M100-S21

Qui trnh thao tc chun v th nghim tnh nhy cm khng sinh

Tiu chun c kt qu khng sinh v MIC
Phin bn cp nht ln th 21 (Nm 2011)

Ngi dch : 1. ThS. DS. Th Thu Nga, OUCRU Ngy ___/___/___

Ngi sa : 1. PGS.TS. Phm Vn Ca, NHTD Ngy ___/___/___

2. BS. T Song Dip, HTD Ngy ___/___/___
3. ThS. DS. Ng Th Bch H, MoH Ngy ___/___/___
4. TS. on Mai Phng, BV Bch Mai Ngy ___/___/___
5. PGS.TS. Nguyn V Trung, NHTD Ngy ___/___/___
6. TS. Heiman Wertheim, OUCRU Ngy ___/___/___

Ngi ph duyt : TS. Nguyn Vn Knh Ngy ___/___/___

Gim c-NHTD
Ch tch GARP-Vit Nam
 M100-S21
Vin Tiu chun Lm sng v Xt nghim
Cht lng vt tri trong th nghim chm sc sc khe
Vin Tiu chun Lm sng v Xt ngim (CLSI tn c NCCLS) l mt t chc quc t, a ngnh, phi li nhun, chuyn pht trin cc tiu chun, v gio
dc. Vin thc y s pht trin v s dng nhng tiu chun v hng dn trong vic to s ng thun t nguyn trong lnh vc chm sc sc khe. Vin
c c th gii cng nhn v s p dng cc quy trnh c nht to s ng thun trong vic pht trin cc tiu chun v hng dn cho cc th nghim
trn bnh nhn v nhng vn lin quan ti chm sc sc khe. Cc quy trnh ca vin da trn nguyn l m qu trnh to s ng thun l qu trnh hiu
qu v c gi thnh tt cng c cc th nghim trn bnh nhn v chm sc sc khe.

Xut Bn

Ti liu ny c xut bn nh l mt tiu chun, hng dn, hoc bo co

Tiu chun Ti liu ny c pht trin thng qua qu trnh to s ng thun. Qu trnh ny ng nht ha mt cch r rng nhng yu cu cn thit v
c bit cho nguyn vt liu, phng php v s thc hnh cho vic s dng nhng quy trnh khng th thay i.
Hng dn Ti liu ny c pht trin thng qua qu trnh to s ng thun. Qu trnh ny m t chi tit cc yu cu cho s thc hnh chung, quy trnh,
hoc cc vt liu s dng khng bt buc. Hng dn ny c th c s dng nh dng c son tho ra hay c th thay i bi ngi s dng cho ph
hp vi nhng mc ch cn thit c bit.
Bo co Ti liu ny khng phi bnh duyt li qu trnh to s ng thun v c xut bn bi Hi ng y Tr.

Qu Trnh To S ng Thun

Qu trnh to s ng thun t nguyn ca CLSI l mt quy trnh thit lp nhng yu cu chnh thng cho:
Quyn ca d n
S pht trin v bnh duyt ti liu c tnh cht m
S sa cha ti liu l s p ng li vi nhng phn hi t ngi s dng
S chp thun ti liu l mt quy trnh to s ng thun chun hoc hng dn chun
 M100-S21
Mi ti liu c thit k bao gm hai mc to s ng thun trnh v ph duyt. Da vo yu cu cho tng lnh vc nh gi hoc qu trnh thu
thp d liu. Ti liu c th c son tho mc to s ng thun trung gian
trnh Giai on u ca qu trnh ng thun ti liu l thc thi qu trnh bnh duyt bi cng ng cc nh nghin cu trong lnh vc chm sc sc
khe. Qu trnh ny nh l mt tiu chun hay hng dn ang trong qu trnh trnh. Ti liu phi tip thu ton b nhng bnh xt chuyn mn bao gm
s bnh xt bao qut v mc ch, cch tip cn, v li ch cng nh nhng bnh xt t m tng ni dung chuyn mn v nh dng vn bn.
Chp thun Mt tiu chun hoc hng dn mun c chp thun phi thu c s ng thun trong cng ng cc nh nghin cu trong lnh vc chm
sc sc khe. Qu trnh ny phi c sot xt nh gi li ch ca ti liu cui cng v bo m s ng thun t c (nhng ch gii trong ti liu
mi nht phi tha mn nhng mc tiu t ra) v xc nh s cn thit cho s ng thun ti liu b sung.
Tiu chun v hng dn ny ca chng ti i din cho mt quan im ng thun cho nhng s thc hnh tt v phn nh s tn thnh cn thit t nhng
nh hng v mt vt cht, kh nng thc thi v quyn li ca bnh nhn thu c t nhng quy trnh to s ng thun c xc nh ca CLSI. Nhng
iu khon trong tiu chun v hng dn ca CLSI c th nghim ngt hn hoc km nghim ngt hn cc quy nh trong cc vn bn lut php. Do , s
chp hnh theo ti liu c ng thun mt cch t nguyn khng da vo trch nhim t nguyn ca ngi dung nh i vi cc vn bn ni quy.

Phn Hi

Nhng phn hi t ngi s dng l v cng cn thit cho qu trnh to s ng thun. Bt k ai mun phn hi xin r a ch theo nh quy trnh to s
ng thun c t ra bi Hi ng c vit trong ti liu ny. Bt c phn hi no, bao gm c nhng phn hi ng gp vo s thay i ca vn bn
trong n phm k tip hoc nhng phn hi khng to ra s thay i cho ti liu xin r a ch nh trong phn ph lc ca ti liu. Chung ti nhit lit
khuyn khch ngi c gi phn hi v bt c phn no ca ti liu bt c phin bn no. a ch phn hi: Clinical Laboratory Standards Instittute, 940
West Valley Road, Suite 1400, Wayne, PA 19087, USA

Tham Gia Tnh Nguyn

CLSI hi thc cc chuyn gia trong lnh vc chm sc sc khe mi chuyn khoa tham gia tnh nguyn vo d n ca chng ti. Xin hy lin lc vi
chng ti qua a ch customerservice@clsi.org hoc s in thoi +610.688.0100 c thm nhng thng tin t y ban.
 M100-S21
Qui trnh thao tc chun v th nghim tnh nhy cm khng sinh; Phin bn cp nht ln th 21

M u

Nhng thng tin trong ti liu ny nhm mc ch b sung cho nhng quy trnh chun v xc nh tnh nhy cm vi khng sinh c cng b trong nhng
ti liu trc ca CLSI nh: M02-A10-Quy Trnh Chun cho Th Nghim Xc nh Tnh Nhy Cm Khng Sinh bng Phng php Khoanh Giy
Khuch tn; v M07-A8- Xc nh Tinh Nhy Cm Khng Sinh bng Phng Php Pha Long i vi cc Vi Khun Hiu Kh. Tiu chun ny mang nhng
thng tin v quy trnh chun cho th nghim bng c phng php khoanh giy v pha long cho cc vi khun hiu kh.

Thng tin t cc Labo Vi sinh Lm sng cc k quan trng vi cc Bc s Lm sng trong vic iu tr cc bnh nhn nng. Kt qu ca th nghim tinh
nhy cm khng sinh c gi tr lm sng khi th nghim c thc hin di iu kin ti u nht v Labo c kh nng cung cp nhng thng tin
v nhng nhm khng sinh mi nht.

Nhng thng tin dng bng trong ti liu ny th hin nhng thng tin mi nht trong quy trnh chun v la chn khng sinh, din gii kt qu khng sinh
v m bo cht lng xt nghim trong M02 v M07. Ngi s dng phi thay th nhng bng c bng nhng bng mi ny. Nhng s thay i ny
c th hin bng in m.

Vin Tiu chn Lm sng v Xt nghim. Qui Trnh Thao Tc Chun v Th Nghim Tnh Nhy Cm Khng Sinh; Phin bn cp nht ln th 21. Ti liu
ca CLSI M100-S21 (ISSBN 1-56238-742-1). Vin Tiu chun Lm sng v Xt nghim, 940 West Valley, Suite 1400, Wayne, Pennsylvania 19087 Hoa
K, 2011
Nhng thng tin c din gii di dng bng trong ti liu ny ch c gi tr khi quy trnh c thc hin theo ng nh ti liu M02-A10 Quy
Trnh Chun cho Th Nghim Xc nh Tnh Nhy Cm Khng Sinh bng Khoanh Giy; Tiu Chun c Chp Thun-Phin Bn Ln Th
Mi v M07-A08 Phng Php Xc nh Tinh Nhy Cm Khng Sinh bng Pha Long vi Vi Khun Hiu Kh; Tiu Chun c Chp
Thun-Phin Bn Ln Th Tm.
 M100-S21
Tm tt quy trnh ca CLSI cho vic xc nh tiu chun din gii v nhng khong cho php ca qun l cht lng xt nghim
Vin Tiu chun Lm sng v Xt ngim (CLSI tn c NCCLS) l mt t chc quc t, a ngnh, phi li nhun, chuyn pht trin cc tiu chun, v c
chc nng gio dc. Vin c chng nhn bi Vin cc Tiu chun Quc gia Hoa K (American National Standards Institute). Vin thc y v pht trin
vic s dng nhng tiu chun v hng dn c ng thun trong lnh vc chm sc sc khe. Nhng tiu chun v hng dn c ng thun
c pht trin nhm vo nhng lnh vc quan trng ca cc th nghim chun on v chm sc sc khe, v c pht trin bi mt quy trnh to s
ng thun m cng vi s tho lun. CLSI cu th mi c nhn v t chc quan tm ti lnh vc th nghim chun on v chm sc bnh nhn. Nhng
thng tin v CLSI c th c tm thy ti www.clsi.org.
y ban v th nghim tnh nhy cm khng sinh (Khng sinh ) ca CLSI tin hnh sot xt d liu t rt nhiu nghin cu v cc ngun khc nhau (v d,
nghin cu in vitro, nghin cu dc ng hc, nghin cu lm sng) xc nh nhng phng php khng sinh , tiu chun din gii kt qu, v cc
tham s cho qun l cht lng (QC). Nhng yu cu i vi cc d liu cho vic xc lp tiu chun din gii kt qu, cc d liu cho cc tham s ca QC,
quy trnh ca vic cn nhc, nh gi cc d liu c trnh by trong ti liu CLSI-M23- Pht trin cc Tiu chun cho Th nghim Nhy cm Khng
sinh v cc Tham s cho Kim sot Cht lng (Development of In Vitro Susceptibility Testing Criteria and Quality Control Parameters).
Mc nhy cm ca vi khun vi khng sinh ngy cng suy gim, gy ln tnh trng khng hiu qu v/hoc thiu an ton cho lm sng. Cc phng php
khng sinh v cc tham s QC cn phi c iu chnh m bo chnh xc hn, d dng thc hin hn. Chnh v nhng l do trn, CLSI lin tc gim
st v cp nht thng tin co cc ti liu ca Vin. Mc d, cc tiu chun v hng dn ca CLSI c pht trin da trn nhng thng tin mi nht, nhng
kin thc ph hp vi thi im hin hnh. Nhng vi nhng thay i lin tc trong lnh vc Khoa hc v Y-Sinh hc, nhng hng dn v tiu chun ny
phi c p dng mt cch hi ha vi nhng iu chnh lm sng, sao cho, mi kt qu xt nghim phi ph hp v c gi tr trong vic iu tr bnh
nhn ca tng trung tm.
Nhng thng tin b sung, cp nht v cc thay i trong ti liu ny c tm thy ti phn ring ca y ban Th nghim Nhy cm Khng sinh theo s
sau: trang nh www.clsi.org -> Committees -> Microbiology -> S/C Antimicrobial Susceptibility Testing.
 M100-S21
Tuyn b v Nhim v ca y ban Th nghim Nhy cm Khng sinh
y ban v th nghim nhy cm khng sinh c thnh lp bao gm cc i din t chuyn gia, chnh ph, v cng nghim, bao gm phng xt nghim vi
sinh, c quan chnh ph, cung cp dch v chm sc sc khe v gio dc, dc phm v cng nghim chn on vi sinh. Bng quy trnh to s ng thun
t nguyn ca CLSI, y ban pht trin nhng tiu chun m thc y s chnh xc trung th nghim khng sinh v s ph hp trong bo co kt qu
khng sinh .
Nhim v ca y ban Th nghim Nhy cm Khng sinh l:
Pht trin cc phng php tham chiu chun cho cc th nghim nhy cm khng sinh.

Cung cp cc tham s QC cho cc phng php th nghim chun.

Xc nh tiu chun din gii kt qu cho cc th nghim nhy cm khng sinh chun.

Cung cp nhng gi v chin lc th nghim v bo co m c gi tr lm sng v hiu qu kinh t.

Lin tc iu chnh cc tiu chun v ti u ha s pht hin cc c ch khng mi ni t pht trin hoc ci tin cc phng php, tiu chun
din gii kt qu, v tham s cho QC.

Tuyn truyn cho ngi s dng cc tiu chun v hng dn thng qua cc knh truyn thng a phng tin.

Khuyn khch s trao i vi ngi s dng v cc phng php.

Mc tiu thc tin cho nhim v ca y ban l cung cp nhng thng tin hu dng cc phng xt nghim c th h tr lm sng trong vic la chn liu
php khng sinh ph hp iu tr bnh nhn. Nhng tiu chun v hng dn c ngha l cha ng y cc thng tin tng minh ca tt c cc khng
sinh v phi tha mn cc tiu chun c ra bi CLSI. Gi tr dn ng cho nhim v ca y ban l cht lng, chnh xc, tng minh, thi gian,
hp tc, ng thun, ang tin cy.
 M100-S21
I. La chn khng sinh cho th nghim v bo co
A. Vic la chn cc loi khng sinh ph hp nht cho th nghim v bo co l quyt nh do cc phng xt nghim vi sinh lm sng kt hp tho
lun vi Bc s chuyn khoa Truyn nhim v khoa Dc, cng nh vi Hi ng Thuc v iu tr v Khoa Chng nhim khun ca bnh vin.
Nhng khuyn co trong ti liu ny vi tng nhm vi khun cng vi cc khng sinh c chng minh hiu qu bng cc k thut in vitro. Qu
trnh cn nhc nh gi cho tng nhm khng sinh th nghim/bo co da trn hiu qu lm sng, tnh trng khng khng sinh, gim thiu nguy
c khng khng sinh, gi thnh, nhng ch dn s dng lm sng ca FDA, v nhng khuyn co chung mi nht v nhm khng sinh u tin v cc
nhm khng sinh thay th. S khng thuc bt thng phi c bo co (v d Enterobacteriaceae khng vi carbapenems). Th nghim i vi
cc loi thuc khng sinh chn lc c th s dng cho mc ch chng nhim khun.
B. Cc khng sinh xp trong cng mt ch chng cng mt nhm khng sinh do gii thch kt qu (nhy cm, trung gian, khng) v hiu qu
trn lm sng tng t.. Trong mi , hoc gia cc khng sinh thuc cng mt nhm khng sinh, ch kh nng khng cho hoc nhy cho gn
nh l hon ton. C ngha l cc li ln khng qu 3% v cc li nh khng qa 10% tng s th nghim. Ngoi ra, khi khng nh rng t nht 100
chng khng li hoc vi nhm khng sinh c th nghim th kt qu l khng ch c th rt ra khi c trn 95% chng khng vi tt c cc
khng sinh c th nghim. Ch hoc cu trn cn c th dng trong trng trng hp cng th nghim vi cc chng trn nhng kt qu thu
c l nhy v kt qu din gii l nhy cm (v d cefotaxime hoc ceftriaxone vi Haemophilis influenzae). C th da trn kt qa th nghim
i vi mt khng sinh suy ra kt qu i vi khng sinh cn li (v d, h vi khun ng rut (Enterobacteriaceae) khng sinh ESBL nhy cm
vi cefotaxime c th suy ra cng nhy cm vi ceftriaxone). Do , kt qu thu c t th nghim vi cefotaxime c th c bo co cng vi
ch thch i km trong bo co rng vi khun cng nhy cm vi ceftriaxone. Vi cc khng sinh khng thuc cng mt nhm hoc khng thuc
cng mt , th nghim ca mt khng sinh khng th dng d on kt qu cho cc khng sinh khc lin quan, cn thc hin nhng th nghim
ring r hoc thu thp thng tin.

C. Th nghim/Bo co theo nhm

1. Trong bng 1A, 1B v 1C, cc khng sinh Nhm A l la chn thch hp cho c th nghim thng qui, cc khng sinh u tin ln bo co thng
qui cc kt qu i vi mt s vi khun c th thng gp.
 M100-S21
2. Nhm B gm cc khng sinh gip cng c th nghim u tin. Tuy nhin bo co cc kt qu mt cch chn lc v d nh vi khun khng cc
khng sinh trong nhm A. Ch dn khc cho vic bo co kt qu c th bao gm cc loi bnh phm c bit (v d cephalosporin th h 3 dng cho
trc khun gy bnh ng rut phn lp t dch no tu hoc trimethoprim-sulfamethoxazole dng cho cc vi khun phn lp t nc tiu), a
nhim, nhim nhiu v tr, cc trng hp bnh nhn b d ng thuc, khng dung np thuc, khng p ng vi cc khng sinh trong nhm A hoc
dng cho mc ch chng nhim khun.
3. Nhm C bao gm cc khng sinh thay th hoc b sung. Nhng khng sinh ny i hi phi th nghim nhng bnh vin cha cc cn nguyn vi
khun khng li nhiu loi khng sinh hng u (c bit l cng nhm, v d cc khng sinh nhm -lactam hoc nhm aminoglycoside), hoc dng
trong iu tr i vi cc bnh nhn c tin s khng mt s thuc thuc nhm u tin, hoc iu tr cc vi khun bt thng (v d, cloramphenicol
iu tr Salmonella spp., phn lp ngoi rut hoc mt s chng khng vancomycin) hoc bo co Khoa Chng nhim khun nh mt bin php
h tr v mt dch t hc.
4. Nhm U (Urine-nc tiu) bao gm mt s loi khng sinh nht nh (v d nitrofurantoin v cc quinolone) thng ch dng trong iu tr
nhim trng tit niu Nhng khng sinh ny khng c php bo co thng qui vi cc cn nguyn vi khun phn lp c t ngoi ng tit
niu c kh nng cha tr. Cc khng sinh ph rng c th c cho vo nhm U trong iu tr cc tc nhn gy vim ng tit niu (v d,
Pseudomonas aeruginosa v ofloxacin).
5. Nhm O (Other-khc) gm cc khng sinh c ch nh lm sng i vi mt nhm vi khun, nhng thng khng phi l la chn cho th
nghim cng nh bo co thng qui Hoa K.
6. Nhm Inv (Investigational-nghin cu) gm cc khng sinh ang trong qu trnh nghin cu, cha c FDA thng qua s dng Hoa K.

D. Bo co chn lc
Mi phng th nghim phi quyt nh la chn khng sinh no trong cc bng cho bo co thng qui (nhm A), v khng sinh no ch c la
chn cho bo co chn lc (nhm B), ng thi nn tham kho kin t vn ca cc nh lm sng, cc dc s, Khoa chng nhim khun, Hi ng
thuc v iu tr cng Khoa dc ca bnh vin. Cc bo co cn em li nhng gi tr v hiu qu trn lm sng ng thi h tr gim thiu c
s pht trin ca cc chng thuc vi h bnh thng a khng thuc do s lm dng khng sinh ph rng. Kt qu bo co vi cc khng sinh trong
 M100-S21
nhm B khng c trong bo co thng qui nhng lun cn c sn trong trng hp cn thit i vi mt s bnh phm. Cn bo co khi pht hin
s khng thuc mi (v d, vi khun khng khng sinh thay th mc d vi khun ny nhy cm vi khng sinh u tin-hng u).

