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GPC Amr
GPC Amr
Dr.S.T.Renuka
postgraduate
CLSI guidelines for Staphylococcus spp
Tier 1 Tier 2 Tier 3 Tier 4
Azithromycin or
Clarithromycin or Penicillin Ceftaroline Cipro/levo/
Erythromycin Daptomycin Tedizolid moxifloxacin
Linezolid Rifampin Dalbavancin
Clindamycin
Lefamulin Oritavancin
Oxacillin Telavancin
Cefoxitin(surrogate) Gentamicin
Marker for oxacillin)
Doxy/Mino/
Tetracycline
Trimethoprim-
sulfamethoxazole
Vancomycin
Urine only-
Nitrofurantoin
FOOT NOTES
Macrolides,clindamycin,Minocycline – not reported for urinary
specimens
Enterococcus spp
• High level amino glycoside resistance
• VRE
Test for detection of
Betalactamase in
Staphylococcus
spp
Disk diffusion (Penicillin zone edge test)
Beta Beta
lactamas lactamas
e e
Positive- Negative
Sharp – Fuzzy
zone zone
edge(clif edge(bea
f) ch)
A – Beta lactamase positive
B- Beta lactamase negative
Nitrocefin based test
CLSI RECOMMENDED:
1. Disk diffusion: Oxacillin and Cefoxitin diffusions test
2. Oxacillin Salt Agar Screening method
3. Dilution method: Agar dilution and Broth dilution
OTHERS:
4. Chromagar
5. E test method
6. Latex agglutination – detect PBP2a
7. Automated methods (VITEK2 system- Cefoxitin screening)
8. Molecular methods – detection of mecA gene
Cefoxitin disk diffusion
method
SPECIES SUSCEPTIBLE INTERMEDIATE RESISTANT
(18 hrs if R)
Isolates that are positive for mecA mediated resistance
should be reported as methicillin(not cefoxitin)
resistant and other beta lactam agents except
ceftaroline should be reported as resistant or should
not be reported
Oxacillin disk diffusion method
Only indicated in species for S.epidermidis, S.psuedintermedius,
S.schleiferi
1µgm oxacillin disk on MHA for 16 to 18 hrs
≤17mm-positive
for mecA
mediated ≥18mm- negative for
resistance mecA mediated
resistance
Oxacillin salt agar screening
for S.aureus only
MHA with 4% Nacl ; 6µgm/ml oxacillin
Colony suspension to 0.5 MC farland turbidity. Add 1 µg/ml and spot an
area 10-15 mm diameter.
After 24 hrs of incubation with transmitted light
> 1 colony - positive for mec A mediated resistance
Broth Microdilution using
cefoxitin
Cation adjusted MHB with 4µgm/ml cefoxitin
Standard broth microdilution procedure
Read after 16- 20 hrs of incubation.
Standard procedure after 24 hrs (18 Standard procedure after 24 hrs (18 hrs
hrs if R) if R)
S S No need MSSA(MecA -
VE)
R R No need MRSA(MecA
+VE)
S R Cx DD MRSA(MecC
+VE)
VISA – 4-8µg/ml
Vancomycin screen agar
Efflux msrA R S
D zone test
(-)
15µg erythromycin & 2µg clindamycin 15µg erythromycin & 2µg clindamycin
disk 15-26mm apart after 16- 18 hrs disk 12mm apart after 20-24 hrs
4 µg/ml erythromycin & 0.5 µg/ml 1µg/ml erythromycin & 0.5 µg/ml
clindamycin in same well clindamycin in same well
MHA CAMHB
Std procedure and read after 24 hrs Std procedure and read after 24 hrs
Linezolid Fosfomycin
Tetracycline
Urine only-
Ciprofloxacin
Norfloxacin
Footnotes
Ampicillin S S to Amoxicillin,Amoxy – clav,ampi-sulbactam,piptaz
among non beta lactamase producing enterococci.
Similarly penicillin S S to ampicillin, Amoxicillin,Amoxy – clav,ampi-
sulbactam,piptaz among non beta lactamase producing enterococci.
But if ampicillin S cant be assumed to be Penicillin S.