Minimum Inhibitory Concentration Mic Breakpoints - en

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1 December 2022
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Therapeutic Areas Department
Minimum inhibitory concentration (MIC) breakpoints

This document presents MIC information in a tabular format. It contains separate tabs for each active substance, in alphabetical order.
The following abbreviations are used:
"S" for susceptibility breakpoints;

"R" for resistance breakpoints;
"IE" for where there is insufficient evidence that a bacteria or group of bacteria is a good target for therapy with a given active substance;
"IP" for breakpoints under preparation.
The EMA is relocating MIC data from the product information (PI) of authorised products in order to ensure that the breakpoints for both centrally and nationally
authorised products are kept up to date. This data relocation followed the adoption of revision 3 of the Guideline on the evaluation of medicinal products indicated
for treatment of bacterial infections. For reference, see
https://www.ema.europa.eu/documents/scientific-guideline/guideline-evaluation-medicinal-products-indicated-treatment-bacterial-infections-revision-3_en.pdf
Recent taxonomic studies have narrowed the definition of the family Enterobacteriaceae. Some previous members of this family are now included in other families
within the Order Enterobacterales. Breakpoints in this table apply to all members of the Enterobacterales.
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terdam ● The Netherlands
a.europa.eu/how-to-find-us
hone +31 (0)88 781 6000
rally and nationally

al products indicated
evision-3_en.pdf
ded in other families
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Amikacin
Minimum Inhibitory Concentration (MIC) breakpoi
Organisms
Susceptible (S ≤)
Acinetobacter spp. (infections originating from the urinary tract) 8
Acinetobacter spp. (systemic infections) (8)1
Coagulase-negative staphylococci (16)1
Enterobacterales (infections originating from the urinary tract) 8
Enterobacterales (systemic infections) (8)1
Enterococcus spp. Note2
Haemophilus influenzae IE
Moraxella catarrhalis IE
Pseudomonas spp. (infections originating from the urinary tract) 16
Pseudomonas spp. (systemic infections) (16)1
S. aureus (16)1
Viridans group streptococci Note2
1. For information on how to use breakpoints in brackets, see https://www.eucast.org/eucastguidancedocuments/.

2. Gentamicin can be used to screen for high-level aminoglycoside resistance (HLAR).
_x000D_ Classified as internal/staff contractors by the European Medicines Agency

#
Concentration (MIC) breakpoints (mg/L)
Resistant (R >)
8
(8)1
(16)1
8
(8)1
Note2
IE
IE
16
(16)1
(16)1
Note2
astguidancedocuments/.

#
Amoxicillin
Organisms
Susceptible (S ≤)
Aerococcus sanguinicola and urinae Note1
Enterobacterales 8
Enterococcus spp. 42
Kingella kingae 0.1253
Neisseria gonorrhoeae Note4
Neisseria meningitidis (indications other than meningitis) 0.125
Neisseria meningitidis (meningitis) IE
Pasteurella multocida 1
Staphylococcus spp. Note5,6,7
Streptococcus groups A, B, C and G Note8
Viridans group streptococci 0.5
1. Infer susceptibility from ampicillin susceptibility.

2. Susceptibility to ampicillin, amoxicillin and piperacillin (with and without beta-lactamase inhibitor) can be inferred from a
Ampicillin resistance is uncommon in E. faecalis (confirm with MIC) but common in E. faecium.
3. Susceptibility can be inferred from benzylpenicillin susceptibility.
4. Always test for beta-lactamase (tests based on a chromogenic cephalosporin can be used). If beta-lactamase positive, re
resistant to ampicillin and amoxicillin. If beta-lactamase negative, determine the MIC of benzylpenicillin. Infer the susceptib
ampicillin and amoxicillin from the benzylpenicillin MIC (do not report benzylpenicillin susceptibility).
5. Most S. aureus are penicillinase producers and some are methicillin resistant. Either mechanism renders them resistant t
benzylpenicillin, phenoxymethylpenicillin, ampicillin, amoxicillin, piperacillin and ticarcillin. Isolates that test susceptible to
benzylpenicillin and cefoxitin can be reported susceptible to all penicillins. Isolates that test resistant to benzylpenicillin but
to cefoxitin are susceptible to β-lactam β-lactamase inhibitor combinations, the isoxazolylpenicillins (oxacillin, cloxacillin, di
and flucloxacillin) and nafcillin. For agents given orally, care to achieve sufficient exposure at the site of the infection should
exercised. Isolates that test resistant to cefoxitin are resistant to all penicillins.
6. Most coagulase-negative staphylococci are penicillinase producers and some are methicillin resistant. Either mechanism r
them resistant to benzylpenicillin, phenoxymethylpenicillin, ampicillin, amoxicillin, piperacillin and ticarcillin. No currently av
method can reliably detect penicillinase production in all species of staphylococci but methicillin resistance can be detected
cefoxitin as described.
7. Ampicillin susceptible S. saprophyticus are mecA-negative and susceptible to ampicillin, amoxicillin and piperacillin (with
a beta-lactamase inhibitor).
8. The susceptibility of streptococcus groups A, B, C and G to penicillins is inferred from the benzylpenicillin susceptibility (i
other than meningitis) with the exception of phenoxymethylpenicillin and isoxazolylpenicillins for streptococcus group B.

#
Resistant (R >)
Note1
8
82
0.1253
Note4
1
IE
1
Note5,6,7
Note8
2
e inhibitor) can be inferred from ampicillin.

ium.
ed). If beta-lactamase positive, report

enzylpenicillin. Infer the susceptibility to
eptibility).
chanism renders them resistant to

Isolates that test susceptible to
t resistant to benzylpenicillin but susceptible
penicillins (oxacillin, cloxacillin, dicloxacillin
at the site of the infection should be
illin resistant. Either mechanism renders

llin and ticarcillin. No currently available
icillin resistance can be detected with
amoxicillin and piperacillin (without or with
e benzylpenicillin susceptibility (indications

ins for streptococcus group B.

#
Amoxicillin iv
Organisms
Susceptible (S ≤)
Haemophilus influenzae (indications other than meningitis) 2
Haemophilus influenzae (meningitis) IE
Streptococcus pneumoniae (indications other than meningitis) Note1,2
Streptococcus pneumoniae (meningitis) 0.5
1. The oxacillin 1 µg disk diffusion screening test or a benzylpenicillin MIC test shall be used to exclude beta-lactam resistan
mechanisms. When the screen is negative (oxacillin inhibition zone ≥20 mm, or benzylpenicillin MIC ≤0.06 mg/L) all beta-l
agents for which clinical breakpoints are available, including those with “Note” can be reported susceptible without further t
except for cefaclor, which if reported, should be reported as “susceptible, increased exposure” (I). When the screen is posit
(oxacillin zone <20 mm, or benzylpenicillin MIC >0.06 mg/L), see flow chart below.
2. Susceptibility inferred from ampicillin (indications other than meningitis).