II. Kt qu bo co
Cc gi tr MIC (nng c th ca MIC) nh c m t trong bng M07-A8 c th c bo co trc tip cho bc s lm sng nhm phc v
cng tc chm sc sc kho. Tuy nhin bc s lm sng cng cn phi hiu cc kt qu ny. Do cc Bc s lm sng cn c cung cp nhng
thng tin v s din gi kt qu khng sinh mt cch u n. Tiu chun c kt qu v nh gi gi tr MIC i vi tng nhm vi khun c
gii thiu trong ti liu CLSI-M23.
Cc tiu chun c kt qu v nh gi gi tr MIC v khoanh giy khuch tn c da trn liu dng v ng dng thng thng M.
A. Din gii kt qu khng sinh nhy cm, trung gian v khng c bo co v nh ngha nh sau:
1. Nhy cm (S)
Kt qu l nhy cm khi vi khun b c ch bi nng thng thng t c ca mt khng sinh no khi dng vi liu c ch nh iu tr
nhim trng.
2. Trung gian (I)
Khng trung gian (Intermediate) l kiu khng trong vi nhng nng c ch ti thiu ca mt khng sinh thng t c trong mu v t
chc cho p ng thp hn so vi kiu nhy cm (S). Khng trung gian phn nh hiu qu lm sng ti cc c quan, b phn m thuc phn b (VD:
nng khng sinh nhm quinolones v khng sinh nhm beta-lactam trong nc tiu) hoc kt qu iu tr t c khi s dng khng sinh vi
liu cao hn liu thng thng, (VD: khng sinh nhm beta-lactam). i vi kiu khng ny cn thn trng khi nh gi ranh gii mc khng,
trnh gy ra s khng thng nht trong vic nhn nh kt qu, c bit i vi cc loi thuc c gii hn c tnh hp.
3. Khng (R)
Khng (Resistant), l kiu khng m khng sinh liu thng thng khng c kh nng c ch s pht trin ca vi khun hoc c khng nh
qua nng c ch v ng knh vng c ch nm trong gii hn ca c ch khng, hoc thc t khng sinh khng c hiu qu trong iu tr lm
sng.
4. Khng nhy cm (NS)
 M100-S21
L mt cch din gii kt qu dng cho mt s chng vi khun ch c tiu chun c kt l nhy cm. Bi v him hoc khng c cc trng hp
khng xy ra cc chng vi khun ny. Cc chng vi khun c gi tr MIC cao hn hoc c ng knh vng c ch thp hn gi tr nhy cm cn
c bo co l khng nhy cm.
LU 1: Mt chng cho kt qu khng nhy cm khng c ngha l chng thc s c c ch khng. iu ny c th do cc chng, c gi tr
MIC ln hn gi tr nhy cm hoc thiu c ch khng. C ch khng ny c th gp phi trong nhm phn b t nhin rng sau thi im xy dng
gi tr nhy cm.
LU 2: i vi cc chng cho kt qu khng nhy cm, phn lp nh danh v th nghim nhy cm khng sinh cn c khng nh li (Xem
Ph lc A).
B. i vi mt s nhm vi khun khng c lit k trong cc bng t 2A n bng 2J, tham kho ti liu hng dn CLSI-M45- Phng Php cho
Th Nghim Tnh Nhy Cm Khng Sinh bng Phng Php Pha Long v Khoanh Giy vi Vi Khun Kh Pht Trin v Vi Khun Him Gp. Ti
liu ny cung cp nhng phng php chun khuyn co cho th nghim tnh nhy cm khng sinh. N bao gm cc thng tin v la chn khng
sinh, din gii kt qu, kim sot cht lng. Cc nhm vi khun c cp trong ti liu ny l Abiotrophia v Granulicatella spp. (hay
Streptococci thiu ht v mt dinh dng), Aeromonas hydrophilia, Bacillus spp., (tr B. anthracis), Campylobacter jejuni/coli, Corynebacterium
spp., (bao gm c C. diphtheriae), Erysipelothrix rhusiopathiae, nhm HACEK: Aggregatibacter spp. (trc y l nhm Aphrophilus ca h
Haemophilus (v d, H. aphrophilus, H. paraphrophilus, H. segnis) Actinobacillus actinomycetemcomitans, Cardiobacterium spp., Eikenella
corrodens v Kingella spp.; Helicobacter pylori; Lactobacillus spp., Leuconostoc spp., Listeria monocytogenes, Moraxella catarrhalis, Pasteurella
spp., Pediococcus spp., cc chng vi khun c th s dng trong khng b sinh hc v Vibrio spp., bao gm c Vibrio cholerae
i vi cc vi khun khc khng c cp trn, cc nghin cu cha xy dng tiu chun phn tch kt qu. Cc vi khun ny c th i
hi iu kin nui cy, mi trng nui cy khc hoc c s pht trin khng n nh. i vi cc vi khun ny, tham kho t vn ca cc chuyn
gia v bnh truyn nhim v vic tin hnh cc th nghim tnh nhy cm khng sinh v phn tch kt qu. Trong trng hp cn thit tin hnh th
nghim, phng php khng sinh pha long l thch hp nht, v c th chuyn chng n phng th nghim chun xt nghim. Cn cnh bo cho
bc s lm sng nhng hn ch ca th nghim cng nh vic phn tch kt qu.
 M100-S21
C. Cn c s phi hp gia cc chuyn gia v bnh truyn nhim, cc dc s, cc chuyn gia chng nhim khun v hi ng iu tr trong vic xy
dng cc chnh sch lin quan n cc th h khng sinh lu tin. a s cc trng hp, kt qu khng v trung gian khng nn phi hp trong cng
mt s liu thng k. Tham kho ti liu CLSI-M39-Phn tch v trnh by s liu th nghim nhy cm khng sinh lu tin.
III. Tho lun v liu php
Mt s tho lun c a ra lin quan n nhng bn khon trong qu trnh iu tr. Nhng tho lun ny c nh du bng k hiu Rx. C th
a cc tho lun ny vo bnh n hoc bo co. V d: cn a vo bo co v tnh nhy cm ca enterococcus phn lp t bnh phm mu vi
nhn xt liu php phi hp khng sinh ampicillin, penicillin hoc vancomycin (i vi cc chng nhy cm) vi mt khng sinh nhm
aminoglycoside thng c ch nh trong nhim khun enterococal th nng, v d nh vim ni tm mc, tr khi khng mc cao vi c
gentamicin v streptomycin. Phi hp ny c tc dng hip ng tiu dit vi khun Enterococcus
Liu khng sinh c ch nh thng rt khc nhau. Trong mt s trng hp, gi tr MIC da vo ch s dc ng hc hoc s dng liu lng
c bit cho bnh nhn. Trong trng hp s dng liu lng c bit cho bnh nhn c t ra, nhng ch thch v liu lng phi a vo bng
bo co.
IV. Khng nh kt qu trn bnh nhn
Cc thng s ca th nghim c kim sot bi qui trnh qun l cht lng khuyn co c m t trong ti liu ny. Tuy nhin, kt qu chp
nhn c c t vic th nghim cc chng chun khng th m bo chc chn tuyt i cho kt qu thu c khi tin hnh th nghim vi cc
chng phn lp t bnh nhn. Do cn xem xt tt c cc kt qu th nghim vi tt c cc loi khng sinh vi cc chng phn lp t bnh phm
trc khi bo co. iu gip m bo: 1) Kt qu khng sinh nht qun vi kt qu nh danh vi khun; 2) kt qu ca tng khng sinh c th
trong mt nhm khng sinh phi mang tnh logic th bc theo hot ph khng khun (v d: cephems th h 3 phi c tc dng mnh hn cephem th
h 1 v 2 i vi Enterobacteriaceae); 3) vi khun nhy cm vi mt s loi khng sinh v cha c bo co no v s khng thuc i vi khng
sinh c ghi nhn vi tiu chun c kt qu l nhy cm trong ti liu M100 (v d, vancomycin v Streptococcus spp).
i vi cc trng hp kt qu bt thng hoc khng nht qun, cn kim tra li cc thng s sau: 1) li ghi chp; 2) nhim trong qu trnh th
nghim (kim tra v trng); 3) i vi th nghim MIC, a mi trng khng m bo cht lng (v, mi trng khng kn a, dy khng
ng tiu chun); 4) kt qu trc trn bnh nhn (v d, bnh nhn phn lp c cng loi vi khun c kt qu khng sinh bt thng trc
). Trong trng hp khng xc nh c nguyn nhn gy ra kt qu sai lch, cn tin hnh li th nghim v/hoc nh danh li tc nhn gy
 M100-S21
bnh. Hoc c th thay i phng php th nghim. Tham kho ph lc A danh sch cc kt qu cn xc nh li. Mi phng xt nghim nn xy
dng phng php x l cc kt qu bt thng v nhn mnh v nh hng ca cc kt qu n vic chm sc sc kho ca bnh nhn.
V. S pht trin ca tnh trng khng thuc v th nghim phn lp lp li
Mt s vi khun ban u nhy cm khng sinh nhng sau mt thi gian iu tr tr nn khng trung gian hoc khng thuc. Do , vic phn lp
c cng mt chng gy bnh trn cng bnh nhn cng v tr ly bnh phm nn c th nghim pht hin s xut hin ca cc chng khng
thuc. S khng thuc c th xy ra trong vng 3 ti 4 ngy v mt s vi khun khng thuc thng gp bao gm Enterobacter, Citrobacter,
Serratia spp., khng cephalosporin th h 3; trc khun m xanh P. aeruginosa khng tt c cc loi khng sinh, t cu khng khng sinh nhm
quinolones. i vi t cu vng (S. aureus), cc chng nhy cm vi vancomycin cng c th tr nn khng trung gian nu iu tr ko di.
Trong mt s trng hp, th nghim pht hin cc chng khng mi c tin hnh sm hn 3-4 ngy v hin tng khng mi c th xy ra sm
hn. a ra c quyt nh th nghim sm cn c s hiu bit v cc tnh hung c th v tnh trng sc kho ca bnh nhn (v d,
Enterobacter cloaceae phn lp t cy mu trn bnh nhn s sinh thiu thng). Phng xt nghim hng dn thi im thc hin th nghim xc
nh hin tng khng mi sau khi t vn cng cc cn b y t khc trong bnh vin.
VI. Cnh bo
Mt s gp c ghi trong bng. Nhng gp ny lin quan n vic hiu nhng kt qu mt cch sai lch gy nguy him c th xy ra khi mt s
loi khng sinh c th nghim v bo co l nhy cm i vi mt s vi khun gy bnh. Nhng chng ny c nh du vi ch Cnh bo.
Cnh bo: Cc cp khng sinh v vi khun sau y c th c tc dng trong phng xt nghim nhng khng c hiu qu iu tr trn lm sng, do
khng c bo co l nhy cm
V tr Vi khun Khng sinh khng c bo co l nhy cm
Bng 2A Salmonella spp., Shigella spp. Cephalosporin th h 1, 2, cephamycins, aminoglycoside
Penicillins, phi hp khng sinh -lactam/cht c ch men -lactamase,
Bng 2C Staphylococcus spp., khng oxacillin
cephems c kh nng khng staphylococcal, carbapenems
Aminoglycosides (khng k nng cao), cephalosporins, clindamycin v
Bng 2D Enterococcus spp.
trimethoprim-sulfamethoxazole
 M100-S21

VII. Th nghim sng lc

Th nghim sng lc, theo nh m t trong ti liu ny, xc nh mt chng l nhy cm hoc khng vi mt hoc mt s khng sinh da trn c ch khng
c th hoc biu hin khng c th. Mt s th nghim sng lc c nhy v c hiu m bo. Kt qu ca th nghim sng lc ny cho kt qu ng
tin cy v c th bo co m khng cn n th nghim h tr khc. Cc chng khc i hi th nghim thm khng nh kt qu thu c t th nghim
sng lc. Di y l bng tng kt cc th nghim sng lc; chi tit ca tng th nghim bao gm c hiu ca th nghim, cc hn ch, v cc th
nghim h tr cn c khng nh kt qu, c cung cp trong cc bng b sung c lit k di y.
Chng vi khun V tr bng C ch khng hoc Th nghim sng lc Th nghim h tr khng nh?
biu hin khng
Enterobacteriaceae 2A-S1 Sinh ESBL C 2 phng php vi pha long v khoanh C, nu th nghim sng lc dng
giy khuch tn vi cc khng sinh nhm tnha
cephalosporin v aztreonam
2A-S2 Sinh Carbapenemase C 2 phng php vi pha long v khoanh C, nu th nghim sng lc dng
giy khuch tn vi cc khng sinh nhm tnh
carbapenems
2C-S3 Sinh Carbapenemase C 2 phng php vi pha long v khoanh C, nu th nghim sng lc dng
giy khuch tn vi cc khng sinh nhm tnh
carbapenems
Staphylococcus aureus 2C-S4 Sinh beta-lactamase Test nhanh xc nh -lactamase Nu th nghim sng lc m tnh, tin
hnh th nghim MIC vi penicillin v
th nghim sinh beta-lactamase (nu
MIC penicillin 0.12 g/ml hoc
ng knh vng c ch 29 mm) trn
 M100-S21
cc chng tip theo trn cng bnh
nhn; cn nhc lm PCR xc nh gen
blaZ

Khng Oxacilllin Pha long trn thch: MHA vi 4% NaCl Khng

v 6 g/ml oxacillin
C ch khng oxacillin C 2 phng php vi pha long v khoanh Khng
qua trung gian mecA giy khuch tn vi cefoxitin
MIC Vancomycin 8 Pha long trn thch; BHI vi 6 g/ml C, nu th nghim sng lc cho kt
g/ml vancomycin qu dng tnh
Khng clindamycin suy C 2 phng php vi pha long v khoanh Khng
din giy khuch tn vi clindamycin v
erythromycin
Khng mupirocin mc C 2 phng php vi pha long v khoanh Khng
cao giy khuch tn vi mupirocin
T cu khng sinh men 2C-S5 Sinh beta-lactamase Test nhanh xc nh -lactamase Nu th nghim sng lc m tnh, tin
coagulase hnh th nghim MIC vi penicillin v
th nghim sinh beta-lactamase (nu
MIC penicillin 0.12 g/ml hoc
ng knh vng c ch 29mm) trn
cc chng tip theo trn cng bnh
nhn; cn nhc lm PCR xc nh gen
blaZ
 M100-S21

C ch khng oxacillin Khoanh giy khuch tn vi cefoxitin Khng

qua trung gian mecA
Khng clindamycin suy C 2 phng php vi pha long v khoanh Khng
din giy khuch tn vi clindamycin v
erythromycin
Enterococci 2D-S6 Khng vancomycin Pha long trn thch vi vancomycin C, nu th nghim sng lc dng
tnh
Khng aminiglycoside C phng php vi pha long, pha long Khng i vi MIC; c i vi khoanh
mc cao (HLAR) trn thch v khoanh giy khuch tn vi giy, nu khng thuyt phc
gentamicin v streptomycin
Streptococcus 2G Khng penicillin Khoanh giy khuch tn vi oxacillin C, nu khng nhy cm
pneumoniae
Streptococcus spp. 2H-1-S7 Khng clindamycin C 2 phng php vi pha long v Khng
Nhm tan mu beta suy din khoanh giy khuch tn vi clindamycin
v erythromycin

Vit tt: BHI, canh thang BHI; ESBL, khng lactam ph rng; FDA, Cc qun l Thuc v An ton Thc phm Hoa K; HLAR, khng amynoglycoside
nng cao; MHA, thch Mueller-Hinton; MIC, Nng c ch ti thiu; MRSA, T cu vng khng methicilin
a
Nu s dng cc im nhy cm cephalosporin v aztreonam sa, khng cn tin hnh th nghim ESBL; nu vn tin hnh th nghim sng lc ESBL,
cn tin hnh th nghim khng nh xc nh s c mt ca ESBL.
 M100-S21
VII. Cc ch vit tt
AST th nghim nhy cm khng sinh
ATCC tn thng mi ca h thng chng chun theo tiu chun ca Hoa K
BHI Canh thang no tim
BLA -lactamase dng tnh (pht hin bng th nghim chromogenic cephalosporin)
BLNAR -lactamase m tnh, khng ampicillin
BSC t an ton sinh hc
BSL2 An ton sinh hc cp 2
BSL3 An ton sinh hc cp 3
CAMHB canh thang Mueller-Hinton iu chnh cation
CDC Trung tm kim sot v phng nga dch bnh (Hoa K)
CoNS T cu khng sinh men coagulase
CSF dch no tu
DMF dimethyl formamide
DMSO dimethyl sulfoxide
ESBL men -lactamase ph rng
FDA Cc qun l an ton thuc v thc phm
HLAR khng aminoglycoside nng cao
HTM Mi trng th nghim Haemophilus
KPC K. pneumonia sinh men carbapenemases
LHB Ly gii mu nga
MHA Thch Mueller-Hinton
MHB Canh thang Mueller-Hinton
MIC Nng c ch ti thiu (Nng khng sinh ti thiu c ch vi khun)
MRS Staphylococci khng methicillin
MRSA T cu vng khng methicillin
NAD nicotinamide adenine dinucleotide
PABA para-aminobenzoic axit
PBP 2a Protein 2a gn penicillin
QC kim sot cht lng
 M100-S21
Bng 1A. Cc nhm khng sinh vi cc ch dn lm sng ca FDA cn c th nghim v bo co thng qui i vi cc vi khun d mc ti cc
phng xt nghim vi sinh lm sng Hoa K

Enterobacteriaceaeg Pseudomonas aeruginosa Staphylococcus spp. Enterococcus spp.n

NHM A. TH NGHIM

Ampicilling Azithromycinc hoc

V BO CO U TIN

Ceftazidime Ampicillin
clarithromycinc hoc Penicillino
erythromycinc
Clindamycinc
Oxacillin ( cefoxitin)k,l
Cefazolinh, i Gentamicin Penicillink
Tobramycin

Gentamicin Piperacillin Trimethoprim-

Tobramycin sulfamethoxazole
NHM Be. TH NGHIM U TIN V BO

* *
Amikacin Amikacin Daptomycin Daptomycin
Aztreonam Linezolid Linezolid
Amoxicillin-clavulanic axit Cefepime Telithromycind Quinupristin-
Ampicillin-sulbactam dalfopristinp
Piperacillin-tazobactam
CO CHN LC

Ticarcillin-clavulanic axit
Cefuroxime Doxycycline Vancomycin
Minocycline
Tetracyclined
Ciprofloxacin Vancomycin
Levofloxacin

Cefepime Imipenem Rifampinb

Meropenem
Cefotetan Piperacillin-tazobactam
Cefoxitin Ticarcillin
 M100-S21
g,h,i
Cefotaxime hoc
Ceftriaxoneg,h,i
Ciprofloxacing
Levofloxacing
Doripenem
Ertapenem
Imipenem
Meropenem
Piperacillin

Trimethoprim-
sulfamethoxazoleg

Aztreonami Chloramphenicolc Gentamicin (ch dng

Ceftazidimei sng lc khng mc cao)
NHM Cf. BO CO CHN LC

Ciprofloxacin hoc levofloxacin Streptomycin (ch dng

B SUNG

hoc sng lc khng mc cao)

ofloxacin

Moxifloxacin
c,g
Chloramphenicol Gentamicin
Quinupristin-dalfopristinm
Tetracyclinea
 M100-S21
f
Cephalothin Lomefloxacin Ciprofloxacin

BNH PHM NC TIU

NHM U. B SUNG CHO Lomefloxacin hoc Norfloxacin Levofloxacin
Ofloxacin Norfloxacin

Lomefloxacin hoc Nitrofurantoin

ofloxacin Norfloxacin
Nitrofurantoin
Norfloxacin
Nitrofurantoin Sulfisoxazole
Sulfisoxazole Trimethoprim
Trimethoprim Tetracyclinea

*
Ch th nghim nng c ch ti thiu MIC, th nghim khoanh giy khuch tn khng ng tin cy
 M100-S21
Bng 1A (Tip)

Acinetobacter spp. j Burkholderia cepacia j Stenotrophomonas *

Cc chng khc khng
maltophilia j,k thuc nhm
NHM A. TH NGHIM V

Enterobacteriaceaej
BO CO U TIN

Ampicillin-sulbactam Trimethoprim- Trimethoprim- Ceftazidime

sulfamethoxazole sulfamethoxazole
Ceftazidime

Ciprofloxacin
Levofloxacin
Imipenem Gentamicin
Meropenem Tobramycin
Gentamicin Piperacillin
Tobramycin

*
Amikacin Ceftazidime Ceftazidime Amikacin
NHM Be. TH NGHIM U TIN

* c * c
Chloramphenicol Chloramphenicol Aztreonam
*
BO CO CHN LC

Levofloxacin Levofloxacin Cefepime

Piperacillin-tazobactam Meropenem Minocycline Ciprofloxacin
Ticarcillin-clavulanic axit Levofloxacin
*
Minocycline Ticarcillin-clavulanate Imipenem
*
Ticarcillin-clavulanate Meropenem
Cefepime Piperacillin-tazobactam
Ticarcillin-clavulanate

