ױ: ̷а  (2002 NCCLS ħ)

 

- Performance Standards for Antimicrobial Susceptbility Testing, NCCLS 2002 -

 

 

ױ з

 

1. -Lactams: 4-membered -lactam ring, ռ

1) Penicillins: ַ -lactamase ʴ ׶缺հ Ϻ ׶

    (1) Aminopenicillins: ׶ (Enterobacteriaceae)

    (2) Carboxypenicillins, ureidopenicillins: ׶ (Pseudomonas, Burkholderia)

    (3) Penicillinase stable penicillins: penicillinase staphylococci

2) -Lactam/-lactamase inhibitor combination: clavulanate, sulbactam, tazobactam

3) Cephems

    - ׶缺

    - ׶տ : 1, 2, 3, 4

4) Cabapenems

    - -lactamase ׷

    - ׶缺

5) Monobactams: ׶

 

2. Non--Lactams

1) Glycopeptides: ռ , ׶缺

2) Aminoglycosides: ܹ ռ

    - ַ ׶

    - ׶缺: ռ ױ ۿ

3) Macrolides: ܹ ռ

    - ׶缺 Ϻ ׶

    - ſ : erythromycin

4) Tetracycline: ܹ ռ

    - ׶缺 Ϻ ׶

    - ſ : tetracycline

5) Quinolones: DNA gyrase Ȱ

    - ׶缺

    - : ˻

 

   -Lactams: Class and subclass designation and generic name

Class

Subclass

Agents: Generic name

Penicillin

Penicillin G

Penicillin

Aminopenicillin

Amoxicillin, Ampicillin

 

Ureidopenicillin

Azlocillin, Mezlocillin, Piperacillin

 

Carboxypenicillin

Carbenicillin, Ticarcillin

 

Penicillinase stable

penicillin

Cloxacillin, Dicloxacillin, Methicillin, Nafcillin,

Oxacillin

 

Amidinopenicillin

Mecillinam

-lactam/-lactamase

inhibitor combination


Amoxicillin/clavulanate, Ampicillin/sulbactam,

Piperacillin/tazabactam, Ticarcillin/clavulanate

Cephem (parenteral)

Cephalosporin I

Cefazolin, Cephalothin, Cephapirin, Cephradine

Cephalosporin II

Cefamandole, Cefonicid, Cefuroxime (sodium)

 

Cephamycin

Cefmetazole, Cefotetan, Cefoxitin

 

Cephalosporin III

Cefoperazone, Cefotaxime, Ceftazidime, Ceftizoxime, Ceftriaxone

 

Oxacephem

(cephalosporin III)

Moxalactam

 

Cephalosporin IV

Cefepime

Cephem (oral)

Cephalosporin

Cefaclor, Cefadroxil, Cefdinir, Cefditoren,

Cefetamet, Cefixime, Cefpodoxime, Cefprozil,

Cefuroxime (axetil), Cephalexin, Cephradine,

Ceftibuten

Carbacephem

Loracarbef

Monobactam


Aztreonam

Carbapenem


Ertapenem, Imipenem, Meropenem

 

  Non--Lactams: Class and subclass designation and generic name

Class

Subclass

Agents: Generic name

Aminocyclitol


Spectinomycin, Trospectinomycin

Aminoglycoside


Amikacin, Gentamicin, Kanamycin, Netilmicin, Streptomycin, Tobramycin

Ansamycin


Rifampin

Quinolone


Cinoxacin, Nalidixic acid

Fluoroquinolone


Ciprofloxacin, Clinafloxacin, Enoxacin, Fleroxacin,

Gatifloxacin, Gemifloxacin, Grepafloxacin, Levofloxacin, Lomefloxacin, Moxifloxacin, Norfloxacin, Ofloxacin, Sparfloxacin, Trovafloxacin