#
Resistant (R >)
2
IE
Note1,2
0.5
ed to exclude beta-lactam resistance

icillin MIC ≤0.06 mg/L) all beta-lactam
rted susceptible without further testing,
ure” (I). When the screen is positive

#
Amoxicillin oral
Organisms
Susceptible (S ≤)
Haemophilus influenzae 0.001
Helicobacter pylori 0.125
Streptococcus pneumoniae 0.5

#
Resistant (R >)
2
0.125
1

#
Amoxicillin-clavulanic acid
Organisms
Susceptible (S ≤)
Burkholderia pseudomallei 0.0011
Enterobacterales 81
Enterobacterales (uncomplicated UTI only) 321
Enterococcus spp. 41,2
Kingella kingae Note3
Moraxella catarrhalis 11
Neisseria gonorrhoeae IE
Viridans group streptococci Note8,9
1. For susceptibility testing purposes, the concentration of clavulanic acid is fixed at 2 mg/L.
3. The intrinsic activity of clavulanic acid in K. kingae is such that the organism is inhibited by 2 mg/L clavulanic acid. There
breakpoints for amoxicillin-clavulanic acid can be given.
8. Benzylpenicillin (MIC or disk diffusion) can be used to screen for beta-lactam resistance in viridans group streptococci. Is
categorised as screen negative can be reported susceptible to beta-lactam agents for which clinical breakpoints are listed (i
those with “Note”). Isolates categorised as screen positive should be tested for susceptibility to individual agents or reporte
9. For benzylpenicillin screen negative isolates (inhibition zone ≥18 mm or MIC ≤0.25 mg/L), susceptibility can be inferred
benzylpenicillin or ampicillin. For benzylpenicillin screen positive isolates (inhibition zone <18 mm or MIC >0.25 mg/L), sus
inferred from ampicillin.

#
Resistant (R >)
81
81
321
81,2
Note3
11
IE
11
Note4,5,6
Note7
Note8,9
L.
ium.
d by 2 mg/L clavulanic acid. Therefore no



in viridans group streptococci. Isolates

h clinical breakpoints are listed (including
ty to individual agents or reported resistant.
/L), susceptibility can be inferred from

18 mm or MIC >0.25 mg/L), susceptibility is

#
Amoxicillin-clavulanic acid iv
Organisms
Susceptible (S ≤)
Haemophilus influenzae 21
Streptococcus pneumoniae Note2,3

#
Resistant (R >)
21
Note2,3
L.


#
Amoxicillin-clavulanic acid oral
Organisms
Susceptible (S ≤)

#
Resistant (R >)
21
11
L.

#
Ampicillin
Organisms
Susceptible (S ≤)
Aerococcus sanguinicola and urinae 0.25
Enterobacterales 8
Enterococcus spp. 41
Haemophilus influenzae (meningitis) IE
Neisseria meningitidis (indications other than meningitis) 0.125
Neisseria meningitidis (meningitis) IE
S. saprophyticus Note4,5
Streptococcus pneumoniae (indications other than meningitis) 0.5
2. Susceptibility can be inferred from benzylpenicillin susceptibility.

#
Resistant (R >)
0.25
8
81
1
IE
0.062
Note3
1
IE
1
Note4,5
Note6
1
0.5
2

ium.

eptibility).



#
Ampicillin iv
Organisms
Susceptible (S ≤)
Listeria monocytogenes (all indications) 1

#
Resistant (R >)
1

#
Ampicillin-sulbactam
Organisms
Susceptible (S ≤)
Acinetobacter spp. IE
Enterobacterales 81
Enterococcus spp. 41,2
Haemophilus influenzae 11,3
Moraxella catarrhalis 11,4
Neisseria meningitidis IE
1. For susceptibility testing purposes, the concentration of sulbactam is fixed at 4 mg/L.

3. Susceptibility can be inferred from amoxicillin-clavulanic acid iv.
4. Susceptibility can be inferred from amoxicillin-clavulanic acid.
11. Benzylpenicillin (MIC or disk diffusion) can be used to screen for beta-lactam resistance in viridans group streptococci. I

#
Resistant (R >)
IE
81
81,2
11,3
11,4
IE
IE
Note5,6,7
Note8
Note9,10
Note11,12

ium.




e in viridans group streptococci. Isolates

g/L), susceptibility can be inferred from


#
Azithromycin
Organisms
Susceptible (S ≤)
Campylobacter jejuni and coli Note1
Haemophilus influenzae Note2
Moraxella catarrhalis 0.254
Staphylococcus spp. 26
Streptococcus groups A, B, C and G 0.254
Vibrio spp. 4
Viridans group streptococci IE
1. Erythromycin can be used to determine susceptibility to azithromycin and clarithromycin.
2. Clinical evidence for the efficacy of macrolides in H. influenzae respiratory infections is conflicting due to high spontaneou
rates. Should there be a need to test any macrolide against this species, the epidemiological cut-offs (ECOFFs) should be u
detect strains with acquired resistance. The ECOFFs for each agent are: azithromycin 4 mg/L, clarithromycin 32 mg/L, eryth
mg/L and telithromycin 8 mg/L. There are insufficient data available to establish an ECOFF for roxithromycin.
3. Susceptibility can be inferred from erythromycin susceptibility.

4. Erythromycin can be used to determine susceptibility to azithromycin, clarithromycin and roxithromycin.
5. Azithromycin is always used in conjunction with another effective agent. For testing purposes with the aim of detecting a
resistance mechanisms, the ECOFF is 1 mg/L.
6. Erythromycin can be used to screen for macrolide resistance in staphylococci. Isolates categorised as screen negative ca
reported susceptible to azithromycin, clarithromycin and roxithromycin. Isolates categorised as screen positive should be te
susceptibility to individual agents or reported resistant.

#
Resistant (R >)
Note1
Note2
0.253
0.54
Note5
26
0.54
0.54
4
IE
n.
conflicting due to high spontaneous cure

cal cut-offs (ECOFFs) should be used to
g/L, clarithromycin 32 mg/L, erythromycin 16
F for roxithromycin.
d roxithromycin.
poses with the aim of detecting acquired
ategorised as screen negative can be

ed as screen positive should be tested for

#
Aztreonam
Organisms
Susceptible (S ≤)
Aeromonas spp. 1
Enterobacterales 1
Pseudomonas spp. 0.001

#
Resistant (R >)
4
4
IE
IE
IE
16

#
Bedaquiline
Organisms
Susceptible (S ≤)
Mycobacterium tuberculosis 0.251
1. Breakpoints were determined on MICs performed on Middlebrook 7H11/7H10 medium. The comparability of tests perform
other media has not been established. There is ongoing work to review breakpoints using the EUCAST reference method (d
above).

