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EUCAST Breakpoints v1.1
EUCAST Breakpoints v1.1
Page
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Group of organisms
All
Changes
S > corrected to S and S < corrected to S at several positions. All comments referring to "adjusting MIC breakpoints to avoid dividing wild type MIC distributions" have been removed. A list can be obtained from EUCAST. Note on zone diameter breakpoints for ampicillin corrected (14/14 and 50/14 instead of 12/12 and 50/12). New comments on mecillinam and nitrofurantoin, cephalosporins, carbapenems and aztreonam. New MIC and zone diameter breakpoints for cefepime, ceftazidime and aztreonam. New MIC breakpoints for colistin. Zone diameter breakpoints for S. maltophilia and trimethoprim-sulfamethoxazole added. New comment on penicillins. Zone diameter breakpoints for S. saprophyticus and ampicillin. Cefpoxitin corrected to cefoxitin for coagulase-negative staphylococci. New comment on nitrofurantoin. Zone diameter breakpoints for E. faecium and quinupristin-dalfopristin added. MIC breakpoints for carbapenems removed. Susceptibility is inferred from the penicillin susecptibility. Zone diameter breakpoints for norfloxacin added (screen disk for fluoroquinolone resistance). New comment on nitrofurantoin. Zone diameter breakpoints for oxacillin changed from 18/18 to 20/20.
Enterobacteriaceae
Stretococcus pneumoniae
Enterobacteriaceae
Penicillins1 MIC breakpoint (mg/L) S R>
Benzylpenicillin Ampicillin
Note1
10 NoteA
14
A. Different dosing and reporting practices in different countries mean that wild type (without resistance mechanisms) Enterobacteriaceae may be categorized as either susceptible or intermediate to aminopenicillins. If it is common practice to categorize wild type Enterobacteriaceae as susceptible, use breakpoints of S 14mm, R <14 mm; to categorize the wild type as intermediate use S 50 mm, R <14 mm. 2. For susceptibility testing purposes, the concentration of sulbactam is fixed at 4 mg/L. B. Susceptibility inferred from ampicillin. 3. For susceptibility testing purposes, the concentration of clavulanate is fixed at 2 mg/L. 4. For susceptibility testing purposes, the concentration of clavulanate is fixed at 4 mg/L.
Ampicillin-sulbactam2 Amoxicillin Amoxicillin-clavulanate3 Piperacillin Piperacillin-tazobactam4 Ticarcillin Ticarcillin-clavulanate3 Phenoxymethylpenicillin Mecillinam (uncomplicated UTI only) 5
8 8 8 16 16 16 16 8
IP NoteB NoteA 18 18 23 23 -
IP NoteB 12 15 15 22 22 15
10
15
5. Mecillinam (pivmecillinam) breakpoints relate to E. coli, Klebsiella spp. and P. mirabilis only.
Cephalosporins1
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) R< S
1. The cephalosporin breakpoints for Enterobacteriaceae will detect all clinically important resistance mechanisms (including ESBL, plasmid mediated AmpC). Some strains that produce beta-lactamases are susceptible or intermediate to 3rd or 4th generation cephalosporins with these breakpoints and should be reported as found, i.e. the presence or absence of an ESBL does not in itself influence the categorization of susceptibility. In many areas, ESBL detection and characterization is recommended or mandatory for infection control purposes.
Cefaclor Cefadroxil (uncomplicated UTI only) Cefalexin (uncomplicated UTI only) Cefazolin Cefepime Cefixime (uncomplicated UTI only) Cefotaxime Cefoxitin Cefpodoxime (uncomplicated UTI only) Ceftazidime Ceftibuten (uncomplicated UTI only) Ceftriaxone Cefuroxime Cefuroxime axetil (uncomplicated UTI only)
16 16 1 1 1 NA 1 1 1 1 82 8
16 16 4 1 2 NA 1 4 1 2 8 8
30 30 30 5 5 10 10 30 30 30 30
12 IP 24 17 21 NA 21 21 21 23 18 18
12 IP 21 17 18 NA 21 18 21 20 18 18
2. The breakpoint relates to a dosage of 1.5 g x 3 and to E. coli, P. mirabilis and Klebsiella spp. only.
Enterobacteriaceae
Carbapenems1 MIC breakpoint (mg/L) S R>
1 0.5 2 2
4 1 8 8
10 10 10 10
24 25 21 22
18 22 15 16
2. Proteus and Morganella species are considered poor targets for imipenem.
Monobactams
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) R< S
30 27 24 1. The aztreonam breakpoints for Enterobacteriaceae will detect clinically important resistance mechanisms (including ESBL). Some strains that produce beta-lactamases are susceptible or intermediate to 3rd or 4th generation cephalosporins with these breakpoints and should be reported as found, i.e. the presence or absence of an ESBL does not in itself influence the categorization of susceptibility. In many areas, ESBL detection and characterization is recommended or mandatory for infection control purposes.
Aztreonam1
Fluoroquinolones
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) R< S
5 22 19 1. Salmonella spp. - there is clinical evidence for ciprofloxacin to indicate a poor response in systemic infections caused by Salmonella spp. with low-level fluoroquinolone resistance (MIC>0.064 mg/L). The available data relate mainly to S. typhi but there are also case reports of poor response with other Salmonella species.
Ciprofloxacin1
0.5
1 0.5 Note2
2 1 Note2
5 5 30
22 20 16A
19 17 16A 2/A. Nalidixic acid may be used to screen for fluoroquinolone resistance in Enterobacteriaceae. The zone diameter breakpoint correlates with an MIC value of 16 mg/L in most Enterobacteriaceae. If Salmonella spp. are resistant report resistant to all fluoroquinolones. If other Enterobacteriaceae are resistant, then test the agent in question.
