Adult Therapy Guide-9020-7705 PDF

Adult Therapy
Guide Legend
LabPro Panel Update-05
9020-7705, Rev. A
9020-7705, Rev. A Page 1

Adult Therapy Guide Legend
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9020-7705, Rev. A
05/2015
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Spec: 9900-3929
9020-7705, Rev. A Page 2

FASTIDIOUS PANELS - STREPTOCOCCI
Table of Contents
Revision Record 4
GENERAL NOTES FOR REPORTING RESULTS: 5
DRIED OVERNIGHT AND RAPID (FLUOROGENIC) GRAM-NEGATIVE PANELS 13
SYNERGIES PLUS GRAM-NEGATIVE PANELS 26
DRIED OVERNIGHT GRAM-POSITIVE PANELS 36
SYNERGIES PLUS GRAM-POSITIVE PANELS 47
FASTIDIOUS PANELS - STREPTOCOCCI 51
Species Classifications for Organism Groups 57
9020-7705, Rev. A Page 3

Revision Record
Rev. Date Affected Pages
A 05/2015 Replacement document for business name change to Beckman Coulter.
9020-7705, Rev. A Page 4

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.
INTERPRETIVE GUIDELINES
The Therapy Guide contains Interpretive Guidelines cleared for Siemen’s use by the FDA.
These FDA cleared guidelines align with CLSI M100-S22 and M45-A2 reporting unless otherwise noted.
Reference Revision
CLSI M45-A2; Methods for Antimicrobial August 2010
Dilution and Disk Susceptibility Testing of
Infrequently Isolated or Fastidious Bacteria,
2nd edition
CLSI M100-S14, S17, S19, S20, S21 and January 2004, 2007, 2009, 2010,
S22; Performance Standards for Antimicrobial 2011 and 2012
Susceptibility Testing; Informational
Supplements
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- A2 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), the 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, 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, 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.
9020-7705, Rev. A Page 5

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 S* = Extrapolated susceptible result
 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: Ampicillin, Chloramphenicol, Tetracycline,
Trimethoprim-Sulfamethoxazole and Sulfamethoxazole.
Urine/Systemic Therapy Interpretation Rules:

1. For all panels (dried overnight, rapid fluorogenic, Synergies plus, gram-positive or gram-negative) therapy
interpretation will be driven by source of specimen.
2. In the LabPro System, the note “Only systemic therapy will be reported” indicates no therapy interpretations will
be reported if the source is urine.
3. In the LabPro System, the note “Only urine therapy will be reported” indicates no therapy interpretations will
be reported for a systemic source.
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, and cefotaxime or 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 and 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 (i.e., the bacteria included in Tables 2A-2J):
agents administered by oral route only

1st- and 2nd-generation cephalosporins (except cefuroxime parenteral)
and cephamycins
clindamycin
macrolides
tetracyclines
fluoroquinolones
Extreme Caution from the CLSI M45-A2:

Notify public health officials of 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 that is only available in reference or public health laboratories.
9020-7705, Rev. A Page 6

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 Providencia spp.
Citrobacter sedlakii Pseudomonas aeruginosa
Citrobacter werkmanii Serratia liquefaciens
Citrobacter youngae Serratia marcescens
Beta-lactam antimicrobial agents:
Amoxicillin-K Clavulanate Ceftriaxone

Ampicillin Cefuroxime
Ampicillin-Sulbactam Cephalothin
Aztreonam Mezlocillin
Cefazolin Piperacillin
Cefotaxime Piperacillin-Tazobactam
Cefotetan Ticarcillin
Cefoxitin Ticarcillin-K Clavulanate
Ceftazidime
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 CLSI therapy (S).
9020-7705, Rev. A Page 7

Cefoxitin Screen
The Dried Cefoxitin Screen is intended to determine the susceptibility of S. aureus and S. lugdunensis 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 penicillin-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
≤ 4 Neg ≤0.25 S
0.5 S
1 or 2 S
>2 R
> 4 Pos ≤0.25 R*
0.5 R*
1 or 2 R*
>2 R
Interpretations of R* are used by the LabPro software when the Cefoxitin Screen result changes the interpretation
of the Oxacillin MIC result. 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
μg/ml for S. aureus and S. lugdunensis and ≥0.5 μg/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 μg/ml or Oxacillin MIC's are >2 μg/ml for S. aureus and S. lugdunensis and Oxacillin is ≥
0.5 μg/ml for other coagulase negative staphylococci.
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 ≤ 4/0.5 > 4/0.5
Test - Staphylococci
When ICd is reported as Positive (>4/0.5) the clindamycin result will be reported as resistant (R*) regardless of the
MIC.
9020-7705, Rev. A Page 8

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

1. MICroSTREP plus panels can report antimicrobial agents results for all streptococci: S. pneumoniae, beta-
hemolytic streptococci, viridans streptococci and S. bovis group(Group D).
2. The Dried Overnight Gram-Positive panels can report antimicrobial agents results for S. agalactiae (Group B) and
S. bovis group (Group D) only.
3. Antimicrobial agents results for S. bovis group (Group D) will be reported using viridans streptococci breakpoints.
Streptococci Limitations:
1. S. pneumoniae is contraindicated for use on MicroScan Dried Overnight panels.
2. All streptococci, except S. agalactiae (Group B) and S. bovis group (Group D) are contraindicated on MicroScan
Dried Overnight panels.
Miscellaneous Fastidious Organism Limitation:

1. MICs for Actinobacillus actinomycetemcomitans, Bordetella pertussis, Bordetella parapertussis, CDC groups EO-
2, HB-5, EF-4A andEF-4B, Eikenella corrodens, Kingella species, Moraxella atlantae, Moraxella lacunata,
Moraxella non-liquefaciens, 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 will not be reported on MicroScan Dried Overnight panels and Synergies plus panels. An ID may be obtained
on the Synergies plus panels with the exception of Bordetella pertussis and Bordetella parapertussis. Refer to
back of guide (Miscellaneous Fastidious Organism Group).
2. CLSI document M45-A suggests reference testing with CAMHB with LHB for the following organisms. Efficacy
testing has not been established using CAMHB with LHB as the reference. Therefore, drug, therapy and MIC’s
for Actinobacillus actinomycetemcomitans, Eikenella corrodens, Kingella spp., Leuconostoc spp., Pasteurella
spp. and Pediococcus spp. are contraindicated for use and will not be reported on MicroScan Dried Overnight
panels and Synergies plus panels.
3. MIC resultsfor 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 will 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 guide (Miscellaneous Fastidious Organism Group-Pos).
Miscellaneous Organism Recommendation:

1. 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 Streptomycin Synergy

Screen Screen
(GmS) Reporting1 (StS) Reporting1
Enterococci <=500 = S, >500 = R <=1000 = S, >1000 = R
1. Based on CLSI M100-S22.
9020-7705, Rev. A Page 9

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 Antimicrobial Antimicrobial If If If Penicillin-S
Class Subclass Agent Penicillin–S Penicillin-R or R &
& & Oxacillin-R
Oxacillin-S Oxacillin-S
Penicillins Aminopenicillin Ampicillin S* R* R*
Ureidopenicillin Piperacillin S* R* R*
Carboxypenicillin Ticarcillin S* R* R*
β-lactam/ β- Amoxicillin- S* S* R*
lactamase inhibitor clavulanate
combinations (Aug)
Ampicillin- S* S* R*
sulbactam
Piperacillin- S* S* R*
tazobactam
Ticarcillin- S* S* R*
clavulanate
(Tim)
Cephems Cefaclor S* S* R*
Cefazolin S* S* R*
Cefepime S* S* R*
Cefotaxime 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
9020-7705, Rev. A Page 10

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 for suspected ESBL-producing
organisms. The SCREEN for suspected ESBL-producing organisms is for Escherichia coli, Klebsiella oxytoca, K.
pneumoniae, and Proteus mirabilis only. E. coli, K. oxytoca, and K. pneumoniae utilize cefpodoxime (1 or 4 µg/ml,
depending on panel type), aztreonam, cefotaxime, ceftazidime, ceftriaxone, ESBL-a (cefpodoxime at 1 or 4 µg/ml
depending on panel type) and ESBL-b (ceftazidime, 1µ/ml) as screening agents. P. mirabilis utilizes the same
screening drugs with the exception of Aztreonam or Ceftriaxone. 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 (4ug/ml), or cefotaxime to cefotaxime/ K. clavulanate (4ug/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 species E. coli, K. oxytoca, K.
pneumoniae, and P. mirabilis.
When the customer chooses to activate the ESBL screen, 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 of E. coli, K. pneumoniae, K. oxytoca, or P. mirabilis will
still report MIC values for all antimicrobial agents tested; however, the screening antimicrobial agents, including ESBL-
a or ESBL-b, giving the 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.
 “R*” Predicted resistant interpretation.
These special interpretations will not appear if the laboratory chooses “no” when a suspected or confirmed ESBL-
producer is flagged; normal SIR interpretive categories will be reported.
9020-7705, Rev. A Page 11

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

Ranges
Aztreonam 2-16 ≥4
4-16 >8
AZT 8-16 >16
Cefotaxime 2, 8-32 ≥8
2, 16 ≥16
2-32 ≥4
CFT 4-32 >8
4-8, 32 ≥8
8-32 >16
8,32 >32
Ceftazidime 1, 4-16 ≥4
1, 8 ≥8
CAZ 2-16 >4
1-16 >2
1,8-16 and 4-32 >8
8-16 >16
Ceftriaxone3 1-2, 8, 32 >2
1-8 ≥2
CAX 4-32 >8
4-8, 32 ≥8
8-32 >16
8,32 >32
ESBL-a1,2 4 >4
(Cefpodoxime)
ESBL-b2 1 >1
(Ceftazidime)
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 (<16 hrs) are not provided for ESBL-a and ESBL-b on Synergies plus Gram-Negative panels. Results
are available at 16-20 hours.
3. Ceftriaxone ESBL screening functionality has been disabled in LabPro v4.11– Panel Update-05 for panel types
which are reporting the updated Enterobacteriaceae interpretive breakpoints and minimally contain Ceftriaxone
dilutions 1 and 2 µg/mL and DO NOT contain ESBL confirmation antimicrobial agents (ie. Cft/CA, Caz/CA)
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 Ampicillin AM Piperacillin PI
Cefepime CPE Cephalothin CF Ticarcillin TI
Ceftizoxime CZ
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
Piperacillin-Tazobactam P/T Ertapenem ETP
Ticarcillin-K Clavulanate TIM Doripenem DOR
9020-7705, Rev. A Page 12

DRIED OVERNIGHT AND RAPID (FLUOROGENIC) GRAM-NEGATIVE PANELS
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
NOTE: 1. For Rapid fluorogenic panel MIC format, do not report drug, therapy or MIC for P. mirabilis, M. morganii
or Salmonella/Shigella group. See back of guide for species names.
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.
Amoxicillin - MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA

K Clavulanate (Aug)
> R
16/8 I
8/4 S
NOTE: 1. Do not report therapy for Y. pestis because dangerously misleading results can occur.
2. Do not report drug, therapy or MIC for B. pseudomallei.
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. For Rapid fluorogenic panels, do not report drug, therapy or MIC for C. braakii/C. freundii/
C. sedlakii, C. werkmanii/C. youngae, C. amalonaticus/koseri group, Citrobacter species or other Species
group. See back of guide for species names.
2. For Rapid fluorogenic panel MIC format do not report drug, therapy or MIC for Proteus/Providencia group
(except P. mirabilis)
3. For Rapid fluorogenic panel Breakpoint format, do not report drug, therapy or MIC for P. mirabilis or
M. morganii
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.
Amp-Sulbactam (A/S) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA

(Acinetobacter spp. only)
> R R
16/8 I I
8/4 S S
4/2 S S
NOTE: 1. Report therapy for Enterobacteriaceae and Acinetobacter spp. See back of guide for Acinetobacter species
names.
9020-7705, Rev. A Page 13

Aztreonam (Azt) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R R R
16 I I I
8 S S S
4 S S S
2 S S S
NOTE: 1. Therapy for Enterobacteriaceae based on CLSI M100-S19 breakpoints.
2. For Rapid fluorogenic panel breakpoint format, do not report drug, therapy or MIC for P. aeruginosa.
3. 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 Acinetobacter spp., B. cepacia, B. pseudomallei, S. maltophilia and Vibrio spp.
Cefazolin (Cfz) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P AERUGINOSA
> N/R
4 S
2 S
NOTE: 1. Use for NC68 and NUC73 panels.
2. Based on the FDA (CLSI M100-S19) Enterobacteriaceae interpretive guidelines cleared for Beckman Coulter
use, all MICs of >4 will report as N/R, since these dilutions do not differentiate between S, I and R
(S≤8, I=16 R≥32).
3. Do not report therapy for Salmonella/Shigella group because dangerously misleading results can occur.
> R
16 I
8 S
4 S
2 S
NOTE: 1. Therapy is based on CLSI M100-S19 breakpoints.
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 guide for species names.
Cefepime (Cpe) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R R R
16 I I I
8 S S S
4 S S S
2 S S S
1 S S S
NOTE: 1. Do not report therapy for Y. pestis because dangerously misleading results can occur.
2. Do not report therapy for B. cepacia, B. pseudomallei, and S. maltophilia.
9020-7705, Rev. A Page 14

Cefotaxime (Cft) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R R
32 I I
16 I I
8 S S
4 S S
2 S S
2. Cefotaxime is a screening antimicrobial agent for extended-spectrum beta-lactamases (ESBL). For Dried
Overnight panels and E. coli, K. oxytoca, K. pneumoniae, and P. mirabilis, see ESBL information in front
of guide.
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.
>
16
2
NOTE: 1. Use for NC67 panel for ESBL confirmation use only.
2. Cefotaxime is a screening antimicrobial agent for extended-spectrum beta-lactamases (ESBL). For Dried
of guide.
Cefotaxime-K MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA

Clavulanate (Cft/CA)
>
4/4
0.5/4
NOTE: 1. Cefotaxime-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) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R
32 I
16 S
8 S
4 S
NOTE: 1. Do not report therapy for Salmonella/Shigella group and Y. pestis because dangerously misleading results
can occur.
2. Do not report therapy for Aeromonas spp., Plesiomonas shigelloides and Vibrio spp.
9020-7705, Rev. A Page 15

Cefoxitin (Cfx) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R
16 I
8 S
4 S
2 S
NOTE: 1. Do not report therapy for Salmonella/Shigella group and Y. pestis because dangerously misleading results
can occur.
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
1 S S S S
2. For Rapid fluorogenic panel MIC format, do not report drug, therapy or MIC for P. mirabilis and M. morganii.
3. Ceftazidime is a screening antimicrobial agent for extended-spectrum beta-lactamases (ESBL). For Dried
of guide.
>
8
1
NOTE: 1. Use for NC67 panel for ESBL confirmation use only.
2. Ceftazidime is a screening antimicrobial agent for extended-spectrum beta-lactamases (ESBL). For Dried
Overnight panels and E. coli, K. oxytoca, K. pneumoniae, and P. mirabilis, see ESBL information in front of
guide.
Ceftazidime-K MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA

Clavulanate (Caz/CA)
>
2/4
0.25/4
NOTE: 1. Ceftazidime-K Clavulanate is a confirmation antimicrobial for extended-spectrum beta-lactamases (ESBL)
on Dried Overnight panels. See ESBL information in front of guide.
9020-7705, Rev. A Page 16

Ceftizoxime (Cz) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R R
32 I I
8 S S
NOTE: 1. Therapy for Enterobacteriaceaebased on CLSI M100-S19 breakpoints.
3. Do not report therapy for Acinetobacter spp., Aeromonas spp., B. cepacia, B. pseudomallei, Plesiomonas
shigelloides, S. maltophilia and Vibrio spp.
Ceftriaxone (Cax) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R R
32 R I
8 R S
4 R S
2 I S
1 S S
NOTE: 1. Use for NC68, NM42, NM43, NUC60, NUC61 and NUC73 panels.
3. Do not report therapy for B. cepacia, B. pseudomallei, S. maltophilia, and Vibrio spp.
> R N/R
8 R S
4 R S
2 I S
1 S S
NOTE: 1. Use for NC67.
2. Based on the FDA (CLSI M100-S22) Non- Enterobacteriaceae interpretive guidelines cleared for
Beckman Coulter use, all MICs of >8 will report as N/R, since these dilutions do not differentiate
between S, I and R (S8, I=16-32, R≥64).
9020-7705, Rev. A Page 17

> R R
32 I I
16 I I
8 S S
4 S S
2. For Rapid fluorogenic panel MIC format, do not report drug, therapy or MIC for P. aeruginosa.
3. Ceftriaxone is a screening antimicrobial agent for extended-spectrum beta-lactamases (ESBL). For Dried
Cefuroxime sodium (Crm) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA

(parenteral)
> R
16 I
8 S
4 S
2 S
NOTE: 1. 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 guide for species names.
2. Do not report therapy for Salmonella/Shigella group and Y. pestis because dangerously misleading results
can occur.
3. The CLSI breakpoints for Cefuroxime axetil (oral) are 4=S, 8-16 =I, >16=R.
Cephalothin (Cf) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R
16 I
8 S
4 S
2 S
NOTE: 1. Report for Urine sources only, as per CLSI M100-S20
2. Do not report therapy Salmonella/Shigella group and Y. pestis because dangerously misleading results can
occur.
3. Do not report therapy for Aeromonas spp., Plesiomonas shigelloides and Vibrio spp
Chloramphenicol (C) MIC ENTEROBACTERIACEAE NON- P. AERUGINOSA V .CHOLERAE Y. PESTIS

ENTEROBACTERIACEAE
> R R R R
16 I I I I
8 S S S S
NOTE: 1. Only systemic therapy will be reported.
2. Do not report therapy for Acinetobacter spp. and B. pseudomallei.
9020-7705, Rev. A Page 18

Cinoxacin (Cn) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R
16 S
NOTE: 1. Only urine therapy will be reported.
2. Do not report therapy for Aeromonas spp., Plesiomonas shigelloides, Vibrio spp. and Y. pestis.
Ciprofloxacin (Cp) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA Y. PESTIS
> R R R R
4 R R R R
2 I I I I
1 S S S S
0.5 S S S S
NOTE: 1. Do not report therapy for B. cepacia, B. pseudomallei, and S. maltophilia.
2. Therapy for Y. pestis is based on CLSI M100-S17 breakpoints.
3. Therapy for Salmonella species is based on CLSI M100 S21 breakpoints.
Doripenem (Dor) MIC ENTEROBACTERIACEAE A.BAUMANNII P. AERUGINOSA
> - - -
2 - - S
1 - S S
0.5 S S S
NOTE: 1. Do not report drug, therapy or MIC, for Aeromonas spp., Plesiomonas shigelloides and Vibrio spp.
Including V. cholerae.
2. Do not report drug, therapy or MIC for all organisms, except A. baumannii, Enterobacteriaceae, and
P. aeruginosa.
3 Therapy based on FDA interpretive breakpoints which differ from CLSI M100-S22.
4. The FDA interpretive breakpoints for Doripenem with Enterobacteriaceae are 0.5 for susceptible.
Because intermediate and resistant interpretations have not been defined for Enterobacteriaceae, no
interpretations will be provided if the result is >0.5.
5. The FDA interpretive breakpoints for Doripenem with A. baumannii are 1 for susceptible. Because
intermediate and resistant interpretations have not been defined for A. baumannii, no interpretations will
be provided if the result is >1.
6. The FDA interpretive breakpoints for Doripenem with P. aeruginosa are 2 for susceptible. Because
intermediate and resistant interpretations have not been defined for P. aeruginosa no interpretations will
be provided if the result is >2.
Ertapenem (Etp) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R
4 R
2 R
1 I
0.5 S
NOTE: 1. Use for NC67, NC68, NM42, NM43 and NUC73 panels
3. Do not report therapy for Aeromonas spp., Plesiomonas shigelloides andVibrio spp.
9020-7705, Rev. A Page 19

> R
4 I
2 S
1 S
3. Do not report therapy for Vibrio spp.
ESBL-a (ESa) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
>
4
NOTE: 1. ESBL-a is Cefpodoxime.
2. ESBL-a is a screening antimicrobial agent for extended-spectrum beta-lactamases (ESBL). For Dried
Overnight panels and E. coli, K. oxytoca, K. pneumoniae, and P. mirabilis, see ESBL information in front of guide.
ESBL-b (ESb) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
>
1
NOTE: 1. ESBL-b is Ceftazidime.
2. ESBL-b is a screening antimicrobial agent for extended-spectrum beta-lactamases (ESBL). For Dried
Overnight panels and E. coli, K. oxytoca, K. pneumoniae, and P. mirabilis, see ESBL information in front of guide.
Gatifloxacin (Gat) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R
4 I
2 S
NOTE: 1. Do not report drug, therapy or MIC for non-Enterobacteriaceae and P. aeruginosa (efficacy has not been
established).
2. Do not report therapy for Aeromonas spp., Plesiomonas shigelloides, Vibrio spp, and Y. pestis.
Gemifloxacin (Gem) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R
0.5 I
0.25 S
NOTE: 1. Do not report therapy for Aeromonas spp., Plesiomonas shigelloides, Vibrio spp, and Y. pestis.
9020-7705, Rev. A Page 20

Gentamicin (Gm) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA Y. PESTIS
> R R R R
8 I I I I
4 S S S S
2 S S S S
1 S S S S
NOTE: 1. Do not report therapy for Salmonella/Shigella group because dangerously misleading
results can occur.
Imipenem (Imp) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA B. PSEUDOMALLEI
> R R R R
8 R I R I
4 R S I S
2 I S S S
1 S S S S
NOTE:1. Use for NBC47, NC50, NC68, NM30, NM38, NM42, NM43, NUC51, NUC55, NUC61 and NUC73
panels,
2. Do not report drug, therapy or MIC, for Acinetobacter spp. and P. mirabilis.
4. Do not report therapy for Aeromonas spp., B. cepacia, Plesiomonas shigelloides, S. maltophilia, and Vibrio spp.
Imipenem (Imp) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA B. PSEUDOMALLEI
> R R R R
8 I I I I
4 S S S S
2. Therapy for P. aeruginosa is based on CLSI M100-S21.
3. For Rapid fluorogenic panels, do not report drug, therapy or MIC for all gram-negative organisms.
4. Do not report drug, therapy or MIC, for Acinetobacter spp.
6. Do not report therapy for B. cepacia and S. maltophilia.
Levofloxacin (Lvx) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R R R
4 I I I
2 S S S
1 S S S
0.5 S S S
NOTE: 1. Do not report therapy for B. pseudomallei and Y. pestis.
9020-7705, Rev. A Page 21