#
Resistant (R >)
0.251
The comparability of tests performed by

the EUCAST reference method (described

#
Benzylpenicillin
Organisms
Susceptible (S ≤)
Clostridium perfringens 0.5
Corynebacterium spp. 0.125
Cutibacterium acnes 0.06
Fusobacterium necrophorum 0.06
Listeria monocytogenes (indications other than meningitis) 1
Listeria monocytogenes (meningitis) IE
Neisseria gonorrhoeae (surrogate agent) 0.061
Neisseria meningitidis (all indications) 0.25
other staphylococci Note2
Pasteurella multocida 0.5
Prevotella spp. 0.5
S. agalactiae (group B streptococci) (meningitis)2 0.125
S. aureus 0.1253
S. lugdunensis 0.125
Streptococcus groups A, B, C and G (indications other than meningit 0.25
Viridans group streptococci (screen only) 0.254

#
Resistant (R >)
0.125
0.5
0.125
0.06
0.06
IE
0.03
1
IE
1
0.25
Note2
0.5
0.5
0.125
0.1253
0.125
0.25
2
0.06
2
0.254

eptibility).




#
Cefaclor
Organisms
Susceptible (S ≤)
Staphylococcus spp. Note1
1. Susceptibility of staphylococci to cephalosporins is inferred from the cefoxitin susceptibility except for cefixime, ceftazidim
ceftazidime-avibactam, ceftibuten and ceftolozane-tazobactam, which do not have breakpoints and should not be used for
staphylococcal infections. For agents given orally, care to achieve sufficient exposure at the site of the infection should be e
cefotaxime and ceftriaxone are reported for methicillin-susceptible staphylococci, these should be reported “Susceptible, inc
exposure” (I). Some methicillin-resistant S. aureus are susceptible to ceftaroline and ceftobiprole, see Notes 5/D and 7/F.
2. The susceptibility of streptococcus groups A, B, C and G to cephalosporins is inferred from the benzylpenicillin susceptibi

#
Resistant (R >)
Note1
Note2
0.5
lity except for cefixime, ceftazidime,

oints and should not be used for
e site of the infection should be exercised. If
ould be reported “Susceptible, increased
biprole, see Notes 5/D and 7/F.
om the benzylpenicillin susceptibility.

#
Cefadroxil
Organisms
Susceptible (S ≤)

#
Resistant (R >)
16
Note1
Note2


#
Cefalexin
Organisms
Susceptible (S ≤)

#
Resistant (R >)
16
Note1
Note2


#
Cefazolin
Organisms
Susceptible (S ≤)
E. coli (infections originating from the urinary tract) 0.0011
Klebsiella spp. (except K. aerogenes) (infections originating from the 0.0011
1. Isolates susceptible to cefadroxil and/or cefalexin can be reported "susceptible, increased exposure” (I) to cefazolin.

#
Resistant (R >)
41
41
Note2
Note3
ed exposure” (I) to cefazolin.


#
Cefepime
Organisms
Susceptible (S ≤)
Aeromonas spp. 1
Enterobacterales 1
Streptococcus pneumoniae 1

#
Resistant (R >)
4
4
0.25
4
8
Note1
Note2
2
0.5


#
Cefiderocol
Organisms
Susceptible (S ≤)
Acinetobacter spp. IE1
Enterobacterales 21
P. aeruginosa 21
Stenotrophomonas maltophilia IE1
Streptococcus groups A, B, C and G IE
Streptococcus pneumoniae IE
1. Broth microdilution MIC determination must be performed in iron-depleted Mueller-Hinton broth and specific reading inst
must be followed. For testing conditions and reading instructions, see https://www.eucast.org/eucastguidancedocuments/.

#
Resistant (R >)
IE1
21
IE
IE
IE
IE
21
IE1
IE
IE
IE
on broth and specific reading instructions

.org/eucastguidancedocuments/.

#
Cefixime
Organisms
Susceptible (S ≤)
Neisseria gonorrhoeae 0.125

#
Resistant (R >)
1
0.125
1
0.125

#
Cefotaxime
Organisms
Susceptible (S ≤)
Enterobacterales (indications other than meningitis) 1
Enterobacterales (meningitis) 1
Haemophilus influenzae (indications other than meningitis) 0.125
Haemophilus influenzae (meningitis) 0.125
V. fluvialis IE
Vibrio spp. 0.25

#
Resistant (R >)
2
1
0.125
0.125
0.125
2
0.125
0.125
0.03
Note1
Note2
2
0.5
IE
0.25
0.5


#
Cefoxitin
Organisms
Susceptible (S ≤)
coagulase-negative staphylococci except S. epidermidis (screen only Note1,2
Enterobacterales (screen only) Note3
S. aureus (screen only) Note1,2
S. epidermidis (screen only) Note2
S. lugdunensis (screen only) Note1,2
S. pseudintermedius (screen only) Note4
S. schleiferi andS. coagulans (screen only) Note4
S.lugdunensis (screen only) Note2
1. S. aureus and S. lugdunensis with cefoxitin MIC values >4 mg/L and S. saprophyticus with cefoxitin MIC values >8 mg/L
methicillin resistant, mostly due to the presence of the mecA or mecC gene. Disk diffusion reliably predicts methicillin resist
2. For staphylococci other than S. aureus, S. lugdunensis and S. saprophyticus, the cefoxitin MIC is a poorer predictor of m
resistance than the disk diffusion test.
3. The cefoxitin ECOFF (8 mg/L) has a high sensitivity but poor specificity for identification of AmpC-producing Enterobacte
agent is also affected by permeability alterations and some carbapenemases. Classical non-AmpC producers are wild type,
plasmid AmpC producers or chromosomal AmpC hyperproducers are non-wild type.
4. In S. pseudintermedius,S. schleiferi and S. coagulans the cefoxitin disk is less predictive for the detection of methicillin r
than in other staphylococci. Use the oxacillin 1 µg disk with zone diameter breakpoints S≥20, R<20 mm.

#
Resistant (R >)
Note1,2
Note3
IE
IE
IE
Note1,2
Note2
Note1,2
Note4
Note4
Note2
IE
IE
IE
with cefoxitin MIC values >8 mg/L are

reliably predicts methicillin resistance.
tin MIC is a poorer predictor of methicillin
of AmpC-producing Enterobacterales as this

n-AmpC producers are wild type, whereas
e for the detection of methicillin resistance

20, R<20 mm.

#
Cefpodoxime
Organisms
Susceptible (S ≤)
Moraxella catarrhalis IP

#
Resistant (R >)
1
0.25
IP
Note1
Note2
0.5


#
Ceftaroline
Organisms
Susceptible (S ≤)
Enterobacterales 0.5
S. aureus (indications other than pneumonia) 11
S. aureus (pneumonia) 11
1. Methicillin-susceptible isolates can be reported susceptible to ceftaroline without further testing.

2. Resistant isolates are rare.

#
Resistant (R >)
0.5
0.03
IE
21,2
11
Note3
0.25
testing.

#
Ceftazidime
Organisms
Susceptible (S ≤)
Aeromonas spp. 1
Enterobacterales 1
Vibrio spp. 1

#
Resistant (R >)
4
8
4
8
1

#
Ceftazidime-avibactam
Organisms
Susceptible (S ≤)
Enterobacterales 81
P. aeruginosa 81
1. For susceptibility testing purposes, the concentration of avibactam is fixed at 4 mg/L.