Norfloxacin Ofloxacin
0.5 0.5
1 1
10 5
22 22
19 19
Enterobacteriaceae
Aminoglycosides1 MIC breakpoint (mg/L) S
Amikacin Gentamicin Netilmicin Tobramycin 8 2 2 2
R>
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) R< S
1. Azithromycin has been used in the treatment of infections with Salmonella typhi (MIC 16 mg/L for wild type isolates) and Shigella spp.
Azithromycin1
Tetracyclines
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) R< S
18 15
15
1. Tigecycline has decreased activity against Morganella spp., Proteus spp. and Providencia spp.
Miscellaneous agents
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) R< S
30 17 NoteA 11 18 16 17 NoteA 11 15 13 A. Test by MIC method only.
Chloramphenicol Colistin Daptomycin Fosfomycin iv Fosfomycin-trometamol (uncomplicated UTI only) Fusidic acid Linezolid Metronidazole Nitrofurantoin (uncomplicated UTI only)1 Rifampicin Spectinomycin Trimethoprim (uncomplicated UTI only) Trimethoprim-sulfamethoxazole (co-trimoxazole) 2
8 2 32 32 64 2 2
100
5 1.25-23.75
2. Trimethoprim:sulfamethoxazole in the ratio 1:19. Breakpoints are expressed as the trimethoprim concentration.
Pseudomonas spp.
Penicillins MIC breakpoint (mg/L)
S
Benzylpenicillin Ampicillin Ampicillin-sulbactam Amoxicillin Amoxicillin-clavulanate Piperacillin Piperacillin-tazobactam1,2 Ticarcillin3 Ticarcillin-clavulanate2, 3 Phenoxymethylpenicillin
1
R>
16 16 16 16 -
R<
19 19 IP IP 1. Breakpoints are based on high dose therapy (with or without tazobactam, 4 g x 4). 2. For susceptibility testing purposes, the concentration of beta-lactamase inhibitor is fixed at 4 mg/L. 3. Breakpoints are based on high dose therapy (with or without clavulanate, 3 g x 4).
16 16 16 16 -
Cephalosporins
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) R< S
30 18 NA 10 16 18 NA 16 1. The breakpoints relate to high dose therapy (2 g x 3).
Cefaclor Cefadroxil Cefalexin Cefazolin Cefepime Cefixime Cefotaxime Cefoxitin Cefpodoxime Ceftazidime Ceftibuten Ceftriaxone Cefuroxime Cefuroxime axetil
81 NA 81 -
Pseudomonas spp.
Carbapenems MIC breakpoint (mg/L) S
Doripenem Ertapenem Imipenem Meropenem 1 4 2
1
R>
4 8 8
Monobactams
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) R< S
30 50 16 1. The resistant breakpoint relates to high dose therapy. The susceptible breakpoint is set to ensure that wild type isolates are reported intermediate.
Aztreonam
Fluoroquinolones
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) R< S
5 5 25 20 NA 22 17 NA -
0.5 1 NA -
Aminoglycosides1
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) R< S
1. Aminoglycoside breakpoints are based on once-daily administration of high aminoglycoside dosages. Most often aminoglycosides are given in combination with beta-lactam agents.
8 4 4 4
16 4 4 4
30 10 10 10
18 15 10 15
15 15 10 15
Pseudomonas spp.
Miscellaneous MIC breakpoint (mg/L) S
Chloramphenicol Colistin Daptomycin Fosfomycin iv1 Fosfomycin-trometamol (uncomplicated UTI only) Fusidic acid Linezolid Metronidazole Nitrofurantoin (uncomplicated UTI only) Rifampicin Spectinomycin Trimethoprim (uncomplicated UTI only) Trimethoprim-sulfamethoxazole (co-trimoxazole)
2
R>
4 32 4
3
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) R< S
Note A
4 32 4
3
NoteA NoteA B
A. Test by MIC method only. 1. Intravenous fosfomycin may be used in combination with other drugs to treat P. aeruginosa infections.
NoteA 1.25-23.75 16
16B
2. Trimethoprim:sulfamethoxazole in the ratio 1:19. Breakpoints are expressed as the trimethoprim concentration. 3/B. S. maltophilia only.
Acinetobacter spp.
Penicillins1 MIC breakpoint (mg/L) S
Benzylpenicillin Ampicillin Ampicillin-sulbactam Amoxicillin Amoxicillin-clavulanate Piperacillin Piperacillin-tazobactam Ticarcillin Ticarcillin-clavulanate Phenoxymethylpenicillin IE IE IE IE IE -
R>
Carbapenems
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) S R<
10 10 10 21 23 21 15 17 15
1 2 2
Monobactams
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) S R<
-
Aztreonam
10
Acinetobacter spp.
Fluoroquinolones MIC breakpoint (mg/L) S
Ciprofloxacin Levofloxacin Moxifloxacin Nalidixic acid (screen) Norfloxacin Ofloxacin 1 1 NA -
R>
1 2 NA -
Aminoglycosides1
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) S R<
1. Aminoglycoside breakpoints are based on once-daily administration of high aminoglycoside dosages. Most often aminoglycosides are given in combination with beta-lactam agents. 30 10 10 10 18 15 15 15 15 15 15 15
8 4 4 4
Tetracyclines
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) S R<
IE IE IE IE
IE IE
11
Acinetobacter spp.
Miscellaneous MIC breakpoint (mg/L) S
Chloramphenicol Colistin Daptomycin Fosfomycin iv Fosfomycin-trometamol (uncomplicated UTI only) Fusidic acid Linezolid Metronidazole Nitrofurantoin (uncomplicated UTI only) Rifampicin Spectinomycin Trimethoprim (uncomplicated UTI only) Trimethoprim-sulfamethoxazole (co-trimoxazole) 1 2 2
R>
2 4
NoteA 13 1. Trimethoprim:sulfamethoxazole in the ratio 1:19. Breakpoints are expressed as the trimethoprim concentration. A. Test by MIC method only.
12
Staphylococcus spp.