Meropenem (Mer) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R R R
8 I I I
4 S S S
2 S S S
1 S S S
NOTE: 1. Therapy for Enterobacteriaceae and P. aeruginosa based on CLSI M100-S20 breakpoints.
3. Do not report therapy for B. pseudomallei and S. maltophilia.
Mezlocillin (Mz) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R R R
64 I I S
32 I I S
16 S S S
8 S S S
2. For Rapid fluorogenic panel MIC format, do not report drug, therapy or MIC for Serratia group. See back of
guide for species names.
3. For Rapid Fluorogenic panels, do not report therapy for S. maltophilia
5. Do not report therapy for Aeromonas spp., B. cepacia, B. pseudomallei, Plesiomonas shigelloides and
Vibrio spp.
Moxifloxacin (Mxf) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
 R
4 I
2 S
NOTE: 1. For Dried Overnight panels, do not report drug, therapy or MIC for P. aeruginosa (efficacy has not been
established).
2. Therapy based on FDA interpretive breakpoints which are not established in CLSI.
3. Only systemic therapy will be reported.
Nitrofurantoin (Fd) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R
64 I
32 S
9020-7705, Rev. A Page 22

Norfloxacin (Nxn) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R R R
8 I I I
4 S S S
2. Do not report therapy for Acinetobacter spp., Aeromonas spp., B. cepacia, B. pseudomallei,
Plesiomonas shigelloides, S. maltophilia, Vibrio spp. and Y. pestis.
Ofloxacin (Ofl) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R R R
4 I I I
2 S S S
1 S S S
0.5 S S S
NOTE: 1. For Rapid fluorogenic panel breakpoint format, do not report drug, therapy or MIC for A. baumannii,
A. haemolyticus, A. baumannii/haemolyticus, Acinetobacter spp. or P. aeruginosa. See back of guide for
species names.
2. Do not report therapy for Acinetobacter spp., Aeromonas spp., B. cepacia, B. pseudomallei,
Plesiomonas shigelloides, S. maltophilia and Y. pestis.
.
Piperacillin (Pi) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R R R
64 I I S
32 I I S
16 S S S
8 S S S
NOTE: 1. For Dried Overnight panels, do not report drug, therapy or MIC for S. maltophilia.
2. For Rapid fluorogenic panels, do not report therapy for S. maltophilia.
4. Do not report therapy for Aeromonas spp., B. cepacia, B. pseudomallei and Plesiomonas shigelloides.
5. Therapy for P. aeruginosa based on CLSI M100-S21 breakpoints.
Piperacillin-Tazobactam MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA

(P/T)
> R R R
64 I I S
32 I I S
16 S S S
8 S S S
NOTE: 1. For Dried Overnight panels, do not report drug, therapy or MIC for S. maltophilia and Acinetobacter species.
See back of guide for species names.
3. Do not report therapy for B. cepacia and B. pseudomallei.
9020-7705, Rev. A Page 23

Tetracycline (Te) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA V. CHOLERAE
> R R R
8 I I I
4 S S S
2 S S S
MIC B. PSEUDOMALLEI Y. PESTIS

> R R
8 I I
4 S S
2 S S
NOTE: 1. Do not report therapy for B. cepacia and S. maltophilia
Ticarcillin (Ti) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R R R
64 I I S
16 S S S
NOTE: 1. For Rapid fluorogenic panels, do not report therapy for S. maltophilia.
3. Do not report therapy for Aeromonas spp., B. cepacia, B. pseudomallei, Plesiomonas shigelloides and
Vibrio spp.
Ticarcillin- MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA

K Clavulanate (Tim)
> R R R
64 I I S
32 I I S
16 S S S
8 S S S
4 S S S
NOTE: 1. For Rapid fluorogenic panel MIC format, do not report drug, therapy or MIC for E. coli or Klebsiella spp.
2. For Rapid fluorogenic panel breakpoint format, do not report drug, therapy or MIC for P. aeruginosa, E. coli
or Klebsiella spp. See back of guide for species names.
4. Do not report therapy for Aeromonas spp., B. pseudomallei, Plesiomonas shigelloides, and Vibrio spp.
9020-7705, Rev. A Page 24

Tigecycline (Tgc) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R
4 I
2 S
1 S
NOTE: 1. Therapy based on FDA interpretive breakpoints which are not established in CLSI.
2. Do not report drug, therapy or MIC for Acinetobacter spp., P. aeruginosa, P. mirabilis, and all non-
Enterobacteriaceae.
3. Do not report therapy for Y. pestis.
Tobramycin (To) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R R R
8 I I I
4 S S S
2 S S S
1 S S S
NOTE: 1. For Rapid fluorogenic panel MIC format, do not report drug, therapy or MIC for Salmonella/Shigella group.
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 Aeromonas spp., B. cepacia, B. pseudomallei, Plesiomonas shigelloides,
S. maltophilia, Vibrio spp. and Y. pestis.
Trimethoprim (T) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R
8 S
2. For Rapid fluorogenic panel breakpoint format, do not report drug, therapy or MIC for A. baumannii,
A. haemolyticus, A. baumannii/haemolyticus and Acinetobacter spp. See back of guide for species names.
Trimethoprim- MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA V. CHOLERAE

Sulfamethoxazole (T/S)
> R R R
2/38 S S S
1/19 S S S
0.5/9.5 S S S

> R R
2/38 S S
1/19 S S
0.5/9.5 S S S
NOTE: 1. For Rapid fluorogenic panel MIC and breakpoint format, do not report drug, therapy or MIC for P. aeruginosa.
2. For Dried Overnight panels, do not report therapy for P. aeruginosa.
9020-7705, Rev. A Page 25

SYNERGIES PLUS GRAM-NEGATIVE PANELS
Amikacin (Ak) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R R R
32 I I I
16 S S S
8 S S S
NOTE: 1. Do not report therapy for Salmonella/Shigella group because dangerously misleading results can occur.
2. Do not report therapy for B. cepacia, B. pseudomallei, S. maltophilia and Y. pestis.
Amoxicillin- MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA

K Clavulanate (Aug)
> R
16/8 I
8/4 S
NOTE: 1. Rapid results (<16 hrs) are not provided for Amoxicillin-K Clavulanate on Synergies plus Gram-Negative
panels. Results are available at 16-20 hours.
3. Do not report drug, therapy or MIC for B. pseudomallei.
Ampicillin (Am) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA V. CHOLERAE
> R
16 I
8 S
4 S
2 S
NOTE: 1. Do not report drug, therapy or MIC for P. vulgaris or Shigella spp. See back of guide for species names.
2. For the following groups, Citrobacter spp., Enterobacter spp., Klebsiella spp. or Providencia spp., do not
report rapid Synergies plus results (<16 hrs) for drug, therapy or MIC. Overnight results (16-20 hrs) can be
reported. See back of guide for species names.
3. For rapid Synergies plus results (<16 hrs), intermediate/resistant MICs obtained for P. mirabilis must be
confirmed with overnight incubation (16-20 hours) of the Synergies plus panels.
5. Do not report therapy for Aeromonas spp., Plesiomonas shigelloides, and V. cholerae.
Amp-Sulbactam (A/S) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA

(Acinetobacter spp. Only)
> R
16/8 I
8/4 S
4/2 S
NOTE: 1. Use this table for the Synergies plus Neg Combo Type 2,
and Synergies plus Neg/Urine Combo 5 panels.
2. Do not report drug, therapy or MIC for the following groups: Citrobacter spp., Enterobacter spp., M. morganii,
Salmonella spp. or Shigella spp. See back of guide for species names.
3. Do not report therapy for Acinetobacter spp. because “according to the FDA approved pharmaceutical
manufacturer’s package insert, sufficient strains of Acinetobacter spp. have not been tested to establish
efficacy with Ampicillin-Sulbactam.”
9020-7705, Rev. A Page 26

Aztreonam (Azt) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R R R
16 I I I
8 S S S
2. Rapid results (<16 hrs) are not provided for Aztreonam on Synergies plus Gram-Negative panels.
Results are available at 16-20 hours.
3. Aztreonam cannot be used as a screening antimicrobial agent for extended-spectrum beta lactamases
(ESBL) on Synergies plus panels.
4. On Synergies plus panels, ESBL-a and ESBL-b can be used as screening antimicrobial agents for
extended spectrum beta lactamases (ESBL), see information under ESBL-a and ESBL-b.
6. Do not report therapy for Acinetobacter spp., B. cepacia, B. pseudomallei, S. maltophilia, and Vibrio spp.
> R
16 I
8 S
2. Use this table for Synergies plus Neg/Urine Combo Type 5 panels.
3. Do not report drug, therapy or MIC for K. oxytoca, K. pneumoniae/oxytoca and Klebsiella spp.
4. Do not report therapy for Salmonella/Shigella group and Y. pestis because dangerously misleading
results can occur.
5. Due to expected natural resistance to Cefazolin, drug, MIC, and interpretative results from Enterobacter spp.,
C. freundii Group, M. morgannii, P. vulgaris, P.penneri, Providencia spp., Serratia spp. or Y.enterolitica
will not be reported in the software or on patient reports. See back of guide for species names.
Cefazolin (Cfz) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R
16 I
8 S
2. Use this table for the Synergies plus Neg BP Combo Type 7 and Synergies plus Neg Combo Type 2 panels.
3. Rapid results (<16 hrs) are not provided for Cefazolin for the Synergies plus Gram-Negative panels listed
in Note 2. Results are available at 16-20 hours.
Cefepime (Cpe) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R R R
16 I I I
8 S S S
4 S S S
NOTE: 1. Rapid results (<16 hrs) are not provided for Cefepime on Synergies plus Gram-Negative panels.
9020-7705, Rev. A Page 27

> R R
32 I I
16 I I
8 S S
2 S S
2. Use this table for the Synergies plus Neg BP Combo Type 7, Synergies plus Neg/Urine Combo Type 1,
Synergies plus Neg/Urine Combo Type 2, and Synergies plus Neg/Urine Combo Type 5 panels.
3. Rapid results (<16 hrs) are not provided for Cefotaxime on the Synergies plus Gram-Negative panels
listed in Note 1. Results are available at 16-20 hours.
4. Cefotaxime cannot be used as a screening antimicrobial agent for extended-spectrum beta
lactamases (ESBL) on Synergies plus panels.
Cefotaxime-K MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA

Clavulanate (Cft/CA)
>
4/4
0.5/4
NOTE: 1. On Synergies plus panels, Cefotaxime-K Clavulanate is a confirmation antimicrobial for extended-
spectrum beta-lactamases (ESBL). See ESBL information in front of guide.
Cefotetan (Ctn) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R
32 I
16 S
NOTE: 1. Rapid results (<16 hrs) are not provided for Cefotetan on Synergies plus Gram-Negative panels. Results
4. Do not report therapy for Aeromonas spp., Plesiomonas shigelloides, and Vibrio spp.
Cefoxitin (Cfx) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R
16 I
8 S
NOTE: 1. Rapid results (<16 hrs) are not provided for Cefoxitin on Synergies plus Gram-Negative panels. Results
9020-7705, Rev. A Page 28

> R R R R
16 I I I I
8 S S S S
4 S S S S
2 S S S S
2. For E. cloacae, do not report rapid Synergies plus results (<16 hrs) for drug, therapy or MIC. Overnight
results (16-20 hrs) can be reported.
3. Ceftazidime cannot be used as a screening antimicrobial agent for extended-spectrum beta lactamases
4. On Synergies plus panels, ESBL-a and ESBL-b can be used as screening antimicrobial agents for extended
spectrum beta lactamases (ESBL), see information under ESBL-a and ESBL-b.
ESBL Confirm MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA B. PSEUDOMALLEI

Ceftazidime (ECAZ)
>
8
1
NOTE: 1. ECaz is Ceftazidime. Rapid results (<16 hrs) are not provided for ECaz on Synergies plus Gram-Negative
2. ECaz is a confirmation antimicrobial agent for extended-spectrum beta-lactamases (ESBL). For Dried
Overnight results and E. coli, K. oxytoca, K. pneumoniae, and P. mirabilis, see ESBL information in front
of guide.
Ceftazidime-K MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA

Clavulanate (Caz/CA)
>
2/4
0.25/4
NOTE: 1. On Synergies plus panels, Ceftazidime-K Clavulanate is a confirmation antimicrobial for extended-
spectrum beta-lactamases (ESBL). See ESBL information in front of guide.
> R R
32 I I
8 S S
NOTE: 1. Therapy for Enterobacteriaceae CLSI M100-S19 breakpoints.
2. Use for Synergies plus Neg BP Combo Type 7, Synergies plus Neg/Urine Combo Type 1, Synergies plus
Neg/Urine Combo Type 2 and Synergies plus Neg Combo 2 panels.
3. Do not report drug, therapy or MIC for P. vulgaris.
4. For Citrobacter spp. or E. cloacae, do not report rapid Synergies plus results (<16 hrs) for drug, therapy
or MIC. Overnight results (16-20 hrs) can be reported. See back of guide for species names.
5. Ceftriaxone cannot be used as a screening antimicrobial agent for extended-spectrum beta lactamases
8. Do not report therapy for B. cepacia, B. pseudomallei, S. maltophilia and Vibrio spp.
9020-7705, Rev. A Page 29

> R R
32 I I
8 S S
2. Use for Synergies plus Gram-Negative/Urine Combo 5 panels.
3. Rapid results (<16 hrs) are not provided for Ceftriaxone on the Synergies plus Gram-Negative/Urine
Combo 5 panels. Results are available at 16-20 hours.
4. Ceftriaxone is a screening antimicrobial agent for extended-spectrum beta-lactamases (ESBL). For Dried
Cefuroxime sodium (Crm) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA

(parenteral)
> R
16 I
8 S
4 S
NOTE 1. For Enterobacter spp. or K. pneumoniae, do not report rapid Synergies plus results (<16 hrs) for drug,
therapy or MIC. Overnight results (16-20 hrs) can be reported. See back of guide for species names.
3. The CLSI breakpoints for Cefuroxime axetil (oral) are 4=S, 8-16 =I, >16=R.
Cephalothin (Cf) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R
16 I
8 S
NOTE: 1. Report for Urine source only, as per CLSI M100-S20.
2. Rapid results (<16 hrs) are not provided for Cephalothin on Synergies plus Gram-Negative panels. Results
3. Do not report therapy for Salmonella/Shigella group and Y. pestis because dangerously misleading results can
occur.
Ciprofloxacin (Cp) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA Y. PESTIS
> R R R R
2 I I I I
1 S S S S
NOTE: 1. Do not report therapy for B. cepacia, B. pseudomallei and S. maltophilia.
2. Therapy for Y. pestis is based on CLSI M100-S17 breakpoints.
3. Therapy for Salmonella species is based on CLSI M100 S21 breakpoints.
9020-7705, Rev. A Page 30

> R
4 I
2 S
1 S
2. Rapid results (<16 hrs) are not provided for Ertapenem on the Synergies plus Gram-Negative panels.
4. Do not report therapy for Vibrio spp.
ESBL-a (ESa) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
>
4
NOTE: 1. ESBL-a is Cefpodoxime. Rapid results (<16 hrs) are not provided for ESBL-a on Synergies plus Gram-
Negative panels. Results are available at 16-20 hours.
2. ESBL-a is a screening antimicrobial agent for extended-spectrum beta-lactamases (ESBL). For Dried
Overnight results and E. coli, K. oxytoca, K. pneumoniae, and P. mirabilis, see ESBL information in front
of guide.
ESBL-b (ESb) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
>
1
NOTE: 1. ESBL-b is Ceftazidime. Rapid results (<16 hrs) are not provided for ESBL-b on Synergies plus Gram-
Negative panels. Results are available at 16-20 hours.
2. ESBL-b is a screening antimicrobial agent for extended-spectrum beta-lactamases (ESBL). For Dried
Overnight results and E. coli, K. oxytoca, K. pneumoniae, and P. mirabilis, see ESBL information in front of
guide.
Gatifloxacin (Gat) MIC ENTEROBACTERIACEAE A. LWOFFII P. AERUGINOSA
> R R
4 I I
2 S S
NOTE: 1. Use this table for the Synergies plus Neg BP Combo Type 7, Synergies plus Neg/Urine Combo Type 1,
Synergies plus Neg/Urine Combo Type 2, and Synergies plus Neg Combo Type 2 panels.
2. Do not report drug, MIC or therapy for non-Enterobacteriaceae (except A. lwoffii) and P. aeruginosa.
Gentamicin (Gm) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA Y. PESTIS
> R R R R
8 I I I I
4 S S S S
2 S S S S
1 S S S S
9020-7705, Rev. A Page 31

Imipenem (Imp) MIC ENTEROBACTERIACEAE NON- P. AERUGINOSA B. PSEUDOMALLEI

ENTEROBACTERIACEAE
> R R R R
8 - - - -
4 - - - -
NOTE: 1 Therapy for Enterobacteriaceae based on CLSI M100-S20 breakpoints.
3. Do not report drug, therapy or MIC for any organism with susceptible or intermediate results.
4. Do not report drug, therapy or MIC, for Acinetobacter spp.
5. Do not report therapy for B. cepacia and S. maltophilia.
Levofloxacin (Lvx) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R R R
4 I I I
2 S S S
NOTE: 1. Do not report therapy for B. pseudomallei and Y. pestis
Meropenem (Mer) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R R R
8 - - -
4 - - -
2 - - -
1 - - -
2. Do not report drug, therapy or MIC for any organism with susceptible or intermediate results.
3. For P. aeruginosa, do not report rapid Synergies plus results (<16 hrs) drug, therapy or MIC. Overnight
results (16-20 hrs) can be reported.
5. Do not report therapy for B. pseudomallei and S. maltophilia.
> R
64 I
32 S
16 S
NOTE: 1. Use this table for the Synergies plus Neg/Urine Combo Type 5 and Synergies plus Neg BP Combo Type 7
panels.
2. Only urine therapy will be reported.
3. Due to expected natural resistance to Nitrofurantoin, drug, MIC and interpretive results from M. morganii,
Proteus spp., Providencia spp. or Serratia spp. will not be reported in the software or on patient reports.
9020-7705, Rev. A Page 32

> R
64 I
32 S
NOTE: 1. Use this table for the Synergies plus Neg/Urine Combo Type 1 and Synergies plus Neg/Urine Combo
Type 2.
2. Rapid results (<16 hrs) are not provided for Nitrofurantoin on the Synergies plus Gram-Negative panels
Piperacillin (Pi) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R R R
64 I I S
16 S S S
NOTE: 1. Use this table for the Synergies plus Neg/Urine Combo Type 1 panels.
2. Rapid results (<16 hrs) are not provided for Piperacillin on the Synergies plus Gram-Negative panels listed
in Note 1. Results are available at 16-20 hours.
3. Do not report drug, therapy or MIC for S. maltophilia.
5. Do not report therapy for Aeromonas spp., B. cepacia, B. pseudomallei and Plesiomonas shigelloides

(P/T)
> R R R
64 I I S
32 I I S
16 S S S
NOTE: 1. Use this table for the Synergies plus Neg Combo Type 2 panels.
2. Do not report drug, therapy, or MIC for S. maltophilia and Acinetobacter spp. See back of guide for species
names.
3. For Citrobacter spp. or Enterobacter spp., do not report rapid Synergies plus results (<16 hrs) for drug,
therapy or MIC. Overnight results (16-20 hrs) can be reported. See back of guide for species names.
4. For rapid Synergies plus results (<16 hrs), do not report drug, therapy or MIC for Serratia spp. with MICs
of > 32 (I, R).
5. For rapid Synergies plus results (<16 hrs), intermediate/resistant MICs obtained for Serratia spp. must be
confirmed with overnight incubation (16-20 hrs) of the Synergies plus panels.
9020-7705, Rev. A Page 33


(P/T)
> R R R
64 I I S
16 S S S
NOTE: 1. Use this table for the Synergies plus Neg BP Combo Type 7, Synergies plus Neg/Urine Combo Type 1,
Synergies plus Neg/Urine Combo Type 2, and Synergies plus Neg/Urine Combo Type 5 panels.
2. Rapid results (<16 hrs) are not provided for Piperacillin-Tazobactam on the Synergies plus Gram-
Negative panels listed in Note 1. Results are available at 16-20 hours.
3. Do not report drug, therapy or MIC for S. maltophilia and Acinetobacter spp. See back of guide for
species names.
Tetracycline (Te) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA V. CHOLERAE
> R R
8 I I
4 S S

> R R
8 I I
4 S S
NOTE: 1. Use these tables for the Synergies plus Neg/Urine Combo Type 1 panels.
2. Rapid results (<16 hrs) are not provided for Tetracycline on the Synergies plus Gram-Negative panels
3. Do not report therapy for B. cepacia, S. maltophilia and V. cholerae.
Ticarcillin- MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA

K Clavulanate (Tim)
> R R R
64 I I S
16 S S S
NOTE: 1. Rapid results (<16 hrs) are not provided for Ticarcillin-K Clavulanate on Synergies plus Gram-Negative
3. Do not report therapy for Aeromonas spp., B. pseudomallei, Plesiomonas shigelloides and Vibrio spp.
Tigecycline (Tgc) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R
4 I
2 S
NOTE: 1. Therapy based on FDA interpretive breakpoints which are not established in CLSI.
2. Rapid results (<16 hrs) are not provided for Tigecycline on the Synergies plus Gram-Negative panels.
3. Do not report drug, therapy or MIC for Acinetobacter spp., P. aeruginosa, P. mirabilis, and all non-
Enterobacteriaceae.
4. Do not report therapy for Y. pestis.
9020-7705, Rev. A Page 34

Tobramycin (To) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R R R
8 I I I
4 S S S
2 S S S
2. Do not report therapy for Aeromonas spp., B. cepacia, B. pseudomallei, Plesiomonas shigelloides, S.
maltophilia, Vibrio spp. and Y. pestis.
Trimethoprim (T) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA
> R
8 S
NOTE: 1. Rapid results (<16 hrs) are not provided for Trimethoprim on Synergies plus Gram-Negative panels.
Trimethoprim- MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA V. CHOLERAE

> R R
2/38 S S
> R R
2/38 S S
NOTE: 1. Use these tables for Synergies plus Neg BP Combo Type 7, Synergies plus Neg/Urine Combo Type 1,
Synergies plus Neg/Urine Combo Type 2, Synergies plus Neg/Urine Combo Type 5 and Synergies plus
Neg Combo Type 2 panels.
2. For rapid Synergies plus results (<16 hrs), do not report drug, therapy or MIC for P. aeruginosa.
3. For overnight results (16-20 hours), do not report therapy for P. aeruginosa.
4. Do not report therapy for V. cholerae.
9020-7705, Rev. A Page 35

DRIED OVERNIGHT GRAM-POSITIVE PANELS
Amoxicillin- MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI

K Clavulanate (Aug)
> R
4/2 S
NOTE: 1. For S. aureus and S. lugdunensis, if Oxacillin is >2 or Cefoxitin screen (CfxS) is >4, report Amoxicillin-K
Clavulanate as resistant regardless of MIC.
2. For coagulase-negative staphylococci (CNS) other than S. lugdunensis , if Oxacillin MIC is 0.5, report
Amoxicillin-K Clavulanate as resistant regardless of MIC.
3. For streptococci and beta-lactamase negative enterococci, refer to Penicillin result.
Ampicillin MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI STREPTOCOCCI LISTERIA