#
Resistant (R >)
81
81

#
Ceftibuten
Organisms
Susceptible (S ≤)

#
Resistant (R >)
1
1
IE
Note1

#
Ceftobiprole
Organisms
Susceptible (S ≤)
Pseudomonas spp. IE
S. aureus 21
1. Methicillin-susceptible isolates can be reported susceptible to ceftobiprole without further testing.

#
Resistant (R >)
0.25
IE
IE
IE
21
IE
0.5
er testing.

#
Ceftolozane-tazobactam
Organisms
Susceptible (S ≤)
Enterobacterales 21
Haemophilus influenzae (pneumonia) 0.5
P. aeruginosa 41
S. anginosus group IE
1. For susceptibility testing purposes, the concentration of tazobactam is fixed at 4 mg/L.

#
Resistant (R >)
21
0.5
IE
41
IE
IE

#
Ceftriaxone
Organisms
Susceptible (S ≤)
Haemophilus influenzae (indications other than meningitis) 0.125
Neisseria meningitidis (all indications including prophylaxis) 0.125

#
Resistant (R >)
2
1
0.125
0.125
0.06
2
0.125
0.125
Note1
Note2
2
0.5
0.5


#
Cefuroxime iv
Organisms
Susceptible (S ≤)
E. coli 0.001
Kingella kingae 0.5
Klebsiella spp. (except K. aerogenes) 0.001
P. mirabilis 0.001
Raoultella spp. 0.001

#
Resistant (R >)
8
2
0.5
8
8
8
8
Note1
Note2
1
0.5


#
Cefuroxime oral
Organisms
Susceptible (S ≤)
E. coli (uncomplicated UTI only) 8
Klebsiella spp. (except K. aerogenes) (uncomplicated UTI only) 8
P. mirabilis (uncomplicated UTI only) 8
Raoultella spp. (uncomplicated UTI only) 8

#
Resistant (R >)
8
1
8
4
8
8
Note1
Note2
0.5


#
Chloramphenicol
Organisms
Susceptible (S ≤)
Enterobacterales 8
Moraxella catarrhalis Note1
Neisseria meningitidis (meningitis) 2
Streptococcus groups A, B, C and G 8
1. For topical use of chloramphenicol, see tables of topical agents.

#
Resistant (R >)
8
8
2
Note1
2
8
8
8

#
Ciprofloxacin
Organisms
Susceptible (S ≤)
Acinetobacter spp. 0.001
Aerococcus sanguinicola and urinae (uncomplicated UTI only) 2
Aeromonas spp. 0.25
Bacillus spp. except B. anthracis 0.001
Campylobacter jejuni and coli 0.001
Coagulase-negative staphylococci 0.001
Enterococcus spp. (uncomplicated UTI only) 4
Neisseria meningitidis (prophylaxis only) 0.03
S. aureus 0.001
Salmonella spp. 0.06
Vibrio spp. 0.25

#
Resistant (R >)
1
2
0.5
0.5
0.5
1
1
0.5
4
0.06
0.06
0.125
0.06
0.03
0.06
0.5
1
0.06
0.25

#
Clarithromycin
Organisms
Susceptible (S ≤)
Helicobacter pylori 0.25
3. Susceptibility can be inferred from erythromycin susceptibility.


#
Resistant (R >)
Note1
Note2
0.5
0.53
0.54
25
0.54
0.54
IE
n.

d roxithromycin.

#
Clindamycin
Organisms
Susceptible (S ≤)
Bacillus spp. except B. anthracis 1
Bacteroides spp. (4)1
Prevotella spp. 0.25
Staphylococcus spp. 0.25

#
Resistant (R >)
1
(4)1
0.25
0.5
0.25
0.25
0.25
0.25
0.5
0.5
0.5

#
Cloxacillin
Organisms
Susceptible (S ≤)
Staphylococcus spp. Note1,2

#
Resistant (R >)
Note1,2



#
Colistin
Organisms
Susceptible (S ≤)
Acinetobacter spp. (2)1
Enterobacterales (2)2
Pseudomonas spp. (4)2
1. For information on how to use breakpoints in brackets, see hhttps://www.eucast.org/eucastguidancedocuments/.


#
Resistant (R >)
(2)1
(2)2
(4)2
ucastguidancedocuments/.

#
Dalbavancin
Organisms
Susceptible (S ≤)
Enterococcus spp. IE
S. anginosus group 0.1251,2
Staphylococcus spp. 0.1251,3
Streptococcus groups A, B, C and G 0.1251,2
1. MICs must be determined in the presence of polysorbate-80 (0.002% in the medium for broth dilution methods; agar dil
methods have not been validated). Follow the manufacturer's instructions for commercial systems.
2. Isolates susceptible to vancomycin can be reported susceptible to dalbavancin and oritavancin.
3. S. aureus isolates susceptible to vancomycin can be reported susceptible to dalbavancin and oritavancin.

#
Resistant (R >)
IE
0.1251
0.1251
0.1251
IE
r broth dilution methods; agar dilution

systems.
vancin.
n and oritavancin.

#
Daptomycin
Organisms
Susceptible (S ≤)
1. Daptomycin MICs must be determined in the presence of Ca2+ (50 mg/L in the medium for broth dilution methods; agar
methods have not been validated). Follow the manufacturers' instructions for commercial systems.
2. Daptomycin MICs must be determined in the presence of Ca2+ (50 mg/L in the medium for broth dilution methods; agar

#
Resistant (R >)
IE
11
12
IE
m for broth dilution methods; agar dilution

systems.
m for broth dilution methods; agar dilution
systems.

#
Delafloxacin
Organisms
Susceptible (S ≤)
E. coli 0.125
Pseudomonas spp. IE
S. anginosus group 0.03
S. aureus (community-acquired pneumonia) 0.016
S. aureus (skin and skin structure infections) 0.25

#
Resistant (R >)
IE
0.125
IE
IE
IE
IE
IE
IE
0.03
0.016
0.25
0.03
IE

#
Delamanid
Organisms
Susceptible (S ≤)
Mycobacterium tuberculosis 0.06

#
Resistant (R >)
0.06

#
Dicloxacillin
Organisms
Susceptible (S ≤)

#
Resistant (R >)
Note1,2



#
Doripenem
Organisms
Susceptible (S ≤)
Enterobacterales 1
Neisseria meningitidis Note1
Viridans group streptococci 1
1. Breakpoints for serious N. meningitidis systemic infections (meningitis with or without septicemia) have been determined
meropenem only. The meningitis breakpoint can be used to categorise meropenem for other serious infections.
2. Susceptibility of staphylococci to carbapenems is inferred from the cefoxitin susceptibility.
3. The susceptibility of streptococcus groups A, B, C and G to carbapenems is inferred from the benzylpenicillin susceptibilit

#
Resistant (R >)
2
2
1
1
IE
Note1
2
Note2
Note3
1
1
epticemia) have been determined for

er serious infections.
ty.
m the benzylpenicillin susceptibility.