Penicillins1 MIC breakpoint (mg/L) S R>
Benzylpenicillin Ampicillin Ampicillin-sulbactam Amoxicillin Amoxicillin-clavulanate Piperacillin Piperacillin-tazobactam Ticarcillin Ticarcillin-clavulanate Phenoxymethylpenicillin Oxacillin2 Cloxacillin Dicloxacillin Flucloxacillin Mecillinam (uncomplicated UTI only)
0.121 Note1 Note1 Note1 Note1 Note1 Note1 Note1 Note1 Note1 Note1,2 Note1 Note1 Note1 -
0.121,2 Note1 Note1 Note1 Note1 Note1 Note1 Note1 Note1 Note1 Note1,2 Note1 Note1 Note1 -
1 unit 2
26A 15A,B NoteA NoteA NoteA NoteA NoteA NoteA NoteA NoteA NoteA NoteA NoteA NoteA -
26A 15A,B NoteA NoteA NoteA NoteA NoteA NoteA NoteA NoteA NoteA NoteA NoteA NoteA -
2. S. aureus and S. lugdunensis with oxacillin MIC values >2 mg/L are mostly methicillin resistant due to the presence of the mecA gene. The corresponding oxacillin MIC for coagulase-negative staphylococci is >0.25 mg/L.
13
Staphylococcus spp.
Cephalosporins1 MIC breakpoint (mg/L) S R>
Cefaclor2 Cefadroxil Cefalexin Cefazolin Cefepime Cefixime Cefotaxime Cefoxitin (screen) S. aureus, S. lugdunensis
3. S. aureus and S. lugdunensis with cefoxitin MIC values >4 mg/L are mostly methicillin resistant due to the presence of the mecA gene whereas MIC for coagulase-negative staphylococi other than S. lugdunensis is a poorer predictor of methicillin resistance than the disk diffusion test.
Cefoxitin (screen) Coagulase-negative staphylococci Cefpodoxime Ceftazidime Ceftibuten Ceftriaxone Cefuroxime Cefuroxime axetil
Note3 Note IE
1
Note3 Note IE
1
30
25A Note IE
A
Carbapenems1
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) S R<
1/A. Susceptibility of staphylococci to carbapenems is inferred from the cefoxitin susceptibility. NoteA NoteA NoteA NoteA NoteA NoteA NoteA NoteA
14
Staphylococcus spp.
Fluoroquinolones1 MIC breakpoint (mg/L) S
Ciprofloxacin2 Levofloxacin Moxifloxacin Nalidixic acid Norfloxacin (screen) 1 1 0.5 NA NA
R>
1 2 1 NA NA
Ofloxacin2
IP
IP
Aminoglycosides1
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) S R<
30 10 10 10 18 18 IP 19 15 18 IP 19 1. Aminoglycoside breakpoints are based on once-daily administration of high aminoglycoside dosages. Most often aminoglycosides are given in combination with beta-lactam agents. 2. Resistance to amikacin is most reliably determined by testing with kanamycin (zone diameter breakpoints under development).
8 1 1 1
Glycopeptides
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) S R<
NoteA NoteA 1. S. aureus with vancomycin MIC values of 2 mg/L are on the border of the wild type MIC distribution and there may be an impaired clinical response. The I/R breakpoint has been reduced to 2 mg/L to avoid reporting "GISA" isolates intermediate as serious infections with "GISA" isolates are not treatable with increased doses of vancomycin or teicoplanin. Glycopeptide MICs are method dependent and should be determined by broth microdilution (reference ISO 20776 ). A. Disk diffusion is unreliable and cannot distinguish between wild type organisms and those with non-vanA -mediated resistance.
21
41 21
41 21
NoteA NoteA
NoteA NoteA
15
Staphylococcus spp.
Macrolides1, lincosamides and streptogramins MIC breakpoint (mg/L) S
Azithromycin1 Clarithromycin1 Erythromycin Roxithromycin Telithromycin Clindamycin2 Quinupristin-dalfopristin
1
R>
Tetracyclines1
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) S R<
NoteA 30 30 15 IPA 22 18 NoteA IPA 19 18 1/A. Staphylococci susceptible to tetracycline are also susceptible to doxycycline and minocycline. Some staphylococci resistant to tetracycline may be susceptible to minocycline and/or doxycycline.
1 0.5 1 0.52
2. Strains with MIC values above the S/I breakpoint are very rare or not yet reported. The identification and antimicrobial susceptibility tests on any such isolate must be repeated and if the result is confirmed the isolate must be sent to a reference laboratory. Until there is evidence regarding clinical response for confirmed isolates with MIC above the current resistant breakpoint they should be reported resistant.
16
Staphylococcus spp.
Miscellaneous MIC breakpoint (mg/L) S
Chloramphenicol Colistin Daptomycin 8 1
R>
8 1
1
18 NoteA 1. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and antimicrobial susceptibility tests on any such isolate must be repeated and if the result is confirmed the isolate must be sent to a reference laboratory. Until there is evidence regarding clinical response for confirmed isolates with MIC above the current resistant breakpoint they should be reported resistant. A. Test by MIC method only.
Fosfomycin iv Fosfomycin-trometamol (uncomplicated UTI only) Fusidic acid Linezolid Metronidazole Nitrofurantoin (uncomplicated UTI only)2 Rifampicin Spectinomycin Trimethoprim (uncomplicated UTI only) Trimethoprim-sulfamethoxazole (co-trimoxazole) 3
32 1 4 64 0.06 2 2
NoteA 22 17 13 25 17 17
NoteA 22 17 13 22 14 14 3. Trimethoprim:sulfamethoxazole in the ratio 1:19. Breakpoints are expressed as the trimethoprim concentration. 2. Breakpoints relate to S. saprophyticus only.
17
Enterococcus spp.