Cefotaxime Trimethoprim-
Ceftriaxone sulfamethoxazole
 M100-S21
Doxycycline
Minocycline
Tetracycline
Piperacillin
Trimethoprim-
sulfamethoxazole

Cefotaxime
NHM Cf. BO CO

Ceftriaxone
CHN LC
B SUNG

Chloramphenicolc

Lomefloxacin hoc
NHM U. B SUNG
CHO BNH PHM

oloxacin
NC TIU

Norfloxacin
Sulfisoxazole

Tetracyclinea

*
=Ch th nghim nng c ch ti thiu MIC, th nghim khoanh giy khuch tn khng ng tin cy
 M100-S21
Bng 1A. (Tip)
Cnh bo: Cc khng sinh sau y c cp trong ti liu ny khng nn bo co thng qui vi cc chng vi khun phn lp t dch no
ty. Cc khng sinh ny khng phi l cc thuc c la chn v c th khng c hiu qu trong iu tr nhim khun dch no ty do cc
chng vi khun ny gy ra (v d: cc chng vi khun trong bng 2A n 2J:
Cc khng sinh ch dng ng ung
Cc khng sinh Cephalosporin th h 1 v 2 (tr Cefuroxime ng tim)
v cephamycins
Clindamycin
Macrolides
Tetracycline
Fluoroquinolones

LU 1: Vic la chn cc loi khng sinh thch hp nht cho th nghim v bo co nhy cm khng sinh i vi cc bnh nhim khun do cc
phng xt nghim lm sng trc tip tho lun vi khoa dc, Hi ng Thuc v iu tr v khoa chng nhim khun quyt nh. Cc bng
trn bao gm cc vi khun cng vi cc khng sinh i kem c chng minh hiu qu bng cc th nghim in vitro. Cc nhm A, B, C v
U gm danh sch mt s loi khng sinh c la chn cho th nghim tnh nhy cm khng sinh i vi tng nhm vi khun. S la chn
ny da trn hiu qu lm sng, tnh trng khng khng sinh ca vi khun vi khng sinh, v gim thiu s pht trin ca tnh trng khng
khng sinh, gi thnh, ch nh lm sng ca FDA, cng nh da vo nhng hng dn mi nht ca cc khng sinh trong bng thuc khng
sinh u tin v thuc khng sinh thay th, ngoi ra c cc gi c th trong phn ghi ch e v f.Khng khng sinh mi (khng khng sinh
khng mong mun) phi c bo co (Enterobacteriaceae vi nhm carbapenem) Th nghim i vi cc loi thuc khng sinh chn lc c
th s dng cho mc ch chng nhim khun.
LU 2: Danh sch khng sinh trong tng bng c lit k theo nhm c kt qu th nghim tnh nhy cm (nhy cm, trung gian, khng) v hiu
qu trn lm sng tng t. Do , ch la chn i din mt thuc trong mi nhm cho vic th nghim. Trong mi bng, ch hoc c
dng ch cc nhm khng sinh cho kt qu khng r rng v s khng thuc hoc tnh nhy cm. C ngha l cc li ln khng qu 3% v
 M100-S21
cc li nh khng qa 10% tng s th nghim. Ngoi ra, dng ch hoc, khi th nghim t nht 100 chng th c trn 95% chng khng.
Hoc cng c dng ch cc khng sinh c tc dng tng ng, c th la chn thay th trong khi la chn cho th nghim (v d
cefotaxime hoc ceftriaxone dng cho Haemophilis influenzae). C th da trn kt qa th nghim i vi mt khng sinh suy ra kt qu
i vi khng sinh cn li (v d, vi khun ng rut khng sinh ESBL nhy cm vi cefotaxime c th suy ra cng nhy cm vi
ceftriaxone). Cc khng sinh c la chn bo co, phi l cc khng sinh c th nghim, tr khi c th suy lun kt qu t mt th
nghim khc chnh xc hn (v d, tnh nhy cm ca staphylococci i vi oxacillin da trn th nghim vi cefoxitin) v nn ph hp vi
bo co ca bnh vin. Cc trng hp khng mi cn phi c bo co (v d, Enterobacteriaceae khng carbapenems).
LU 3: Cc thng tin c in m l mi hoc c hiu chnh so vi phin bn trc .

Ghi ch
Lu chung:
a. Mt s chng nhy vi tetracycline cng c th coi l nhy vi doxycycline v micocycline. Tuy nhin, mt s chngm khng trung gian hoc khng
tetracycline c th vn cn nhy cm vi doxycycline v/hoc minocycline.
b. Rx: Rifampin khng nn s dng n c trong iu tr cc bnh nhim khun.
c. Khng bo co thng qui vi cc chng phn lp t ng tit niu
d. Cc khng sinh nhm B c th tin hnh th nghim u tin nhng khi bo co ch nn chn lc khng sinh da trn cc tiu ch sau : vi khun khng
khng sinh cng nhm trong nhm A. Cc ch tiu khc cho bo co c th bao gm ngun gc bnh (v d, cephalosporin th h 3 i vi trc khun
gy bnh ng rut phn lp t dch no tu hoctrimethoprim-sulfamethoxazole cho cc vi khun gy vim ng tit niu), cc trng hp d ng
hoc qu mn hay khng p ng vi khng sinh nhm A, bi nhim, nhim a nhiu v tr, hoccho mc ch chng nhim trng v h tr cng tc
dch t.
e. Nhm C bao gm cc khng sinh thay th hoc b sung c th yu cu th nghim ti cc bnh vin m ang hng chu nhng v dch gy ra bi cc vi
khun khng li vi nhiu nhm khng sinh u tin hng u (c bit l cc khng sinh cng nhm, v d -lactams), i vi bnh nhn b d ng vi
cc khng sinh u tin (hng u), hoc i vi iu tr cc vi khun c bit (v d, chloramphenicol i vi Salmonella spp., phn lp ngoi rut)
hoc cho mc ch chng nhim trng v h tr cng tc dch t.
 M100-S21

Enterobacteriaceae
f. Tiu chun c kt qu Cephalothin c th c s dng d on kt qu i vi cc khng sinh cefadroxil, cefpodoxime, cephalexin v
loracarbef ng ung. Cc d liu c gi rng cc kt qu ca cephalothin c th d on tnh nhy cm vi mt s cephalosporin khc vn
c th ng, nhng khng c cc d liu mi y khng nh iu ny.
g. Cc chng Salmonella v Shigella spp., phn lp t phn ch kt qu th nghim vi ampicillin, quinolone v trimethoprim-sulfamethoxazole nn c
bo co thng qui. Ngoi ra, cephalosporin th h 3 nn c th nghim v bo co i vi Salmonella spp. phn lp ngoi rut, chloramphenicol
c th th nghim v bo co nu c yu cu.
h. Cefotaxime v ceftriaxone nn c th nghim v bo co i vi cc vi khun phn lp t dch no ty thay cho cephalothin v cefazolin.
i. Theo nhng thng tin mi v c tnhdc ng hc (PK-PD) v hn ch lm sng, cc tiu chun c kt qu mi i vi cephalosporins (cefazolin,
cefotaxime, ceftazidime, ceftizoxime v ceftriaxone) v aztreonam c xy dng v lit k trong Bng 2. Cc tiu chun c kt qu cho Cefepime v
cefuroxime (khng dng cho ng ung) cng c xc nh nhng khng c s thay i ln no v c trnh by Bng 2A. Khi s dng cc
tiu chun mi, khng cn th nghim ESBL mt cch thng quy trc khi bo co kt qu (v d, khng cn thay i cc kt qu i vi
cephalosporins, aztreonam, hoc penicillin t nhy cm sang khng). Tuy nhin, cho n khi cc phng xt nghim thc hin tin hnh theo cc tiu
chun c kt qu mi, th nghim ESBL nn tin hnh nh m t trong Bng 2A-S1. Th nghim ESBL c th vn c ngha i vi dch t hc hoc
mc ch chng nhim khun.
Lu rng, cc tiu chun c kt qu i vi cc thuc khng sn c nhiu nc (v d, moxalactam, cefonicid, cefamandole, v cefoperazone)
khng c nh gi. Nu xem xt s dng cc thuc ny cho E. Coli, Klebsiella, hoc Proteus spp., nn tin hnh th nghim ESBL (xem Bng 2A-
S1). Nu cc chng cho kt qu th nghim ESBL dng tnh, cc kt qu i vi moxalactam, cefonicid, cefamandole v cefoperazone nn bo co l
khng.
Pseudomonas aeruginosa v cc vi khun khc khng thuc h Enterobacteriaceae
j. Cc vi khun khng thuc h Enterobacteriaceae bao gm Pseudomonas spp. V cc trc khun Gram m, khng ln men glucose, d mc tr P.
aeruginosa, Acinetobacter spp., Burkholderia cepacia, B. mallei, B. pseudomallei v Stenotrophomonas maltophilia bi v c cc danh sch ring i
vi cc thuc c gi th nghim v bo co i vi cc chng ny.
 M100-S21
xut th nghim v bo co i vi B. mallei v B. pseudomallei trong ti liu CLSI M45.

Staphylococcus spp.
k. Cc chng t cu nhy cm vi penicillin th cng nhy cm vi cc sinh khc cng nhm; cc phi hp -lactam/c ch -lactamase, cc khng sinh
cephems, v carbapenems c FDA thng qua trong iu tr nhim t cu. Cc chng khng Penicillin, nhy cm vi oxacillin th thng khng vi cc
penicillin d b phn hu bi men penicillinase, nhng nhy cm vi cc penicillin n nh vi penicilinase, cc phi hp khng sinh -lactam/cht c
ch -lactamase, cephems c hot tnh khng staphylococcal thch hp v carbapenems. Staphylococci khng oxacillin th cng khng vi tt c cc
khng sinh nhm beta-lactam hin nay tr cc cephalosporin th h mi vi hot tnh chng MRSA. Do , tnh nhy cm hoc tnh khng vi cc
khng sinh thuc nhm beta-lactam c th c suy lun t kt qu ca th nghim vi penicillin v hoc cefoxintin hoc oxacillin. Th nghim
thng qui vi cc khng sinh penicillin khc, cc phi hp khng sinh -lactam/cht c ch -lactamase, cc khng sinh nhm cephem, hoc cc khng
sinh nhm carbapenem khng c khuyn dng.
l. Kt qu ca th nghim khoanh giy khng sinh khuch tn v/hoc MIC vi cefoxitin c th dng d on tnh trng khng oxacillin qua trung gian
mecA cc chng S. aureus, S. lugdunensis. Vi cc staphylococci khng sinh coagulase (ngoi tr S. Lugdunensis) s dng khoanh giy cefoxitin l
phng php tt nht pht hin khng oxacillin qua trung gian mecA. . Cefoxitin c th c s dng lm i din pht hin khng oxacillin; bo
co kt qu l nhy cm hay khng vi oxacillin da trn kt qu ca cefoxitin.. Nu mt khng sinh thuc nhm penicillin bn vi men penicillinase
c th nghim, th oxacillin l khng sinh c la chn dng v kt qu c th c p dng cho cc khng sinh penicillin bn vi men penicillinase
khc nh cloxacillin, dicloxacillin v flucloxacillin.
m. Cc bo co i lp v cc chng Staphylococcus aureus nhy cm vi methicillin.
Enterococcus spp.
n. Cnh bo: i vi Enterococcus spp., cephalosporin, aminoglycoside (tr th nghim sng lc khng mc cao), clindamycin v trimethoprim-
sulfamethoxazole c th cho hiu qu trn in vitro nhng khng c hiu qu trn lm sng, v cc chng vi khun thng khng c bo co cc kt qu
nhy cm.
o. Enterococci nhy cm vi penicillin th cng nhy cm vi ampicillin, amoxicillin, ampicillin-sulbactam, amoxicillin-clavulanate, piperacillin-
tazobactam i vi cc chng Enterococci khng sinh men -lactamase. Tuy nhin, Enterococci nhy cm vi ampicillin khng th suy lun l nhy cm
 M100-S21
vi penicillin. Nu cn thit, phi tin hnh th nghim mc nhy cm vi penicillin. Rx: S phi hp ampicillin, penicillin, hoc vancomycin (i vi
cc chng nhy cm), vi aminoglycoside, thng c ch nh trong trng hp nhim enterococcal nng, v d vim mng trong tim, tr trng hp
khng mc cao vi c gentamicin v streptomycin, s phi hp ny c hiu qu trong iu tr nhim Enterococcus.
p. Cc bo co i lp v chng Enterococcus faecium khng vancomycin.
 M100-S21
Bng 1B. Cc nhm khng sinh vi ch dn lm sng ca FDA cn th nghim v bo co thng qui i vi cc vi khun kh nui cy c thc
hin ticc phng xt nghim vi sinh lm sng Hoa K.

Haemophilus spp. f Neisseria gonorrhoeae i Streptococcus Streptococcus spp. Streptococcus spp.

NHM A. TH NGHIM V

pneumoniae j Nhm tan mu betaq nhm Viridansr

BO CO U TIN

Ampicillin f,h Erythromycina,e Clindamycine,p *

Ampicillinm
Erythromycina,e,p *
Penicillinm
Penicillink (khoanh khng Penicillinn hoc
sinh oxacillin) Ampicillinn
Trimethoprim- Trimethoprim-
sulfamethoxazole sulfamethoxazole

*
Ampicillin-sulbactam Cefepime Cefepime hoc Cefepime
NHM Bb. TH NGHIM U TIN

*
Cefotaximek Cefotaxime Cefotaxime
*
Ceftriaxonek Ceftriaxone Ceftriaxone
BO CO CHN LC

Cefuroxime (ng Clindamycine

tim)

Cefotaximef hoc Gemifloxacink Vancomycin Vancomycin

ceftazidime hoc Levofloxacink
ceftriaxonef Moxifloxacink
Ofloxacin
 M100-S21
* k
Meropenem

Telithromycin

Chloramphenicole,f Tetracyclined

Meropenemf,

Vancomycink

Azithromycing Cefixime hoc *

Amoxicillin Chloramphenicole Chloramphenicole
Clarithromycing cefpodoxime *
Amoxicillin-clavulanic
axit
NHM Cc. BO CO CHN LC

Aztreonam Clindamycine

Amoxicillin-clavulanic axitg Cefotaxime hoc ceftriaxone Erythromycina,e

B SUNG

Cefaclorg Cefoxitin *
Cefuroxime *
Daptomycin
Cefprozilg Cefuroxime
Cefdinirg hoc Levofloxacin
cefiximeg hoc Ofloxacin
Cefpodoxime g

Cefuroxime (ng ung)g Ciprofloxacin hoc Chloramphenicole Linezolid Linezolid

ofloxacin
 M100-S21
Quinupristin-
dalfopristino
Ciprofloxacin hoc Penicillini *
Ertapenem
*
levofloxacin hoc Imipenem
lomefloxacin hoc
moxifloxacin hoc
Ofloxacin
Linezolid

Gemifloxacin
Ertapenem hoc Spectinomycin Rifampinl
imipenem
Tetracyclined

Rifampin

Telithromycing

Tetracyclined

*
Ch th nghim nng c ch ti thiu MIC, th nghim khoanh giy khuch tn khng ng tin cy.
Th nghim thng qui l khng cn thit (xem ghi ch n)
 M100-S21
Bng 1B. (Tip)
Cnh bo: Cc khng sinh sau y c cp trong ti liu ny khng nn bo co thng qui vi cc chng vi khun phn lp t Dch no
ty . Cc khng sinh ny khng phi l cc thuc c la chn v c th khng c hiu qu trong iu tr nhim khun Dch no ty do cc
chng vi khun ny gy ra (v d: cc chng vi khun trong bng 2A n 2J:
Cc khng sinh ch dng ng ung
Cc khng sinh Cephalosporin th h 1 v 2 (tr Cefuroxime ng tim)
v cephamycins
Clindamycin
Macrolides
Tetracycline
Fluoroquinolones Tetracycline
Fluoroquinolones

LU 1: Vic la chn cc loi khng sinh thch hp nht cho th nghim nhy cm khng sinh i vi cc bnh nhim khun do cc phng xt
nghim lm sng trc tip lm vic kt hp vi khoa dc, Hi ng Thuc v iu tr v Hi ng - Gim st nhim khun quyt nh. Cc
nhm A, B, C v U gii thiu danh sch mt s loi khng sinh c la chn cho th nghim tnh nhy cm khng sinh i vi tng nhm
vi khun. i vi tng th nghim c th, c th iu chnh vic la chn khng sinh cho hp l da trn hiu qu lm sng, tnh khng ph
bin, gim thiu mc khng, gim chi ph, cc ch s lm sng ca FDA v vic s dng khng sinh, nhng hng dn mi nht v cc
nhm thuc la chn hng u v nhm thuc thay th, ngoi ra c cc gi c th trong phn ghi ch b v c. Th nghim i vi cc
loi thuc khng sinh chn lc c th s dng cho mc ch chng nhim khun.
LU 2: Danh sch khng sinh trong tng bng c lit k theo nhm c kt qu th nghim tnh nhy cm (nhy cm, trung gian, khng) v hiu
qu trn lm sng tng t. Do , ch la chn i din mt thuc trong mi nhm cho vic th nghim. Trong mi bng, ch hoc c
dng ch cc nhm khng sinh cho kt qu khng r rng v s khng thuc hoc tnh nhy cm. C ngha l cc li ln khng qu 3% v
 M100-S21
cc li nh khng qa 10% tng s th nghim. Ngoi ra, dng ch hoc, khi th nghim t nht 100 chng th c trn 95% chng khng.
Hoc cng c dng ch cc khng sinh c tc dng tng ng, c th la chn thay th trong khi la chn cho th nghim (v d
cefotaxime hoc ceftriaxone dng cho Haemophilis influenzae). C th da trn kt qa th nghim i vi mt khng sinh suy ra kt qu
i vi khng sinh cn li. V d, vi khun ng rut khng sinh ESBL nhy cm vi cefotaxime c th suy ra cng nhy cm vi
ceftriaxone. Cc kt qu thu c t th nghim vi cefotaxime s c bo co trong bo co s bao gm c lu v tnh nhy cm ca
chng vi ceftriaxone. Khi khng c hoc gia cc khng sinh trong bng, th nghim mt khng sinh khng th c s dng d on
kt qu ca khng sinh cn li hoc kt qu khc nhau hoc s liu khng y .
LU 3: Cc thng tin c in m l mi hoc c hiu chnh so vi phin bn trc .
Ghi ch
Lu chung:
a. C th da trn kt qu th nghim erythromycin suy ra mc nhy cm v khng vi azithromycin, clarithromycin, v dirithromycin.
b. Cc khng sinh nhm B c th tin hnh th nghim c lp nhng khi bo co ch nn chn lc khng sinh i din, i vi cc vi khun khng khng
sinh cng nhm trong nhm A. Cc ch tiu khc cho bo co c th bao gm ngun gc bnh phm chn lc (v d, cephalosporin th h 3 i vi
Haemophilus influenzae phn lp t dch no tu hoc TMX cho cc vi khun gy vim ng tit niu), cc trng hp d ng hoc qu mn hay khng
p ng vi khng sinh nhm A, bi nhim, nhim a v tr vi nhiu loi vi khun, hoc bo co cho mc ch chng nhim trng v h tr cng tc
dch t.
c. Nhm C gm cc khng sinh i din, thay th hoc b sung c th yu cu th nghim cc vi khun khng trong vng nguy c v mt dch t hc i
vi mt s khng sinh c bn (c bit l cc khng sinh cng nhm, v d -lactams), hoc i vi iu tr cc vi khun c bit (v d,
chloramphenicol i vi Salmonella spp., phn lp ngoi rut) hoc bo co cho mc ch chng nhim trng v h tr cng tc dch t.
d. Cc vi khun nhy cm vi tetracycline th cng nhy cm vi doxycycline v minocycline.
e. Khng bo co thng qui cc chng phn lp t ng tit niu
Haemophilus spp.
f. Ch cc kt qu th nghim vi ampicillin, mt trong s cc khng sinh cephalosporin th h 3, chloramphenicol, v meropenem nn c bo co
thng qui i vi H. influenzae phn lp t Dch no ty.
 M100-S21
g. Amoxicillin-axit clavulanic, azithromycine, clarithromycin, cefaclor, cefprozil, loracarbef, cefdinir, cefixime, cefpodoxime, cefuroxime and
telithromycin l cc khng sinh ng ung c th c dng theo kinh nghim trong iu tr nhim khun h hp do Heamophilus spp. Kt qu th
nghim nhy cm khng sinh i vi cc loi khng sinh ny thng t c ngha s dng trong iu tr. Tuy nhin, nhng kt qu ny c th s dng
trong cc nghin cu dch t.
h. Kt qu nhy cm vi ampicillin c th c dng d on tnh nhy cm vi amoxicillin. Phn ln cc chng H. Influenza khng ampicillin v
amoxicillin c kh nng sinh men -lactamase kiu TEM. Phn ln cc trng hp, th nghim -lactamase trc tip c th pht hin nhanh mc
khng ampicillin v amoxicillin.
Neiseria gonorrhoeae
i. Th nghim -lactamase s pht hin chng N.gonorrhoeae khng penicillin v cng c th c s dng trong nghin cu dch t hc. Cc chng
khng qua trung gian chromosome c th pht hin bng k thut khoanh giy khuch tn hoc khng sinh pha long MIC.
Streptococcus pneumoniae
j. Cc chng S. pneumoniae nhy cm vi levofloxacin th c th suy ra nhy cm vi gemifloxacin v moxifloxacin. Tuy nhin, S. pneumoniae nhy cm
vi gemifloxacin hoc moxifloxacin khng th suy ra nhy cm vi levofloxacin.
k. Penicillin v cefotaxime hoc ceftriaxone hoc meropenem nn c th nghim bng phng php MIC ng cy (v d nh m t trong ti liu CLSI
M07-A8) v c bo co thng qui vi cc chng S. pneumoniae phn lp t dch no ty. Cc chng ny nn c th nghim vi vancomycin bng
phng php MIC hoc khoanh giy khuch tn. Vi cc chng phn lp t cc v tr khc, c th dng th nghim sng lc bng khoanh giy oxacillin.
Nu vng c ch ca oxacillin c ng knh 19mm, cn th nghim khng nh MIC ca mt trong s cc khng sinh nh penicillin hoc cefotaxime
hoc ceftriaxone hoc meropenems.
l. Rx: Khng nn ch nh Rifampin n c trong iu tr.
Streptococcus spp.
m. Rx: Cc chng khng trung gian vi penicillin hoc ampicillin c th cn liu php kt hp vi mt khng sinh nhm aminoglycoside c tc dng
khng khun.
n. Penicillin v ampicillin l thuc c la chn iu tr cc trng hp nhim lin cu tan mu beta. Th nghim nhy cm khng sinh i vi
penicillin v cc khng sinh nhm -lactam khc c ph duyt bi FDA trong iu tr nhim lin cu tan mu beta khng cn tin hnh thng qui v
 M100-S21
cc chng khng rt him gp trong nhm lin cu tan mu beta (penicillin MIC > 0.12 v ampicillin MIC > 0.25 g/ml v cha c bo co ghi
nhn i vi Streptococcus pyogenes. Cc chng pht hin khng nhy cm cn tin hnh nh danh li, lp li th nghim hoc gi ti phng
xt nghim chun thc khng nh kt qu (Tham kho Ph lc A).
o. Cc bo co tnh khng ca S. pyogenes
p. Rx: Hai khng sinh c xut cho d phng nhim Streptococci nhm B l penicillin v ampicillin. Cefazolin c s dng i vi bnh nhn n d
ng vi penicillin, trong trng hp bnh nhn n qu mn mc cao, la chn clindamycin hoc erythromycin. Streptococci nhm B nhy cm vi
ampicillin, penicillin v cefazolin, nhng c th khng vi clindamycin v/hoc erythromycin. i vi ph n c thai nhim Streptococci nhm B, qu
mn vi penicillin th khng sinh clindamycin v erythromycin cn c th nghim v bo co.
q. i vi bng ny, cc vi khun tan mu beta bao gm cc chng sinh m vi hnh thi khun lc ln nh Streptococci nhm A (S. pyogenes), C hoc G
v cc chng vi khng nguyn nhm B (S. agalactiae). Cc chng vi hnh thi khun lc nh c xem l mt phn ca nhm viridans, do d nn s
dng tiu chun c kt qu i vi nhm viridans.
 M100-S21
Bng 1C. Cc khng sinh nn c th nghim v bo co i vi cc vi khun k kh
Nhm Bacteroides fragilis v cc vi khun Gram m k kh khc Gram dng k kh
Amoxicillin-clavulanic acid Ampilicillina
Ampilicillin-sulbactam Penicillina
Piperacillin-tazobactam Amoxicillin-clavulanic acid
TH NGHIM v BO CO U TIN