Folate pathway inhibitor


Sulfonamides, Trimethoprim,

Trimethoprim/sulfamethoxazole

Fosfomycin


Fosfomycin

Ketolide


Telithromycin

Lincosamide


Clindamycin

Lipopeptide


Daptomycin

Macrolide


Azithromycin, Clarithromycin, Dirithromycin, Erythromycin

Nitrofurantoin


Nitrofurantoin

Nitroimidazole


Metronidazole

Oxazolidinone


Linezolid

Glycopeptide

Glycopeptide

Vancomycin

Lipoglycopeptide

Teicoplanin

Phenicol


Chloramphenicol

Streptogramin


Quinupristin/dalfopristin

Tetracycline


Doxycycline, Minocycline, Tetracycline

Quinupristin/dalfopristin (Synercid) Linezolid (Zyvox)

    1. Quinupristin/dalfopristin: Vancomycin-resistant E. faecium, MRSA

    2. Linezolid: VRE, MRSA, GISA, PRSP, Anaerobes

 

ױ

1. Group A: ϰ

2. Group B: ϵ

    - , հ, ð, Group A ױ ġ

3. Group C: ߰ ʿ

    - Epidemic Ǵ endemic پ հ, 1 ˷ ִ , 幮      (Salmonella ܰ, VRE ),

4. Group U: ΰ ȿ (nitrofurantoin, quinolones)

 

ߺ ˻ ʿ䰡

1) Cluster group

    - usually similar interpretive results, comparable clinical efficacy

    - designate boxes in the table

2) Related group

    - almost identical spectrum of activity and interpretive results

    - nearly complete cross-resistance and susceptibility

    - designate "or"

з

     

    1. Enterobacteriaceae

    2. Pseudomonas aeruginosa and other non-Enterobacteriaceae

    3. Staphylococcus spp.

    4. Enterococcus spp.

    5. Haemophilus spp.

    6. Neisseria gonorrhoeae

    7. Streptococcus pneumoniae

    8. Streptococcus spp. other than S. pneumoniae

    9. Vibrio cholera

     

  • Vitek ױ

    - з: Enterobacteriaceae, Non-fermenting bacilli, Staphylococci, Enterococci

    - Ұ

  • Warning: CSF и ִ 汸θ Ǵ 1, 2 cephalosporins (cefuroxime sodium ), clindamycin, macrolides, tetracyclines, fluoroquinolones ִ
  • ظ ִ ױ: ƴϸ 񰨼 (nonsusceptible) ϰ NCCLS ǥ 񼮹 Ȯ ˻

 

   1. Enterobateriaceae

 

Group A

Ampicillin

Cefazolin, Cephalothin

 

Gentamicin 

Group B

Amikacin

Amoxicillin/clavulanate or ampicillin/sulbactam

Piperacillin/tazobactam, Ticarcillin/clavulanate

 

Cefamandole or cefonicid or cefuroxime 

 

Cefepime 

 

Cefmetazole, Cefoperazone, Cefotetan, Cefoxitin 

 

Cefotaxime or ceftizoxime or ceftriaxone 

 

Ciprofloxacin or levofloxacin 

 

Imipenem or meropenem 

 

Mezlocillin or piperacillin, Ticarcillin 

 

Trimethoprim/sulfamethoxazole 

Group C

Aztreonam, Ceftazidime (indicator of ESBL)

Chloramphenicol

 

Kanamycin 

 

Netilmicin 

 

Tetracycline 

 

Tobramycin 

Group U

Carbenicillin

Cinoxacin, Lomefloxacin or norfloxacin or ofloxacin

 

Gatifloxacin 

 

Loracarbef 

 

Nitrofurantoin 

 

Sulfisoxazole 

 

Trimethoprim 

 

  • Ampicillin: amoxicillin ǥ
  • Salmonella, Shigella: 1, 2 cephalosporins aminoglycosides ˻ ӻ ȿ . 뺯 ü , trimethoprim/sulfamethoxazole, ampicillin, quinolones ϳ ˻ϰ . Salmonella spp. ܰ chloramphenicol, 3 cephalosporins ϳ ߰ ˻ϰ
  • Cephalothin: cephapirin, cephradine, cephalexin, cefaclor, cefadroxil ǥ
  • Cefazolin, cefuroxime, cefpodoxime, cefprozil, loracarbef ˻ : Cephalothin 쿡
  • CSF и: Cefotaxime̳ ceftriaxone ݵ
  • Tetracycline: tetracyclines (minocycline, doxycycline ) ǥ