Penicillins1,2 MIC breakpoint (mg/L) S R>
4 4 4 4 Note3 Note3 -
8 8 8 8 Note3 Note3 -
8 NoteA NoteA NoteA NoteA NoteA 3/A. Susceptibility to ampicillin, amoxicillin and pipercillin with and without beta-lactamase inhibitor can be inferred from the ampicillin susceptibility test.
Phenoxymethylpenicillin
Carbapenems
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) S R<
10 21 18 -
4 -
Aminoglycosides
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) S R<
NoteA NoteA 1/A. Aminoglycoside monotherapy is ineffective against enterococci. There is synergism between aminoglycosides and beta-lactams against enterococci without acquired resistance mechanisms. There is no synergistic effect against enterococci with high-level aminoglycoside resistance, i.e with gentamicin MIC >128 mg/L or an inhibition zone diameter <8 mm with a gentamicin 30 g disk.
Amikacin1
Note1 -
Note1 -
30
18
Enterococcus spp.
Glycopeptides MIC breakpoint (mg/L) S
Teicoplanin 21
R>
2
Vancomycin
41
12A
12A
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) S R<
15 22A 20A 1/A. Quinupristin/dalfopristin breakpoints are valid for E. faecium only.
19
Enterococcus spp.
Tetracyclines MIC breakpoint (mg/L) S
Doxycycline Minocycline Tetracycline Tigecycline 0.251
R>
0.5
15
1. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and antimicrobial susceptibility tests on any such isolate must be repeated and if the result is confirmed the isolate must be sent to a reference laboratory. Until there is evidence regarding clinical response for confirmed isolates with MIC above the current resistant breakpoint they should be reported resistant.
Miscellaneous
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) S R<
IE 10 100 19 15 5 1.25-23.75 50 50 IE 19 15 21 21 1. The activity of trimethoprim is uncertain against enterococci, hence the wild type population is categorized as intermediate. 2. Trimethoprim-sulfamethoxazole in the ratio 1:19. Breakpoints are expressed as the trimethoprim concentration.
Chloramphenicol Colistin Daptomycin Fosfomycin iv Fosfomycin-trometamol (uncomplicated UTI only) Fusidic acid Linezolid Metronidazole Nitrofurantoin (uncomplicated UTI only) Rifampicin Spectinomycin Trimethoprim (uncomplicated UTI only)
1
IE 4 64 0.03 0.03
Trimethoprim-sulfamethoxazole (co-trimoxazole) 2
20
R>
0.25
21
R>
NoteA NoteA NoteA NoteA NoteA NoteA NA NoteA NoteA NoteA NoteA NoteA
Note1
1 1
Note1
1 1
NoteA
A A
Carbapenems
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) R< S
NoteA NoteA Note Note
A A
1/A. The beta-lactam susceptibility of beta-haemolytic streptococcus groups A, B, C and G is inferred from the penicillin susceptibility.
22
R>
2 1 NA NA
15 15 NA 12A A. Screen for fluoroquinolone resistance using the norfloxacin disk. Isolates categorized as susceptible can be reported susceptible to levofloxacin and moxifloxacin. Isolates categorized as resistant should be tested for susceptibility to individual agents.
Ofloxacin
Glycopeptides
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) R< S
30 IPA IPA 1. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and antimicrobial susceptibility tests on any such isolate must be repeated and if the result is confirmed the isolate must be sent to a reference laboratory. Until there is evidence regarding clinical response for confirmed isolates with MIC above the current resistant breakpoint they should be reported resistant. A. Zone diameter breakpoints are based on wild type distributions as there are currently no resistant isolates. There are problems in detection of low-level glycopeptide resistance with other organisms, where MIC methods have proved more reliable than disk diffusion.
Teicoplanin
21
Vancomycin
21
IPA
IPA
R>
0.5 0.5 0.5 1 0.5 0.5 -
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) R< S
1/A. Erythromycin can be used to determine susceptibility to azithromycin, clarithromycin and roxithromycin. NoteA NoteA 15 15 2 21 NoteA IP 17B NoteA NoteA 18 NoteA IP 17B 2/B. Inducible clindamycin resistance can be detected only in the presence of a macrolide antibiotic. In disk diffusion tests look for apparent antagonism of clindamycin by erythromycin (D-test).
23
R>
2 1 2 0.5
Miscellaneous agents
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) R< S
30 IP NoteA IP NoteA 1. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and antimicrobial susceptibility tests on any such isolate must be repeated and if the result is confirmed the isolate must be sent to a reference laboratory. Until there is evidence regarding clinical response for confirmed isolates with MIC above the current resistant breakpoint they should be reported resistant. A. Test by MIC method only.
8 11
Fosfomycin iv Fosfomycin-trometamol (uncomplicated UTI only) Fusidic acid Linezolid Metronidazole Nitrofurantoin (uncomplicated UTI only)2 Rifampicin Spectinomycin Trimethoprim (uncomplicated UTI only) Trimethoprim-sulfamethoxazole (co-trimoxazole)
3
IE 2 64 0.06 1
IE 19 15 21 18
IE 16 15 15 15 3. Trimethoprim-sulfamethoxazole in the ratio 1:19. Breakpoints are expressed as the trimethoprim concentration. 2. Nitrofurantoin breakpoints apply to S. agalactiae (Group B streptococci) only.
24
Streptococcus pneumoniae
Penicillins1 MIC breakpoint (mg/L) S R>
Benzylpenicillin2
0.06
1 unit
NoteA
NoteA
2. In pneumonia, when a dose of 1.2 g x 4 is used, isolates with MIC 0.5 mg/L should be regarded as susceptible to benzylpenicillin. In pneumonia, when a dose of 2.4 g x 4 or 1.2 g x 6 is used, isolates with MIC 1 mg/L should be regarded as susceptible to benzylpenicillin. In pneumonia, when a dose of 2.4 g x 6 is used, isolates with MIC 2.0 mg/L should be regarded as susceptible. In meningitis, only isolates with MICs 0.06 mg/L (susceptible by oxacillin disk screen, see note A) should be categorized susceptible to benzylpenicillin, otherwise report resistant. For other indications, use breakpoints of 0.06/2 mg/L for categorization of benzylpenicillin susceptibility. See note A. 3/B. Isolates fully susceptible to benzylpenicillin (MIC0.064 mg/L; susceptible by oxacillin disk screen, see note A) can be reported susceptible to ampicillin, amoxicillin and piperacillin (with or without beta-lactamase inhibitor) without further testing. Otherwise use ampicillin to categorize susceptibility to ampicillin, amoxicillin and piperacillin.
