
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• Gradient tests?

L i b
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– Etest, bioMérieux

e ho
– MIC Test Strip (MTS), Liofilchem
– Poor correlation with reference BMD

D ut
–

I
Warning on www.eucast.org

M a
• Disk diffusion?

C
– Poor separation between resistant and susceptible isolates

S b y
• The poor performance of diffusion tests is probably due to poor

E
diffusion of colistin in agar.

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EUCAST evaluation of colistin MIC methods
•
i b r
75 Gram-negative bacteria with varying colistin MICs (0.25-128 mg/L)

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– E. coli, K. pneumoniae, P. aeruginosa and Acinetobacter spp.

• BMD
e ho
D ut
– According to ISO 20776-1 and EUCAST/CLSI recommendations

M I
– Frozen panels as reference
– Commercial freeze-dried panels

a
• Sensititre, MICRONAUT-S, MICRONAUT MIC Strip

S C
– Etest

b y
Gradient tests
• Mueller-Hinton agar: Oxoid, BBL and MHE

E ©
– MIC Test Strip (MTS)
• Mueller-Hinton agar: Oxoid and BBL
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Results
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• Correlation with reference MICs was good for all BMD

L
methods.

e ho r
I D ut
• Gradient tests generally underestimated colistin MICs

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resulting in very major errors (false susceptibility).

S C b y
• The poor performance of gradient tests could not be

E
detected with QC strains.

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Results BMD vs. EUCAST Breakpoints v 7.1
Sensititre

r a
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Colistin reference MIC (mg/L)
0.25 0.5 1 2 4 8 16 32 64 128
≤0.25 MICs within ± 1 dilution of reference

L
2 3

r
0.5 9 1
1 2 8 (= Essential Agreement, EA)

e ho
2 5 5
4 2 1 7
8 1 3 2 3
Red text = categorical error
16 5 5 1

D ut
32 5 4

I
≥64 1

MICRONAUT-S MICRONAUT MIC Strip

M a
Colistin reference MIC (mg/L) Colistin reference MIC (mg/L)
0.25 0.5 1 2 4 8 16 32 64 128 0.25 0.5 1 2 4 8 16 32 64 128

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0.125 0.125 1
0.25 1 1 0.25 6

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0.5 1 10 1 0.5 1 6 2
1 2 7 1 2 10
2 1 8 1 2 2 4 2 2

E
4 4 5 4 4 7

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8 2 3 5 4 8 1 1 7 3
16 2 6 1 16 9 3
32 3 2 32 1 2
64 2 1 64 1
128 128
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Results gradient tests vs. EUCAST Breakpoints v 7.1
Etest

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Oxoid MH BBL MH MHE
Colistin reference MIC (mg/L) Colistin reference MIC (mg/L) Colistin reference MIC (mg/L)

L
0.25 0.5 1 2 4 8 16 32 64 128 0.25 0.5 1 2 4 8 16 32 64 128 0.25 0.5 1 2 4 8 16 32 64 128

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0.06 0.06 0.06 1
0.125 1 0.125 2 11 5 2 1 0.125 1 12 4 1

e ho
0.25 1 0.25 2 2 1 2 0.25 2 2 2 1 1
0.5 13 6 2 2 3 0.5 1 8 1 2 2 1 0.5 7 3 1
1 1 9 3 1 1 1 1 1 1 1 1 1 3
2 1 1 2 1 2 1 2 2 1 2 1 2 1 1
4 2 6 3 6 1 4 1 7 3 4 4 2 8 3 5

D ut
8 2 2 1 1 8 1 1 2 2 8 1 3 3
16 2 16 1 16 1 1 1

I
32 32 32 1
64 64 64
128 128 128

MIC Test Strip

Oxoid MH

CM y a BBL MH

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Colistin reference MIC (mg/L) Colistin reference MIC (mg/L)
0.25 0.5 1 2 4 8 16 32 64 128 0.25 0.5 1 2 4 8 16 32 64 128
0.25 0.25 1
0.5 0.5

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1 2 2 2 1 2 12 4 2 1

©
2 12 14 7 5 3 7 1 2 2 12 5 2 4 7 2 1
4 5 4 5 3 4 8 3 3 1
8 1 2 8 1 2
16 16
32 32
64 64
128 128
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Conclusions
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• BMD should be used for colistin MIC determination.