Ticarcillin-clavulanic acid Ampilicillin-sulbactam

Piperacillin-tazobactam
Ticarcillin-clavulanic acid
Clindamycin
NHM A

Ertapenem Clindamycin
Imipenem
Meropenem
Metronidazole Ertapenem
Imipenem
Meropenem
Metronidazole

Penicillina Ceftizoxime
CHN LC B

Ampilicillina Ceftriaxone
BO CO
NHM C

XUNG

Ceftizoxime Cefotetam
Ceftriaxone Cefocitin
Chloramphenicol
 M100-S21
Cefotetam Piperacillin
Cefocitin Ticarcillin
Tetracyclineb
Moxifloxacin
Piperacillin
Moxifloxacin

Bng 1C. (Tip)

LU 1: Thng tin in m l mi hoc c hiu chnh so vi phin bn trc
LU 2: Phn ln cc nhim khun k kh l s bi nhim nhiu loi vi khun gm cc chng betalactamase dng tnh (c xc nh bng th
nghim cephalosporin nhim sc th) v cc chng m tnh vi betalactamase nhng c kh nng khng khng sinh. Vi nhng ca nhim trng gy
ra bi duy nht mt chng lactamase m tnh, penicillin hoc ampicillin l khng sinh ph hp th nghim v bo co.
LU 3: Phn ln cc vi khun k kh Gram dng c phn lp t cc trng hp bi nhim nhiu vi khun khng khng sinh; tuy nhin, mt
vi loi ca Clostridium spp (C. perfringens, C. septicum, C. sordellii) l cn nguyn n c ca tnh trng nhim trng. Trong trng hp ny, cc
chng in hnh nhy cm vi penicillin v ampicillin. Hai khng sinh trn cn phi c th nghim v bo co.
LU 4: Cc khng sinh xp cng mt l thuc cng mt nhm. Do , din gii kt qu khng sinh (nhy, trung gian, khng) v hiu qu
lm sng l tng t nhau. Do , ch cn chn mt trong cc khng sinh th nghim v bo co.
a. Nu -lactamase dng tnh, bo co l khng vi penicillin v ampicillin. Cn nh rng mt s chng -lactamase m tnh nhng thc cht vn khng
vi nhm -lactama bi nhng c ch khc..
b. Khng phi mi thng tin u y cho vic ct ngha khng -lactama c cp trn (v d, im nhy cm [Bng 2J] v gi tr ca kim sot
cht lng [Bng 4D v 4E]. Nhng thng tin chc chn s c b sung sm nht c th. Vic tin hnh th nghim c th l hu dng cho vic tch l
cc thng tin v mc ch nghin cu.
c. Rt nhiu trc khun Gram dng k kh khng sinh nh bo khng vi metronidazole..
 M100-S21
Bng 2A. Tiu chun c kt qu ng knh vng c ch v nng c ch ti thiu (MIC) i vi Enterobacteriaceae

iu kin th nghim
Cc yu cu kim sot cht lng ti thiu
(Xem bng 3A v bng 4A v gii hn QC cho php)
Mi trng: Khoanh giy khuch tn: MHA
Canh thang pha long: CAMHB
Escherichia coli ATCC* 25922
Thch pha long: MHA
Escherichia coli ATCC* 35218
Huyn dch vi khun: Phng php tng sinh hoc trc tip t khun lc
(dng cho phi hp -lactam/c ch men -lactamase)
vi mt vi khun tng ng c chun 0.5
McFarland
iu kin nui cy: 352oC, hiu kh,
Khoanh giy khuch tn: 16-18h
Phng php pha long: 16-20h

*ATTC l nhn hiu thng mi c ng k cho H thng chng chun theo tiu chun Hoa K
Lu chung

(1) Khoa giy khuch tn: o ng knh vng c ch ( bng mt thng), bao gm ng knh khoanh giy. Soi a trn nn en vi nh sng xuyn
qua. Ranh gii vng c ch xc nh bng mt vng khng c bt k khun lc no c th pht hin bng mt thng, b qua cc khun lc li ti mp
m ch c th pht hin di knh hin vi. Cc chng Proteus spp., c th pht trin lan vo vng c ch i vi tng loi khng sinh nht nh. i
vi chng Proteus spp., b qua s pht trin yu trong trng hp vng v khun khng r rng. i vi trimethoprim v sulfonamides, cht i
khng trong mi trng c th cho php vi khun pht trin yu, do , nu vi khun pht trin mc khong 20% hoc t hn th c th khng
quan tm v o ng knh vng c ch ranh gii r rng nht.

(2) i vi cc chng Salmonella v Shigella spp., c phn lp t phn, ch tin hnh th nghim v bo co thng qui i vi ampicillin, mt khng
sinh nhm quinolon v/ mt khng sinh nhm fluoroquinolone, v trimethoprim-sulfamethoxazole. Ngoi ra, cephalosporin th h 3 phi c th
nghim v bo co i vi Salmonella spp. phn lp t ng tiu ho v chloramphenicol c th th nghim v bo co nu yu cu

(3) im nhy cm-gii hn (breakpoint) trong cc bng i y da trn hm lng khng sinh t do trong huyt tng ngi (c chc
nng gan v thn bnh thng). Khi mt im nhy cm mi c b sung, khoa xt nghim phi chia s nhng thng tin ny ti cc Bc s
chuyn khoa truyn nhim, cc dc s, Hi ng thuc v iu tr, v Khoa chng nhim khun. Thng tin v k n cn phi c sot xt
li v cc nh lm sng phi tin hnh hi chn xc nh liu lng iu tr cho bnh nhn nhim trng c bit..

LU : Cc thng tin c in m l mi hoc c hiu chnh so vi phin bn trc .

 M100-S21
Bng 2A. (Tip)
Nhm th Khng sinh Hm Gii hn ng knh Gii hn nng c ch ti Lu
nghim/ lng vng c ch (mm) thiu (g/mL)
bo co S I R S I R
PENICILLINS
A Ampicillin 10 g 17 14-16 13 8 16 32 (4) i din i vi ampicillin
v amoxicillin.
Xem lu (2).
B Piperacillin 100 g 21 18-20 17 16 32-64 128
O Mecillinam 15 12-14 11 8 16 32 (5) Ch s dng i vi E. coli
10 g
phn lp t ng tit niu.
O Carbenicillin 100 g 23 20-22 19 16 32 64
O Mezlocillin 75 g 21 18-20 17 16 32-64 128
O Ticarcillin 75 g 20 15-19 14 16 32-64 128
PHI HP -LACTAM/ CHT C CH -LACTAMASE
B Amoxicillin-clavulanic 20/10 g 18 14-17 13 8/4 16/8 32/16
B axit Ampicillin-sulbactam 10/10 g 15 12-14 11 8/4 16/8 32/16
B Piperacillin-tazobactam 100/10 g 21 18-20 17 16/4 32/4-64/4 128/4
B Ticarcillin-clavulanic axit 75/10 g 20 15-19 14 16/2 32/2-64/2 128/2
CEPHEMS (NG TIM) (Bao gm cephalosporin th h I, II, III v IV. Tham kho Bng ch thch I.)
(6) CNH BO: i vi Salmonella spp., v Shigella spp., cephalosporin th h 1 v 2 v cephamycins c th c tc dng in vitro, nhng khng c hiu
qu trn lm sng, do khng c bo co v s nhy cm.
(7) Theo cc nh gi mi v cc c tnh dc l-dc ng hc (PK-PD) v cc d liu lm sng gii hn, cc tiu chun c kt qu mi ( sa) i
vi cc khng sinh nhm cephalosporins (cefotaxime, ceftazidime, ceftizoxime v ceftriaxone) v aztreonam ln u tin c cng b trong phin bn
M100-S20 thng 1 nm 2010 v c lit k trong bng ny. Tiu chn nh gi Cefazolin cng c xem xt li vo thng 6 nm 2010 v c
lit k trong bng di. Cefepime v cefuroxime (ng tim) cng c nh gi, tuy nhin, khng c s thay i cc tiu chun c kt qu i vi
cc liu dng c ch nh di y. Khi s dng cc tiu chun mi, khng cn th nghim ESBL thng qui trc khi bo co (v d, khng cn thay
i cc kt qu i vi cephalosporins, aztreonam, hoc penicillin t nhy cm sang khng). Tuy nhin, cho n khi cc phng xt nghim thc hin cc
tiu chun mi, th nghim ESBL nn tin hnh nh m t trong Bng 2A-S1. Th nghim ESBL c th vn c ngha i vi dch t hc hoc mc ch
chng nhim khun.
Lu rng, cc tiu chun c kt qu i vi cc thuc khng sn c nhiu nc (v d, moxalactam, cefonicid, cefamandole, v cefoperazone) khng
c nh gi. Nu xem xt s dng cc thuc ny cho E. Coli, Klebsiella, hoc Proteus spp., nn tin hnh th nghim ESBL (xem Bng 2A-S1). Nu
cc chng cho kt qu th nghim ESBL dng tnh, cc kt qu i vi moxalactam, cefonicid, cefamandole v cefoperazone nn bo co l khng.
 M100-S21
(8) Cc chng Enterobacter, Citrobacter v Seratia c th tr nn khng khng sinh sau qu trnh iu tr ko di vi khng sinh nhm cephalosporin th
h ba. Do , cc chng ny ban u c th nhy cm, nhng sau c th tr nn khng thuc sau 3-4 ngy iu tr. Nn tin hnh th nghim lp li vi
cc chng ny.
A Cefazolin 30 g 23 20-22 19 2 4 8 (9) Tiu chun c kt da trn
liu lng 2g mi 8 gii.
Xem lu (7)
U Cephalothin 30 g 18 15-17 14 8 16 32 (10) Tiu chun c kt qu
cephalothin ch nn s dng
d on kt qu i vi cc
khng sinh ng ung,
cefadroxil, cefpodoxime,
cephalexin, v loracarbef. Cc
d liu c ch ra rng cc kt qu
cephalothin c th d on tnh
nhy cm vi mt s khng sinh
nhm cephalosporins khc c th
vn chnh xc nhng khng c
s liu mi y khng nh
iu ny.
B Cefepime 30 g 18 15-17 14 8 16 32 (11) Tiu chun c kt qu da
trn liu iu tr 1 g mi 8 h
hoc 2 g mi 12 h.
Xem lu (7).
B Cefotaxime hoc 30 g 23-25 22 1 2 4 (12) Tiu chun c kt qu da
B ceftriaxone 30 g 20-22 19 1 2 4 trn liu iu tr 1 g mi 24 h
26
i vi ceftriaxone v 1 g mi 8
23
h i vi cefotaxime.
Xem lu (7).
B Cefotetan 30 g 16 13-15 12 16 32 64
B Cefoxitin 30 g 18 15-17 14 8 16 32
B Cefuroxime (tim) 30 g 18 15-17 14 8 16 32 (13) Cc tiu chun c kt qu
c da trn liu dng 1,5g
mi 8h.
Xem lu (7)
 M100-S21
C Ceftazidime 30 g 18-20 4 8 16 (14) Cc tiu chun c kt qu
21 17 c da trn liu dng 1g mi
8h.
Xem lu (7)

O Cefamandole 30 g 18 15-17 14 8 16 32 Xem lu (7)

O Cefmetazole 30 g 13-15 32 64
16 12 16

O Cefonicid 30 g 18 15-17 14 8 16 32 Xem lu (7)

O Cefoperazone 75 g 21 16-20 15 8 32 64 Xem lu (7)
O Ceftizoxime 30 g 25 22-24 21 1 2 4 (15) Cc tiu chun c kt qu
c da trn liu dng 1g mi
12h.
Xem lu (7).

O Moxalactam 30 g 23 15-22 14 8 16-32 64 Xem lu (7).

CEPHEMS (NG UNG)
B Cefuroxime (ung) 30 g 23 1522 14 4 816 32
O Loracarbef 30 g 18 1517 14 8 16 32 (16) Bi v cc chng
Citrobacter, Providencia, v
Enterobacter spp. c bo
co cho kt qu nhy cm gi
vi cefdinir v loracarbef, cc
chng ny khng nn th
nghim v bo co kt qu nhy
cm bng phng php khoanh
giy khuch tn.
O Cefaclor 30 g 18 1517 14 8 16 32
 M100-S21
O Cefdinir 5 g 20 1719 16 1 2 4 Xem lu (16).
O Cefixime 5 g 19 1618 15 1 2 4 (17) i vi khoanh giy khuch
tn, khng p dng i vi
chng Morganella spp.
O Cefpodoxime 10 g 21 1820 17 2 4 8 Xem lu (17).
O Cefprozil 30 g 18 1517 14 8 16 32 (19) Bi v cc chng
Providencia spp. c bo
co cho kt qu nhy cm gi
vi cefprozil, cc chng ny
khng nn th nghim v bo
co kt qu nhy cm bng
phng php khoanh giy
khuch tn.
Inv. Cefetamet 10 g 18 1517 14 4 8 16 Xem lu (17).
Inv. Ceftibuten 30 g 21 1820 17 8 16 32 (19) Ch dng cho cc chng
phn lp t ng tit niu.
MONOBACTAMS
C Aztreonam 30 g 21 1820 17 4 8 16 (20) Cc tiu chun c kt qu
da trn liu dng 1g mi 8 gi.
Xem lu (7).
CARBAPENEMS

(21) Theo nhng thng tin v c im dc ng hc (PK-PD) c nh gi, nhng thng tin lm sng cn mc gii hn, v khong phn
b MIC thu c t c nhng chng c kh nng to ra carbapenemase, nhng xem xt li v tiu chun nh gi cho carbapenem c xut
bn ln u thng 1 nm 2010 (M100-S20-U) v c trnh by y. Do s khim khuyt trong cc phc iu tr cho cc cn nguyn c gii
hn nh gi c MIC v ng knh vng c ch ri vo gi tr khng trung gian, cc nh lm sng iu tr bng cch tng ti a lng
carbapenem trong gii hn khuyn co v c l tng thi gian s dng thuc theo ng tim, nh l c bo co trong mt s cng trnh
nguyn cu. Khi phn lp c cc chng m c kt qu MIC v ng knh vng c ch l khng hoc khng trung gian, tin hnh tho lun
vi cc bc s lm sng chuyn khoa truyn nhim.
Cho ti khi cc labo cha th b sung tiu chun din gii mi, th nghim Hodge ci tin MHT cn phi c tin hnh nh c m t
trong phin bn cp nhn Bng 2A-3S. Sau khi tin hnh b sung tiu chun din gii mi, khng cn thit phi tin hnh MHT ngoi tr v mc
ch Dch t v Chng nhim khun (tham kho Bng 2A-S2)
Nhng thng tin di y c cung cp nh l nhng kin thc c bn v Enterobacteriaceae sinh carbapenemase. Phn ln nhng chng ny
c MIC v ng knh vng c ch trong gi tr ca khng trung gian v khng. l l do vi sao phi thit lp li gii hn nng c ch ti
 M100-S21
thiu v ng knh vng c ch vi nhm carbapenem.
Hiu qu iu tr ca carbapenem vi cc nhim trng gy ra bi cc chng c MIC v ng knh vng c ch vi carbapenem trong khong
khng trung gian l khng chc chn do thiu nhng nhng nghin cu lm sng i chng.
MIC (khong gi hn ca khng v trung gian) ca imipenem vi Proteus spp., Providencia spp., v Morganella morganii c xu hng cao hn
MIC ca meropenem hoc doripenem. C ch lm tng MIC nhng chng ny ngoi do carbapenemase cn c nhng c ch khc.
B Doripenem 10 g 23 20-22 19 1 2 4 (22) Tiu chun din gii kt
qu da trn liu 500 mg mi 8
gii
B Ertapenem 10 g 23 20-22 19 0,25 0,5 1 (23) Tiu chun din gii kt
qu da trn liu 1 g mi 24
gii
Imipenem 10 g 23 20-22 19 1 2 4 (24) Tiu chun din gii kt
B qu da trn liu 500 mg mi 6
gii hoc 1 g mi 8 gii
B Meropenem 10 g 23 20-22 19 1 2 4 (25) Tiu chun din gii kt
qu da trn liu 1 g mi 8 gii

AMINOGLYCOSIDES

(26) CNH BO: i vi Salmonella spp. v Shigella spp., cc khng sinh nhm aminoglycoside c th c tc dng in vitro nhng khng c hiu
qu trn lm sng v khng nn bo co kt qu nhy cm.
A Gentamicin 10 g 15 1314 12 4 8 16
A Tobramycin 10 g 15 1314 12 4 8 16
B Amikacin 30 g 17 1516 14 16 32 64
O Kanamycin 30 g 18 1417 13 16 32 64
O Netilmicin 30 g 15 1314 12 8 16 32
O Streptomycin 10 g 15 1214 11 - - - (27) Khng c tiu chun c
kt qu MIC.
TETRACYCLINES
(28) Cc chng vi khun nhy cm vi tetracycline cng c th xem nh nhy cm vi doxycycline v minocycline. Tuy nhin, mt s chng khng
hoc khng trung gian vi tetracycline c th vn nhy cm vi doxycycline v/hoc minocycline.
C Tetracycline 30 g 15 1214 11 4 8 16
O Doxycycline 30 g 14 1113 10 4 8 16
 M100-S21
O Minocycline 30 g 16 1315 12 4 8 16
FLUOROQUINOLONES
(29) Cc chng Salmonella nhy cm vi fluoroquinolone, khi xt nghim cho kt qu khng vi nalidixic axit c th dn n tht bi trn lm sng hoc
p ng chm trn bnh nhn nhim vi khun thng hn ngoi rut iu tr vi fluoroquinolones. Cc chng Salmonella ngoi rut nn c xt nghim
tnh khng vi axit nalidixic. i vi cc chng nhy cm vi fluoroquinolones v khng vi axit nalidixic, nn thng tin cho bc s rng cc chng
khng th b loi tr khi iu tr bng fluoroquinolone. Tham kho kin cc chuyn gia v bnh nhim khun.

