Etest Reading 2
Etest Reading 2
Etest Reading 2
Etest Reading
AB bioMrieux 2008
Etest Reading
Organism specific
Resistance mechanisms
Etest Reading Guides (ERG 001, 002) Customer Information Sheets (CIS 006, CIS 007) Etest Technical Guide (ETG 006) Mycobacteria
Molecule Size
Between Markings
Is it a sharp endpoint?
YES: then read MIC where growth intersects the strip. VA, MIC 1.0 g/mL
Is it a sharp endpoint?
cidal
static
Macrocolonies
MIC 32 g/mL
Bactericidal
Bacteriostatic
15
16
17
18
19
Isoniazide Aminoglycosides
Quinolones
Metronidazole Rifampicin
Ethambutol
Glycopeptides Fosfomycin
Amphotericin B
20
Pneumo - Pen G
Obtain good confluent growth Look for microcolonies and hazes MIC: 4.0 g/mL
21
22
23
Induction of regrowth at higher concentrations of the antimicrobial Read the highest value
24
Bacteriostatic Drugs
Read at 80% inhibition i.e. first point of significant change as judged by the naked eye (CIS 007).
Lincomycins
Chloramphenicol Sulfonamides Trimethoprim
Macrolides
Azoles
Echinocandins
25
26
Linezolid
27
28
Pipercillin/tazobactam
Ticarcillin/clavulanic acid Ignore the inhibition of growth caused by the activity of the inhibitor (tazobactam, clavulanic acid) and extrapolate the ellipse to give the MIC of pipercillin or ticarcillin.
Echinocandins
Distorted ellipse
ESBL POSITIVE
Report:
ESBL producer and resistant to all penicillins, Cephalosporins and aztreonam (CLSI M100-S series).
TZ 1 and TZ/TZL 8
or
Phantom
ESBL
ESBL +
Categorisation of S, I, R
Use MIC breakpoints from most recent CLSI M100-S or own regulatory body (eg. EUCAST, BSAC) If not available, consult the litterature Etest gives values in-between 2-fold dilutions
35
R I S
36
Technical Documents
AB bioMrieux 2008
MIC: 16 g/mL
Comment: Dont over-read
39
FX code for: Cefoxitin Endpoint rule: 100% inhibition MIC: 32 g/mL Comment: Macro-colonies = resistant subpopulation
40
MZ code for: Metronidazole Endpoint rule: 100% inhibition MIC: 0.75 g/mL Comment: Wide ellipse, sharp endpoint
42
43
44
MIC: 1 g/mL
Comment: Ignore hazes between 1-2
45
TZ code for: Ceftazidime Endpoint rule: 100% inhibition MIC: 32 g/mL Comment: Read all microcolonies (SCVs) 6 - 32
46
47
48
49
MIC: 8 g/mL
Comment: Macrocolonies within ellipse, ignore line of growth along the strip
50
LZ code for: Linezolid Endpoint rule: 90% inhibition MIC: 1 g/mL Comment: Ignore hazes between 1-2
52
CD code for: Cefdinir (or other lactam) Endpoint rule: 100% inhibition MIC: 256 g/mL Comment: Paradoxical effect, regrowth 2- >256
53
AT code for: Aztreonam Endpoint rule: 100% inhibition MIC: 3 g/mL Comment: Sharp endpoint
54
55
56
TLc code for: Ticarcillin/clavulanic acid (2 g/ mL) Endpoint rule: 100% inhibition MIC: 2 g/mL Comment: Deformation of ellipse to straight dip 4 0.023 due to clav.acid activity Extrapolate ellipse curve to strip
57
TLc code for: Ticarcillin/clavulanic acid Endpoint rule: 100% inhibition MIC: 256 g/mL Comment: Resistance induced by clavulanic acid
58
59
MIC: 1 g/mL
Comment:
AP code for: Amphotericin B Endpoint rule: 100% inhibition MIC: 0.38 g/mL
FC code for: Flucytosine Endpoint rule: 90% inhibition MIC: 2 g/mL Comment: Ignore trailing, minute colonies above 2
FC code for: Flucytosine Endpoint rule: 90% inhibition MIC: 0.094 g/mL
CS code for: Caspofungin Endpoint rule: 80% inhibition MIC: 0.032 g/mL
CS code for: Caspofungin Endpoint rule: 80% inhibition MIC: 0.125 g/mL
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