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e ho r
• The poor performance of disk diffusion was confirmed.

I D ut
• EUCAST advices against using gradient tests at this point.

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– Even when QC results are within range!

S C b y
• Quality control of colistin must be performed with both a
susceptible QC strain and the colistin resistant E. coli NCTC

E ©
13846 (mcr-1 positive).
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Frequently Askedib
L
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Questions

I D ut
Can I use PK-PD breakpoints when there are

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a dash (“–”) or IE in breakpoint tables?

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PK-PD breakpoints, “–” and IE

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 PK-PD (non species related) breakpoints are used only when

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there are no species-specific breakpoints or other recommendations

e ho r
(a dash or a note) in the species-specific tables.
“–” indicates that susceptibility testing is not recommended as the species

I D ut
is a poor target for therapy with the agent: isolates may be reported as R
without prior testing and PK-PD breakpoints should not be used

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IE indicates that there is insufficient evidence that the organism or group is
a good target for therapy with the agent:

S b
- An MIC with a comment but without categorisation may be reported

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- Eventually, PK-PD breakpoints can be used but, if available, also

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taking into account ECOFFs
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PK-PD breakpoints, “–” and IE

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©
mg/L mg/L
S (≤) R (>) S (≤) R (>)
A.baumanii ceftriaxone – – A.baumanii tigecycline IE IE
PK-PD 1 2 PK-PD 0.25 0.5
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Frequently Askedib
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Questions

I D ut
Why does the ceftazidime-avibactam

M a
combination have higher breakpoints

C y
S b
compared with ceftazidime alone?

E ©
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CEFTAZIDIME-AVIBACTAM vs CEFTAZIDIME

i b r
 CAZ-AVI: CAZ + β-lactamase inhibitor (AVI) which inhibits Ambler class A,

L r
class C and some class D enzymes but not metallo-β-lactamases (class B)

e ho
 Indications for treatment in adults1:

D ut
- complicated intra-abdominal infections

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- complicated urinary tract infections, including pyelonephritis

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- nosocomial pneumonia, including ventilator associated pneumonia
- infections caused by aerobic Gram-(-) organisms in patients with

C y
limited treatment options

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 Dosage of CAZ-AVI: 2 g CAZ + 0.5 g AVI x 3 iv over 2 h

E © 1Summary of product characteristics. EMA

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CEFTAZIDIME-AVIBACTAM vs CEFTAZIDIME

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Organisms

L i b Antibiotic MIC breakpoints (mg/L)

r
S≤ R>

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Enterobacteriaceae CAZ 1 4
CAZ-AVI 8 8

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P. aeruginosa CAZ 8 8

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CAZ-AVI 8 8

C y a
PK-PD breakpoints CAZ
CAZ-AVI
4
8
8
8

E S b
For susceptibility testing, avibactam is fixed at 4 mg/L

©
 Dosages CAZ: 1 g (standard) -2 g (high) x 3 IV
CAZ-AVI: 2 g CAZ + 0.5 g x 3 IV over 2h
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CEFTAZIDIME-AVIBACTAM vs CEFTAZIDIME

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 Probability of target attainment (PTA) of T>MIC was 50% (1-log kill) for both

L i
drugs, but for CAZ-AVI, unlike CAZ, 2 h extended infusion was considered

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e ho
 For Enterobacteriaceae
- CAZ PK-PD breakpoints (≤4 / >8 mg/L) were reduced to ≤1 / 4 mg/L to

I D ut
avoid ESBL producers with MICs of 2-4 mg/L reported as S and with
8 mg/L reported as “I” due to clinical data of failure

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- CAZ/AVI is doubling CAZ dose, additionally extended infusion (2 h) is used

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 For P. aeruginosa

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- CAZ “S” breakpoint (4 mg/l) was increased one dilution (8 mg/L) to avoid

©
dividing the wild type distribution and was the same for CAZ-AVI (8 mg/L)
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CEFTAZIDIME-AVIBACTAM vs CEFTAZIDIME

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PTA analysis overlaying MIC distributions (global surveillance data*)