 

  Klebsiella pneumoniae, K. oxytoca, E. coli ESBL Ȯ˻

Method

Initial screen test

Phenotypic confirmatory test

Antimicrob.

agents

Dilution(g/ml)

Disk(g)

Dilution(g/ml)

Disk(g)

CPD: 4

CAZ: 1

AZT: 1

CTX: 1

CRO: 1

CPD: 10

CAZ: 30

AZT: 30

CTX: 30

CRO: 30

CAZ: 0.25-128

CAZ-CLA: 0.25/4-128/4

&

CTX: 0.25-64

CTX-CLA: 0.25/4-64/4

CAZ: 30

CAZ-CLA:30/10

&

CTX: 30

CTX-CLA: 30/10

Results

Dilution(g/ml)

Disk(mm)

Dilution

Disk

CPD: 8

CAZ: 2

AZT: 2

CTX: 2

CRO: 2

CPD 17

CAZ 22

AZT 27

CTX 27

CRO 25

Clavulanate ÷ױ MIC 3 ̻

Clavulanate ÷

ũ 밡 5 mm ̻

 

  • ESBL Klebsiella spp. E. coli: ̴ penicillins, cephalosporins, aztreonam ӻ ȿ . , Һ и ESBL ִ ױ S Ǵ I̸ ġ ȿ
  • Vitek: phenotypic confirmatory test ̿
  • MicroScan: Cefpodoxime ̿

 

  2. Pseudomonas aeruginosa & non-Enterobacteriaceae

 

Group A

Ceftazidime

Gentamicin

 

Mezlocillin or ticarcillin, Piperacillin

Group B

Amikacin

Cefepime

 

Cefoperazone, Aztreonam

 

Ciprofloxacin 

 

Imipenem or meropenem 

 

Ticarcillin/clavulanate

 

Tobramycin

 

Trimethoprim/sulfamethoxazole

Group C

Cefotaxime or ceftriaxone

Chloramphenicol

 

Netilmicin

Group U

Carbenicillin

Ceftizoxime

 

Levofloxacin or lomefloxacin or norfloxacin or ofloxacin

 

Sulfisoxazole

 

Tetracycline


  • Non-Enterobacteriaceae: Acinetobacter spp., Stenotrophomonas maltophilia, other nonfastidious glucose-nonfermenting gram-negative bacilli
  • P. aeruginosa ̳ agranulocytopenic ȯ: Antipseudomonal penicillin (carboxypenicillin or ureodopenicillin)̳ ceftazidime aminoglycoside ġ
  • Ticarcillin/clavulanate: P. aeruginosa̿ Pseudomonas, S. maltophilia, Acinetobacter spp. 1 ˻
  • Ampicillin/sulbactam: پ Acinetobacter spp.
  • Moxalactam: S. maltophilia 1 ˻
  • Tetracycline: tetracyclines (minocycline, doxycycline ) ǥ
  • Vitek: cephalothin (ص )

 

  3. Staphylococcus spp.

 

Group A

Oxacillin

Penicillin

Group B

Azithromycin or clarithromycin or erythromycin

Clindamycin

 

Linezolid

 

Trimethoprim/sulfamethoxazole

 

Vancomycin

Group C

Chloramphenicol

Ciprofloxacin or levofloxacin or ofloxacin, Gatifloxacin

 

Quinupristin/dalfopristin

 

Gentamicin

 

Rifampin

 

Tetracycline

Group U

Lomefloxacin or norfloxacin

Nitrofurantoin

 

Sulfisoxazole

 