Xem lu (2).
B Ciprofloxacin 5 g 21 1620 15 1 2 4
B Levofloxacin 5 g 17 1416 13 2 4 8
U Lomefloxacin hoc 10 g 22 1921 18 2 4 8
U ofloxacin 5 g 16 1315 12 2 4 8
U Norfloxacin 10 g 17 1316 12 4 8 16
O Enoxacin 10 g 18 1517 14 2 4 8
O Gatifloxacin 5 g 18 1517 14 2 4 8
O Gemifloxacin 5 g 20 1619 15 0.25 0.5 1 (30) FDA ph duyt s dng i
vi Klebsiella pneumoniae
O Grepafloxacin 5 g 18 1517 14 1 2 4
Inv. Fleroxacin 5 g 19 1618 15 2 4 8
QUINOLONES
O Cinoxacin 100 g 19 1518 14 16 32 64 Xem lu (19)
O Nalidixic axit 30 g 19 1418 13 16 32 (31) i vi cc chng phn lp
t nc tiu, c th s dng axit
nalidixic th nghim gim
nhy cm vi fluoroquinolone
ca cc chng phn lp t bnh
nhn nhim Salmonella ngoi
rut.

Xem lu (19) v (29).

C CH CON NG FOLATE
B Trimethoprim- 1.25/23.75 16 1115 10 2/38 - 4/76 Xem lu (2).
sulfamethoxazole g
 M100-S21
U Sulfonamides 250 hoc 17 1316 12 256 - 512 (32) Sulfisoxazole c th i
300 g din cho cc khng sinh nhm
sulfonamide khc.
U Trimethoprim 5 g 16 1115 10 8 - 16
PHENICOLS
C Chloramphenicol 30 g 18 1317 12 8 16 32 (33) Khng bo co thng qui
vi cc chng phn lp t nc
tiu.
FOSFOMYCINS
O Fosfomycin 200 g 16 1315 12 64 128 256 (34) Ch nh i vi cc chng
E. coli phn lp t ng tit
niu.
(35) Khoanh khng sinh
fosfomycin hm lng 200-g
cha 50 g
glucose-6-phosphate.
(36) S dng phng php pha
long trn thch xc nh
MIC. Mi trng thch nn b
sung vi 25 g/mL of glucose-6-
phosphate. Khng nn tin hnh
phng php pha long trn
thch.

NITROFURANS
U Nitrofurantoin 300 g 17 1516 14 32 64 128
 M100-S21
Bng thng tin thm 2A-S1. Th nghim sng lc v khng nh ESBL cc chng Klebsiella pneumoniae, Klebsiella oxytoca, Escherichia coli, v
Proteus mirabilisa i vi cc trng hp Bng 2A
LU : Theo nhng thng tin v c im dc ng hc c nh gi v cc thng tin lm sng cn hn ch, cc tiu chun din gii kt qu mi
i vi cc cephalosporins (cefazolin, cefotaxime, ceftazidime, ceftizoxime, v ceftriaxone) v aztreonam c cng b ln u vo thng 1 nawmg
2010 (phin bn M100-S20) v lit k trong bng 2A. Cefepime v cefuroxime (ng tim) cng c nh gi; tuy nhin, khng c s thay i v tiu
chun c kt qu i vi cc liu lng trnh by trong Bng 2A. Khi s dng cc tiu chun c kt qu mi, khng cn thit tin hnh th nghim ESBL
thng qui trc khi bo co kt qu (v d, khng cn iu chnh tiu chun c kt qu khng i vi cephalosporins, aztreonam, hoc penicillins). Tuy
nhin, vn nn tin hnh xt nghim ESBL nh m t trong bng di y cho n khi phng xt nghim p dng tiu chun c kt qu mi. Th nghim
ESBL c th vn c ch cho dch t hc v cng tc chng nhim khun.

Xt nghim Xt nghim sng lc ban u Xt nghim xc nh kiu hnh

Phng php xt Khoanh giy khuch tn
nghim
Mi trng MHA
Nng i vi K. pneumoniae,
khng sinh K. oxytoca, v E. coli:
Cefpodoxime 10 g hoc
Ceftazidime 30 g hoc
Aztreonam 30 g hoc
Cefotaxime 30 g hoc
Ceftriaxone 30 g
i vi P. mirabilisa:
Cefpodoxime 10 g hoc
Ceftazidime 30 g hoc
Cefotaxime 30 g
(S dng hn mt khng sinh i vi
xt nghim sng lc gip tng nhy
pht hin)
Huyn dch vi Khuyn co s dng khoanh giy
khun khuch tn chun
Vi pha long trn canh thang Khoanh giy khuch tn Vi pha long trn canh
thang
CAMHB MHA CAMHB
i vi K. pneumoniae, K. Ceftazidime 30 g Ceftazidime
oxytoca, v E. coli: Ceftazidime-clavulanic 0.25 128 g/mL
Cefpodoxime 4 g/mL hoc axitb 30/10 g Ceftazidime-clavulanic axit
Ceftazidime 1g/mL hoc 0.25/4128/4 g/mL
Aztreonam 1 g/mL hoc v
Cefotaxime 1 g/mL hoc v
Ceftriaxone 1 g/mL Cefotaxime 30 g
Cefotaxime-clavulanic Cefotaxime
i vi P. mirabilisa: axitb 30/10 g 0.25 64 g/mL
Cefpodoxime 1 g/mL hoc Cefotaxime-clavulanic axit
Ceftazidime 1 g/mL hoc (Xt nghim khng nh 0.25/464/4 g/mL
Cefotaxime 1 g/mL yu cu s dng c
cefotaxime v (Xt nghim khng nh
(S dng hn mt khng sinh ceftazidime, n c hoc yu cu s dng c
i vi xt nghim sng lc phi hp vi axit cefotaxime v ceftazidime,
gip tng nhy pht hin) clavulanic) n c hoc phi hp vi
axit clavulanic)
Khuyn co s dng canh Khuyn co s dng Khuyn co s dng canh
thang pha long chun khoanh giy khuch tn thang pha long chun
chun
 M100-S21
iu kin nui cy 35 2 C; hiu kh 35 2 C; hiu kh 35 2 C; hiu kh 35 2 C; hiu kh
Thi gian nui cy 16-18h 16-20h 16-18h 16-20h
Kt qu i vi K. pneumoniae, K. oxytoca, v Pht trin ti hoc cao hn Tng ng knh vng c Gim nng MIC 3 ln
E. coli: nng sng lc c th cho ch 5-mm i vi mt i vi mt khng sinh khi
Cefpodoxime zone 17 mm thy kh nng sinh ESBL (v khng sinh khi phi hp dng phi hp vi axit
Ceftazidime zone 22 mm d, i vi E. coli, K. vi clavulanic axit so vi clavulanic so vi gi tr
Aztreonam zone 27 mm pneumoniae, v K. oxytoca, ng knh vng c ch MIC ca khng sinh khi
Cefotaxime zone 27 mm MIC 8 g/mL i vi khi dng khng sinh dng n c = ESBL (v
Ceftriaxone zone 25 mm cefpodoxime hoc n c = ESBL (v d, d, ceftazidime MIC = 8
MIC 2 g/mL i vi ceftazidime cho vng = g/mL; ceftazidime-axit
i vi P. mirabilisa: ceftazidime, aztreonam, 16; ceftazidime- clavulanic MIC = 1
cefotaxime, hoc ceftriaxone; clavulanic axit cho vng g/mL).
Cefpodoxime zone 22 mm v i vi P. mirabilis, MIC = 21).
Ceftazidime zone 22 mm 2 g/mL i vi cefpodoxime,
Cefotaxime zone 27 mm ceftazidime, hoc cefotaxime).

ng knh vng c ch nh trn c

th cho thy kh nng sinh ESBL.
Bo co
Cc xut v QC Khi xt nghim sng lc ESBL,
K.pneumoniae ATCC 700603 c th
l chng QC b sung (v d, cho tp
hun, hi thao, nh gi xt nghim).
Cc chng khc, K. pneumoniae
ATCC 700603 hoc E. coli ATCC
25922, u c th s dng i vi kim
sot cht lng thng qui (v d, hng
tun hoc hng ngy).
i vi cc chng sinh ESBL:
Nu phng xt nghim cha p dng cc tiu chun c
kt qu mi i vi cephalosporin v aztreonam, nn
bo co kt qu khng vi tt c cc khng sinh nhm
penicillin, cephalosporin v aztreonam.
Nu phng xt nghim p dng cc tiu chun mi
i vi cephalosporin v aztreonam, khng cn thay i
cc xt nghim i vi cc khng sinh ny.
Khi xt nghim sng lc Khi tin hnh xt nghim Khi tin hnh xt nghim
ESBL, K. xc nhn ESBL, K. xc nh ESBL, K.
pneumoniae ATCC 700603 pneumoniae pneumoniae
c th l chng QC b sung (v ATCC 700603 hoc E. ATCC 700603 hoc E.
d, cho tp hun, hi thao, coli ATCC 25922, nn coli ATCC 25922, nn
nh gi xt nghim). c dng cho kim sot c dng kim sot
Cc chng khc, K. cht lng thng qui (v cht lng thng qui (v
pneumoniae ATCC 700603 d, hng tun hoc hng d, hng tun hoc hng
hoc E. coli ATCC 25922, ngy). ngy).

E. coli ATCC 25922 (xem cc gii
hn v kim sot trong Bng 3) K.
pneumoniae ATCC 700603:
Cefpodoxime ng knh vng c ch
916 mm
Ceftazidime ng knh vng c ch
1018 mm
Aztreonam ng knh vng c ch 9
17 mm
Cefotaxime ng knh vng c ch
1725 mm
Ceftriaxone ng knh vng c ch
1624 mm
M100-S21
u c th s dng i vi E. coli ATCC 25922: E. coli ATCC 25922:
kim sot cht lng thng tng 2-mm ng knh gim <3 ln nng MIC
qui (v d, hng tun hoc vng c ch ca khng ca khng sinh phi hp
hng ngy). sinh n so vi khng vi axit clavulanic
E. coli ATCC 25922 = Khng sinh phi hp vi axit K. pneumoniae ATCC
pht trin (xem cc gii hn v clavulanic. 700603:gim 3 ln nng
kim sot trong Bng4A). K. pneumoniae ATCC MIC ca khng sinh
K. pneumoniae ATCC 700603: tng 5-mm phi hp vi axit
700603 = Pht trin: ng knh vng c ch clavulanic so vi khng
Cefpodoxime MIC 8 g/mL ceftazidime-clavulanic sinh khi th n c.
Ceftazidime MIC 2 g/mL axit;
Aztreonam MIC 2 g/mL tng 3-mm ng knh
Cefotaxime MIC 2 g/mL vng c ch cefotaxime-
Ceftriaxone MIC 2 g/mL clavulanic
axit.

Vit tt: ATTC, tn thng mi ca h thng chng chun theo tiu chun ca Hoa K; CAMHB: Canh thang Mueller-Hinton iu chnh cation; ESBL:
men -lactamase ph rng; MHA: thch Mueller-Hinton; MIC: nng ti thiu c ch;

Ghi ch

a. Sng lc Proteus mirabilis sinh ESBL ch i vi cc chng quan trng v lm sng (v d, chng nhim khun huyt)
b. Chun b khoanh giy ceftazidime-axit clavulanic (30 g/10 g) v cefotaxime-axit clavulanic (30 g/10 g): S dng dung dch m axit clavulanic
nng 1000 g/mL (hoc chun b mi t mt lng nh ng bng 70 C), thm 10 L axit clavulanic vo khoanh giy ceftazidime (30 g) v
cefotaxime (30 g). S dng micropipette nh 10 L dung dch m ln khoanh giy ceftazidime v cefotaxime trong vng 1h trc khi t ln a,
c th ch cn 30 pht axit clavulanic hp ph ln khoanh giy khng sinh, kh v t ln a. S dng cc khoanh giy sau khi chun b hoc
vt b, khng gi li cho ln sau..
 M100-S21
Bng b sung 2A-S2. Xt nghim khng nh cc chng nghi ng sinh Carbapenemase Enterobacteriaceae khi s dng tiu chun din gii kt
qu mi cho carbapenem
Ch khi no s dng tiu chun din gii mi cho carbapenem c cng b vo thng 1 nm 2010 (M100-S20-U)
1. Xt nghim sng lc ban u (c trnh by trong bng b sung 2A-S3) v xt nghim xc nhn (vd, MHT) l khng cn thit cho xt
nghim thng quy trn bnh nhn.
2. Xt nghim MHT c l hu dng cho vic xt nghim cc chng v mc ch dch t hc hoc chng nghim khun
3. Khng c s thay i no trong din gii kt qu xt nghim nhy cm carbapenem i vi cc chng cho kt qu dng tnh vi th
nghim Hodge ci tin (MHT).

Khi thc hin xt Nhng quy trnh kim sot nhim khun hoc cc cuc kho st dch t hc yu cu xc nh nhng chng thuc Enterbacteriaceae
nghim ny: sinh carbapenemae. Cc chng sinh carbapenemase thng khng trung gian hoc khng vi mt hoc hn mt khng sinh thuc
nhm carbapenem theo tiu chun din gii c lit k trong bng 2A (ch : khng nhy cm vi Ertapenem l mt biu hin nhy
nht ca sinh carbapenemase). Hoc cac chng ny thng khng vi mt hoc trn mt khng sinh thuc cephalosporin nhm III
(vd, cefoperazone, cefotaxime, ceftazidime, ceftizoxime v ceftriaxone. Do , xt nghim ny ch gii hn vi cc chng c biu
hin trn.
Phng php xt Xt nghim Hodge iu chnh
nghim
Mi trng MHA
Nng khng Khoanh Ertapenem 10 g hoc
sinh Khoanh Meropenem 10 g
Huyn dch vi (1) Chun b huyn dch vi khun E. coli ATCC 25922 (chng ch nh) trong nc mui hoc canh thang vi m chun 0.5
khun McFarland (pha long trc tip t khun lc hoc qua tng sinh) sau pha long 1:10 trong nc mui hoc canh thang. Cy huyn
dch chng ch nh pha long 1:10 trn a MHA nh phng php khng sinh thng qui. a kh t nhin 3 n 10 pht.
t s khoanh giy ertapenem hoc meropenem trn a vi s lng nh lu sau y v trong Hnh 1 v 2.
(2) S dng u que cy trn (vng u que cy c th tch 10-L) hoc tm bng nht 35 khun lc chng cn xt nghim hoc
chng chun c tng sinh qua m. Dng que cy hoc tm bng c khun lc cn lm xt nghim vch mt ng thng t
mp ca khoanh bi mp ca ia. ng cy t nht 2025 mm. S chng xt nghim trong mi a nh lu sau y v trong Hnh
1 v 2.
S lng chng/khoanh giy xt nghim trong a MHA nh v ln (100-mm hoc 150-mm, tng ng):
Nh Ln
S khoanh giy 1 14
Cc chng xt nghim 1 16
Cc chng QC 2 2
iu kin nui 35 2 C; hiu kh
cy
 M100-S21
Thi gian nui 16-20h
cy
Kt qu Sau khi tng sinh, trn MHA kho st s tng sinh (biu hin bng cc khun lc to thnh hnh lan qut) ti vng giao thoa gia
vt cy v chu vi vng c ch ca chng ch nh (E. coli ATCC 25922) nh m t di (Hnh 1 v 2).
C tng sinh = carbapenemase dng tnh.
Khng tng sinh = carbapenemase m tnh.
Mt s vi khun c th sinh cht c ch s pht trin ca E. coli ATCC25922. Nu c s c ch ny, s xut hin mt vng sng
xung quanh vt cy (xem Hnh 3). Nh vy xt nghim Hodge iu chnh khng thch hp vi nhng chng ny.
i vi cc chng dng tnh vi xt nghim Hodge, tin hnh xt nghim MIC trc khi bo co kt qu i vi carbapenem. Mi
kt qu bo co u da duy nht vo MIC.
Bo co Bo co kt qu ca th nghim Hodge ci tin cho khoa chng nhim khun, hoc ti cc khoa c chc nng dch t hc.
Khng c s thay i no trong din gii kt qu xt nghim nhy cm carbapenem i vi cc chng cho kt qu dng
tnh vi th nghim Hodge ci tin (MHT)
Chng chun Kim tra cc chng chun dng tnh v m tnh mi ngy c xt nghim
khuyn co K. pneumoniae ATCC BAA-1705xt nghim Hodge dng tnh
K. pneumoniae ATCC BAA-1706xt nghim Hodge m tnh
Vit tt: ATTC tn thng mi ca h thng chng chun theo tiu chun ca Hoa K; KPC, K. pneumonia sinh men carbapenemases; MHA, Thch
Mueller-Hinton; MHT, Th nghim Hodge ci tin (Modified Modge test); MIC, Nng c ch ti thiu; QC, kim sot cht lng
 M100-S21
Bng 2A-S2. (Tip)
Lu :
1. Xt nghim sng lc v khng nh theo khuyn co phn ln xut pht t cc chng Enterobacteriaceae Theo tiu h thng th nghim Hoa K v cho
nhy (>90%) v c hiu (>90%) cao v kh nng pht hin kiu sinh carbapenemase loi(KPC) nhng chng ny. nhy v c hiu ca xt
nghim pht hin kh nng sinh metallo--lactamase cn mc thp.
2. Khng c d liu v s cn thit ca cc xt nghim pht hin kh nng sinh carbapenemase trc khun Gram m khng ln men.

E. coli ATCC25922

Vng c ch E. coli ATCC25922 bng

ertapenem
C tng sinh E. coli ATCC25922. K.
pneumoniae ATCCBAA-1705 sinh
carbapenemase gy bt hot ertapenem trong
mi trng. Do , khng c ertapenem c
ch E. coli ATCC25922 v lu v s lm vo
ca vng c ch (hnh lan qut).

Hnh 1. MHT tin hnh trn a MHA nh

(1) K. pneumoniae ATCCBAA-1705, kt qu dng tnh;
(2) K. pneumoniae ATCCBAA-1706, kt qu m tnh;
(3) Chng lm sng, kt qu dng tnh
 M100-S21

Hnh 2. MHT thc hin trn a MHA ln vi Ertapenem.

(1) K. pneumoniae ATCCBAA-1705, kt qu dng tnh;
(2) K. pneumoniae ATCCBAA-1706, kt qu m tnh;
(3-8) Chng lm sng; (6) kt qu m tnh;
(3,4,5,7,8) kt qu dng tnh.

Hnh 3. V d v kt qu khng r rng.