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against Enterobacteriaceae and P. aeruginosa

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Enterobacteriaceae (N=13,949) P. aeruginosa (N=2,208)

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© Global Surveillance Study, AZ. 2013
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Frequently Askedib
L
e ho r
Questions

I D ut
Why are fluoroquinolones

CM a
breakpoints now lower?

y
E S b
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FLUOROQUINOLONE BREAKPOINTS

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b
 Previous breakpoints established during harmonization process with

i
a compromise of microbiological, PK-PD and clinical data available

L
e ho r
 New breakpoints established according to
- Pharmacodynamic targets for fluoroquinolones as a class1

I D ut
- Monte Carlo simulations for each compound1
- Probability of target attainments1

M a
- PK-PD breakpoints with recommended doses

C
- Requirements to avoid splitting wild type distributions

S b y
- Clinical data relating MIC to outcome (if available)

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Approved (Sept 2016) after consultation (June 2016) and published Jan 2017, also

©
discussed at CLSI and approved in Jan 2017 (they will be published in 2018)

1USCAST. Quinolone In Vitro Susceptibility Test Interpretive Criteria Evaluations. Version 1.2, 2017. http://www.uscast.org
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FLUOROQUINOLONE BREAKPOINTS

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b
MIC breakpoints (mg/L)

i
≤2016 ≥2017

L
S≤ S≤

r
R> R>

e ho
PK-PD breakpoints CIP 0.5 1 0.25 0.5
LVF 1 2 0.5 1

I D ut
E. coli CIP 0.5 1 0.25 0.5
LVF 1 2 0.5 1

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P. aeruginosa CIP 0.5 1 0.51 0.51

C
LVF 1 2 11 11

S
S. aureus

b y CIP
LVF
1
1
1
2
11
11
11
11

E1high
©
S. pneumoniae CIP
LVF
dose should always be used
0.5
2
1
2
-
21
-
21
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FLUOROQUINOLONE BREAKPOINTS

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b
Percent probabilities of CIP and LVF PK-PD target attainments based on free-drug

i
AUC:MIC ratio targets relative to the MIC distribution for P. aeruginosa

L
e ho r
I D ut
S / R S / R
≤0.5 / >0.5 ≤1 / >1

CM y a
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©
PK-PD breakpoint indicates S ≤0.5 mg/L. S breakpoint (>0.5 mg/L), based on a high dose, was
R (>0.5 mg/L) is based on a high dose increased (>1 mg/l) to avoid spliting WT distribution
1USCAST. Quinolone In Vitro Susceptibility Test Interpretive Criteria Evaluations. Version 1.2, 2017. http://www.uscast.org
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FLUOROQUINOLONE BREAKPOINTS

r a
b
Percent probabilities of CIP and LVF PK-PD target attainments based on free-drug

i
AUC:MIC ratio targets relative to the MIC distribution for S. pneumoniae

L
e ho r
I D ut
S / R S / R
- / - ≤2 / >2

CM y a
E S b
©
CIP is a por agent for S. pneumonae. PTA is R breakpoint (>1 mg/L), based on a high dose, was
too low even when a hgh dose is used increased (>2 mg/l) to avoid spliting WT distribution
1USCAST. Quinolone In Vitro Susceptibility Test Interpretive Criteria Evaluations. Version 1.2, 2017. http://www.uscast.org
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Frequently Askedib
L
e ho r
Questions

I D ut
There is often colonies within fosfomycin

CM a
zones for E. coli.

y
S b
How shall we read these zones?

E ©For more results, see poster P159

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EUCAST Breakpoint Table v 7.1, 2017
Enterobacteriaceae

i b r
L r
Miscellaneous agents MIC breakpoint Disk Zone diameter

e ho
(mg/L) content breakpoint
(µg) (mm)
S≤ R> S≥ R<

D ut
322 322 200B 24C,D 24C,D

I
Fosfom ycin iv
2 2 B
Fosfom ycin oral (uncom plicated UTI only) 32 32 200 24C,D 24C,D

M a
2. Agar dilution is the reference method for fosfomycin. MICs must be
determined in the presence of glucose-6-phosphate (25 mg/L in the medium).

C y
Follow the manufacturers' instructions for commercial systems.