Trimethoprim


  • Penicillin : penicillins, cephems, carbapenems
  • Penicillin , oxacillin : -lactamase labile penicillins (ampicillin, amoxicillin, azlocillin, carbenicillin, mezlocillin, piperacillin, ticarcillin) , -lactamase stable penicillins, -lactamase inhibitor combinations, cephems, carbapenems
  • Oxacillin : -lactams , aminoglycosides, clindamycin, macrolides, phenicols, quinolones, sulfonamides, tetracycline ̳ ٸ 迭 ױ
  • mecA gene̳ PBP2a : oxacillin
  • Oxacillin , penicillin : (micrococci) Ǵ
  • -lactams : Penicillin oxacillin
  • Tetracycline: tetracyclines (minocycline, doxycycline ) ǥ
  • Rifampin: ܵ ϸ ʵ
  • Vitek: cephalothin (ص )

 

  4. Enterococcus spp.

 

Group A

Penicillin or ampicillin

Group B

Linezolid

Quinupristin/dalfopristin

 

Vancomycin

Group C

Gentamicin (high-level screening only)

Streptomycin (high-level screening only)

 

Chloramphenicol, Erythromycin, Rifampin, Tetracycline (may be tested for VRE)

Group U

Ciprofloxacin, Levofloxacin, Norfloxacin

Nitrofurantoin

 

Tetracycline


  • Cephalosporins, Ϲ aminoglycosides, trimethoprim/sulfamethoxazole, clindamycin: ˻ ̶ ӻ ȿ
  • Penicillin or ampicillin: Non--lactamae enterococci ampicillin, amoxicillin, ampicillin/sulbactam, amoxicillin/clavulanate, piperacillin, piperacillin/tazobactam ǥ
  • Endocarditis: տ (high-dose penicillin or high-dose ampicillin or vancomycin or teicoplanin + gentamicin or streptomycin)
  • Vancomycin : 24ð ä ǵ
  • Tetracycline: tetracyclines (minocycline, doxycycline ) ǥ
  • Rifampin: ܵ ϸ ȵ
  • Quinupristin/dalfopristin: vancomycin E. faecium
  • Vitek: Clindamycin

 

  5. Haemophilus spp.:Haemophilus Test Medium (HTM), 350C, 5% CO2, 16-18 h

 

Group A

Ampicillin

Trimethoprim/sulfamethoxazole

Group B

Cefotaxime or ceftazidime or ceftizoxime or ceftriaxone

Cefuroxime sodium (parenteral)

 

Chloramphenicol

 

Meropenem

Group C

Azithromycin or clarithromycin

Aztreonam

 

Cefaclor or cefprozil or loracarbef

Cefdinir or cefixime or cefpodoxime

 

Cefuroxime axetil (oral)

 

Ciprofloxacin or gatifloxacin or levofloxacin or lomefloxacin or

moxifloxacin or ofloxacin or sparfloxacin

 

Imipenem

 

Rifampin

 

Tetracycline


  • CSF и H. influenzae: Ampicillin, 3 cephalosporins ϳ, chloramphenicol, meropenem ˻
  • Ampicillin: Ampicillin, amoxicillin ǥ
  • ȣⰨ: Amoxicillin/clavulanate, azithromycin, clarithromycin, cefaclor, cefprozil, loracarbef, cefdinir, cefixime, cefpodoxime, cefuroxime axetil 汸 ġ
  • -lactamase test: Ampicillin, amoxicillin
  • Meropenem: Meningitis meningitis bacteremia϶

 

  6. Neisseria gonorrhoeae: GC agar, 350C, 5% CO2, 20-24 h

 

Group A


Group B


Group C

Cefixime or cefotaxime or cefpodoxime or ceftizoxime or ceftriaxone

Cefmetazole, Cefotetan, Cefoxitin, Cefuroxime

 

Ciprofloxacin or gatifloxacin or ofloxacin

 

Penicillin

 

Spectinomycin

 

Tetracycline


  • -lactamase 缺: Penicillin, ampicillin, amoxicillin
  • Ampicillin, penicillin, rifampin: ũ Ȯ, MIC ˻

 

  7. Streptococcus pneumoniae: MHA + 5% sheep blood, 350C, 5% CO2, 20-24 h

 

Group A

Erythromycin

Penicillin (oxacillin disk)

 