(1) Chng lm sng vi kt qu khng r rng (chng c ch s pht trin ca E. coli ATCC25922;
(2) chng lm sng vi kt qu m tnh
 M100-S21
Bng b sung 2A-S3. Xt nghim sng lc v xc nhn cc chng Enterobacteriaceae nghi ng sinh carbapenemase khi s dng tiu chun din gii
kt qu Carbapenem C (S dng vi bng 2A trong phin bn M100-S20 [Thng 1 nm 2010])
Cho ti khi tiu chun din gii mi c b sung cho carbapenem, cc th nghim sng lc v xc nhn phi c thc hin v bo co theo
nhng ch dn mi cho cc trng hp MHT dng tnh c m t nh di y. Khng cn thit tin hnh th nghim carbapenemase cho
mi chng bng th nghim MHT khi m tt c cc khng sinh ca nhm carbapenem u c bo co l khng trung gian hoc khng.

Xt nghim Xt nghim sng lc ban u Xt nghim khng nh kiu hnh

Khi thc hin CH p dng nhng iu sau khi m s dng tiu chun din Xt nghim sng lc dng tnh v khng vi mt hoc mt s
xt nghim gii kt qu cho carbapenam c trnh by trong M100-S20 khng sinh cephalosporin th h III (v d, cefoperazone,
ny (thng 1 nm 2010) cefotaxime, ceftazidime, ceftizoxime v ceftriaxone)
Phng php Khng sinh Vi pha long canh thang Xt nghim Hodge iu chnh
xt nghim
Mi trng MHA CAMHB MHA
Nng Ertapenem 10 g hoc Ertapenem 1 g/mL hoc Khoanh Ertapenem 10 g hoc
khng sinh Meropenem 10 g Imipenem 1 g/mL hoc Khoanh Meropenem 10 g
(LU : Xt nghim dng Meropenem 1 g/mL
khoanh giy imipenem sng
lc carbapenemases thng km
hiu qu)
Huyn dch vi Khuyn co s dng phng Khuyn co s dng phng (1) Chun b huyn dch vi khun E. coli ATCC 25922 (chng
khun php khng sinh tiu chun php pha long chun ch nh) bng nc mui sinh l hoc canh thang vi m 0.5
McFarland (s dng hoc trc tip t khun lc hoc qua tng
sinh) sau pha long 1:10 trong nc mui hoc canh thang.
Cy trn a MHA nh phng php khng sinh thng qui.
a kh t nhin 3 n 10 pht. t s khoanh giy ertapenem
hoc meropenem trn a nh lu sau y v trong Hnh 1 v 2.
(2) S dng u que cy vng (10-L) hoc tm bng, nht 35
khun lc chng cn xt nghim hoc chng chun c tng
sinh qua m trn thch mu v cy ng thng t mp ca
khoanh giy ertapanem vi mp ca a thch. Cy mt ng t
nht 2025 mm. Xt nghim s chng mi a nh lu sau y
v trong Hnh 1 v 2.
S lng khoanh giy v chng th nghim ca a MHA nh
v ln (100-mm hoc 150-mm, tng ng):
Nh Ln
 M100-S21
S khoanh giy 1 14
Cc chng xt nghim 1 16
Cc chng QC 2 2
iu kin 35 2 C; hiu kh 35 2 C; hiu kh 35 2 C; hiu kh
nui cy
Thi gian nui 16-18h 16-20h 16-20h
cy
Kt qu Ertapenem 1621 mm Ertapenem 2-4 g/mL Sau khi tng sinh, trn MHA kho st s tng sinh (biu hin
Meropenem 1421 mm Imipenem 28 g/mL bng cc khun lc to thnh hnh lan qut) ti vng giao thoa gia
Cc ng knh vng c ch Meropenem 28 g/mL vt cy v chu vi vng c ch ca chng ch nh (E. coli ATCC
nh trn chng t chng vi Cc gi tr MIC nh trn chng 25922) (Hnh 1 v 2).
khun xt nghim sinh t chng vi khun xt nghim C tng sinh = carbapenemase dng tnh.
carbapenemase, mc d thc t sinh carbapenemase, mc d Khng tng sinh = carbapenemase m tnh.
cc chng vn trong danh thc t cc chng vn trong Mt s vi khun c th sinh cht c ch s pht trin ca E. coli
sch nhy cm. khng nh, danh sch nhy cm theo nh ATCC25922. Nu c s c ch ny, s xut hin mt vng sng
tin hnh xt nghim Hodge. phin bn M100-S20 (thng 1 xung quanh vt cy (xem Hnh 3). Nh vy xt nghim Hodge
(LU : Khoanh giy nm 2010) iu chnh khng thch hp vi nhng chng ny.
imipenem khng thch hp cho i vi cc chng dng tnh vi th nghim sng lc bng
sng lc carbapenemases.) khoanh giy ertapenem hoc meropenem V xt nghim Hodge
dng tnh, tin hnh xt nghim MIC trc khi bo co kt qu
i vi mi carbapenem. Mi kt qu bo co u da duy nht
vo MIC.
Bo co CH p dng nhng iu sau khi m s dng tiu chun din
gii kt qu cho carbapenam c trnh by trong M100-S20
(thng 1 nm 2010)

i vi cc chng m xt nghim Hodge dng tnh v MIC

ca ertapenem khong 2-4 g/mL; MIC ca imipenem 2-8
g/mL; hoc MIC ca meropenem 2-8 g/mL, bo co kt
qu mi carbapenem u b khng

Nu MHT m tnh, din gii kt qu MIC ca carbapenem theo

tiu chun din gii ca CLSI c trnh by trong Bng 2A
trong phin bn M100-S20 (thng 1 nm 2010)
 M100-S21

Khuyn co S dng E. coli ATCC 25922 S dng E. coli ATCC 25922 Kim tra cc chng chun dng tnh v m tnh mi ngy c xt
kim sot cht trong kim sot cht lng trong kim sot cht lng nghim
lng thng qui. thng qui. K. pneumoniae ATCC BAA-1705xt nghim Hodge dng
tnh
K. pneumoniae ATCC BAA-1706xt nghim Hodge m tnh
Vit tt: ATTC tn thng mi ca h thng chng chun theo tiu chun ca Hoa K; KPC, K. pneumonia sinh men carbapenemases; MHA, Thch
Mueller-Hinton; MHT, Th nghim Hodge ci tin (Modified Modge test); MIC, Nng c ch ti thiu; QC, kim sot cht lng
 M100-S21
Bng 2A-S3. (Tip)
Lu :
1. Proteus spp., Providencia spp., v Morganella spp. c MIC vi imipenem cao hn bi nhng c ch khc khng ch bi carbapenamase, do , MIC ca
imipenem cho cc test sng lc xc nh carbapenemase 3 tc ny khng c xc lp. Tng t nh vy, khoanh giy imipenem th nghim
sng lc carpabenemase Enterobacteriaceae c gi tr rt thp.
2. Xt nghim sng lc v khng nh theo khuyn co phn ln xut pht t cc chng Enterobacteriaceae Theo tiu h thng th nghim Hoa K v
cho nhy (>90%) v c hiu (>90%) cao v kh nng pht hin kiu sinh carbapenemase loi(KPC) nhng chng ny. nhy v c hiu
ca xt nghim pht hin kh nng sinh metallo--lactamase cn mc thp.
3. Khng c d liu v s cn thit ca cc xt nghim pht hin kh nng sinh carbapenemase trc khun Gram m khng ln men.

E. coli ATCC25922

Vng c ch E. coli ATCC25922 bi

ertapenem
C tng sinh E. coli ATCC25922. K.
pneumoniae ATCCBAA-1705 sinh
carbapenemase gy bt hot ertapenem trong
mi trng. Do , khng c ertapenem c
ch E. coli ATCC25922 v lu v s lm vo
ca vng c ch (hnh lan qut).

Hnh 1. MHT tin hnh trn a MHA nh

(1) K. pneumoniae ATCCBAA-1705, kt qu dng tnh;
(2) K. pneumoniae ATCCBAA-1706, kt qu m tnh;
(3) Chng lm sng, kt qu dng tnh
 M100-S21

Hnh 2. MHT thc hin trn a MHA ln vi Ertapenem.

(1) K. pneumoniae ATCCBAA-1705, kt qu dng tnh;
(2) K. pneumoniae ATCCBAA-1706, kt qu m tnh;
(3-8) Chng lm sng; (6) kt qu m tnh;
(3,4,5,7,8) kt qu dng tnh.

Hnh 3. V d v kt qu khng r rng.

(1) Chng lm sng vi kt qu khng r rng (chng c ch s pht trin ca E. coli ATCC25922;
(2) chng lm sng vi kt qu m tnh
 M100-S21
Bng 2B-1. Tiu chun c kt qu ng knh vng c ch v nng c ch ti thiu tng ng (MIC) i vi Pseudomonas aeruginosa

iu kin th nghim Cc xut kim sot cht lng ti thiu

(Xem bng 3A v 4A: gii hn QC cho php)
Mi trng: Khoanh giy khuch tn: MHA
Pha long canh thang: CAMHB Escherichia coli ATCC 25922
Pha long trn thch: MHA Pseudomonas aeruginosa ATCC 27853
Huyn dch vi khun: Cy chuyn vi khun qua canh thang hoc pha Escherichia coli ATCC 35218
huyn dch vi khun trc tip t khun lc vi mt (dng cho phi hp -lactam/c ch men -
vi khun tng ng c chun 0.5 lactamase)
McFarland
iu kin nui cy: 352oC, hiu kh,
Khng sinh : 16-18h
Phng php pha long: 16-20h

Lu chung
(1) Khoa giy khuch tn: o ng knh vng c ch ( bng mt thng), bao gm ng knh khoanh giy. Soi a trn nn en vi nh sng xuyn
qua. Ranh gii vng c ch xc nh bng mt vng khng c bt k khun lc no c th pht hin bng mt thng, b qua cc khun lc li ti
mp m ch c th pht hin di knh hin vi. Cc chng Proteus spp., c th pht trin lan vo vng c ch i vi tng loi khng sinh nht nh.
i vi chng Proteus spp., b qua s pht trin yu trong trng hp vng v khun khng r rng. i vi trimethoprim v sulfonamides, cht i
khng trong mi trng c th cho php vi khun pht trin yu, do , nu vi khun pht trin mc khong 20% hoc t hn th c th khng
quan tm v o ng knh vng c ch ranh gii r rng nht.

(2) S nhy cm ca P. aeruginosa phn lp t bnh nhn b bnh s ha h thng c th khng nh bng phng php khoanh giy khuch tn, nhng
cn tng thi gian nui cy ln 24h trc khi bo co kt qu nhy cm.
(3) P. aeruginosa c th tr nn khng tt c cc loi khng sinh sau thi gian iu tr ko di. Do , cc chng ny ban u c th nhy cm nhng sau
3-4 ngy iu tr tr nn khng thuc. Cn tin hnh th nghim lp li.
(4) im nhy cm-gii hn (breakpoint) trong cc bng i y da trn hm lng khng sinh t do trong huyt tng ngi (c chc
nng gan v thn bnh thng). Khi mt im nhy cm mi c b sung, khoa xt nghim phi chia s nhng thng tin ny ti cc Bc s
chuyn khoa truyn nhim, cc dc s, Hi ng thuc v iu tr, v Khoa chng nhim khun. Thng tin v k n cn phi c sot
xt li v cc nh lm sng phi tin hnh hi chn xc nh liu lng iu tr cho bnh nhn nhim trng c bit..
 M100-S21
LU : Cc thng tin c in m l mi hoc c hiu chnh so vi phin bn trc .

Nhm th Khng sinh Hm Gii hn ng knh vng Gii hn nng c ch ti Lu

nghim/ lng c ch (mm) thiu (g/mL)
bo co S I R S I R
PENICILLINS
(5) Rx: S phn chia kiu nhy cm, trung gian v khng hm rng cn thit dng khng sinh liu cao i vi cc trng hp nhim khun nng gy ra
bi P. aeruginosa. i vi cc trng hp ny, liu php khng sinh n s gp tht bi trn lm sng.
A Piperacillin 100 g 18 - 17 64 128
B Ticarcillin 75 g 15 - 14 64 128
O Azlocillin 75 g 18 - 17 64 128
O Carbenicillin 100 g 17 14-16 13 128 256 512
O Mezlocillin 75 g 16 - 15 64 128
PHI HP -LACTAM/ CHT C CH -LACTAMASE
Xem ghi ch (5).
B Piperacillin-tazobactam 100/10 g 18 - 17 64/4 - 128/4
Ticarcillin-clavulanic
O axit 75/10 g 15 - 14 64/2 - 128/2
CEPHEMS (Bao gm cephalosporins th h I, II, III, v IV. Tham kho ph lc I.)
(6) Tiu chun din gii
kt qu da trn liu 1
gam mi 6 gii hoc 2 g
A Ceftazidime 30 g 18 15-17 14 8 16 32 mi 8 gii
(7) Tiu chun din gii
kt qu da trn liu 1
gam mi 8 gii hoc 2 g
B Cefepime 30 g 18 15-17 14 8 16 32 mi 12 gii

MONOBACTAMS
B Aztreonam 30 g 22 16-21 15 8 16 32 (8) Tiu chun din gii
 M100-S21
kt qu da trn liu 1
gam mi 6 gii hoc 2 g
mi 8 gii
CARBAPENEMS
B Imipenem 10 g 16 14-15 13 4 8 16
B Meropenem 10 g 16 14-15 13 4 8 16
LIPOPEPTIDES
O Colistin 10 g 11 - 10 2 4 8
300 n
O Polymyxin B v 12 - 11 2 4 8
AMINOGLYCOSIDES
A Gentamicin 10 g 15 13-14 12 4 8 16
A Tobramycin 10 g 15 13-14 12 4 8 16
B Amikacin 30 g 17 15-16 14 16 32 64
O Netilmicin 30 g 15 13-14 12 8 16 32
FLUOROQUINOLONES
B Ciprofloxacin 5 g 21 16-20 15 1 2 4
B Levofloxacin 5 g 17 14-16 13 2 4 8
U Lomefloxacin hoc 10 g 22 19-21 18 2 4 8
U ofloxacin 5 g 16 13-15 12 2 4 8
U Norfloxacin 10 g 17 13-16 12 4 8 16
O Gatifloxacin 5 g 18 15-17 14 2 4 8 (9) Tiu chun ny p dng
i vi cc chng phn lp
t ng tit niu.
Vit tt: ATCC, tn thng mi ca h thng chng chun theo tiu chun ca Hoa K; CAMHB, canh thang Mueller-Hinton iu chnh cation; MHA,
Thch Mueller-Hinton; MIC, Nng c ch ti thiu;
 M100-S21
Bng 2B-2. Tiu chun c kt qu ng knh vng c ch v nng c ch ti thiu (MIC) i vi Acinetobacter spp.

iu kin th nghim Cc yu cu kim sot cht lng ti thiu

(Xem bng 3A v 4A: gii hn QC cho php)
Mi trng: Khoanh giy khuch tn: MHA
Pha long canh thang: CAMHB Escherichia coli ATCC 25922
Pha long trn thch: MHA Pseudomonas aeruginosa ATCC 27853
Huyn dch vi khun: Phng php tng sinh bng canh thang hoc pha huyn dch vi Escherichia coli ATCC 35218
khun trc tip t khun lc vi mt vi khun tng ng (dng cho phi hp -lactam/c ch men
c chun 0.5 McFarland -lactamase)
iu kin nui cy: 352oC, hiu kh, 20-24h, tt c cc phng php

Lu chung
(1) i vi khoa giy khuch tn, o ng knh vng c ch (bng mt thng), bao gm ng knh khoanh giy. Soi a trn nn en vi nh sng
xuyn qua. Ranh gii vng c ch xc nh bng mt vng khng c bt k khun lc no c th pht hin bng mt thng, b qua cc khun lc li ti
mp m ch c th pht hin di knh hin vi.. i vi trimethoprim v sulfonamides, cc cht i khng trong mi trng c th cho php vi
khun pht trin yu; do c th b qua s pht trin yu ny (khng qu 20%) v o ng knh vng c ch ranh gii r rng nht..

LU : Cc thng tin c in m l mi hoc c hiu chnh so vi phin bn trc .

Nhm th Gii hn ng knh vng Gii hn nng c ch ti

Lu
nghim/ Khng sinh Hm lng c ch (mm) thiu (g/mL)
bo co S I R S I R
PENICILLINS
B Piperacillin 100 g 21 18-20 17 16 3264 128
O Mezlocillin 75 g 21 18-20 15 16 3264 128
O Ticarcillin 75 g 20 15-19 14 16 3264 128
PHI HP -LACTAM/ CHT C CH -LACTAMASE
A Ampicillin-sulbactam 10/10 g 15 12-14 11 8/4 16/8 32/16
B Piperacillin- 100/10 g 21 18-20 17 16/4 32/4-64/4 128/4
 M100-S21
tazobactam
Ticarcillin-clavulanic
B axit 75/10 g 20 15-19 14 16/2 32/2-64/2 128/2
CEPHEMS (NG TIM) (Bao gm cephalosporins th h I, II, III, v IV. Tham kho ph lc I.)
A Ceftazidime 30 g 18 15-17 14 8 16 32
B Cefepime 30 g 18 15-17 14 8 16 32
B Cefotaxime 30 g 23 15-22 14 8 1632 64
B Ceftriaxone 30 g 21 14-20 13 8 1632 64
CARBAPENEMS
A Imipenem 10 g 16 14-15 13 4 8 16
A Meropenem 10 g 16 14-15 13 4 8 16
LIPOPEPTIDES
O Polymyxin B - - - - 2 - 4
O Colistin - - - - 2 - 4
AMINOGLYCOSIDES
A Gentamicin 10 g 15 13-14 12 4 8 16
A Tobramycin 10 g 15 13-14 12 4 8 16
B Amikacin 30 g 17 15-16 14 16 32 64
C Netilmicin - - - - 8 16 32
TETRACYCLINES
(2) Cc chng nhy cm vi tetracycline cng c xem nh nhy cm vi doxycycline v minocycline. Tuy nhin, mt s chng c th khng trung
gian hoc khng vi tetracycline vn c th nhy cm i vi doxycycline v/hoc minocycline.
B Tetracycline 30 g 15 12-14 11 4 8 16
B Doxycycline 30 g 13 10-12 9 4 8 16
B Minocycline 30 g 16 13-15 12 4 8 16
FLUOROQUINOLONES
A Ciprofloxacin 5 g 21 16-20 15 1 2 4
A Levofloxacin 5 g 17 14-16 13 2 4 8
O Gatifloxacin 5 g 18 15-17 14 2 4 8
THUC C CH CON NG CHUYN HO FOLATE
Trimethoprim- 1.25/
B sulfamethoxazole 23.75 g 16 11-15 10 2/38 - 4/76
 M100-S21
Vit tt: ATCC, tn thng mi ca h thng chng chun theo tiu chun ca Hoa K; CAMHB, canh thang Mueller-Hinton iu chnh cation; MHA,
Thch Mueller-Hinton; MIC, Nng c ch ti thiu;
 M100-S21
Bng 2B-3. Tiu chun c kt qu ng knh vng c ch v nng c ch ti thiu tng ng (MIC) i vi Burkholderia cepacia

iu kin th nghim Cc xut kim sot cht lng ti thiu

(Xem bng 3A v 4A: gii hn QC cho php)
Mi trng: Khng sinh : MHA
Pha long canh thang: CAHMB Escherichia coli ATCC 25922
Pha long trn thch: MHA Pseudomonas aeruginosa ATCC 27853
Huyn dch vi khun: Cy chuyn vi khun qua canh thang hoc pha huyn dch vi Escherichia coli ATCC 35218
khun trc tip t khun lc vi mt vi khun tng ng (dng cho phi hp -lactam/c ch men
c chun 0.5 McFarland -lactamase)
iu kin nui cy: 352oC, hiu kh, 20-24h tt c cc phng php

Lu chung
(1) i vi khoa giy khuch tn, o ng knh vng c ch (bng mt thng), bao gm ng knh khoanh giy. Soi a trn nn en vi nh sng
xuyn qua. Ranh gii vng c ch xc nh bng mt vng khng c bt k khun lc no c th pht hin bng mt thng, b qua cc khun lc li ti
mp m ch c th pht hin di knh hin vi.. i vi trimethoprim v sulfonamides, cc cht i khng trong mi trng c th cho php vi
khun pht trin yu; do c th b qua s pht trin yu ny (khng qu 20%) v o ng knh vng c ch ranh gii r rng nht..