S b
B. Fosfomycin 200 µg disks must contain 50 µg glucose-6-phosphate.

E
C. Zone diameter breakpoints apply to E. coli only. For other

©
Enterobacteriaceae, use an MIC method.
D. Ignore isolated colonies within the inhibition zone.
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Reading of fosfomycin zones
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i b
Ignore isolated colonies within the inhibition zone and

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read the outer zone edge.

e ho
D ut
a) b) c) d)

M I
C y a
S b
No zone

E ©
a-c) Ignore all colonies and read the outer zone edge
d) Record as no inhibition zone
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Calibration of fosfomycin disk diffusion test

i b r
• Agar dilution MICs were used as reference

L r
– All isolates with fosA genes according to WGS had fosfomycin MICs ≥128 mg/L

e ho
• Ignoring colonies within the inhibition zones (fosfomycin 200 µg

I D ut
disks with 50 µg G6P) for E. coli:
– Reproducible results

M a
– Good correlation with agar dilution

C
• The reading instructions were validated at 9 laboratories

S b y
• Other Enterobacteriaceae and P. aeruginosa to be evaluated during

E
2017

©
 ry Fosfomycin 200 µg vs. MIC (agar dilution)

r a
E. coli, 17 clinical isolates tested at 9 sites (x 2 disks)

b
30

i
MIC

L
(mg/L)

r
25

e ho
≥256
No of readings

20 128

D ut
64

I
15 32
16

M a
10 8

C y
4
5

S b
2
1

E
0

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6
8
10
12
14
16
18
20
22
24
26
28
30
32
34
36
38
40
Inhibition zone diameter (mm)
 ry Fosfomycin 200 µg
35

r a E. coli, 230 consecutive isolates

30

L i b
25

e ho r
No of isolates

D ut
20

M I
15

C
10

y a
S b
5

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0
10

12

14

16

18

20

22

24

26

28

30

32

34

36

38

40
6

Inhibition zone diameter (mm)

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Frequently Askedib
L
e ho r
Questions

D ut
Why has EUCAST changed the
I
recommendations for screening for methicillin

M
C y a
resistance in coagulase-negative

b
staphylococci and S. pseudintermedius?

E S
© For more results, see poster P164
 ry
Screen for methicillin resistance in

r a
staphylococci

i b
EUCAST breakpoint table v 7.1

L
e ho r
Cefoxitin (screen), S. aureus and coagulase-negative
staphylococci other than S. epidermidis
Note3,4 Note3,4 30 22A,B 22A,B

D ut
Cefoxitin (screen), S. epidermidis Note4 Note4 30 25A,B 25A,B

I
Cefoxitin (screen), S. pseudintermedius NA NA 30 NoteE NoteE

M a
B. If coagulase-negative staphylococci are not identified to species level use zone

C
diameter breakpoints S≥25, R<25 mm.

S b y
E. Cefoxitin screen for methicillin resistance in S. pseudintermedius is less
predictive of the presence of mecA than in other staphylococci. Use the oxacillin 1

E
µg disk with zone diameter breakpoints S≥20, R<20 mm to screen for methicillin

©
resistance.
 ry Cefoxitin 30 µg vs. mecA status

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CoNS (not S. epidermidis), 276 isolates (873 correlates)

b
180

i
160 New breakpoint Old breakpoint

L
S≥22, R<22 mm

r
140

e ho
No of observations

120 mecA
2 S. hominis isolates with
status

D ut
100 confirmed silent mecA genes

I
Positive
80 Negative

M a
60

C y
40

S b
20

E
0

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6
8
10
12
14
16
18
20
22
24
26
28
30
32
34
36
38
40
Inhibition zone diameter (mm)
 ry Cefoxitin 30 µg vs. mecA status

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S. epidermidis, 100 isolates (193 correlates)

b
20

i
One isolate with varying results
18 depending on MH agar (24-26 mm)