[S. agalactiae [S. bovis group
(Am) (Group B)] (Group D)]
> R - R -
8 S - R -
4 S - I -
2 S - I S
1 S - I S
0.5 S - I S
0.25 S S S S
NOTE: 1. Use this table for non-staphylococci.
2. Do not report drug, therapy or MIC for all streptococci except for S. agalactiae (Group B) and
S. bovis group (Group D).
4. For enterococci, if beta-lactamase positive, report Ampicillin as Blac regardless of MIC.
5. The CLSI interpretative guideline for Ampicillin with Listeria spp. is 2 for susceptible. Because intermediate
and resistant interpretations have not been defined for Listeria spp., no interpretations will be provided if the
result is >2.
6. The CLSI interpretative guideline for Ampicillin with beta-hemolytic streptococci is 0.25 for susceptible.
Because intermediate and resistant interpretations have not been defined for S. agalactiae (Group B),
no interpretations will be provided if the result is >0.25.
Ampicillin (Am) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI LISTERIA
> R
8 R
4 R
2 R
1 R
0.5 R
0.25 S
NOTE: 1. Use this table for staphylococci.
2. For S. aureus and S. lugdunensis, if Oxacillin MIC is >2 or Cefoxitin screen (CfxS) is >4, report Ampicillin as
resistant regardless of MIC.
3. For CNS other than S. lugdunensis, if Oxacillin MIC is 0.5, report Ampicillin as resistant regardless of MIC.
4. If beta-lactamase positive, report Ampicillin as Blac regardless of MIC.
5. If Penicillin MIC is >0.12, report Ampicillin as resistant regardless of MIC.
9020-7705, Rev. A Page 36

Ampicillin (Am) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI LISTERIA
> N/R R N/R -

8 N/R S N/R -
4 N/R S N/R -
2 N/R S N/R S
NOTE: 1. Use this table for PC29, PC33, PC34, PMIC26 and PMIC29.
2. For S. aureus and S. lugdunensis, if Oxacillin MIC is >2 or Cefoxitin screen (CfxS) is >4, report Ampicillin as
3. For CNS other than S. lugdunensis, if Oxacillin MIC is 0.5, report Ampicillin as resistant regardless of MIC.
4. For streptococci, refer to Penicillin result.
5. If beta-lactamase positive for staphylococci or enterococci, report Ampicillin as Blac regardless of MIC.
6. If Penicillin MIC is >0.12, report Ampicillin as resistant regardless of MIC.
7. The CLSI interpretative guideline for Ampicillin with Listeria spp. is 2 for susceptible. Because
intermediate and resistant interpretations have not been defined for Listeria spp., no interpretations will be
provided if the result is >2.
8. Based on CLSI breakpoints for streptococci and staphylococci, dilutions no longer differentiate between S,
I, and R.
Amp-Sulbactam (A/S) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI
> R
16/8 I
8/4 S
NOTE: 1. For S. aureus and S. lugdunensis, if Oxacillin MIC is >2 or Cefoxitin screen (CfxS) is >4, report Ampicillin-
Sulbactam as resistant regardless of MIC.
2. For CNS other than S. lugdunensis, if Oxacillin MIC is 0.5, report Ampicillin-Sulbactam as resistant
regardless of MIC.
Azithromycin (Azi) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI
> R
4 I
2 S
2. Use for panels with breakpoint format.
3. Do not report drug, therapy or MIC for enterococci, streptococci or L. monocytogenes.
Cefazolin (Cfz) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI
> R
16 I
8 S
4 S
2 S
NOTE: 1. Do not report therapy for enterococci or L. monocytogenes because dangerously misleading results can
occur.
2. For S. aureus and S. lugdunensis, if Oxacillin MIC is >2 or Cefoxitin screen (CfxS) is >4, report Cefazolin as
3. For CNS other than S. lugdunensis, if Oxacillin is 0.5, report Cefazolin as resistant regardless of MIC.
9020-7705, Rev. A Page 37

Cefepime (Cpe) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI
> R N/R
16 I N/R
8 S N/R
occur.
2. For S. aureus and S. lugdunensis, if Oxacillin MIC is >2 or Cefoxitin screen (CfxS) is >4, report Cefepime
as resistant regardless of MIC.
3. For CNS other than S. lugdunensis, if Oxacillin MIC is 0.5, report Cefepime as resistant regardless
of MIC.
4. Based on CLSI breakpoints for streptococci, these dilutions do not differentiate between S, I and R.
Cefotaxime (Cft) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI
> R N/R
32 I N/R
8 S N/R
NOTE: 1. Use for panels with breakpoint format.
2. Do not report therapy for enterococci or L. monocytogenes because dangerously misleading results can
occur.
3. For S. aureus and S. lugdunensis, if Oxacillin MIC is >2 or Cefoxitin screen (CfxS) is >4, report Cefotaxime
4. For CNS other than S. lugdunensis, if Oxacillin MIC is 0.5, report Cefotaxime as resistant regardless of
MIC.
5. Based on CLSI breakpoints for streptococci, these dilutions do not differentiate between S, I and R.
Ceftriaxone (Cax) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI
> R N/R
32 I N/R
16 I N/R
8 S N/R
4 S N/R
occur.
2. For S. aureus and S. lugdunensis, if Oxacillin MIC is >2 or Cefoxitin screen (CfxS) is >4, report Ceftriaxone as
3. For CNS other than S. lugdunensis, if Oxacillin MIC is 0.5, report Ceftriaxone as resistant regardless of
MIC.
4. Based on CLSI breakpoints for streptococci, these dilutions do not differentiate between S, I, and R.
9020-7705, Rev. A Page 38

Cephalothin (Cf) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI
> R
16 I
8 S
occur.
2. For S. aureus and S. lugdunensis, if Oxacillin MIC is >2 or Cefoxitin screen (CfxS) is >4, report Cephalothin
3. For CNS other than S. lugdunensis, if Oxacillin MIC is 0.5, report Cephalothin as resistant regardless of
MIC.
Chloramphenicol (C) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI
> R R N/R
16 I I N/R
8 S S N/R
2. Use for panels with breakpoint format.
3. Based on CLSI breakpoints of 4=S, 8 =I, 16=R for streptococci, these dilutions no longer differentiate
between S, I, and R.
Ciprofloxacin (Cp) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI
> R R
2 I I
1 S S
Clindamycin (Cd) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI
> R R
4 R R
2 I R
1 I R
0.5 S I
0.25 S S
2. Do not report therapy for enterococci because dangerously misleading results can occur.
3. Do not report drug, therapy or MIC for all streptococci except for S. agalactiae (Group B) and S. bovis group
(Group D).
4. For Staphylococci, if Inducible Clindamycin Test (ICd) is positive (>4/0.5) report Clindamycin as resistant
regardless of MIC.
9020-7705, Rev. A Page 39

Clindamycin (Cd) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI
> R N/R
4 R N/R
2 I N/R
1 I N/R
0.5 S N/R
3. Based on CLSI breakpoints for Streptococci, dilutions no longer differentiate between S, I, and R.
4. For Staphylococci, if Inducible Clindamycin Test (ICd) is positive (>4/0.5) report Clindamycin as resistant
regardless of MIC.
Daptomycin (Dap) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI
> - - -
4 - S -
2 - S -
1 S S S
0.5 S S S
0.25 S S S
NOTE: 1. For Dried Overnight panels, do not report drug, therapy or MIC for all streptococci except for
S. agalactiae (Group B) and S. bovis group (Group D).
2. The CLSI interpretative guideline for Daptomycin with Staphylococci and Streptococci is 1 for susceptible.
Because intermediate and resistant interpretations have not been defined for Staphylococci and Streptococci,
no interpretations will be provided if the result is >1.
3. The CLSI interpretative guideline for Daptomycin with Enterococci is 4 for susceptible. Because
intermediate and resistant interpretations have not been defined for Enterococci, no interpretations will be
Ertapenem (Etp) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI

[S. agalactiae
(GroupB)]
> R N/R
4 I N/R
2 S N/R
NOTE: 1. Do not report drug, therapy or MIC for Listeria monocytogenes, and Coagulase-Negative Staphylococci
(CNS), except S. lugdunensis, with an Oxacillin MIC of ≥ 0.5.
2. Do not report drug, therapy or MIC for S. lugdunensis when the Oxacillin MIC is >2 and/or CfxS is >4.
3. For S. aureus, if Oxacillin MIC is >2, and/or CfxS is >4, report Ertapenem as resistant regardless of MIC.
4. Based on CLSI breakpoints for beta-hemolytic streptococci, these dilutions no longer differentiate
between S and non-susceptible (NS).
9020-7705, Rev. A Page 40

Ertapenem (Etp) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI

[S. agalactiae
(GroupB)]
> R -
4 I -
2 S -
1 S S
0.5 S S
NOTE: 1. Do not report drug, therapy or MIC for Listeria monocytogenes, and Coagulase-Negative Staphylococci
(CNS), except S. lugdunensis, with an Oxacillin MIC of ≥0.5.
. 2. Do not report drug, therapy or MIC for S. lugdunensis when the Oxacillin MIC is >2 and/or CfxS is >4.
3. For S. aureus, if Oxacillin MIC is >2, and/or CfxS is >4, report Ertapenem as resistant regardless of MIC.
4. The CLSI interpretative guideline for Ertapenem with Beta-hemolytic Streptococci is 1 for susceptible.
Because intermediate and resistant interpretations have not been defined for S. agalactiae (Group B), no
interpretations will be provided if the result is >1.
5. Do not report therapy for S. bovis group (Group D).
Erythromycin (E) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI

[S. agalactiae (Group B)]
> R R R
4 I I R
2 I I R
1 I I R
0.5 S S I
0.25 S S S
2. Do not report drug, therapy or MIC for L. monocytogenes.
Erythromycin (E) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI

[S. agalactiae (Group B)]
> R R N/R
4 I I N/R
2 I I N/R
1 I I N/R
0.5 S S N/R
2. Use for panels PC20, PC21, PC25, PC26, PBC20, PBC23, PM20A, PM23, PC29, PC33 & PC34.
3. Do not report drug, therapy or MIC for L. monocytogenes.
4. Based on CLSI breakpoints of 0.25=S, 0.5=I, 1=R for streptococci, these dilutions no longer differentiate
between S and I.
5. Do not report therapy for S. bovis (Group D).
Gatifloxacin (Gat) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI
 R
4 I
2 S
1 S
0.5 S
NOTE: 1. Therapy based on FDA interpretive breakpoints which differ from CLSI M100-S22.
9020-7705, Rev. A Page 41

Gentamicin (Gm) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI
> R
8 I
4 S
2 S
1 S
NOTE: 1. Do not report drug, therapy or MIC for S. agalactiae (Group B).
Imipenem (Imp) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI
> R
8 I
4 S
2 S
1 S
NOTE: 1. For S. aureus and S. lugdunensis, if Oxacillin MIC is >2 or Cefoxitin screen (CfxS) is >4, report Imipenem
2. For CNS other than S. lugdunensis, if Oxacillin MIC is 0.5, report Imipenem as resistant regardless of MIC.
4. Do not report drug, therapy or MIC for E. faecium and E. faecium group.
Levofloxacin (Lvx) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI
> R R R
4 I I I
2 S S S
1 S S S
0.5 S S S
NOTE: 1. Do not report drug, therapy or MIC for all streptococci except for S. agalactiae (Group B) and S. bovis group
(Group D).
2. Therapy for Staphylococci based on CLSI (NCCLS) M100-S14 breakpoints.
Linezolid (Lzd) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI
 - R -
4 S I -
2 S S S
1 S S S
0.5 S S S
NOTE: 1. Therapy for Staphylococci based on CLSI M100-S19 breakpoints.
(Group D).
3. The CLSI interpretative guideline for Linezolid with staphylococci is 4 for susceptible. Because
intermediate and resistant have not been defined for staphylococci, no interpretations will be provided if the
result is >4.
4. The CLSI interpretative guideline for Linezolid with streptococci is 2 for susceptible. Because
intermediate and resistant have not been defined for streptococci, no interpretations will be provided if the
result is >2.
9020-7705, Rev. A Page 42