Ampicillin1,3
0.5
28A,B
22A,B
NoteA,B NoteA,B NoteA,B NoteA,B NoteA,B NoteA,C 4/C. Isolates fully susceptible to benzylpenicillin (MIC 0.064 mg/L; susceptible by oxacillin disk screen, see note A) can be reported susceptible to phenoxymethylpenicillin. Otherwise report as phenoxymethylpenicillin resistant without further testing.
NA -
NA -
20A -
20A -
25
Streptococcus pneumoniae
Cephalosporins MIC breakpoint (mg/L) S
Cefaclor Cefadroxil Cefalexin Cefazolin Cefepime Cefixime Cefotaxime 0.03 1 0.51
R>
0.5 2 2
NA 0.5 IE 2 1 0.5 10
Carbapenems
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) S R<
NoteA NoteA 1. Not for meningitis (meropenem is the only carbapenem used for meningitis). 2. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and antimicrobial susceptibility tests on any such isolate must be repeated and if the result is confirmed the isolate must be sent to a reference laboratory. Until there is evidence regarding clinical response for confirmed isolates with MIC above the current resistant breakpoint they should be reported resistant. A. Screen for beta-lactam resistance with the oxacillin 1 g disk. Isolates categorized as susceptible can be reported susceptible to doripenem, ertapenem, imipenem and meropenem. Isolates categorized as oxacillin resistant should be tested by an MIC method.
Doripenem1
12
Ertapenem1 Imipenem
1 3
0.52 2 2
2
0.5 2 2
NoteA NoteA NoteA,B 3. Meropenem is the only carbapenem used for meningitis. Meropenem breakpoints in meningitis are S 0.25 mg/L and R >1 mg/L. B. For use in meningitis determine the meropenem MIC.
26
Streptococcus pneumoniae
Fluoroquinolones1 MIC breakpoint (mg/L) S R>
2 2 0.5 NA NA 4
5 5 5 10 5
2. Wild type S. pneumoniae are not considered susceptible to ciprofloxacin and are therefore categorized as intermediate. 3. The breakpoints for levofloxacin relate to high dose therapy.
4. Wild type S. pneumoniae are not considered susceptible to ofloxacin and are therefore categorized as intermediate.
Glycopeptides
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) S R<
30 5 IP 15A IP 15A 1. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and antimicrobial susceptibility tests on any such isolate must be repeated and if the result is confirmed the isolate must be sent to a reference laboratory. Until there is evidence regarding clinical response for confirmed isolates with MIC above the current resistant breakpoint they should be reported resistant. A. Zone diameter breakpoints are based on wild type distributions as there are currently no resistant isolates. There are problems in detection of low-level glycopeptide resistance with other organisms, where MIC methods have proved more reliable than disk diffusion
Teicoplanin Vancomycin
21 21
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) S R<
NoteA Note 22
A
1/A. Erythromycin can be used to determine susceptibility to azithromycin, clarithromycin and roxithromycin.
NoteA IP 19B -
2/B. Inducible clindamycin resistance can be detected only in the presence of a macrolide antibiotic. In disk diffusion tests look for apparent antagonism of clindamycin by erythromycin (D-test).
27
Streptococcus pneumoniae
Tetracyclines MIC breakpoint (mg/L) S
Doxycycline1 Minocycline1 Tetracycline Tigecycline 1 0.5 1 IE
R>
2 1 2 IE
Miscellaneous agents
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) S R<
30 20 IE IE 10 20 5 22 1.25-23.75 18 20 IE IE 20 17 15 1. Trimethoprim:sulfamethoxazole in the ratio 1:19. Breakpoints are expressed as the trimethoprim concentration.
Chloramphenicol Colistin Daptomycin Fosfomycin iv Fosfomycin-trometamol (uncomplicated UTI only) Fusidic acid Linezolid Metronidazole Nitrofurantoin (uncomplicated UTI only) Rifampicin Spectinomycin Trimethoprim (uncomplicated UTI only) Trimethoprim-sulfamethoxazole (co-trimoxazole)
1
8 IE IE 4 0.06 1
28
Other streptococci
Penicillins1 MIC breakpoint (mg/L) S
Benzylpenicillin Ampicillin Ampicillin-sulbactam Amoxicillin Amoxicillin-clavulanate Piperacillin Piperacillin-tazobactam Ticarcillin Ticarcillin-clavulanate Phenoxymethylpenicillin Oxacillin Cloxacillin Dicloxacillin Flucloxacillin Mecillinam (uncomplicated UTI only) 0.25 0.5 Note1 0.5 Note1 Note Note IE IE IE 1 1
R>
1 unit 2
A. Use the ampicillin disk to categorize susceptibility to ampicillin, amoxicillin and piperacillin (with or without betalactamase inhibitor).