L r
16

e ho
No of observations

14
mecA
12 status

I D ut 10 Positive
Negative

M
8

C y a 6
4

S b
2

E
0

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22

40
6
8
10
12
14
16
18
20

24
26
28
30
32
34
36
38
Inhibition zone diameter (mm)
 ry Cefoxitin 30 µg
350

r a S. epidermidis, 2673 consecutive isolates

300

L i b
250

e ho r
No of isolates

D ut
200

M I
150

C
100

y a
S b
50

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0
18
6
8
10
12
14
16

20
22
24
26
28
30
32
34
36
38
40
Inhibition zone diameter (mm)
 ry Cefoxitin 30 µg vs. mecA status

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CoNS (non-speciated), 376 isolates (1066 correlates)

b
180

i
160

L
e ho
140

r
No of observations

120 mecA
status

D ut
100

I
Positive
80 Negative

M a
60

C y
40

S b
20

E
0

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6
8
10
12
14
16
18
20
22
24
26
28
30
32
34
36
38
40
Inhibition zone diameter (mm)
 ry Cefoxitin 30 µg vs. mecA status

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S. pseudintermedius, 223 isolates (2007 correlates)

b
250

i
Old breakpoint

L r
200

e ho
No of observastions

mecA
150

D ut
status

M I 100
POS

a
NEG

C y
50

E S b 0

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22
6
8
10
12
14
16
18
20

24
26
28
30
32
34
36
38
40
Inhibition zone diameter
 ry Oxacillin 1 µg vs. mecA status

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S. pseudintermedius, 223 isolates (2007 correlates)

b
350

i
Oxacillin screening breakpoint

L
300 S≥20, R<20 mm

e ho r
No or observations

250
mecA

D ut
200 status

M I 150
Positive

a
Negative
100

S C b y 50

E
0

©
12
6
8
10

14
16
18
20
22
24
26
28
30
32
34
36
38
40
Inhibition zone diameter (mm)
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Frequently Askedib
L
e ho r
Questions

I D ut
Are the expert rule document (v2.0) still valid

CM y a
after publication of intrinsic resistant and
resistant exceptional phenotype tables (v3.1)?

E S b
©
 EXPERT RULES DOCUMENT
ry
r a
i b
 Intrinsic resistance tables

L
e ho r
 Exceptional resistance phenotypes tables

I D ut
 Expert rules tables

CM y a
E S b
©
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EXPERT RULES DOCUMENT

r a
 The new intrinsic resistance & exceptional resistance phenotypes tables

i b
(v3.1) have invalidated these tables in the expert rules document (v2.0)

L r
 Although expert rules tables (IF… THEN…) (v2.0) are presently being

e ho
reviewed, they still be applied unless there is arguments against using them

D ut
- aminoglycoside rules (12.7 to 12.10) might be deleted as clinical evidence is scarce.

I
They can be used for “interpretive reading” (inference of resistance mechanisms)

CM y a
E S b
©
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Frequently Askedib
L
e ho r
Questions

I D ut
Which are the criteria used in the expert rules

CM y a
document to define a species intrinsically
resistant to an antimicrobial agent?

E S b
©
 ry
INTRINSIC RESISTANCE

r a
 Intrinsic resistance tables from Expert rules were reviewed by EUCAST-

i b
SC, approved after general consultation an published Sept-2016 (v3.1)

L r
 Intrinsic resistance, as opposed to acquired and/or mutational resistance,

e ho
is a characteristic of all or almost all isolates of the bacterial species

I D ut
 For a clinical point of view, the drug is considered clinically useless, they
can be reported as “R” and susceptibility testing is unnecessary

CM y a
 Absence of detectable resistance when intrinsic resistance should be
present suggests misidentification or an error on susceptibility testing

S b
Exceptions might occur due to rare mutations, insertions and or/deletions

E
affecting gene expression rendering susceptibility to the drug in question

©
Even if a ‘susceptible' result is confirmed, the drug use is not recommended
INTRINSIC
ry
RESISTANCE
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L i b
e ho r
I D ut
CM y a
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©
http://www.eucast.org/expert_rules_and_intrinsic_resistance/
 r
INTRINSIC RESISTANCE
y
r a
L i b
e ho r
D ut
S/R

I
ECOFF

CM y a
E S b
©
 ry
INTRINSIC RESISTANCE
ECOFF

r a
i b
S/R

L
e ho r ECOFF

I D ut
CM S/R
ECOFF

y a
E S b
©
 ry
INTRINSIC RESISTANCE

r a
L i b
r
ECOFF

e ho
I D ut
CM y a
S b
 Clinical breakpoints for FOX have not been defined. Enterobacteriaceae “intrinsically R” to FOX produce a