Meropenem (Mer) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI
> R N/R
8 I N/R
4 S N/R
2 S N/R
1 S N/R
2. For S. aureus and S. lugdunensis, if Oxacillin MIC is >2 or Cefoxitin screen (CfxS) is >4, report Meropenem
3. For CNS other than S. lugdunensis, if Oxacillin MIC is 0.5, report Meropenem as resistant regardless of
MIC.
4. The CLSI interpretative guideline for Meropenem with streptococci is 0.5 for susceptible. Because
intermediate and resistant interpretations have not been defined for streptococci, no interpretations will be
provided.
Moxifloxacin (Mxf) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI
 R
4 I
2 S
1 S
0.5 S
2. Therapy based on FDA interpretive breakpoints which differ from CLSI M100-S22.
Nitrofurantoin (Fd) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI
> R R
64 I I
32 S S
Norfloxacin (Nxn) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI
> R R
8 I I
4 S S
Ofloxacin (Ofl) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI

[S. agalactiae
(Group B)]
> R R
4 I I
2 S S
NOTE:
1. Therapy for Staphylococci based on CLSI (NCCLS) S-14 breakpoints.
9020-7705, Rev. A Page 43

Oxacillin (Ox) MIC S. AUREUS & OTHER ENTEROCOCCI STREPTOCOCCI

S. LUGDUNENSIS STAPHYLOCOCCI
> R R
2 S R
1 S R
0.5 S R
0.25 S S
NOTE:
1. For S. aureus and S. lugdunensis , report Oxacillin as resistant if the CfxS is >4. See Cefoxitin Screen
information in the front of the guide.
Penicillin MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI STREPTOCOCCI LISTERIA

[S. agalactiae [S. bovis group
(P) (Group B) (Group D)]
> R - R -
8 S - R -
4 S - R -
2 S - I S
1 S - I S
0.5 S - I S
0.25 S - I S
0.12 S S S S
0.06 S S S S
0.03 S S S S
NOTE: 1. Use this table for non-staphylococci.
(Group D).
3 For enterococci, if beta-lactamase positive, report Penicillin as Blac regardless of MIC.
4. The CLSI interpretative guideline for Penicillin with beta-hemolytic streptococci is 0.12 for susceptible.
Because intermediate and resistant interpretations have not been defined for S. agalactiae (Group B), no
5. The CLSI interpretative guideline for Penicillin with Listeria is 2 for susceptible. Because intermediate and
resistant interpretations have not been defined for Listeria, no interpretations will be provided if the result is >2.
Penicillin (P) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI LISTERIA
> R
8 R
4 R
2 R
1 R
0.5 R
0.25 R
0.12 S
0.06 S
0.03 S
NOTE: 1. Use this table for Staphylococci.
2. For S. aureus and S. lugdunensis, if Oxacillin MIC is >2 or Cefoxitin screen (CfxS) is >4, report Penicillin as
3. For CNS other than S. lugdunensis, if Oxacillin MIC is 0.5, report Penicillin as resistant regardless of MIC.
4. If beta-lactamase positive, report Penicillin as Blac regardless of MIC.
9020-7705, Rev. A Page 44

Piperacillin-Tazobactam MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI

(P/T)
> R
8 S
4 S
2 S
1 S
NOTE: 1. Do not report drug, therapy or MIC for Coagulase-Negative Staphylococci (CNS), except S. lugdunensis,
with an Oxacillin MIC of ≥ 0.5.
2. Do not report drug, therapy or MIC for S. aureus and S. lugdunensis when the Oxacillin MIC is >2 and/or
CfxS is >4.
3. For non-beta-lactamase producing enterococci, refer to Penicillin result.
Rifampin (Rif) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI
> R R
2 I I
1 S S
Synercid (Syn) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI
 R
2 I
1 S
0.5 S
0.25 S
NOTE: 1. Do not report drug, therapy or MIC for Enterococci.
Tetracycline (Te) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI
> R R R
8 I I R
4 S S I
2 S S S
1 S S S
1. For Dried Overnight panels, do not report drug, therapy or MIC for all streptococci except for
Tetracycline (Te) MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI
> R R N/R
8 I I N/R
4 S S N/R
NOTE:
1. Based on CLSI breakpoints for streptococci, these dilutions no longer differentiate between S, I and R.
9020-7705, Rev. A Page 45

Trimethoprim- MIC STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI

> R
2/38 S
1/19 S
0.5/9.5 S
NOTE: 1. Do not report therapy for enterococci because dangerously misleading results can occur.
2. If TFG negative, report therapy as TFG for all gram-positive organisms.
Vancomycin (Va) MIC S. AUREUS STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI
> R R R N/R
16 R I I N/R
8 I I I N/R
4 I S S N/R
2 S S S N/R
NOTE: 1. Based on CLSI breakpoints for streptococci, these dilutions no longer differentiate between S and non-
susceptible (NS).
Vancomycin (Va) MIC S. AUREUS STAPHYLOCOCCI ENTEROCOCCI STREPTOCOCCI
> R R R -
16 R I I -
8 I I I -
4 I S S -
2 S S S -
1 S S S S
0.5 S S S S
0.25 S S S S
NOTE: 1. Use for panels PC29, PC33, PC34, PMIC 26 and PMIC29.
2. For Dried Overnight panels, do not report drug, therapy or MIC for all streptococci except for
3. The CLSI interpretive guideline for Vancomycin with streptococci is 1 for susceptible. Because
intermediate and resistant interpretations have not been defined for streptococci, no interpretations will be
9020-7705, Rev. A Page 46

SYNERGIES PLUS GRAM-POSITIVE PANELS
Ampicillin (Am) MIC STAPHYLOCOCCI ENTEROCOCCI
> R
32 R
16 R
8 S
4 S
2 S
1 S
NOTE: 1. Use this table for enterococci.
2. For enterococci, if beta-lactamase positive, report Ampicillin as Blac regardless of MIC.
3. The predicted interpretation for staphylococci will be based on the penicillin and/or Oxacillin MICs.
Chloramphenicol (C) MIC STAPHYLOCOCCI ENTEROCOCCI
> R R
16 I I
8 S S
4 S S
Clindamycin (Cd) MIC STAPHYLOCOCCI ENTEROCOCCI
> R
2 I
1 I
0.5 S
0.25 S
0.12 S
2. Do not report drug, MIC or therapy for enterococci.
3. For staphylococci, if erythromycin MIC is N/R and clindamycin MIC is ≤2, do not report therapy.
Erythromycin (E) MIC STAPHYLOCOCCI ENTEROCOCCI
> R
4 I
2 I
1 I
0.5 S
2. Do not report drug, therapy or MIC for enterococci.
9020-7705, Rev. A Page 47

Gentamicin (Gm) MIC STAPHYLOCOCCI ENTEROCOCCI
> R
8 I
4 S
2 S
1 S
0.5 S
0.25 S
NOTE: 1. Do not report drug, therapy or MIC for enterococci.
Gentamicin Synergy MIC STAPHYLOCOCCI ENTEROCOCCI

Screen (GmS)
> R
500 S
NOTE: 1. For rapid results (<16 hours), do not report drug, MIC, or therapy for E. faecium with an MIC
< 500µg/ml. Overnight (16-20 hours) results can be used.
2. For overnight (16-20 hours) results do not report drug, MIC, or therapy for E. faecium and
Enterococcus species, except E. faecalis, with Gentamicin Synergy Screen MICs of > 500µg/ml.
Susceptible results can be reported at 16-20 hours.
Levofloxacin (Lvx) MIC STAPHYLOCOCCI ENTEROCOCCI
> R R
4 I I
2 S S
1 S S
0.5 S S
0.25 S S
NOTE: 1. Therapy for Staphylococci based on CLSI (NCCLS) M100-S14 breakpoints.
Linezolid (Lzd) MIC STAPHYLOCOCCI ENTEROCOCCI
 - R
4 S I
2 S S
1 S S
0.5 S S
NOTE: 1. Therapy for Staphylococci based on CLSI M100-S19 breakpoints.
2. The CLSI interpretative guideline for Linezolid with staphylococci is 4 for susceptible. Because intermediate
and resistant have not been defined for staphylococci, no interpretations will be provided if the result is >4.
Nitrofurantoin (Fd) MIC STAPHYLOCOCCI ENTEROCOCCI
> R R
64 I I
32 S S
16 S S
9020-7705, Rev. A Page 48

Oxacillin (Ox) MIC S. AUREUS & OTHER ENTEROCOCCI

S. LUGDUNENSIS STAPHYLOCOCCI
> R R
2 S R
1 S R
0.5 S R
0.25 S S
0.12 S S
2. For rapid results (<16 hours), do not report drug, MIC or therapy for S. aureus with Oxacillin MICs <4 µg/ml
and coagulase-negative staphylococci with Oxacillin MICs <0.5 µg/ml. Overnight results (16 – 20) hours
can be used.
Penicillin (P(E)) MIC STAPHYLOCOCCI ENTEROCOCCI
> R
64 R
32 R
16 R
8 S
4 S
2 S
NOTE: 1. Use this table for enterococci.
2. For enterococci, if beta-lactamase positive, report Penicillin as Blac regardless of MIC.
Penicillin (P(S)) MIC STAPHYLOCOCCI ENTEROCOCCI
> R
0.12 S
0.06 S
0.03 S
NOTE: 1. Use this table for Staphylococci.
2. Do not report drug, therapy and MIC for S. saprophyticus.
3. For S. aureus and S. lugdunensis, if Oxacillin MIC is >2, report Penicillin as resistant regardless of MIC.
4. For CNS other than S. lugdunensis, if Oxacillin MIC is 0.5, report Penicillin as resistant regardless of MIC.
5. If beta-lactamase positive, report Penicillin as Blac regardless of MIC.
Rifampin (Rif) MIC STAPHYLOCOCCI ENTEROCOCCI
> R
2 I
1 S
0.5 S
0.25 S
NOTE: 1. Do not report drug, therapy and MIC for enterococci.
9020-7705, Rev. A Page 49

Synercid (Syn) MIC STAPHYLOCOCCI ENTEROCOCCI
 R
2 I
1 S
0.5 S
0.25 S
0.12 S
NOTE: 1. Do not report drug, therapy or MIC for all enterococci.
Streptomycin Synergy MIC STAPHYLOCOCCI ENTEROCOCCI

Screen (StS)
> R
1000 S
< 1000µg/ml. Overnight results (16-20 hours) can be used.
Tetracycline (Te) MIC STAPHYLOCOCCI ENTEROCOCCI
> R R
8 I I
4 S S
2 S S
1 S S
0.5 S S
<8 µg/ml. Overnight results (16-20 hours) can be used.
Trimethoprim- MIC STAPHYLOCOCCI ENTEROCOCCI

> R
2/38 S
1/19 S
0.5/9.5 S
Vancomycin (Va) MIC S. AUREUS STAPHYLOCOCCI ENTEROCOCCI
> R R R
16 R I I
8 I I I
4 I S S
2 S S S
1 S S S
0.5 S S S
0.25 S S S
NOTE: 1. For rapid results (<16 hrs), do not report drug, therapy or MIC for S. aureus with MICs of 8 or 16 µg/ml.
Final results will be reported after overnight incubation (16-20 hrs)
9020-7705, Rev. A Page 50