Trimethoprim/sulfamethoxazole

Group B

Clindamycin

Gatifloxacin or levofloxacin or moxifloxacin or sparfloxacin, Ofloxacin

 

Tetracycline

 

Vancomycin

Group C

Chloramphenicol

Linezolid

 

Rifampin


  • Amoxicillin, ampicillin, cefepime, cefotaxime, ceftriaxone, cefuroxime, imipenem, meropenem: ױ̳ ũȮ , MIC ˻
  • Cefepime, cefotaxime, ceftriaxone: MIC ǵ (S/I/R)
  • 1. Nonmeningitis: 1 / 2 / 4

    2. Meningitis: 0.5 / 1 / 2

  • Meningitis: cefepime ̱ FDA ϴ ġ ƴ, ִ 뷮 cefotaxime̳ ceftriaxone ġؾ
  • CSF и: Penicillin, cefotaxime Ǵ ceftriaxone, meropenem MIC ݵ ˻Ͽ . Vancomycin ˻ (ũ Ǵ MIC )
  • Ÿ и: Oxacillin ũ
  • 1) 20 mm: Penicillin, ampicillin, amoxicillin, amoxicillin/clavulanate,

       ampicillin/sulbactam, cefaclor, cefdinir, cefepime, cefetamet, cefixime,

       cefotaxime, cefprozil, ceftibuten, ceftriaxone, cefuroxime, cefpodoxime,

       ceftizoxime, imipenem, loracarbef, meropenem

    2) 19 mm: Penicillin , ߰ Ǵ (penicillin Ǵ ߰

        ϸ ȵ) --> penicillin, cefotaxime Ǵ ceftriaxone: MIC ˻

  • Rifampin: ܵ ϸ ȵ
  • Erythromycin: Azithromycin, clarithromycin, dirithromycin ǥ
  • Tetracycline: tetracyclines (minocycline, doxycycline ) ǥ, ִ tetracycline minocycline, doxycycline susceptible

 

  8. Streptococcus spp. other than S. pneumoniae: MHA + 5% sheep blood, 350C, 5% CO2, 20-24 h

 

Group A

Erythromycin

Penicillin or ampicillin

Group B

Chloramphenicol

Clindamycin

 

Vancomycin

Group C

Cefotaxime or ceftriaxone

Cefepime

 

Levofloxacin, Ofloxacin

 

Linezolid

 

Quinupristin/dalfopristin

 

  • Beta-hemolytic group

    1. Large-colony: Group A (S. pyogenes), C, or G, B (S. agalactiae)

    2. Small-colony (viridans group): Group A, C, F, G (S. anginosus)

    - other viridans group: S. mitis, S. oralis, S. sanguis, S. salivarius, S.

       intermedius, S. constellatus, S. mutans, S. bovis

  • Oxacillin ũ ˻ penicillin̳ ampicillin ˻
  • Blood, CSF и viridans streptococci: MIC penicillin ˻
  • Penicillin, ampicillin, levofloxacin, ofloxacin ũ ǵ: -hemolytic streptococci ش
  • Penicillin : Penicillin, ampicillin, amoxicillin, amoxicillin/clavulanate, ampicillin/sulbactam, cefaclor, cefazolin, cefdinir, cefepime, cefotaxime, cefprozil, ceftibuten, ceftriaxone, cefuroxime, cefpodoxime, ceftizoxime, cephalothin, cephapirin, cephradine, imipenem, loracarbef, meropenem
  • Erythromycin: Azithromycin, clarithromycin, dirithromycin ǥ
  • Quinupristin/dalfopristin: S. pyogenes

 

  9. Vibrio cholerae

 

Group A

Ampicillin

Group B

Trimethoprim/sulfamethoxazole

Group C

Tetracycline

Sulfonamides

 

Chloramphenicol


  • Ampicillin: Ampicillin, amoxicillin ǥ
  • Tetracycline: doxycycline , doxycycline disk MIC ġ ϸ ʵ
  • Chloramphenicol: minor error

 

[2002 3 5, ѸǴ ۿ  ]