E
chromosomal inducible AmpC β-lactamase (AmpC) responsible for higher FOX MICs when compared with

©
species lacking production of this enzyme
 Some Enterobacter spp. lack AmpC (i.e. E. gergoviae) and cannot be considered “intrinsically R” to FOX
 ry
INTRINSIC RESISTANCE

r a
L i b
e ho r
ECOFF

I D ut
CM y a
E S b
©
 If clinical breakpoints for FOX are stablished, an expert rule for M. morganii will be needed:
- “IF susceptible to cefoxitin THEN report resistant for this antibiotic”
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INTRINSIC RESISTANCE

r a
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 Increasing use of MALDI TOFF and growing speciation will enlarge the

L r
number of species for which intrinsic resistance should be define

e ho
 For this objective, it will be needed

I D ut
- MIC distributions following EUCAST Subcommittee on MIC distributions

M a
and epidemiological cut-off values (ECOFFs)” recommendations 1

C y
- Testing for resistance mechanism at molecular level

S b
- Clinical correlations (MIC and outcomes) if available

E ©
1MIC and ECOFF Subcommittee discussion document v3,
http://www.eucast.org/documents/consultations/
 ry
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Frequently Askedib
L
e ho r
Questions

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How is an “exceptional resistance phenotype”

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defined and why have the “exceptional

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susceptible phenotypes” been removed in the
new expert rules document (v3.1)?
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EXCEPTIONAL RESISTANCE PHENOTYPES

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 Phenotype of resistance of a bacterial species to a particular antimicrobial

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agent that has not yet been reported or are still very rare

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 They may change as resistance may develop and increase over time and
also geographically as a very rare phenotype in one hospital/area/ country

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may be common in another

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 New version has mostly removed “exceptional susceptible phenotypes”

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(i.e. E. faecium ampicillin susceptible) as this might vary among countries

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 Exceptional resistance phenotypes should be checked, as they may also
indicate an error in identification or susceptibility testing

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If confirmed locally, it should be further studied to confirm and sent to a
reference laboratory (or other with expertise) or independent confirmation
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EXCEPTIONAL RESISTANCE PHENOTYPES

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Exceptional resistance phenotypes for Gram-positives

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© http://www.eucast.org/expert_rules_and_intrinsic_resistance
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Frequently Askedib
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Questions

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We have problems with fuzzy zone edges

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and haze within zone on MH-F media.

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How shall we deal with this?

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Fuzzy zone edges and haze within zones

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• Problems with fuzzy zone edges and haze within zones are

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often related to excess humidity.

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• EUCAST recommendations:

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– Make sure that agar plates are at room temperature prior to
inoculation.

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– No drops of water should be visible on the surface of the agar or
inside the lid (often seen with plates stored in plastic bags or sealed

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containers).

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– If necessary, dry plates either at 20-25°C overnight, or at 35°C, with

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the lid removed, for 15 min.
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Store MH-F plates in ventilated racks

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Fuzzy zone edges and haze within zones
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In-house produced
plate stored in
Commercial plate
stored in plastic

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ventilated rack bag

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Frequently Askedib
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Questions
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EUCASTD
I u t h
updates 2016-2017

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New breakpoints

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• Ceftazidime-avibactam

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– Enterobacteriaceae and P. aeruginosa

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• Nitroxoline

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– Uncomplicated UTI

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– E. coli only

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• Fosfomycin zone diameter breakpoints
– E. coli only

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– Other Enterobacteriaceae and P. aeruginosa under revision
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Breakpoints under revision
• Carbapenems
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• Aminoglycosides r
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• Tigecycline

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New or updated documents/resources
•

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Breakpoint Table v 7.1 for bacteria

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• QC Table v 7.0

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• Frequently Asked Questions

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•

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Instruction videos on the EUCAST disk diffusion method
– http://www.eucast.org/videos_from_eucast/

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– YouTube

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Documents under revision

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• Screening for resistance mechanisms
• Intrinsic resistance tables and expert rules

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