LU : Cc thng tin c in m l mi hoc c hiu chnh so vi phin bn trc .

Nhm Khng sinh Hm Gii hn ng knh vng Gii hn nng c ch Lu

th nghim/ lng c ch (mm) ti thiu (g/mL)
bo co S I R S I R
CEPHEMS (NG UNG) (Bao gm cephalosporins I, II, III, and IV. Tham kho ph lc I.)
B Ceftazidime 30 g 21 1820 17 8 16 32
CARBAPENEMS
B Meropenem 10 g 20 1619 15 4 8 16
TETRACYCLINES
B Minocycline 30 g 19 1518 14 4 8 16
THUC C CH CON NG CHUYN HO FOLATE
A Trimethoprim- 1.25/ 16 11-15 10 2/38 - 4/76
 M100-S21
sulfamethoxazole 23.75 g

PHI HP -LACTAM/C CH -LACTAMASE

B Ticarcillin- - - - - 16/2 32/2 128/2
Clavulanic axit 64/2
FLUOROQUINOLONES
B Levofloxacin - - - - 2 4 8
PHENICOLS
(2) Khng bo co thng qui vi
B Chloramphenicol - - - - 8 16 32 cc chng phn lp t nc tiu.
Vit tt: ATCC, tn thng mi ca h thng chng chun theo tiu chun ca Hoa K; CAMHB, canh thang Mueller-Hinton iu chnh cation; MHA,
Thch Mueller-Hinton; MIC, Nng c ch ti thiu, QC, m bo cht lng xt nghim
 M100-S21
Bng 2B-4. Tiu chun c kt qu ng knh vng c ch v nng c ch ti thiu tng ng (MIC) i vi Stenotrophomonas maltophilia

iu kin th nghim Cc xut kim sot cht lng ti thiu

(Xem bng 3A v 4A: gii hn QC cho php)
Mi trng: Khng sinh : MHA
Pha long canh thang: CAMHB Escherichia coli ATCC 25922
Pha long trn thch: MHA Pseudomonas aeruginosa ATCC 27853
Huyn dch vi khun: Cy chuyn vi khun qua canh thang hoc Escherichia coli ATCC 35218
pha huyn dch vi khun trc tip t khun lc vi (dng cho phi hp -lactam/c ch men
mt vi khun tng ng c chun 0.5 -lactamase)
McFarland
iu kin nui cy: 352 oC, hiu kh, 20-24h tt c cc phng php

Lu chung
(1) i vi khoa giy khuch tn, o ng knh vng c ch (bng mt thng), bao gm ng knh khoanh giy. Soi a trn nn en vi nh sng
xuyn qua. Ranh gii vng c ch xc nh bng mt vng khng c bt k khun lc no c th pht hin bng mt thng, b qua cc khun lc li ti
mp m ch c th pht hin di knh hin vi.. i vi trimethoprim v sulfonamides, cc cht i khng trong mi trng c th cho php vi khun
pht trin yu; do c th b qua s pht trin yu ny (khng qu 20%) v o ng knh vng c ch ranh gii r rng nht..

LU : Cc thng tin c in m l mi hoc c hiu chnh so vi phin bn trc

 M100-S21
Bng 2B-4.
Nhm th Khng sinh Hm Gii hn ng knh vng Gii hn nng c ch Lu
nghim/ lng c ch (mm) ti thiu (g/mL)
bo co
S I R S I R
PHI HP -LACTAM/C CH -LACTAMASE
Ticarcillin- 32/2
B clavulanic axit - - - - 16/2 64/2 128/2
CEPHEMS (NG RUT) (Bao gm cephalosporins I, II, III, v IV. Tham kho Ph lc I.)
B Ceftazidime - - - - 8 16 32
TETRACYCLINES
B Minocycline 30 g 19 15-18 14 4 8 16
FLUOROQUINOLONES

B Levofloxacin 5 g 17 14-16 13 2 4 8
THUC C CH CON NG CHUYN HO FOLATE
Trimethoprim- 1.25/
A sulfamethoxazole 23.75 g 16 11-15 10 2/38 - 4/76
PHENICOLS
(2) Khng bo co thng qui
i vi cc chng phn lp t
B Chloramphenicol - - - - 8 16 32 tit niu.
Vit tt: ATCC, tn thng mi ca h thng chng chun theo tiu chun ca Hoa K; CAMHB, canh thang Mueller-Hinton iu chnh cation; MHA,
Thch Mueller-Hinton; MIC, Nng c ch ti thiu, QC, m bo cht lng xt nghim
 M100-S21
Bng 2B-5. Cc tiu chun c kt qu MIC (g/mL) i vi cc chng khng phi Enterobacteriaceae khc (Tham kho Lu 1)

iu kin th nghim Cc xut kim sot cht lng ti thiu

(Xem bng 3A v 4A: gii hn QC cho php)
Mi trng: Khng sinh : MHA
Pha long canh thang: CAMHB Escherichia coli ATCC 25922
Huyn dch vi khun: Cy chuyn vi khun qua canh thang hoc Pseudomonas aeruginosa ATCC 27853
pha huyn dch vi khun trc tip t khun lc vi mt Escherichia coli ATCC 35218
vi khun tng ng c chun 0.5 McFarland (dng cho phi hp -lactam/c ch men
iu kin nui cy: 352 oC, hiu kh, 16-20h -lactamase)

Lu chung

(1) Cc vi khun khng thuc nhm Enterobacteriaceae khc bao gm Pseudomonas spp. (khng P. aeruginosa) v cc vi khun d mc, khng ln
men ng glucose, trc khun gram m khng k P. aeruginosa, Acinetobacter spp., Burkholderia cepacia, B. mallei, B. pseudomallei, v
Stenotrophomonas maltophilia. Tham kho Bng 2B-2, 2B-3, v 2B-4 i vi xt nghim Acinetobacter spp., B. cepacia, v S. maltophilia, v ti
liu CLSI M45 i vi Burkholderia mallei v B. pseudomallei.

LU : Cc thng tin c in m l mi hoc c hiu chnh so vi phin bn trc

Nhm th Khng sinh Hm Gii hn ng knh vng Gii hn nng c ch Lu
nghim/ lng c ch (mm) ti thiu (g/mL)
bo co S I R S I R
PENICILLINS
A Piperacillin - - - - 16 3264 128
O Mezlocillin - - - - 16 3264 128
O Ticarcillin - - - - 16 3264 128
O Carbenicillin - - - - 16 32 64
PHI HP -LACTAM/C CH -LACTAMASE
B Ticarcillin-clavulanic axit - - - - 16/2 32/2 128/2
Piperacillin-tazobactam 64/2
 M100-S21
B - - - - 16/4 32/4-64/4 128/2
CEPHEMS (NG RUT) (Bao gm cephalosporins I, II, III, v IV. Tham kho Ph lc I.)
A Ceftazidime - - - - 8 16 32
B Cefepime - - - - 8 16 32
C Cefotaxime - - - - 8 1632 64
C Ceftriaxone - - - - 8 1632 64
O Cefoperazone - - - - 16 32 64
O Ceftizoxime - - - - 8 1632 64
O Moxalactam - - - - 8 1632 64
MONOBACTAMS
B Aztreonam - - - - 8 1632 32
CARBAPENEMS
B Imipenem - - - - 4 8 16
B Meropenem - - - - 4 8 16
LIPOPEPTIDES
O Colistin - - - - 2 4 8
O Polymyxin B - - - - 2 4 8
AMINOGLYCOSIDES
A Gentamicin - - - - 4 8 16
A Tobramycin - - - - 4 8 16
B Amikacin - - - - 16 32 64
O Netilmicin - - - - 8 16 32
TETRACYCLINES
(2) Cc chng nhy cm vi tetracycline th cng xem nh nhy cm vi doxycycline v minocycline. Tuy nhin, mt s chng khng trung gian hoc
khng vi tetracycline c th vn nhy cm vi doxycycline, minocycline, hoc c hai.
U Tetracycline - - - - 4 8 16
O Doxycycline - - - - 4 8 16
O Minocycline - - - - 4 8 16
 M100-S21
FLUOROQUINOLONES

B Ciprofloxacin - - - - 1 2 4
B Levofloxacin - - - - 2 4 8
U Lomefloxacin hoc - - - - 2 4 8
U ofloxacin - - - - 2 4 8
U Norfloxacin - - - - 4 8 16
(3) Cc tiu chun din gi
ny ch p dng cho cc
chng phn lp t ng tit
O Gatifloxacin - - - - 2 4 8 niu.
THUC C CH CON NG CHUYN HO FOLATE
Trimethoprim-
B sulfamethoxazole - - - - 2/38 - 4/76
(4) Sulfisoxazole c th i
din cho cc khng sinh
U Sulfonamides - - - - 256 - 512 nhm sulfonamide khc.
PHENICOLS
(5) Khng bo co thng
qui i vi cc chng phn
B Chloramphenicol - - - - 8 16 32 lp t tit niu.
Vit tt: ATCC, tn thng mi ca h thng chng chun theo tiu chun ca Hoa K; CAMHB, canh thang Mueller-Hinton iu chnh cation; MHA,
Thch Mueller-Hinton; MIC, Nng c ch ti thiu, QC, m bo cht lng xt nghim
 M100-S21
Bng 2C. Tiu chun c kt qu ng knh vng c ch v nng c ch ti thiu tng ng (MIC) i vi Staphylococcus spp.

iu kin th nghim Cc xut kim sot cht lng ti thiu

(Xem bng 3A v 4A: gii hn QC cho php)
Mi trng: Khoanh giy khuch tn: MHA
Pha long trn canh thang: CAMHB; CAMHB b sung 2% NaCl Staphylococcus aureus ATCC 25923 (Khng sinh
i vi oxacillin, methicillin v nafcillin; CAMHB b sung 50 )
g/mL canxi i vi daptomycin Staphylococcus aureus ATCC 29213 (MIC)
Pha long trn thch: MHA; MHA + 2% NaCl i vi oxacillin, Escherichia coli ATCC 35218
methicillin v nafcillin. Pha long trn thch cha c nh gi (dng cho phi hp -lactam/c ch men
i vi daptomycin -lactamase)
Huyn dch vi khun: Pha huyn dch vi khun trc tip t khun lc vi mt vi
khun tng ng c chun 0.5 McFarland
iu kin nui cy: 352oC, hiu kh,
Khng sinh 16-18h; 24h (staphylococci coagulase m tnh v
cefoxitin);
Phng php pha long: 16-20h;
Tt c cc phng php: 24h i vi oxacillin, methicillin,
nafcillin v vancomycin.
Nu nui cy nhit cao hn 35 oC c th khng pht hin
c MRS.

Tham kho Bng 2C-S4 v 2C-S5 cui Bng 2C i vi cc khuyn co b sung v cc iu kin xt nghim, gi bo co v QC.

Lu chung

(1). i vi phng php khoanh giy khuch tn, o ng knh vng c ch (xc nh ranh gii vng c ch bng mt thng), bao gm ng knh
khoanh giy. Soi a thch trn nn en vi nh sng phn chiu tr trng hp linezolid, oxacilin v vancomycin nn s dng nh sng xuyn qua
(cm a trc n chiu). Vng c ch khng c s pht trin r rng ca vi khun. B qua s pht trin yu v cc khun lc nh li ti ch c th pht
hin khi soi di knh lp hoc knh hin vi b ca vng c ch. i vi trimethoprim v sulfonamides, cc cht i khng trong mi trng c th
cho php vi khun pht trin nh; do c th b qua s pht trin yu ny (khng qu 20%) v o ng knh vng c ch vi ranh gii xc nh
 M100-S21
bng mt thng. Nu c bt k khun lc no trong vng c ch ca oxacillin, linezolid hoc vancomycin chng t c s khng i vi cc khng
sinh .

(2) V mt l thuyt, s khng cc thuc nhm penicillin bn vi men penicilinase (xem Bng ch thch I) c xem nh
khng methicillin hoc khng oxacillin. MRSA l cc chng S. aureus biu hin c ch khng qua mecA hoc qua c ch khng methicillin khc,
v d thay i i lc ca protein gn penicillin vi oxacillin (bin chng S. aureus [MOD-SA]).
(3) i vi cc chng t cu vng Staphylococcus aureus nhy cm vi oxacillin v Staplylococci khng sinh men coagulase, nu tin hnh th nghim
nhy cm i vi cc khng sinh sau: cephems ng ung, ngoi rut, phi hp khng sinh -lactam/cht c ch men -lactamase, v carbapenems,
nn bo co kt qu theo tiu chun din gii thng qui. Xem ghi ch (4) v bo co kt qu nhm -lactam i vi cc chng khng oxacilline.
(4) CNH BO: i vi S. aureus khng oxacillin v Staphylococci coagulase m tnh (MRS), cc khng sinh -lactam khc, v d, penicillins, phi hp
-lactam/-lactamase, cephems (tr cc cephalosporin th h mi vi hot tnh chng li MRSA), v carbapenems, c th c tc dng in vitro,
nhng khng c hiu qu trong iu tr. Kt qu ca cc khng sinh nhm -lactam khng k cc khng sinh cephalosporin c hot tnh khng MRSA
cn c bo co kt qu l khng hoc khng bo co. Bi v phn ln cc trng hp c ghi nhn c p ng rt thp i vi liu php khng
sinh nhm -lactam, hoc cc s liu trn lm sng cha thuyt phc v tnh hiu qu ca cc khng sinh ny.
(5) Pht hin s khng oxacillin: Th nghim i vi mecA hoc protein c m ha bi gene mecA, protein 2a gn penicillin (PBP 2a, hay cn gi l
PBP2'), l phng php chnh xc nht pht hin cc chng khng oxacillin v c th c s dng khng nh kt qu khng sinh i vi cc
chng Staphylococci phn lp t cc trng hp nhim khun nng. Cc chng Staphylococci mang gen mecA hoc gen biu hin protein PBP 2a (sn
phm ca gen mecA), c xem nh khng oxacillin v bo co vi kt qu khng oxacillin. Cc chng khng mang gen mecA hoc khng sinh PBP
2a th xem nh nhy cm vi oxacillin. Bi v cc c ch khc him gp hn c ch sinh men mecA, nn trong trng hp m tnh vi mecA hoc PBP
2a v gi tr MIC ca oxacillin 4 g/mL th c ghi nhn vi kt qu khng oxacillin. Cc chng ny c th nhy cm vi cefoxitin bng phng
php khoanh giy khuch tn.
(6) Khng khuyn co th nghim thng qui i vi S. saprophyticus phn lp t nc tiu, bi v cc trng hp nhim khun ny thng c p ng
vi nng t c trong nc tiu ca cc khng sinh s dng trong iu tr nhim khun tit niu cp tnh, nhim trng tit niu khng bin chng
(v d, nitrofurantoin, trimethoprim sulfamethoxazole, hoc khng sinh nhm fluoroquinolone).
 M100-S21
(7) i vi mt s cp vi khun/khng sinh, hin tng khng hoc him khi pht hin chng khng khng cho php xc nh bt k mt kt qu no
ngoi nhy cm.. i vi cc chng cho kt qu khng nhy cm, ton b qu trinh phn lp nh danh v tin hnh th nghim nhy cm khng
sinh cn c lm li (Xem Ph lc A).
(8) i vi th nghim sng lc chng sinh beta-lactamase, khng oxacillin, khng oxacillin qua trung gian mecA, gim nhy cm vi vancomycin, v
khng clindamycin suy din, tham kho Bng 2C-S4 cui Bng 2C i vi nhm S.aureus v Bng 2C-S5 i vi staphylococci khng sinh men
coagulase cui Bng 2C. Ngoi ra, gii thch thm v s dng cefoxitin d on khng oxacillin qua trung gian mecA c th tham kho trong
Phn 12 ti liu M07-A8 v Phn 11 ti liu M02-A10.
LU : Cc thng tin c in m l mi hoc c hiu chnh so vi phin bn trc
 M100-S21
Bng 2C. (Tip)
Nhm Gii hn ng knh vng c Gii hn nng c ch ti Lu
th Hm ch (mm) thiu (g/mL)
Khng sinh
nghim/ lng
bo co S I R S I R

PENICILLIN
(9) Staphylococci nhy cm vi penicillin th cng nhy cm vi cc penicillins khc, phi hp -lactam/cht c ch -lactamase, cephems chng li
staphylococci, v carbapenems c FDA ph duyt s dng trong iu tr i vi cc trng hp nhim staphylococcal. Cc chng nhy cm vi
oxacillin, khng penicillin th khng vi cc khng sinh nhm penicillins khc khng bn vi men penicillinase, nhng nhy cm vi cc penicillins n
nh vi penicillinase, phi hp -lactam/c ch -lactamase, cephems chng li staphylococci, v carbapenems. Staphylococci khng oxacillin th cng
khng vi tt c cc khng sinh -lactam tr cc khng sinh cephalosporin th h mi c hot tnh khng MRSA. Do , tnh nhy cm hay khng i vi
khng sinh nhm -lactam c th suy lun t th nghim vi penicillin hoc cefoxitin hoc oxacillin.Th nghim thng qui vi cc penicillins khc, cc
phi hp -lactam/c ch -lactamase, cephems, v carbapenems l khng cn thit.
(10) Nu la chn mt khng sinh nhm penicillin bn vi men penicillinase xt nghim th oxacillin l mt la chn v kt qu c th p dng cho cc
penicillin bn vi penicillinase, cloxacillin, dicloxacillin, flucloxacillin, methicillin v nafcillin.

Xem ghi ch (4).

 M100-S21
A Penicillin 10 n v 29 - 28 0.12 - 0.25 (11). S dng khoanh giy
penicillin 10 n v thay v
dng khoanh giy
ampicillin cho th nghim
xc nh cc chng t cu
vng sinh men -lactamase
khng penicillin, nhy cm
vi oxacillin,. Penicillin
phi c s dng th
tnh nhy cm ca cc
staphylococcus vi tt c
cc khng sinh nhm
penicillin bn vi men beta-
lactamase, nh ampicillin,
amoxicillin, azlocillin,
carbenicillin, mezlocillin,
piperacillin, and ticarcillin.
Thc hin th nghim -
lactamase suy on nn tin
hnh i vi cc chng S.
aureusl c gi tr MIC
penicillinl 0.12 g/mL
hoc ng knh vng c
ch 29 mm trc khi bo
co kt qu l nhy cm vi
penicillin. Cc chng
staphylococcus mang gen
to -lactamase nhng kt
qu th nghim -
lactamase suy on m
tnh l rt him. Do ,
i vi cc trng hp
nhim khun nng i hi
liu php penicillin cho
iu tr, phng xt nghim
 M100-S21
nn tin hnh lm MIC
i vi penicillin v xt
nghim sinh -lactamase
suy on i vi tt cc
chng phn lp trn cng
bnh nhn. Xt nghim
gen -lactamase blaZ
bng phng php PCR
c th c cn nhc..
Xem Bng 2C-S4v Bng
2C-S5 cui Bng 2C.
 M100-S21
A Oxacillin 30 g 13 11-12 10 2 - 4 i vi S. aureus
cefoxitin (oxacillin) (oxacillin)
i vi S. aureus v
S. lugdunensis.
1 g 2 - 4 i vi S. lugdunensis.
oxacillin (oxacillin) (oxacillin)

30 g 22 21 4 - 8 i vi S.aureus v
cefoxitin (cefoxitin) (cefoxitin) S.lugdunensis
(12) Cefoxitin c th thay
th cho oxacillin; bo co
kt qu nhy cm hoc
khng oxacillin da trn kt
qu ca cefoxitin.
(13) Nu c cefoxitin v
oxacillin c xt nghim
vi S. aureus hoc S.
lugdunensis v nu kt qu
khng, cc chng ny nn
bo co l khng oxacillin.

Xem lu (9).
 M100-S21
A Oxacillin 1 g - - - 0.25 - 0.5 i vi staphylococci
i vi staphylococci oxacillin (oxacillin) (oxacillin) coagulase m tnh tr S.
coagulase m tnh tr S. lugdunensis
lugdunensis.
(14) Tiu chun din gii
kt qu ca oxacillin c th
ch l khng i vi mt s
staphylococci coagulase m
tnh bi v mt s chng
staphylococci coagulase m
tnh (tr S. epidermidis) c
gi tr MIC oxacillin t 0.5-
2 g/mL mc d chng
thiu mecA. i vi cc
trng hp nhim khun
nng do staphylococci
coagulase m tnh khng
phi S. epidermidis xt
nghim mecA hoc PBP 2a
hoc khng sinh vi
khoanh giy cefoxitin c
th thch hp vi cc chng
c gi tr MIC t 0.5 n 2
g/mL.