#
Doxycycline
Organisms
Susceptible (S ≤)
Vibrio spp. 0.5
1. Tetracycline can be used to determine susceptibility to doxycycline.

2. Tetracycline can be used to screen for resistance in tetracycline agents. Isolates categorised as susceptible to tetracyclin
reported susceptible to doxycycline and minocycline. Isolates categorised as resistant to tetracycline should be tested for su
to individual agents or reported resistant.
3. Tetracycline can be used to screen for resistance in tetracycline agents. Isolates categorised as susceptible can be report
susceptible to doxycycline. Isolates categorised as resistant should be tested for susceptibility to doxycycline or reported re
4. Tetracycline can be used to screen for resistance in tetracycline agents. Isolates categorised as screen negative can be re
susceptible to doxycycline and minocycline. Isolates categorised as screen positive should be tested for susceptibility to ind
agents or reported resistant.

#
Resistant (R >)
2
Note1
22
0.53
22
IE
1
24
24
24
0.5
rised as susceptible to tetracycline can be

etracycline should be tested for susceptibility
rised as susceptible can be reported

ility to doxycycline or reported resistant.
rised as screen negative can be reported

be tested for susceptibility to individual

#
Eravacycline
Organisms
Susceptible (S ≤)
E. coli 0.5
E. faecalis 0.125
E. faecium 0.125
S. aureus 0.25

#
Resistant (R >)
IE
0.5
0.125
0.125
IE
IE
IE
IE
0.25
IE
IE
0.125

#
Ertapenem
Organisms
Susceptible (S ≤)


#
Resistant (R >)
0.5
0.5
0.5
IE
IE
Note1
Note2
0.5
0.5
ty.

#
Erythromycin
Organisms
Susceptible (S ≤)
C. coli 81
C. jejuni 41
Corynebacterium spp. IP
Kingella kingae 0.5
Listeria monocytogenes (indications other than meningitis) 1
Staphylococcus spp. (screen only) 13

#
Resistant (R >)
0.5
81
41
IP
Note2
0.5
1
0.5
2
13
0.54
0.54
IE
n.


d roxithromycin.

#
Fidaxomicin
Organisms
Susceptible (S ≤)
Clostridioides difficile IE1
1. Fidaxomicin breakpoints and ECOFF have not been set because the available data show major variation in MIC distributio
studies.

#
Resistant (R >)
IE1
major variation in MIC distributions between

#
Flucloxacillin
Organisms
Susceptible (S ≤)

#
Resistant (R >)
Note1,2



#
Fosfomycin iv
Organisms
Susceptible (S ≤)
Enterobacterales 321
1. Agar dilution is the reference method for fosfomycin. MICs must be determined in the presence of glucose-6-phosphate (
the medium). Follow the manufacturers' instructions for commercial systems.

#
Resistant (R >)
321
IE
IE
321
IE
resence of glucose-6-phosphate (25 mg/L in

#
Fosfomycin oral
Organisms
Susceptible (S ≤)
1. Agar dilution is the reference method for fosfomycin. MICs must be determined in the presence of glucose-6-phosphate (
the medium). Follow the manufacturers' instructions for commercial systems.

#
Resistant (R >)
81
resence of glucose-6-phosphate (25 mg/L in

#
Fusidic acid
Organisms
Susceptible (S ≤)

#
Resistant (R >)
1
IE

#
Gentamicin
Organisms
Acinetobacter spp. (infections originating from the urinary tract)

Acinetobacter spp. (systemic infections)
Coagulase-negative staphylococci
Corynebacterium spp.
Enterobacterales (infections originating from the urinary tract)
Enterobacterales (systemic infections)
Enterococcus spp. (test for high-level aminoglycoside resistance)
Haemophilus influenzae
Moraxella catarrhalis
Pseudomonas spp. (infections originating from the urinary tract)
Pseudomonas spp. (systemic infections)
S. aureus
Viridans group streptococci (test for high-level aminoglycoside resistance)


#
Minimum Inhibitory Concentration (MIC) breakpoints (mg/L)
Susceptible (S ≤) Resistant (R >)
4 4
(4)1 (4)1
(2)1 (2)1
IE IE
2 2
(2)1 (2)1
Note2 Note2
IE IE
IE IE
IE IE
IE IE
(2)1 (2)1
Note2 Note2
st.org/eucastguidancedocuments/.
LAR).

#
Imipenem
Organisms
Susceptible (S ≤)
Acinetobacter spp. 2
Burkholderia pseudomallei 2
Enterobacterales except Morganellaceae 2
Enterococcus spp. 0.001
Morganellaceae 0.001
Neisseria meningitidis Note1

#
Resistant (R >)
4
0.5
2
4
4
2
2
4
IE
Note1
4
Note2
Note3
2
2

ty.

#
Imipenem-relebactam
Organisms
Susceptible (S ≤)
Enterobacterales except Morganellaceae 21
Neisseria meningitidis Note4,5
P. aeruginosa 21
Streptococcus pneumoniae Note2
1. For susceptibility testing purposes, the concentration of relebactam is fixed at 4 mg/L.

2. The addition of a beta-lactamase inhibitor does not add clinical benefit.
3. The beta-lactamases produced by the organism either do not modify the parent carbapenem or are not affected by the in
Therefore the addition of the beta-lactamase inhibitor does not add clinical benefit.
Therefore The addition of the beta-lactamase inhibitor does not add clinical benefit.

#
Resistant (R >)
21
21
Note2
Note3
Note3
IE
Note4,5
21
Note6
Note2
Note2
21
enem or are not affected by the inhibitor.

ty.

#
Lefamulin
Organisms
Susceptible (S ≤)
S. aureus 0.25
1. Lefamulin has insufficient activity against E. faecalis. For E. faecium, the ECOFF of 0.5 mg/L can be used to distinguish w
from non-wild type isolates.

#
Resistant (R >)
Note1
IE
IE
IE
0.25
IE
0.5
IE
mg/L can be used to distinguish wild type

#
Levofloxacin
Organisms
Susceptible (S ≤)
Aeromonas spp. 0.5
Enterococcus spp. (uncomplicated UTI only) 4
Helicobacter pylori 1
S. aureus 0.001
Vibrio spp. 0.25
1. Susceptibility can be inferred from ciprofloxacin susceptibility.

#
Resistant (R >)
1
21
1
1
1
1
4
0.06
1
0.125
0.125
IE
IE
0.06
2
1
2
2
0.25
IE

#
Linezolid
Organisms
Susceptible (S ≤)
Corynebacterium spp. 2
Enterococcus spp. 4

#
Resistant (R >)
2
2
4
4
2
2
IE

#
Mecillinam oral
Organisms
Susceptible (S ≤)
Citrobacter spp. Klebsiella spp. (pivmecillinam) (uncomplicated UTI only) 81
E. coli (pivmecillinam) (uncomplicated UTI only) 81
Enterobacter spp. (pivmecillinam) (uncomplicated UTI only) 81
P. mirabilis (pivmecillinam) (uncomplicated UTI only) 81
Raoultella spp. (pivmecillinam) (uncomplicated UTI only) 81
1. Agar dilution is the reference method for mecillinam MIC determination.