Amoxicillin- MIC S. PNEUMONIAE BETA-HEMOLYTIC VIRIDANS

STREPTOCOCCI STREPTOCOCCI
K Clavulanate (Aug)
> R
4/2 I
2/1 S
1/0.5 S
0.5/0.25 S
Ampicillin (Am) MIC S. PNEUMONIAE BETA-HEMOLYTIC VIRIDANS

> - R
4 - I
2 - I
1 - I
0.5 - I
0.25 S S
0.12 S S
0.06 S S
NOTE: 1. The CLSI interpretive guideline for Ampicillin with beta-hemolytic streptococci is 0.25 for
susceptible. Because intermediate and resistant interpretations have not been defined no
Azithromycin (Azi) MIC S. PNEUMONIAE STREPTOCOCCI
> R R
2 R R
1 I I
0.5 S S
0.25 S S
2. Susceptibility and resistance to Clarithromycin can be predicted by testing Erythromycin.
Cefaclor (Cfr) MIC S. PNEUMONIAE BETA-HEMOLYTIC VIRIDANS

> R
4 R
2 I
1 S
0.5 S
9020-7705, Rev. A Page 51

Cefepime (Cpe) MIC S. PNEUMONIAE BETA-HEMOLYTIC VIRIDANS

> R - R
2 I - I
1 S - S
0.5 S S S
0.25 S S S
NOTE: 1. The CLSI interpretive guideline for Cefepime with beta-hemolytic streptococci is 0.5 for susceptible.
Because intermediate and resistant interpretations have not been defined no interpretations will be provided
if the result is >0.5.
2. Apply viridans streptococci breakpoints to S. bovis group (Group D).
Cefotaxime (Cft) MIC S. PNEUMONIAE BETA-HEMOLYTIC VIRIDANS

> R - R
2 R - I
1 I - S
0.5 S S S
0.25 S S S
NOTE: 1. The CLSI interpretive guideline for Cefotaxime with beta-hemolytic streptococci is 0.5 for susceptible.
3. For S. pneumoniae, Cefotaxime breakpoints are based on isolates from CSF (meningitis). For all other S.
pneumoniae isolates report both meningitis breakpoints (see table) and non-meningitis breakpoints: <1=S,
2=I and 4=R.
4. Results of testing Cefotaxime should be routinely reported for CSF isolates of S. pneumoniae.
Ceftriaxone (Cax) MIC S. PNEUMONIAE BETA-HEMOLYTIC VIRIDANS

> R - R
2 R - I
1 I - S
0.5 S S S
0.25 S S S
NOTE: 1. The CLSI interpretive guideline for Ceftriaxone with beta-hemolytic streptococci is 0.5 for susceptible.
3. For S. pneumoniae, Ceftriaxone breakpoints are based on isolates from CSF (meningitis). For all other S.
pneumoniae isolates report both meningitis breakpoints (see table) and non-meningitis breakpoints: <1=S,
2=I and 4=R.
4. Results of testing Ceftriaxone should be routinely reported for CSF isolates of S. pneumoniae.
9020-7705, Rev. A Page 52

Cefuroxime sodium (Crm) MIC S. PNEUMONIAE BETA-HEMOLYTIC VIRIDANS

(parenteral)
> R
2 R
1 I
0.5 S
0.25 S
NOTE: 1. The CLSI breakpoints for Cefuroxime axetil (oral) are 1=S, 2=I, 4=R.
Chloramphenicol (C) MIC S. PNEUMONIAE STREPTOCOCCI
> R R
16 R R
8 R I
4 S S
2 S S
1 S S
Clarithromycin (Cla) MIC S. PNEUMONIAE STREPTOCOCCI
> R R
1 R R
0.5 I I
0.25 S S
Note: 1. Only systemic therapy will be reported.
2. Susceptibility and resistance to Clarithromycin can be predicted by testing Erythromycin.
Clindamycin (Cd) MIC S. PNEUMONIAE STREPTOCOCCI
> R R
0.5 I I
0.25 S S
0.12 S S
0.06 S S
9020-7705, Rev. A Page 53

Daptomycin (Dap) MIC S. PNEUMONIAE BETA-HEMOLYTIC VIRIDANS

> -
2 -
1 S
0.5 S
0.25 S
Note: 1. The CLSI interpretative guideline with Beta-hemolytic streptococci is 1 for susceptible.
Because intermediate and resistant interpretations have not been defined no interpretations will be
Erythromycin (E) MIC S. PNEUMONIAE STREPTOCOCCI
> R R
0.5 I I
0.25 S S
0.12 S S
0.06 S S
2. Susceptibility and resistance to Azithromycin and Clarithromycin can be predicted by testing
Erythromycin.
Gatifloxacin (Gat) MIC S. PNEUMONIAE BETA-HEMOLYTIC VIRIDANS

>
2
1
0.5
0.25
0.12
NOTE: 1. Do not report drug, MIC or therapy for Gatifloxacin
Linezolid (Lzd) MIC S PNEUMONIAE STREPTOCOCCI
> - -
4 - -
2 S S
1 S S
0.5 S S
Note: 1. The CLSI interpretative guideline for all Streptococci is 2 for susceptible. Because intermediate and resistant
interpretations have not been defined no interpretations will be provided if the result is >2.
Levofloxacin (Lvx) MIC S. PNEUMONIAE STREPTOCOCCI
> R R
4 I I
2 S S
1 S S
0.5 S S
0.25 S S
9020-7705, Rev. A Page 54

Meropenem (Mer) MIC S. PNEUMONIAE BETA-HEMOLYTIC VIRIDANS

> R -
0.5 I S
0.25 S S
0.12 S S
0.06 S S
2. The CLSI interpretive guideline for Meropenem with viridans streptococci is 0.5 for susceptible. Because
intermediate and resistant interpretations have not been defined no interpretations will be provided if the
result is >0.5.
3. Results of testing Meropenem should be routinely reported for CSF isolates of S. pneumoniae.
Moxifloxacin (Mxf) MIC S PNEUMONIAE BETA-HEMOLYTIC VIRIDANS STREPTOCOCCI

STREPTOCOCCI
> R R R
4 R R R
2 I I I
1 S S S
0.5 S S S
0.25 S S S
NOTE: 1. Therapy based on FDA approved breakpoints which differ from CLSI M100-S22.
Penicillin (P) MIC S. PNEUMONIAE BETA-HEMOLYTIC VIRIDANS

> R - R
4 R - R
2 R - I
1 R - I
0.5 R - I
0.25 R - I
0.12 R S S
0.06 S S S
0.03 S S S
NOTE: 1. The CLSI interpretive guideline for Penicillin with beta-hemolytic streptococci is 0.12 for susceptible.
3. Results of testing Penicillin should be routinely reported for CSF isolates of S. pneumoniae.
4. For S. pneumoniae, Penicillin breakpoints are based on isolates from CSF (meningitis). For all other S.
pneumoniae isolates report both meningitis breakpoints and non-meningitis breakpoints: ≤2 = S, 4 = I,
≥ 8 = R. Breakpoints for oral administration are ≤ 0.06 = S, I = 0.12 -1, ≥2 = R.
9020-7705, Rev. A Page 55

Tetracycline (Te) MIC S. PNEUMONIAE STREPTOCOCCI
> R R
4 I I
2 S S
1 S S
0.5 S S
Trimethoprim- MIC S. PNEUMONIAE STREPTOCOCCI

> R
2/38 I
1/19 I
0.5/9.5 S
0.25/4.75 S
Vancomycin (Va) MIC S. PNEUMONIAE STREPTOCOCCI
> - -
4 - -
2 - -
1 S S
0.5 S S
0.25 S S
0.12 S S
NOTE: 1. The CLSI interpretive guideline for Vancomycin with streptococci is 1 for susceptible.
Because intermediate and resistant interpretations have not been defined for streptococci, no
interpretations will be provided if the result is >1.
2. Results of testing Vancomycin should be routinely reported for CSF isolates of S. pneumo
9020-7705, Rev. A Page 56

SPECIES CLASSIFICATIONS FOR ORGANISM GROUPS
ACINETOBACTER GROUP ENTEROBACTER GROUP

Acinetobacter anitratus/haemolyticus Enterobacter aerogenes
Acinetobacter baumannii Enterobacter amnigenus 1
Acinetobacter baumannii/haemolyticus Enterobacter amnigenus 2
Acinetobacter haemolyticus Enterobacter asburiae
Acinetobacter lwoffii Enterobacter cancerogenous
Acinetobacter species Enterobacter cloacae
Enterobacter gergoviae
AEROMONAS SPP-GROUP Enterobacter hormaechei
Aeromonas caviae Enterobacter intermedius
Aeromonas hydrophila group Enterobacter sakazakii
Aeromonas hydrophila Enterobacter species
Aeromonas jandaei Enterobacter taylorae
Aeromonas schubertii Pantoea agglomerans
Aeromonas sobria
Aeromonas trota ESBL GROUP-SCREENING
Aeromonas veronii Escherichia coli
Aeromonas species Escherichia coli LYS-/ORN-
Escherichia coli O157:H7
CITROBACTER GROUP Klebsiella oxytoca
Citrobacter amalonaticus Klebsiella pneumoniae/oxytoca
Citrobacter amalonaticus/diversus Klebsiella pneumoniae
Citrobacter amalonaticus/koseri Proteus mirabilis
Citrobacter braakii
Citrobacter braakii/freundii/sedlakii ESBL GROUP- CONFIRMATION
Citrobacter diversus Escherichia coli
Citrobacter farmeri Escherichia coli LYS-/ORN-
Citrobacter freundii complex Klebsiella oxytoca
Citrobacter koseri Klebsiella pneumoniae/oxytoca
Citrobacter sedlakii Klebsiella pneumoniae
Citrobacter species Proteus mirabilis
Citrobacter werkmanii
Citrobacter werkmanii/youngae KLEBSIELLA GROUP
Citrobacter youngae Raoultella (K.) ornithinolytica
Klebsiella oxytoca
CITROBACTER FREUNDII GROUP Klebsiella ozaenae
Citrobacter braakii Klebsiella planticola
Citrobacter freundii complex Klebsiella pneumoniae
Citrobacter braakii/freundii/sedlakii Klebsiella pneumoniae/oxytoca
Citrobacter werkmanii/youngae Klebsiella rhinoscleromatis
Citrobacter sedlakii Klebsiella species
Citrobacter werkmanii Klebsiella terrigena
Citrobacter youngae
Citrobacter species PROTEUS/PROVIDENCIA GROUP
Proteus penneri
CITROBACTER AMALONATICUS/KOSERI GROUP Proteus species
Citrobacter amalonaticus/koseri Proteus vulgaris
Citrobacter amalonaticus/diversus Proteus vulgaris/penneri
Citrobacter amalonaticus Providencia alcalifaciens 1-2
Citrobacter farmeri Providencia alcalifaciens/rustigianii
Citrobacter species Providencia rettgeri
Providencia rustigianii
Providencia species
Providencia stuartii
9020-7705, Rev. A Page 57