Cephalosporins1
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) S R<
30 30 5 IP 25 23 NA 30 30 27 26 IP 25 23 NA 27 26 -
Cefaclor Cefadroxil Cefalexin Cefazolin Cefepime Cefixime Cefotaxime Cefoxitin Cefpodoxime Ceftazidime Ceftibuten Ceftriaxone Cefuroxime Cefuroxime axetil
29
Other streptococci
Carbapenems MIC breakpoint (mg/L) S
Doripenem 11
R>
1
0.51 21 21
0.5 2 2
10 10 10
22 30 25
22 30 25
Fluoroquinolones
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) S R<
IE IE NA IE IE NA -
IE IE NA -
Glycopeptides
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) S R<
30 16A 16A 1. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and antimicrobial susceptibility tests on any such isolate must be repeated and if the result is confirmed the isolate must be sent to a reference laboratory. Until there is evidence regarding clinical response for confirmed isolates with MIC above the current resistant breakpoint they should be reported resistant. A. Zone diameter breakpoints are based on wild type distributions as there are currently no resistant isolates. There are problems in detection of low-level glycopeptide resistance with other organisms, where MIC methods have proved more reliable than disk diffusion.
Teicoplanin
21
Vancomycin
21
15A
15A
30
Other streptococci
Macrolides, lincosamides and streptogramins MIC breakpoint (mg/L) S
Azithromycin Clarithromycin Erythromycin Roxithromycin Telithromycin Clindamycin1 Quinupristin-dalfopristin IE IE IE IE IE 0.5 IE
R>
IE IE IE IE IE 0.5 IE
Tetracyclines
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) S R<
IE IE
IE
31
Haemophilus influenzae
Penicillins MIC breakpoint (mg/L) S
Benzylpenicillin Ampicillin1,2,3 IE 1
R>
IE 1
1 1 1 Note3 Note IE IE IE
3
1 1 1 Note3 Note IE IE IE
3
10-10 20-10
10
NA
C. Phenoxymethylpenicillin can be used to screen for but not to distinguish between beta-lactamase producing H. influenzae and BLNAR. Check isolates categorized as resistant for beta-lactamase and non-beta-lactamase-mediated resistance to ampicillin and/or cephalosporins. See "Cephalosporins, note A".
Cephalosporins
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) S R<
30 NA 15A 1. MIC breakpoints render all H.influenzae resistant for cefaclor. A. The disk diffusion test can be used to screen for BLNAR. Isolates with zone diamaters <15 mm should be checked for ampicillin and cephalosporin resistance.
Cefaclor
0.51
0.252
0.25 30
25
25 2. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and antimicrobial susceptibility tests on any such isolate must be repeated and if the result is confirmed the isolate must be sent to a reference laboratory. Until there is evidence regarding clinical response for confirmed isolates with MIC above the current resistant breakpoint they should be reported resistant.
0.122 0.12 NA
2
5 5 30 30 30 30
22 22 NA 24 24 27 25
22 22 NA 21 24 27 22
0.252 12 0.122 1
32
Haemophilus influenzae
Cefuroxime axetil 0.12 1 30 50 25
Carbapenems
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) S R<
10 20 20 1. Not for meningitis (meropenem is the only carbapenem used for meningitis). 2. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and antimicrobial susceptibility tests on any such isolate must be repeated and if the result is confirmed the isolate must be sent to a reference laboratory. Until there is evidence regarding clinical response for confirmed isolates with MIC above the current resistant breakpoint they should be reported resistant.
Doripenem1
12
Ertapenem1 Imipenem
1
0.52 22 22
0.5 2 2
10 10 10
20 16 20A
20 16 20A 3. Meropenem is the only carbapenem used for meningitis. Meropenem breakpoints in meningitis are S 0.25 mg/L, R >1 mg/L. A. For use in meningitis determine the meropenem MIC value.
Monobactams
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) S R<
IE IE
Aztreonam
IE
Fluoroquinolones1,2
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) S R<
5 23 23 1. Low-level fluoroquinolone resistance (ciprofloxacin MICs of 0.12-0.5 mg/L) may occur but there is no evidence that this resistance is of clinical importance in respiratory tract infections with H. influenzae . 2. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and antimicrobial susceptibility tests on any such isolate must be repeated and if the result is confirmed the isolate must be sent to a reference laboratory. Until there is evidence regarding clinical response for confirmed isolates with MIC above the current resistant breakpoint they should be reported resistant.
Ciprofloxacin
0.52
12 0.52 NA
1 0.5 NA
5 5 30
21 23 23A
21 23 23A A. Screen for fluoroquinolone resistance. Isolates with zone diameters 23 mm can be reported susceptible to levofloxacin, ciprofloxacin, moxifloxacin and ofloxacin. Isolates with zone diameters <23 mm may have fluoroquinolone resistance and should be tested against the appropriate agent.
Norfloxacin Ofloxacin
0.52
0.5
21
21
33
Haemophilus influenzae
Aminoglycosides MIC breakpoint (mg/L) S
Amikacin Gentamicin Netilmicin Tobramycin IE IE IE IE
R>
IE IE IE IE
R>
4 32 16 16 8 -
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) S R<
1/A. Erythromycin can be used to determine susceptibility to azithromycin, clarithromycin and roxithromycin. Note
A
Note
2. Correlation between macrolide MICs and clinical outcome is weak for H. influenzae . Therefore, breakpoints for macrolides and related antibiotics have been set to categorize wild type H. influenzae as intermediate.
15 15
NoteA 50 NoteA IP -
NoteA 12 NoteA IP -
Tetracyclines1
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) S R<
NoteA 30 30 IPA 24 IE NoteA IPA 21 IE 1/A. Isolates susceptible to tetracycline are also susceptible to doxycycline and minocycline, but some resistant to tetracycline may be susceptible to minocycline and/or doxycycline.
1 1 1 IE
34
Haemophilus influenzae
Miscellaneous agents MIC breakpoint (mg/L) S
Chloramphenicol Colistin Daptomycin Fosfomycin iv Fosfomycin-trometamol (uncomplicated UTI only) Fusidic acid Linezolid Metronidazole Nitrofurantoin (uncomplicated UTI only) Rifampicin Spectinomycin Trimethoprim (uncomplicated UTI only) Trimethoprim-sulfamethoxazole (co-trimoxazole) 1 1 IE 0.5 0.5
R>
2 IE 0.5 1
35
Moraxella catarrhalis
Penicillins MIC breakpoint (mg/L) S
Benzylpenicillin Ampicillin1 1
R>
1
1 1 1 IP IP IE IE -
1 1 1 IP IP IE IE -
IPB IPA IP
B
IPA IP IE IE B
Cephalosporins
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) S R<
30 IP 30 IP IP IP 1. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and antimicrobial susceptibility tests on any such isolate must be repeated and if the result is confirmed the isolate must be sent to a reference laboratory. Until there is evidence regarding clinical response for confirmed isolates with MIC above the current resistant breakpoint they should be reported resistant.