#
Resistant (R >)
81
81
81
81
81

#
Meropenem
Organisms
Susceptible (S ≤)
Achromobacter xylosoxidans 1
Acinetobacter spp. (indications other than meningitis) 2
Acinetobacter spp. (meningitis) 2
Bacteroides spp. 11
Burkholderia pseudomallei 2
Listeria monocytogenes (all indications) 0.25
Neisseria meningitidis (indications other than meningitis) Note2
P. aeruginosa (indications other than meningitis) 2
P. aeruginosa (meningitis) 2
Pseudomonas other than P. aeruginosa (indications other than menin 2
Streptococcus pneumoniae (indications other than meningitis) 2
Vibrio spp. 0.5
1. The meropenem zone diameter breakpoint will detect all cfiA gene mediated carbapenem resistance in Bacteroides fragil
isolates with an MIC of 1 mg/L may harbour the cfiA gene.

#
Resistant (R >)
4
8
2
0.25
0.25
11
2
0.125
0.125
8
2
0.03
2
0.25
0.03
0.25
2
IE
0.25
Note2
8
2
0.25
8
Note3
Note4
2
0.25
0.5
2
m resistance in Bacteroides fragilis. Some

ty.

#
Meropenem-vaborbactam
Organisms
Susceptible (S ≤)
Acinetobacter spp. Note1
Enterobacterales 82
Neisseria meningitidis Note4,5
P. aeruginosa 82
1. The beta-lactamases produced by the organisms either do not modify the parent carbapenem or are not affected by the
2. For susceptibility testing purposes, the concentration of vaborbactam is fixed at 8 mg/L.
Therefore The addition of the beta-lactamase inhibitor does not add clinical benefit.
7. The addition of a beta-lactamase inhibitor does not add clinical benefit.

#
Resistant (R >)
Note1
82
Note3
Note3
IE
Note4,5
82
Note6
Note7
Note7
Note7
penem or are not affected by the inhibitor.
.

ty.

#
Metronidazole
Organisms
Susceptible (S ≤)
Bacteroides spp. 4
Clostridioides difficile 21
Clostridium perfringens 4
Prevotella spp. 4
1. The breakpoints are based on epidemiological cut-off values (ECOFFs) and apply to oral treatment of C. difficile infection
no conclusive clinical data regarding the relation between MICs and outcomes.

#
Resistant (R >)
4
21
4
0.5
8
4
treatment of C. difficile infections. There are

#
Minocycline
Organisms
Susceptible (S ≤)
Neisseria meningitidis (prophylaxis only) 12
2. Tetracycline can be used to predict susceptibility to minocycline for prophylaxis against N. meningitidis infections.

#
Resistant (R >)
IE
11
11
IE
12
0.53
0.53
0.53

N. meningitidis infections.

#
Moxifloxacin
Organisms
Susceptible (S ≤)
S. aureus 0.25
1. There are no clinical breakpoints for Enterococcus spp. and moxifloxacin, but moxifloxacin has been used for oral step-do
treatment of endocarditis caused by Enterococcus spp. The norfloxacin disk diffusion test or the moxifloxacin MIC ECOFF (1
be used to screen for resistance mechanisms. When screen negative, the isolate should be reported “wild type” or “devoid o
fluoroquinolone resistance mechanisms”, but not as susceptible to moxifloxacin.
2. There are no clinical breakpoints for viridans group streptococci and moxifloxacin, but moxifloxacin has been used for ora
down treatment of endocarditis caused by viridans group streptococci. The moxifloxacin MIC ECOFF (0.5 mg/L) can be used
for resistance mechanisms. When screen negative, the isolate should be reported “wild type” or “devoid of fluoroquinolone
mechanisms”, but not as susceptible to moxifloxacin.

#
Resistant (R >)
0.25
0.5
0.25
Note1
0.125
0.25
IE
IE
0.25
0.5
0.5
Note2
cin has been used for oral step-down

or the moxifloxacin MIC ECOFF (1 mg/L) can
e reported “wild type” or “devoid of
moxifloxacin has been used for oral step-

IC ECOFF (0.5 mg/L) can be used to screen
pe” or “devoid of fluoroquinolone resistance

#
Netilmicin
Organisms
Susceptible (S ≤)
Enterobacterales IE
Pseudomonas spp. IE
Staphylococcus spp. IE

#
Resistant (R >)
IE
IE
Note1
IE
IE
IE
IE
Note1

#
Nitrofurantoin
Organisms
Susceptible (S ≤)
E. faecalis (uncomplicated UTI only) 64
S. agalactiae (group B streptococci) (uncomplicated UTI only) 64
S. saprophyticus (uncomplicated UTI only) 64
_x000D_ Classified as internal/staff contractors by the European Medicines Agency${If.End}${If.App.PowerPoint}

#
${If.End}
Resistant (R >)
16
64
64
64
64

#
${If.End}
Nitroxoline
Organisms
Susceptible (S ≤)
Enterococcus spp. (uncomplicated UTI only) IE
S. saprophyticus (uncomplicated UTI only) IE

#
${If.End}
Resistant (R >)
16
IE
IE

#
${If.End}
Norfloxacin
Organisms
Susceptible (S ≤)
Enterobacterales (uncomplicated UTI only) 0.5

#
${If.End}
Resistant (R >)
0.5

#
${If.End}
Ofloxacin
Organisms
Susceptible (S ≤)
1. Ofloxacin breakpoints for Staphylococcus spp. have been removed since in systemic infections with staphylococci the age
inferior to other fluoroquinolones. For topical use of ofloxacin, see tables of topical agents.

#
${If.End}
Resistant (R >)
0.5
0.06
0.25
0.25
IE
Note1
ections with staphylococci the agent is

#
${If.End}
Oritavancin
Organisms
Susceptible (S ≤)
S. anginosus group 0.251,2
S. aureus 0.1251,3
Streptococcus groups A, B, C and G 0.251,2
2. Isolates susceptible to vancomycin can be reported susceptible to dalbavancin and oritavancin.
3. S. aureus isolates susceptible to vancomycin can be reported susceptible to dalbavancin and oritavancin.

#
${If.End}
Resistant (R >)
IE
0.251
0.1251
0.251
IE

systems.
vancin.
n and oritavancin.

#
${If.End}
Oxacillin
Organisms
Susceptible (S ≤)
other staphylococci Note1,2
2. S. aureus, S. lugdunensis and S. saprophyticus with oxacillin MIC values >2 mg/L are mostly methicillin resistant due to
presence of the mecA or mecC gene. Occasionally oxacillin MIC values are high in S. aureus in absence of mec-gene media
resistance. These isolates have been called BORSA (borderline oxacillin resistant S. aureus). EUCAST does not recommend
screening for BORSA. For coagulase-negative staphylococci other than S. saprophyticus and S. lugdunensis, the oxacillin MI
methicillin resistant isolates is >0.25 mg/L.