PROVIDENCIA GROUP VIBRIO SPP other than V. cholerae

Providencia alcalifaciens 1-2 Vibrio alginolyticus
Providencia alcalifaciens/rustigianii Vibrio hollisae
Providencia rettgeri Vibrio damsela
Providencia rustigianii Vibrio fluvialis
Providencia species Vibrio fluvialis/furnissii
Providencia stuartii (urea +/-) Vibrio furnissii
Vibrio metschnikovii
PROTEUS GROUP Vibrio mimicus
Proteus mirabilis Vibrio parahaemolyticus
Proteus vulgaris Vibrio species
Proteus penneri Vibrio vulnificus
Proteus vulgaris/penneri
Proteus species MISCELLANEOUS FASTIDIOUS GROUP-NEG
Actinobacillus actinomycetemcomitans
SALMONELLA/SHIGELLA GROUP Bordetella parapertussis
Salmonella choleraesuis Bordetella pertussis
Salmonella paratyphi A CDC Group EO-2
Salmonella species CDC Group EF-4A
Salmonella typhi CDC Group EF-4B
Salmonella/Arizona CDC group EF-4B/Neisseria weaveri/N. elongata
Shigella boydii CDC group HB-5
Shigella boydii/dysenteriae/flexneri Chromobacterium violaceum
Shigella dysenteriae Eikenella corrodens
Shigella flexneri Kingella species
Shigella sonnei Mannheimia (P.) haemolytica
Shigella species Moraxella atlantae
Moraxella lacunata
SERRATIA GROUP Moraxella non-liquefaciens
Serratia ficaria Moraxella osloensis
Serratia fonticola Moraxella species/Psychrobacter species
Serratia liquefaciens Myroides species
Serratia marcescens Neisseria elongata subspecies nitroreducens
Serratia odorifera 1 Neisseria weaveri (CDC grp M5)
Serratia odorifera 2 Oligella ureolytica
Serratia plymuthica Oligella urethralis
Serratia rubidaea Pasteurella-Actinobacillus species
Serratia species Pasteurella-Actinobacillus species SF
Pasteurella aerogenes
SHIGELLA GROUP Pasteurella multocida
Shigella boydii P. pneumoniae/A. urea/M. haemolytica
Shigella boydii/dysenteriae/flexneri Pasteurella pneumotropica
Shigella dysenteriae Pasteurella species
Shigella flexneri Psychrobacter (M.) phenylpyruvicus
Shigella sonnei Roseomonas species
Shigella species
9020-7705, Rev. A Page 58

OTHER SPECIES Psychrobacter (M.) phenypyruvicus

Acinetobacter lwoffii Moraxella species/Psychrobacter species
Aeromonas caviae Ochrobactrum anthropi
Aeromonas hydrophila group Oligella species
Aeromonas hydrophila Oligella urethralis
Aeromonas jandaei Pasteurella aerogenes
Aeromonas schubertii Mannheimia (P.) haemolytica
Aeromonas sobria P. pneumoniae/A. urea/M. haemolytica
Aeromonas trota Pasteurella multocida
Aeromonas veronii Pasteurella pneumotropica
Aeromonas species Pasteurella species
Rhizobium (A.) radiobacter Actinobacillus (P.) ureae
Alcaligenes species Photorhabdus luminescens
Alcaligenes spp/Achrom xylosox/Ralstonia paucula Plesiomonas shigelloides
Achromobacter xylosoxidans subsp xylosoxidans Pseudomonas alcaligenes
Brevundimonas (P.) diminuta Pseudomonas alcaligenes/pseudoalcaligenes
Brevundimonas (P.) vesicularis Pseudomonas fluorescens
Brevundimonas species Pseudomonas fluorescens/putida
Burkholderia (P.) cepacia Pseudomonas (C.) luteola
Burkholderia gladioli Pseudomonas mendocina
Burkholderia pseudomallei Pseudomonas (F.) oryzihabitans
Burkholderia species Pseudomonas pseudoalcaligenes
Cedecea species Pseudomonas putida
Cedecea davisae Pseudomonas species
Cedecea lapagei Pseudomonas stutzeri
Cedecea neteri Pseudomonas stutzeri/mendocina
Cedecea spp 3 Ralstonia (B.) pickettii
Cedecea spp 5 Roseomonas species
Chryseobacterium (F.) meningosepticum Shewanella putrefaciens
Chryseobacterium species Sphingomonas (P.) paucimobilis
Delftia (C.) acidovorans Stenotrophomonas (X.) maltophilia
Delftia (C.) acidovorans/Comamonas testosteroni Tatumella ptyseos
Comamonas testosteroni Vibrio alginolyticus
Edwardsiella tarda Vibrio hollisae
Empedobacter (F.) brevis Vibrio cholerae
Enterobacter asburiae Vibrio damsela
Enterobacter hormaechei Vibrio fluvialis
Escherichia albertii Vibrio fluvialis/furnissii
Escherichia fergusonii Vibrio furnissii
Escherichia hermannii Vibrio metschnikovii
Escherichia species Vibrio mimicus
Escherichia vulneris Vibrio parahaemolyticus
Ewingella americana Vibrio species
Flavobacterium species Vibrio vulnificus
Hafnia alvei Yersinia enterocolitica group
Klebsiella rhinoscleromatis Yersinia frederiksenii
Kluyvera ascorbata Yersinia intermedia
Kluyvera cryocrescens Yersinia kristensenii
Kluyvera species Yersinia pestis
Moraxella atlantae Yersinia pseudotuberculosis
Moraxella lacunata Yersinia ruckeri
Moraxella non liquefaciens Yersinia species
Moraxella osloensis Yokenella regensburgei
9020-7705, Rev. A Page 59

VIRIDANS STREPTOCOCCI GROUP MISCELLANEOUS STREPTOCOCCI GROUP

Gamma-hemolytic streptococcus Beta-hemolytic Streptococcus non-group A, non-B
Group F Streptococcus Beta-hemolytic Streptococcus non-group A
Streptococcus acidominimus Group C Streptococcus
Streptococcus anginosus/constellatus Group D Streptococcus
Streptococcus anginosus/milleri Group G Streptococcus
Streptococcus constellatus/milleri Streptococcus agalactiae (Group B)
Streptococcus equi Streptococcus agalactiae, hemolytic
Streptococcus equinus Streptococcus agalactiae, non-hemolytic
Streptococcus iniae Streptococcus bovis group
Streptococcus intermedius/milleri Streptococcus equisimilis
Streptococcus anginosus group Streptococcus equi/equisimilis
Streptococcus milleri group Streptococcus equisimilis
Streptococcus mitis group Streptococcus species
Streptococcus mitis Streptococcus zooepidemicus
Streptococcus mitis/oralis Viridans streptococcus
Streptococcus mutans
Streptococcus parasanguis GROUP A STREPTOCOCCUS GROUP
Streptococcus salivarius Streptococcus pyogenes
Streptococcus sanguis Group A Streptococcus
Streptococcus sanguis II
Streptococcus uberis ENTEROCOCCUS GROUP
Streptococcus species Enterococcus avium
Viridans streptococcus Enterococcus casseliflavus
Viridans streptococcus group Enterococcus durans
Enterococcus durans/hirae
BETA-HEMOLYTIC STREPTOCOCCI GROUP Enterococcus faecalis
Beta-hemolytic Streptococcus non-Group A, non-B Enterococcus faecium
Beta-hemolytic Streptococcus non-Group A Enterococcus faecium group
Group A Streptococcus Enterococcus gallinarum
Group C Streptococcus Enterococcus hirae
Group G Streptococcus Enterococcus mundtii
Group C/G Streptococcus Enterococcus raffinosus
Streptococcus agalactiae (Group B) Enterococcus species
Streptococcus agalactiae, hemolytic
Streptococcus agalactiae, non-hemolytic
Streptococcus equi/equisimilis
Streptococcus equisimilis
Streptococcus pyogenes (Group A)
Streptococcus species
Streptococcus zooepidemicus
9020-7705, Rev. A Page 60

COAGULASE NEGATIVE STAPHYLOCOCCI MISCELLANEOUS FASTIDIOUS GROUP-POS

GROUP
Macrococcus caseolyticus Abiotrophia/Granulicatella species
Staphylococcus arlettae Aerococcus urinae
Staphylococcus auricularis Aerococcus viridans
Staphylococcus capitis Erysipelothrix species
Staphylococcus capitis-capit Gemella haemolysans
Staphylococcus capitis-ureo Gemella morbillorum
Staphylococcus caprae Gemella species
Staphylococcus carnosus Kytococcus sedentarius
Staphylococcus chromogenes Leuconostoc spp.
Staphylococcus cohnii Listeria innocua/seeligeri
Staphylococcus cohnii-cohnii Pediococcus species
Staphylococcus cohnii-urea Rhodococcus equi
Staphylococcus epidermidis Rothia dentocariosa
Staphylococcus equorum Rothia mucilaginosa
Staphylococcus gallinarum Rothia species
Staphylococcus haemolyticus
Staphylococcus hominis
Staphylococcus hominis-hominis
Staphylococcus hominis-novo
Staphylococcus hyicus
Staphylococcus hyicus/chromo
Staphylococcus intermedius
Staphylococcus kloosii
Staphylococcus lentus
Staphylococcus lugdunensis
Staphylococcus saprophyticus
Staphylococcus schleiferi coagulans
Staphylococcus schleiferi schleiferi
Staphylococcus sciuri
Staphylococcus simulans
Staphylococcus species
Staphylococcus warneri
Staphylococcus xylosus
Coagulase Negative Staphylococci
9020-7705, Rev. A Page 61

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Adult Therapy

9020-7705, Rev. A Page 1

 2015 Beckman Coulter, Inc. All Rights Reserved.

9020-7705, Rev. A Page 2

GENERAL NOTES FOR REPORTING RESULTS: 5

DRIED OVERNIGHT AND RAPID (FLUOROGENIC) GRAM-NEGATIVE PANELS 13

SYNERGIES PLUS GRAM-NEGATIVE PANELS 26

DRIED OVERNIGHT GRAM-POSITIVE PANELS 36

SYNERGIES PLUS GRAM-POSITIVE PANELS 47

FASTIDIOUS PANELS - STREPTOCOCCI 51

Species Classifications for Organism Groups 57

9020-7705, Rev. A Page 3

9020-7705, Rev. A Page 4

Synergies plus Gram Negative panels:

Synergies plus Gram Positive panels:

Referenced from the CLSI M100-S22:

9020-7705, Rev. A Page 5

Urine/Systemic Therapy Interpretation Rules:

Warning from the CLSI M100-S22:

agents administered by oral route only

Extreme Caution from the CLSI M45-A2:

9020-7705, Rev. A Page 6

Use of Inducible Beta-Lactamase Flag:

Possible inducible beta-lactamase producing organisms:

Aeromonas caviae Citrobacter braakii/freundii/sedlakii

Beta-lactam antimicrobial agents:

Amoxicillin-K Clavulanate Ceftriaxone

9020-7705, Rev. A Page 7

Tests Negative Positive

9020-7705, Rev. A Page 8

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

Miscellaneous Fastidious Organism Limitation:

Miscellaneous Organism Recommendation:

Synergy Screen Reporting

Gentamicin Synergy Streptomycin Synergy

9020-7705, Rev. A Page 9

Predicted Susceptibility Rules for Synergies plus Pos Panels

9020-7705, Rev. A Page 10

Extended-Spectrum Beta-Lactamase (ESBL) Interpretations:

9020-7705, Rev. A Page 11

Drug Panel Dilution MIC

Interpretations Reported as “R*” for the following Antimicrobial Agents:

9020-7705, Rev. A Page 12

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

Amoxicillin - MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA

Ampicillin (Am) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA V. CHOLERAE

Amp-Sulbactam (A/S) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA

9020-7705, Rev. A Page 13

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

Cefazolin (Cfz) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P AERUGINOSA

Cefazolin (Cfz) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P AERUGINOSA

Cefepime (Cpe) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA

9020-7705, Rev. A Page 14

Cefotaxime (Cft) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA

Cefotaxime (Cft) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA

Cefotaxime-K MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA

Cefotetan (Ctn) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA

9020-7705, Rev. A Page 15

Cefoxitin (Cfx) MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA

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

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

Ceftazidime-K MIC ENTEROBACTERIACEAE NON-ENTEROBACTERIACEAE P. AERUGINOSA

9020-7705, Rev. A Page 16