Aarati clsi2

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Aarati clsi2

  1. 1. Haemophilus influenzae andHaemophilus parainfluenzae
  2. 2. TESTING CONDITIONS• Medium: Disk diffusion: Haemophilus Test Medium (HTM) Broth dilution: HTM broth
  3. 3. Haemophilus Test Mediumhematin stock solution is prepared by dissolving50 mg of hematin powder in 100 mL of 0.01mol/L NaOH with heat and stirring until thepowder is thoroughly dissolved.30 mL of the hematin stock solution and 5 g ofyeast extract is added to 1 L of Mueller-Hintonagar (MHA) and autoclaved.After autoclaving and cooling, add 3 mL of anicotinamide adenine dinucleotide (NAD) stocksolution (50 mg of NAD dissolved in 10 mL ofdistilled water, filter sterilized) aseptically
  4. 4. Testing conditions• Inoculum: Direct colony suspension, equivalent to a 0.5 McFarland standard• Incubation: 35 ± 2 °C;• Disk diffusion: 5% CO2; 16 to 18 hours• Broth dilution: ambient air; 20 to 24 hours
  5. 5. Suggested grouping of antimicrobial agents that should be considered for routine testing and reporting for Haemophilus spp.• GROUP A DRUGS • GROUP B DRUGS PRIMARILY TESTED AND PRIMARILY TESTED AND REPORTED REPORTED SELECTIVELY Ampiciilin  Ampicillin-Sulbactam Trimethoprim-  Cefuroxime(parenteral) Sulfamethoxazole  Cefotaxime or ceftazidime or Ceftriaxone  Chloramphenicol  Meropenem
  6. 6. Suggested grouping of antimicrobial agents that should be considered for routine testing and reporting for Haemophilus spp.• GROUP C (SUPPLEMENTAL) - REPORT SELECTIVELY Azithromycin Clarithromycin Aztreonam Amoxycillin-Clavulanic acid Cefaclor Cefprozil Cefdinir or Cefixime orCefpodoxime Cefuroxime(oral) Ciprofloxacin or Levofloxacin or Lomefloxacin or Moxifloxacin or Ofloxacin Gemifloxacin Ertapenem or Imipenem Rifampin Telithromycin Tetracycline
  7. 7. MINIMAL QC RecommendationsHaemophilus influenzae ATCC® 49247Haemophilus influenzae ATCC® 49766Escherichia coli ATCC® 35218 (when testingamoxicillin-clavulanic acid)
  8. 8. Empiric therapy for respiratory tract infections Amoxicillin-clavulanic acid, Azithromycin, Clarithromycin, Cefpodoxime, Cefixime, Cefuroxime, Cefaclor, Cefprozil, Loracarbef, Cefdinir, Telithromycin
  9. 9. H. influenzae from CSF followingdrugs should be reported routinely.AmpicillinThird Generation CephalosporinsChloramphenicolMeropenem
  10. 10. • The results of ampicillin susceptibility tests should be used to predict the activity of Amoxicillin.• The majority of isolates of H.influenzae that are resistant to Ampicillin and Amoxicillin produce a TEM-type β-lactamase.• In most cases, a direct β-lactamase test can provide a rapid means of detecting resistance to ampicillin and amoxicillin.
  11. 11. • Rare BLNAR strains of H. influenzae should be considered resistant to :- Ampicillin-Sulbactam Amoxacillin-Clavulanic acid Cefuroxime piperacillin-tazobactam Cefaclor Cefetamet Cefonicid cefprozil Loracarbef
  12. 12. • Chloramphenicol not routinely reported on isolates of urinary tract.• Rifampicin should not be used alone for antimicrobial therapy
  13. 13. Drug Conc. Of Drug used H. Enterobacteriacae µm InfluenzaeAmpicillin 10 22 17Ampillin-Sulbactam 10/10 20 15Amoxicillin- 20/10 20 18Clavulanic acidPiperacillin- 100/10 21 21TazobactamCefotaxime or 30 26 26Ceftazidime or 30 26 21Ceftriaxone 30 26 23Cefuroxime 30 20 18Cefpodoxime 10 21 21
  14. 14. Drug Conc. Of Drug used H.influenzae Enterobacteriacae µmCefepime 30 26 18Ciprofloxacin or 5 18 21Levofloxacn or 5 16 17Ofloxacin 5 18 16Trimethoprim- 1.25/23.75 16 16SulfamethoxazoleChloramphenicol 29 18 30Meropenem 10 20 23
  15. 15. Drug Conc. Of Drug used H. Enterobacteriacae µm InfluenzaeTetracycline 30 29 15Imipenem or 10 16 23Etrapenem 10 19 23Azithromycin or 15 12 _Clarithromycin 15 13 _Gatifloxacin 5 18 15Rifampin 5 20 _
  16. 16. NEISSERIA GONORRHOEAE
  17. 17. TESTING CONDITIONS• Medium: Disk Diffusion: GC agar base and 1% defined growth supplement Agar dilution: GC agar base and 1% defined growth supplement
  18. 18. GC agar supplement 1.1g L-cysteine 0.03g guanine HCL 3 mg thiamine HCL 13 mg para-aminobenzoic acid[PABA] 0.1 g B12 0.1 g cocarboxylase 0.25 g NAD 1 g adenine 10 g L-glutamine 100 g glucose 0.02 g ferric nitrate[in 1 L H2O]
  19. 19. TESTING CONDITIONS• Inoculum: Direct colony suspension, equivalent to a 0.5 McFarland standard• Incubation: 36±1 0c, 5% CO 2, 20 to 24 hours
  20. 20. MINIMAL QC RecommendationsNeisseria gonorrhoeae ATCC 49226
  21. 21. Suggested grouping of antimicrobial agents that should be considered for routine testing and reporting for Neisseria gonorrhoeae• GROUP C (SUPPLEMENTAL)-REPORT SELECTIVELY Cefixime or Cefpodoxime Cefotaxime or ceftriaxone Cefoxitin Cefuroxime Ciprofloxacin or Ofloxacin Penicillin Spectinomycin Tetracycline
  22. 22. single dose treatment regimen forNeisseria gonorrhoeaeCeftriaxone (125 mg IM)Cefixime (400mg PO)Ciprofloxacin (500 mg PO)Ofloxacin (400 mg PO)Levofloxacin (250 mg PO)
  23. 23. Standard Zone diameters for AST of Neisseria gonorrhoeaeDrug Conc. Of drug µm ZonePenicillin 10 units 47Cefotaxime or 30 31Ceftriaxone 30 35Cefoxitin 30 28Cefepime 30 31Ceftazidime 30 31Cefpodoxime 10 29Tetracycline 30 38Ciprofloxacin or 5 41ofloxacin 5 31

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