#
${If.End}
Resistant (R >)
Note1,2

mostly methicillin resistant due to the

us in absence of mec-gene mediated
s). EUCAST does not recommend systematic
nd S. lugdunensis, the oxacillin MIC in

#
${If.End}
Phenoxymethylpenicillin
Organisms
Susceptible (S ≤)
S. aureus Note1

#
${If.End}
Resistant (R >)
IE
Note1
Note2
IE



#
${If.End}
Piperacillin
Organisms
Susceptible (S ≤)
Enterobacterales 8

#
${If.End}
Resistant (R >)
IE
8
Note1
IE
16
Note2,3,4
Note5
Note6,7
Note8,9

ium.





/L), susceptibility can be inferred from


#
${If.End}
Piperacillin-tazobactam
Organisms
Susceptible (S ≤)
Achromobacter xylosoxidans 41
B. thetaiotaomicron IE
Bacteroides spp. 81
Enterobacterales 81
Vibrio spp. 11
1. For susceptibility testing purposes, the concentration of tazobactam is fixed at 4 mg/L.

3. Susceptibility can be inferred from amoxicillin-clavulanic acid.

#
${If.End}
10. Benzylpenicillin (MIC or disk diffusion) can be used to screen for beta-lactam resistance in viridans group streptococci. I

#
${If.End}
Resistant (R >)
41
IE
IE
81
0.51
0.251
81
Note2
0.51
0.251
Note3
0.51
161
Note4,5,6
Note7
Note8,9
11
Note10,11

ium.





#
${If.End}
e in viridans group streptococci. Isolates
g/L), susceptibility can be inferred from


#
${If.End}
Pretomanid
Organisms
Susceptible (S ≤)
Mycobacterium tuberculosis IE1
1. MIC data have been generated with MGIT system and not with the EUCAST reference method. Therefore, it has not been
set an ECOFF, nor calibrate MGIT MIC values against the reference method. Consequently, EUCAST cannot endorse the ten
breakpoint set by EMA based on the MGIT method. Breakpoints are pending MIC data with the reference method.

#
${If.End}
Resistant (R >)
IE1
method. Therefore, it has not been possible to

, EUCAST cannot endorse the tentative
the reference method.

#
${If.End}
Quinupristin-dalfopristin
Organisms
Susceptible (S ≤)
E. faecium 1

#
${If.End}
Resistant (R >)
4
2
IE

#
${If.End}
Rifampicin
Organisms
Susceptible (S ≤)
Haemophilus influenzae (for prophylaxis only) 1
Kingella kingae 0.5
Neisseria meningitidis (prophylaxis only) 0.25
1. There are no clinical breakpoints for viridans group streptococci and rifampicin, but rifampicin has been used for oral step
treatment of endocarditis caused by viridans group streptococci. The rifampicin MIC ECOFF (0.125 mg/L) can be used to sc
resistance mechanisms. When screen negative, the isolate should be reported “wild type” or “devoid rifampicin resistance
mechanisms”, but not as susceptible to rifampicin.

#
${If.End}
Resistant (R >)
0.125
0.5
1
1
0.5
0.25
0.06
0.06
0.125
Note1
mpicin has been used for oral step-down

F (0.125 mg/L) can be used to screen for
or “devoid rifampicin resistance

#
${If.End}
Roxithromycin
Organisms
Susceptible (S ≤)


#
${If.End}
Resistant (R >)
Note1
12
23
12
12
IE

d roxithromycin.

#
${If.End}
Spectinomycin
Organisms
Susceptible (S ≤)
Neisseria gonorrhoeae 64

#
${If.End}
Resistant (R >)
64

#
${If.End}
Streptomycin
Organisms
Susceptible (S ≤)
Enterococcus spp. (test for high-level streptomycin resistance) Note1
1. Isolates with high-level gentamicin resistance may not be high-level resistant to streptomycin.

#
${If.End}
Resistant (R >)
Note1
mycin.

#
${If.End}
Tedizolid
Organisms
Susceptible (S ≤)
S. anginosus group 0.5
1. Isolates susceptible to linezolid can be reported susceptible to tedizolid.

#
${If.End}
Resistant (R >)
IE
0.5
0.5
0.5
IE

#
${If.End}
Teicoplanin
Organisms
Susceptible (S ≤)
Coagulase-negative staphylococci 4
Enterococcus spp. 2
S. aureus 2

#
${If.End}
Resistant (R >)
4
2
2
2
2
2

#
${If.End}
Telavancin
Organisms
Susceptible (S ≤)
MRSA 0.1251,2
2. MRSA isolates susceptible to vancomycin can be reported susceptible to telavancin.

#
${If.End}
Resistant (R >)
IE
0.1251
IE
IE
IE

systems.

#
${If.End}
Telithromycin
Organisms
Susceptible (S ≤)
Staphylococcus spp. IE

#
${If.End}
Resistant (R >)
Note1
0.5
IE
0.5
0.5
IE


#
${If.End}
Temocillin
Organisms
Susceptible (S ≤)
E. coli (infections originating from the urinary tract) 0.001
Klebsiella spp. (except K. aerogenes) (infections originating from the 0.001
P. mirabilis (infections originating from the urinary tract) 0.001

#
${If.End}
Resistant (R >)
16
IE
16
IE
IE
16

#
${If.End}
Tetracycline
Organisms
Susceptible (S ≤)
Campylobacter jejuni and coli 21
Kingella kingae 0.5
Neisseria meningitidis (screen only) 23
Staphylococcus spp. (screen only) 14
Streptococcus groups A, B, C and G (screen only) 14
Streptococcus pneumoniae (screen only) 14
1. Tetracycline can be used to determine susceptibility to doxycycline.

3. Tetracycline can be used to predict susceptibility to minocycline for prophylaxis against N. meningitidis infections.

#
${If.End}
Resistant (R >)
21
2
22
1
0.5
22
1
23
2
14
2
14
2
14

N. meningitidis infections.

#
${If.End}
Ticarcillin
Organisms
Susceptible (S ≤)
Enterobacterales 8

#
${If.End}
Resistant (R >)
IE
16
IE
IE
16
Note1,2
IE



#
${If.End}
Ticarcillin-clavulanic acid
Organisms
Susceptible (S ≤)
Enterobacterales 81

#
${If.End}
Resistant (R >)
IE
161
IE
IE
161
Note2,3
IE
L.



#
${If.End}
Tigecycline
Organisms
Susceptible (S ≤)
C. koseri 0.51,2
E. coli 0.51,2
E. faecalis 0.251
E. faecium 0.251
1. For tigecycline broth microdilution MIC determination, the medium must be prepared fresh on the day of use.
2. For other Enterobacterales, the activity of tigecycline varies from insufficient in Proteus spp., Morganella morganii and Pr
spp. to variable in other species. For more information, see https://www.eucast.org/eucastguidancedocuments/.