0.5 0.251
Cefixime Cefotaxime Cefoxitin Cefpodoxime Ceftazidime Ceftibuten Ceftriaxone Cefuroxime Cefuroxime axetil
1 2 NA 0.5 1 2 2 2
5 5 30 30 30 30 30
IP IP NA IP IP IP IP IP
IP IP NA IP IP IP IP IP
36
Moraxella catarrhalis
Carbapenems MIC breakpoint (mg/L) S
Doripenem 11
R>
1
0.51 21 21
0.5 2 2
10 10 10
IP IP IP
IP IP IP
Monobactams
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) S R<
IE IE
Aztreonam
IE
Fluoroquinolones1
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) S R<
1. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and antimicrobial susceptibility tests on any such isolate must be repeated and if the result is confirmed the isolate must be sent to a reference laboratory. Until there is evidence regarding clinical response for confirmed isolates with MIC above the current resistant breakpoint they should be reported resistant.
5 5 5
23 IP IP NA IP
23 IP IP NA IP
Aminoglycosides
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) S R<
IE IE IE IE IE IE IE IE
IE IE IE IE
37
Moraxella catarrhalis
Macrolides1, lincosamides and streptogramins MIC breakpoint (mg/L) S
Azithromycin1 Clarithromycin1 Erythromycin Roxithromycin Telithromycin
1
R>
Clindamycin Quinupristin-dalfopristin
Tetracyclines
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) S R<
NoteA 30 30 IPA 28 IE NoteA IPA 25 IE 1/A. Isolates susceptible to tetracycline are also susceptible to doxycycline and minocycline, but some resistant to tetracycline may be susceptible to minocycline and/or doxycycline.
1 1 1 IE
Miscellaneous agents
Disk Zone diameter Notes content breakpoint (mm) Numbers for comments on MIC breakpoints Letters for comments on disk diffusion (g) S R<
30 IP IE 5 IP 1.25-23.75 18 IP IE IP 15 1. Trimethoprim:sulfamethoxazole in the ratio 1:19. Breakpoints are expressed as the trimethoprim concentration.
Chloramphenicol Colistin Daptomycin Fosfomycin iv Fosfomycin-trometamol (uncomplicated UTI only) Fusidic acid Linezolid Metronidazole Nitrofurantoin (uncomplicated UTI only) Rifampicin Spectinomycin Trimethoprim (uncomplicated UTI only) Trimethoprim-sulfamethoxazole (co-trimoxazole)
1
1 IE 0.5 0.5
38
Disk diffusion criteria for antimicrobial susceptibility testing of Neisseria gonorrhoeae have not yet been determined.
Neisseria gonorrhoeae
Penicillins1
Benzylpenicillin Ampicillin1 Ampicillin-sulbactam Amoxicillin1 Amoxicillin-clavulanate Piperacillin Piperacillin-tazobactam Ticarcillin Ticarcillin-clavulanate Phenoxymethylpenicillin
Cephalosporins
MIC breakpoint Notes Numbers for comments on MIC breakpoints (mg/L) Letters for comments on disk diffusion R> S
0.12 0.12 1. Neisseria gonorrhoeae without resistance mechanisms to cefixime have MICs of 0.06 mg/L and can be treated with current standard dosing. The implications of alternative dosing schedules and recent data relating MIC to outcome are under consideration.
0.12 IE IE 0.12 -
0.12 IE IE 0.12 -
39
Neisseria gonorrhoeae
Carbapenems
Monobactams
MIC breakpoint Notes Numbers for comments on MIC breakpoints (mg/L) Letters for comments on disk diffusion R> S
IE IE
Aztreonam
Fluoroquinolones1
MIC breakpoint Notes Numbers for comments on MIC breakpoints (mg/L) Letters for comments on disk diffusion R> S
0.03 IE IE NA IE 0.12 0.06 IE IE NA IE 0.25
MIC breakpoint Notes Numbers for comments on MIC breakpoints (mg/L) Letters for comments on disk diffusion R> S
0.25 0.5 -
40
Neisseria gonorrhoeae
Tetracyclines1
Miscellaneous agents
MIC breakpoint Notes Numbers for comments on MIC breakpoints (mg/L) Letters for comments on disk diffusion R> S
64 64 -
Chloramphenicol Colistin Daptomycin Fosfomycin iv Fosfomycin-trometamol (uncomplicated UTI only) Fusidic acid Linezolid Metronidazole Nitrofurantoin (uncomplicated UTI only) Rifampicin Spectinomycin Trimethoprim (uncomplicated UTI only) Trimethoprim-sulfamethoxazole (co-trimoxazole)
41
Disk diffusion criteria for antimicrobial susceptibility testing of Neisseria meningitidis have not yet been determined.
Neisseria meningitidis
Penicillins
Benzylpenicillin Ampicillin Ampicillin-sulbactam Amoxicillin Amoxicillin-clavulanate Piperacillin Piperacillin-tazobactam Ticarcillin Ticarcillin-clavulanate Phenoxymethylpenicillin
Cephalosporins
MIC breakpoint Notes Numbers for comments on MIC breakpoints (mg/L) Letters for comments on disk diffusion R> S
0.121 0.12
1. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and antimicrobial susceptibility tests on any such isolate must be repeated and if the result is confirmed the isolate sent to a reference laboratory. Until there is evidence regarding clinical response for confirmed isolates with MIC above the current resistant breakpoint they should be reported resistant.