#
${If.End}
Resistant (R >)
IE
0.51,2
0.51,2
0.251
0.251
IE
IE
IE
IE
0.51
0.1251
IE
IE
esh on the day of use.

spp., Morganella morganii and Providencia
tguidancedocuments/.

#
${If.End}
Tobramycin
Organisms
Susceptible (S ≤)
Acinetobacter spp. (infections originating from the urinary tract) 4
Acinetobacter spp. (systemic infections) (4)1
Coagulase-negative staphylococci (2)1
Enterobacterales (systemic infections) (2)1
Pseudomonas spp. (infections originating from the urinary tract) 2
Pseudomonas spp. (systemic infections) (2)1
S. aureus (2)1


#
${If.End}
Resistant (R >)
4
(4)1
(2)1
2
(2)1
Note2
IE
IE
2
(2)1
(2)1
Note2

#
${If.End}
Trimethoprim
Organisms
Susceptible (S ≤)
Enterococcus spp. (uncomplicated UTI only) Note1
S. agalactiae (group B streptococci) (uncomplicated UTI only) 2
Staphylococcus spp. (uncomplicated UTI only) 4
1. The activity of trimethoprim and trimethoprim-sulfamethoxazole is uncertain against enterococci, and it is not possible to
clinical outcome. The ECOFF to categorise isolates as wild type or non-wild type for both E. faecalis and E. faecium is 1 mg/
corresponding zone diameter ECOFF of 21 mm for trimethoprim and 23 mm for trimethoprim-sulfamethoxazole.

#
${If.End}
Resistant (R >)
4
Note1
2
4
terococci, and it is not possible to predict

. faecalis and E. faecium is 1 mg/L, with a
rim-sulfamethoxazole.

#
${If.End}
Trimethoprim-sulfamethoxazole
Organisms
Susceptible (S ≤)
Achromobacter xylosoxidans 0.125
Aeromonas spp. 2
Enterobacterales 2
Listeria monocytogenes (all indications) 0.06
Stenotrophomonas maltophilia 0.001
Vibrio spp. 0.5
1. The activity of trimethoprim and trimethoprim-sulfamethoxazole is uncertain against enterococci, and it is not possible to
clinical outcome. The ECOFF to categorise isolates as wild type or non-wild type for both E. faecalis and E. faecium is 1 mg/
corresponding zone diameter ECOFF of 21 mm for trimethoprim and 23 mm for trimethoprim-sulfamethoxazole.

#
${If.End}
Resistant (R >)
0.125
4
4
4
4
Note1
1
0.25
0.06
1
0.25
4
4
2
2
0.5
terococci, and it is not possible to predict

. faecalis and E. faecium is 1 mg/L, with a
rim-sulfamethoxazole.

#
${If.End}
Vancomycin
Organisms
Susceptible (S ≤)
Aerococcus sanguinicola and urinae 1
Clostridioides difficile 21
Clostridium perfringens 2
Coagulase-negative staphylococci 4
Cutibacterium acnes 2
Enterococcus spp. 4
S. aureus 2
1. The breakpoints are based on epidemiological cut-off values (ECOFFs) and apply to oral treatment of C. difficile infection
no conclusive clinical data regarding the relation between MICs and outcomes.

#
${If.End}
Resistant (R >)
1
2
21
2
4
2
2
4
2
2
2
2
treatment of C. difficile infections. There are

#
${If.End}

Minimum Inhibitory Concentration Mic Breakpoints - en

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Official address Domenico Scarlattilaan 6 ● 1083 HS Amsterdam ● The Netherlands

Address for visits and deliveries Refer to www.ema.europa.eu/how-to-find-us

An agency of the European Union

Minimum inhibitory concentration (MIC) breakpoints

The following abbreviations are used:

"S" for susceptibility breakpoints;

# Classified as internal/staff contractors by the European Medicines Agency

rally and nationally

ded in other families

# Classified as internal/staff contractors by the European Medicines Agency

1. For information on how to use breakpoints in brackets, see https://www.eucast.org/eucastguidancedocuments/.

_x000D_ Classified as internal/staff contractors by the European Medicines Agency

_x000D_ Classified as internal/staff contractors by the European Medicines Agency

1. Infer susceptibility from ampicillin susceptibility.

_x000D_ Classified as internal/staff contractors by the European Medicines Agency

e inhibitor) can be inferred from ampicillin.

ed). If beta-lactamase positive, report

chanism renders them resistant to

illin resistant. Either mechanism renders

amoxicillin and piperacillin (without or with

e benzylpenicillin susceptibility (indications

_x000D_ Classified as internal/staff contractors by the European Medicines Agency

2. Susceptibility inferred from ampicillin (indications other than meningitis).

_x000D_ Classified as internal/staff contractors by the European Medicines Agency

ed to exclude beta-lactam resistance

_x000D_ Classified as internal/staff contractors by the European Medicines Agency

_x000D_ Classified as internal/staff contractors by the European Medicines Agency

_x000D_ Classified as internal/staff contractors by the European Medicines Agency

_x000D_ Classified as internal/staff contractors by the European Medicines Agency

chanism renders them resistant to

illin resistant. Either mechanism renders

amoxicillin and piperacillin (without or with

e benzylpenicillin susceptibility (indications

in viridans group streptococci. Isolates

/L), susceptibility can be inferred from

_x000D_ Classified as internal/staff contractors by the European Medicines Agency

3. Susceptibility inferred from ampicillin (indications other than meningitis).

_x000D_ Classified as internal/staff contractors by the European Medicines Agency

ed to exclude beta-lactam resistance

_x000D_ Classified as internal/staff contractors by the European Medicines Agency

_x000D_ Classified as internal/staff contractors by the European Medicines Agency

_x000D_ Classified as internal/staff contractors by the European Medicines Agency

_x000D_ Classified as internal/staff contractors by the European Medicines Agency

e inhibitor) can be inferred from ampicillin.

ed). If beta-lactamase positive, report

illin resistant. Either mechanism renders

amoxicillin and piperacillin (without or with

e benzylpenicillin susceptibility (indications

_x000D_ Classified as internal/staff contractors by the European Medicines Agency

_x000D_ Classified as internal/staff contractors by the European Medicines Agency

_x000D_ Classified as internal/staff contractors by the European Medicines Agency

1. For susceptibility testing purposes, the concentration of sulbactam is fixed at 4 mg/L.

10. Susceptibility inferred from ampicillin (indications other than meningitis).

_x000D_ Classified as internal/staff contractors by the European Medicines Agency

e inhibitor) can be inferred from ampicillin.

chanism renders them resistant to

illin resistant. Either mechanism renders

amoxicillin and piperacillin (without or with

e benzylpenicillin susceptibility (indications

ed to exclude beta-lactam resistance

e in viridans group streptococci. Isolates

g/L), susceptibility can be inferred from