Cefoxitin Cefpodoxime Ceftazidime Ceftibuten Ceftriaxone Cefuroxime Cefuroxime axetil 0.121 0.12 -
42
Neisseria meningitidis
Carbapenems
Fluoroquinolones
MIC breakpoint Notes Numbers for comments on MIC breakpoints (mg/L) Letters for comments on disk diffusion R> S
0.031 IE IE NA IE 0.061 IE IE NA IE 1. Breakpoints apply only to use in the prophylaxis of meningococcal disease.
Tetracyclines
MIC breakpoint Notes Numbers for comments on MIC breakpoints (mg/L) Letters for comments on disk diffusion R> S
1 1 IE 2 2 IE 1. Tetracycline can be used to predict susceptibility to minocycline for prophylaxis against N. meningitidis infections.
Doxycycline Minocycline
1
Tetracycline Tigecycline
43
Neisseria meningitidis
Miscellaneous agents
Chloramphenicol Colistin Daptomycin Fosfomycin iv Fosfomycin-trometamol (uncomplicated UTI only) Fusidic acid Linezolid Metronidazole Nitrofurantoin (uncomplicated UTI only) Rifampicin Spectinomycin Trimethoprim (uncomplicated UTI only) Trimethoprim-sulfamethoxazole (co-trimoxazole)
44
Disk diffusion criteria for antimicrobial susceptibility testing of anaerobes have not yet been determined.
Gram-positive anaerobes
Penicillins
Benzylpenicillin1 Ampicillin Ampicillin-sulbactam Amoxicillin Amoxicillin-clavulanate Piperacillin Piperacillin-tazobactam Ticarcillin Ticarcillin-clavulanate Phenoxymethylpenicillin
Carbapenems
MIC breakpoint Notes Numbers for comments on MIC breakpoints (mg/L) Letters for comments on disk diffusion R> S
1 1 2 2 1 1 8 8
Fluoroquinolones
MIC breakpoint Notes Numbers for comments on MIC breakpoints (mg/L) Letters for comments on disk diffusion R> S
IE NA IE NA -
45
Gram-positive anaerobes
Glycopeptides
Teicoplanin Vancomycin
MIC breakpoint Notes Numbers for comments on MIC breakpoints (mg/L) Letters for comments on disk diffusion R> S
IE 4 IE 4 -
Tetracyclines1
MIC breakpoint Notes Numbers for comments on MIC breakpoints (mg/L) Letters for comments on disk diffusion R> S
1. For anaerobic bacteria there is clinical evidence of activity in mixed intra-abdominal infections, but no correlation between MIC values, Pk/Pd data and clinical outcome. Therefore no breakpoints for susceptibility testing are given.
46
Gram-positive anaerobes
Miscellaneous agents
Chloramphenicol Colistin Daptomycin Fosfomycin iv Fosfomycin-trometamol (uncomplicated UTI only) Fusidic acid Linezolid Metronidazole Nitrofurantoin (uncomplicated UTI only) Rifampicin Spectinomycin Trimethoprim (uncomplicated UTI only) Trimethoprim-sulfamethoxazole (co-trimoxazole)
47
Disk diffusion criteria for antimicrobial susceptibility testing of anaerobes have not yet been determined.
Gram-negative anaerobes
Penicillins
4 0.5 4 16 8 16 8 IE
Ticarcillin-clavulanate1 Phenoxymethylpenicillin
Carbapenems
MIC breakpoint Notes Numbers for comments on MIC breakpoints (mg/L) Letters for comments on disk diffusion R> S
1 1 2 2 1 1 8 8
Monobactams
MIC breakpoint Notes Numbers for comments on MIC breakpoints (mg/L) Letters for comments on disk diffusion R> S
-
Aztreonam
48
Gram-negative anaerobes
Fluoroquinolones
MIC breakpoint Notes Numbers for comments on MIC breakpoints (mg/L) Letters for comments on disk diffusion R> S
IE IE
4 -
4 -
Tetracyclines1
MIC breakpoint Notes Numbers for comments on MIC breakpoints (mg/L) Letters for comments on disk diffusion R> S
1. For anaerobic bacteria there is clinical evidence of activity in mixed intra-abdominal infections, but no correlation between MIC values, Pk/Pd data and clinical outcome. Therefore no breakpoints for susceptibility testing are given.
49
Gram-negative anaerobes
Miscellaneous agents
Chloramphenicol Colistin Daptomycin Fosfomycin iv Fosfomycin-trometamol (uncomplicated UTI only) Fusidic acid Linezolid Metronidazole Nitrofurantoin (uncomplicated UTI only) Rifampicin Spectinomycin Trimethoprim (uncomplicated UTI only) Trimethoprim-sulfamethoxazole (co-trimoxazole)
50
Cephalosporins
Cefaclor Cefadroxil Cefalexin Cefazolin Cefepime Cefixime Cefotaxime Cefoxitin Cefpodoxime Ceftazidime Ceftibuten Ceftriaxone Cefuroxime Cefuroxime axetil
51
Monobactams
Aztreonam
Fluoroquinolones
Ciprofloxacin Levofloxacin Moxifloxacin Nalidixic acid Norfloxacin Ofloxacin
Aminoglycosides
Amikacin Gentamicin Netilmicin Tobramycin
Glycopeptides
Teicoplanin Vancomycin
52
Tetracyclines
Doxycycline Minocycline Tetracycline Tigecycline
Miscellaneous
Chloramphenicol Colistin Daptomycin Fosfomycin iv Fosfomycin-trometamol (uncomplicated UTI only) Fusidic acid Linezolid Metronidazole Nitrofurantoin (uncomplicated UTI only) Rifampicin Spectinomycin Trimethoprim (uncomplicated UTI only) Trimethoprim-sulfamethoxazole (co-trimoxazole)
53