30 g 25 - 24 - - - Xem lu (12)
cefoxitin Xem lu (9)

O Ampicillin 10g 29 - 28 0.25 - 0.5 (15) i din cho nhm

Ampicillin and
 M100-S21
Amoxicillin.
(16) i vi chng
staphylococci khng
oxacillin, bo co v tnh
khng hoc khng bo co.

O Methicillin 5g 14 10-13 9 8 - 16 (17) Ch cho vi S. aureus.

O Nafcillin 1g 13 11-12 10 2 - 4 Xem lu (17).

PHI HP KHANG SINH -LACTAM V CHT C CH -LACTAMASE

(18) i vi cc chng staphylococci khng oxacillin, bo co v tnh khng hoc khng bo co

Xem lu (4) v (9).

O Amoxicillin-clavulanic
axit 20/10 g 20 - 19 4/2 8/4
O Ampicillin-sulbactam 15
10/10 g 12-14 11 8/4 16/8 32/16
O Piperacillin-tazobactam 18
100/10 g - 17 8/4 16/4
O Ticarcillin-clavulanic 23
axit 75/10 g - 22 8/2 16/2
CEPHEMS (NG TIM) (Bao gm cephalosporins th h I, II, III, v IV. Tham kho bng ch thch I.)

Xem lu (18).
Xem lu (4) v (9).
O Cefamandole 30 g 18 15-17 14 8 16 32
O Cefazolin 30 g 18 15-17 14 8 16 32
O Cefepime 30 g 18 15-17 14 8 16 32
O Cefmetazole 30 g 16 13-15 12 16 32 64
O Cefonicid 30 g 18 15-17 14 8 16 32
O Cefoperazone 30 g 21 16-20 15 16 32 64
O Cefotaxime 30 g 23 15-22 14 8 1632 64
O Cefotetan 30 g 16 13-15 12 16 32 64
 M100-S21
O Ceftazidime 30 g 18 15-17 14 8 16 32
O Ceftizoxime 30 g 20 15-19 14 8 1632 64
O Ceftriaxone 30 g 21 14-20 13 8 1632 64
O Cefuroxime (tim) 30 g 18 15-17 14 8 16 32
O Cephalothin 30 g 18 15-17 14 8 16 32
O Moxalactam 30 g 23 15-22 14 8 1632 64
CEPHEMS (NG UNG)
Xem lu (18).
Xem lu (4) v (9).
O Cefaclor 30 g 18 15-17 14 8 16 32
O Cefdinir 5 g 20 17-19 16 1 2 4
O Cefpodoxime 10 g 21 18-20 17 2 4 8
O Cefprozil 30 g 18 15-17 14 8 16 32
O Cefuroxime (ung) 30 g 23 15-22 14 4 816 32
O Loracarbef 30 g 18 15-17 14 8 16 32
CARBAPENEM
Xem lu (18).
Xem lu (4) v (9).
O Ertapenem 10 g 19 16-18 15 2 4 8
O Imipenem 10 g 16 14-15 13 4 8 16
O Meropenem 10 g 16 14-15 13 4 8 16
GLYCOPEPTIDES
B Vancomycine - - - - 2 4-8 16 i vi S. aureus

(19) Xt nghim MIC cn

tin hnh khng nh
tnh nhy cm ca cc
chng staphylococci vi
vancomycin. Phng php
khoanh giy khuch tn
khng phn bit c cc
chng nhy cm vi
vancomycin v cc chng
khng trung gian vi khng
sinh ny ng thi cng
 M100-S21
khng phn bit c cc
chng staphylococci
coagulase m tnh nhy
cm, khng v khng trung
gian vi vancomycin, tt c
cc chng ny s cho ng
knh vng c ch tng t
nhau.
(20) Khoanh giy
vancomycin 30-g pht
hin cc chng S. aureus
cha gene vanA khng
vancomycin (VRSA). Cc
chng ny th hin khng
vng c ch xung quanh
khoanh khng sinh (ng
knh = 6
mm). Cc chng th hin
khng vng c ch cn
phi c nh danh li.
Cc chng staphylococci c
ng knh vng c ch
ca vancomycin 7 mm
khng nn bo co l nhy
cm khi cha tin hnh
MIC vancomycin.

(21) Gi cc chng S.
aureus c MIC vancomycin
8 g/mL n cc phng
xt nghim k thut cao
hn. Xem ph lc A

(22) Khoanh giy khuch

tan khng ng tin cy i
 M100-S21
vi vancomycin.

Tham kho Bng 2C-S4i

vi S.
aureus cui Bng 2C,
Phn 12.1.3 ti liu M07-
A8, v Phn 11.1.3 ti liu
M02-A10.

B Vancomycin - - - - 4 816 32 i vi cc chng

coagulase m tnh
Xem lu (19) v (22).

(23) Gi cc chng
Staphylococcus coagulase
m tnh c gi tr MIC 32
g/mL n phng xt
nghim tiu chun cao hn.
Xem ph lc A
Xem Phn 12.1.3 ti liu
M07-A8 v Phn 11.1.3 ti
liu M02-A10.
Inv. Teicoplanin 30 g 14 11-13 10 8 16 32 (24) Tiu chun c kt qu
ca khoanh giy khuch tan
ca Teicoplanin cha c
nh gi li cng nh nh
gi li tiu chun c kt
qu khoanh giy khch tn
ca vancomycin trong cc
nghin cu gn y. Do ,
kh nng phn bit cc
chng staphylococci khng
v khng trung gian vi
teicoplanin so vi cc
chng nhy cm cha r.
 M100-S21
LIPOPEPTIDES
B Daptomycin - - - - 1 - - (25) Khoanh giy khuch
tan khng ng tin cy i
vi daptomycin
(26) Daptomycin khng
c php bo co i vi
nhng chng phn lp
c t bnh phm
ng h hp di.
Xem lu (7).
AMINOGLYCOSIDES
C Gentamicin 10 g 15 13-14 12 4 8 16
O Amikacin 30 g 17 15-16 14 16 32 64
O Kanamycin 30 g 18 14-17 13 16 32 64
O Netilmicin 30 g 15 13-14 12 8 16 32
O Tobramycin 10 g 15 13-14 12 4 8 16
MACROLIDE
(27) Khng bo co thng qui vi cc chng phn lp t ng tit niu.
A Azithromycin hoc 15 g 18 14-17 13 2 4 8
A clarithromycin hoc 15 g 18 14-17 13 2 4 8
A erythromycin 15 g 23 14-22 13 0.5 14 8
O Dirithromycin 15 g 19 16-18 15 2 4 8
KETOLIDES
B Telithromycin 15 g 22 19-21 18 1 2 4
TETRACYCLIN
(26) Cc chng nhy cm vi tetracycline cng c xem nh nhy cm vi doxycycline v minocycline.
Tuy nhin, mt s chng khng trung gian hoc khng vi tetracycline vn c th nhy cm vi doxycycline v/hoc minocycline.

B Tetracycline 30 g 19 15-18 14 4 8 16
B Doxycycline 30 g 16 13-15 12 4 8 16
O Minocycline 30 g 19 15-18 14 4 8 16
FLUOROQUINOLONES
(27) Cc chng Staphylococcus spp. c th tr nn khng thuc trong qu trnh iu tr ko di vi khng sinh quinolones. Do , cc chng ny ban u
c th nhy cm nhng sau 3-4 ngy iu tr tr nn khng thuc. m bo v tin cy nn tin hnh xt nghim lp li vi cc chng ny
 M100-S21

C Ciprofloxacin hoc 5 g 21 16-20 15 1 2 4

C Levofloxacin hoc 5 g 19 16-18 15 1 2 4
C Ofloxacin 5 g 18 15-17 14 1 2 4
C Moxifloxacin 5 g 24 21-23 20 0.5 1 2
U Lomefloxacin 10 g 22 19-21 18 2 4 8
U Norfloxacin 10 g 17 13-16 12 4 8 16
O Enoxacin 10 g 18 15-17 14 2 4 8 (30) Khng sinh ny c
FDA ph duyt dng trong
iu tr S. saprophyticus v
S. epidermidis
(khng dng cho S. aureus).

O Gatifloxacin 5 g 23 20-22 19 0.5 1 2

O Grepafloxacin 5 g 18 15-17 14 1 2 4
O Sparfloxacin 5 g 19 16-18 15 0.5 1 2
Inv. Fleroxacin 5 g 19 16-18 15 2 4 8
NITROFURANTOINS
U Nitrofurantoin 300 g 17 15-16 14 32 64 128
LINCOSAMIDES
A Clindamycin 2 g 21 15-20 14 0.5 4 (31) Khng clindamycin
suy on c th c pht
hin bng phng php
khoanh giy khuch tn s
dng vng D v bng
phng php pha long s
dng mt ging duy nht
cha 2 khng sinh phi hp
erythromycin v
clindamycin. Tham kho
Bng 2C-S4 v 2C-S5,
Phn 12 ti liu M02-A10,
v Phn 13 ti liu M07-A8
v cc khuyn co hin
thi.
 M100-S21

Xem lu (27).

C CH CON NG CHUYN HO FOLATE

A Trimethoprim/Sulfameth 1.25/23.75 16 11-15 10 2/38 - 4/76
oxazole g
U Sulfonamides 250-300 17 13-16 12 256 - 512 (32) C th dng khoanh
g giy khng sinh
sulfisoxazole i din cho
cc khng sinh nhm
sulfonamide ang c s
dng hin thi.
U Trimethoprim 5 g 16 11-15 10 8 - 16
PHENICOLS
C Chloramphenicol 30 g 18 13-17 12 8 16 32 Xem lu (27)
ANSAMYCINS
B Rifampin 5 g 20 17-19 16 1 2 4 (33) Rx: Rifampin khng
nn s dng n c trong
iu tr.

STREPTOGRAMINS
C Quinupristin-dalfopristin 15 g 19 16-18 15 1 2 4 (34) Bo co i lp S.
aureus nhy cm vi
methicillin.
OXAZOLIDINONES
B Linezolid 30 g 21 - 20 4 - 8 (35) Khi xt nghim vi
linezolid, nn kim tra vng
c ch bng nh sng xuyn
qua. Cc chng cho kt qu
khng nhy cm nn khng
nh li bng phng php
MIC.
Vit tt: ATCC, tn thng mi ca h thng chng chun theo tiu chun ca Hoa K; CAMHB, canh thang Mueller-Hinton iu chnh cation; MHA,
Thch Mueller-Hinton; MIC, Nng c ch ti thiu, QC, m bo cht lng xt nghim; FDA,Cc qun l an ton thuc v thc phm; MRS,
 M100-S21
Staphylococci khng methicillin; MOD-SA, t cu vng thay i:PBP, Protein gn penicillin; PCR, phn ng khuch i chui gen; VRSA, gen vanA
khng vancomycin;
 M100-S21
Bng b sung 2C-S4. Xt nghim sng lc cc chng sinh -Lactamase, khng oxacillin, khng oxacillin qua trung gian mecA bng cefoxitin,
vancomycin MIC 8 g/mL, khng clindamycin do kch thch v khng mupirocin mc cao ca cc chng Staphylococcus aureus trong Bng
2C
Xt nghim -Lactamase Khng Khng oxacillin qua Vancomycin Khng clindamycin do kch Khng Mupirocin
sng lc Oxacillin trung gian mecA s MIC thch mc cao a,b,
dng Cefoxitin 8 g/mL
Nhm vi S. aureus v S. S. aureus S. aureus v S. aureus S. aureus v S. lugdunensis S. aureus
khun lugdunensis vi S. lugdunensis Khng vi erythromycin v nhy
MIC penicillin cm hoc khng trung gian vi
0.12 g/mL clindamycin
hoc ng
knh vng c
ch 29 mm
Phng Xt nghim da Pha long Khoanh Vi pha long Pha long Khoanh giy Vi pha long trn Khoanh Vi pha
php xt trn Nitrocefin trn thch giy trong canh trn thch khuch tn thch giy long
nghim khuch thang khuch tn trong
tn canh
thang
Mi trng NA MHA vi 4% MHA CAMHB Thch no MHA hoc CAMHB MHA CAMHB
NaCl tim (BHI) thch mu s
dng cho
MIC
Nng NA Oxacillin 6 Khoanh cefoxitin 4 vancomycin Khoanh giy erythromycin Khoanh Ging
khng sinh g/mL giy g/mL 6 g/mL erythromycin 4 g/mL v 0.5 khng sinh cha
cefoxitin 15-g v g/mL mupirocin mupiroci
30 g khoanh giy clindamycin trong 200-g n
clindamycin cng mt ging 256-
2-g t cch g/mL
nhau 1526
mm
Huyn dch Pht trin th Pha huyn Cc Phng php Pha huyn Cc phng Phng php vi Cc Phng
vi khun pht (v d, ly dch vi khun phng vi pha long dch vi php khoanh pha long chun phng php vi
khun lc t trc tip t php chun c khun trc giy khuch c khuyn co php pha long
vng xung khun lc t khoanh khuyn co tip t khun tn chun khoanh chun
quanh khoanh c tng giy lc t c khuyn giy c
 M100-S21
khng sinh ng c khuch c tng co khuch tn khuyn
oxacillin hoc chun 0.5 tn ng chun co
cefoxitin trn McFarland. chun c chun Hoc c
mi trng S dng que c 0.5 khuyn co
thch mu hoc cy c vng khuyn McFarland. Vng cy dy
MHA sau 16- cy 1-L co S dng que trn a thch
18h nui cy) hoc tm cy c vng
bng cy cy 1-L
ria trn a hoc tm
mt vng c bng cy
ng knh ria trn a
10-15mm mt vng c
hoc a ng knh
thch 10-15mm
hoc a
thch
iu kin Nhit phng 3335 C; 3335 3335 C; 352 C; 352 C; 352 C; 352 C; 352 C;
nui cy Hiu kh. C; Hiu kh. Hiu kh. Hiu kh. Hiu kh. Hiu kh. Hiu kh.
(Nui cy Hiu (Nui cy
nhit trn kh. nhit trn
35 C (Nui 35 C
C th khng cy C th khng
pht hin nhit pht hin c
c trn 35 MRSA.)
MRSA.) C
C th
khng
pht
hin
c
MRSA.)
Thi gian Ti a 1h i 24h; c vi 16-18h 16-20h 24h; c vi 16-18h 18-24h 24h; c 24h; c
nui cy vi xt nghim nh sng nh sng vi nh vi nh
da trn xuyn qua xuyn qua sng xuyn sng
nitrocefin hoc qua xuyn
 M100-S21
theo hng dn qua
ca nh sn
xut
Phng Xt nghim da Pha long Khng Vi pha long Pha long Khng sinh Vi pha long Khng sinh Vi pha
php xt trn Nitrocefin trn thch sinh trn thch long
nghim
Kt qu Xt nghim Kim tra cn 21 >4 g/mL = Kim tra cn Nu xut Bt k s pht Kim tra i vi
Nitrocefin: thn vi nh mm = mecA dng thn vi nh hin vng c trin no=khng cn thn ging
chuyn t mu sng xuyn mecA tnh sng xuyn ch c hnh clindamycin do bng nh 256-
vng sang qua pht dng qua pht dng khng kch thch sng xuyn g/mL
/hng=- hin >1 tnh 4 g/mL = hin >1 trn bn cnh qua pht
lactamase khun lc mecA m tnh khun lc khoanh Khng pht hin s Pht
dng tnh hoc khun 22 hoc khun erythromycin trin=khng pht trin trin=
lc to thnh mm = lc to thnh (vng ch khng yu trong khng
mt lp mecA mt lp D)=khng clindamycin do vng c mupiroci
mng kh m tnh mng kh clindamycin kch thch ch n mc
pht hin pht hin do kch thch cao
Khun lc Khng c
> 1 khun lc > 1 khun pht trin nh vng c Khng
= khng lc = gim trong vng ch=khng pht
oxacillin nhy cm c ch xung mupirocin trin=
vi quanh mc khng
vancomycin khoanh giy cao khng
clindamycin= mupiroci
khng C vng n mc
clindamycin c ch = cao
( sn c) khng c
k c khi s khng
khng xut mupirocin
hin vng D mc
cao
Xt nghim Cc chng Cc chng Cefoxitin c dng lm Tin hnh Bo co cc chng khng Bo co Nu c s
thm v staphylococci - staphylococci i din cho xt nghim MIC cho clindamycin do kch thch vi cc chng pht trin
bo co Lactamase khng c ch khng qua trung vancomycin dng lu khng clindamycin khng c trong
dng tnh th oxacillin th gian mecA. i vi cc vng c ging
 M100-S21
khng vi khng vi tt Cc chng mecA dng chng S. Ghi ch Chng ny c cho l ch l nng
penicillin, c cc khng tnh nn c bo co l aureus pht khng clindamycin da trn s khng 256-
amino-, sinh nhm - khng oxacillin (khng trin trn pht hin khng clindamycin do mupirocin g/mL th
carboxy- v Lactam; cc phi cefoxitin); cc khng mi trng kch thch. Clindamycin c th mc bo co
ureidopenicillin. khng sinh sinh nhm -Lactam nn sng lc vn c hiu qu trn lm sng cao. khng
nhm - c bo co kt qu BHI- mt s bnh nhn mupiroci
Lactam nn khng hoc khng bo vancomycin Nu c n mc
c bo co co. bng cc vng c cao.
kt qu phng php ch, bo
khng hoc Bi v cc c ch khng pht hin co khng Nu
khng bo oxacillin khc thng MIC c gi c s khng c
co. him gp hn mecA, cc tr. Xt khng s pht
chng mc d mecA m nghim trn mupirocin trin
tnh nhng MIC oxacillin mi trng mc trong
nm trong gii hn khng sng lc cao tup
(MIC khng ng nng
4 g/mL) nn c bo tin cy 256-
co l khng oxacillin pht hin tt g/mL th
c cc chng bo co
S. aureus khng c
khng trung s khng
gian vi mupiroci
vancomycin. n mc
MICs bng 4 cao.
g/mL s
khng pht
trin.
Phng Xt nghim da Pha long Khoanh Vi pha Pha long Khoanh giy Vi pha long Khoanh Vi pha
php xt trn Nitrocefin trn thch giy khuch long trn thch khuch tn giy long
nghim tn khuch tn
 M100-S21
xut S. aureus S. aureus S. aureus S. aureus Enterococcu S. aureus S. aureus S. aureus S. aureus
kim sot ATCC ATCC ATCC ATCC s ATCC ATCC BAA- ATCC ATCC
cht lng 29213 29213 faecalis 25923 i vi 976 hoc 29213
29213 dng Nhy cm 25923 mecA m ATCC QC khoanh S. aureus 25923 mupA
tnh mecA tnh 29212 giy khng ATCC 29213 (khoanh m tnh
S. aureus m tnh (MIC Nhy cm sinh thng Khng pht trin giy 200- (MIC
S. aureus ATCC (vng c 1- qui; g) 0.06
ATCC 43300 ch 4g/mL) E. faecalis S. aureus mupA 0.5
Khng 23-29 mm) ATCC Xem Bng 3A ATCC BAA- m tnh g/mL)
25923 m tnh S. aureus 51299 v cc chng 977 (vng c
S. aureus ATCC Khng QC ch 29- 38 E.
(hoc xem ATCC 43300 pht mm) faecalis
hng dn ca mecA trin ATCC
nh sn xut) 43300 dng tnh S. aureus
mecA (MIC ATCC 29212
Dng tnh >4 g/mL) BAA1708 mupA
(vng c mupA m tnh
ch Dng tnh (MIC 16
21 mm) (khng c n
vng c 128g/m
ch) L)

S. aureus
ATCC
BAA170
8 mupA
Dng
tnh (pht
trin
ging
256g/ml
 M100-S21
Vit tt: ATCC, tn thng mi ca h thng chng chun theo tiu chun ca Hoa K; CAMHB, canh thang Mueller-Hinton iu chnh cation; MHA,
Thch Mueller-Hinton; MIC, Nng c ch ti thiu, QC, m bo cht lng xt nghim; FDA,Cc qun l an ton thuc v thc phm; MRS,
Staphylococci khng methicillin;

Lu

a. Mc d khng c nh gi mt cch chnh thc bng nhng phn tch da trn ti liu CLSI M23, mt s nghin cu ch ra mi lin kt gia s
thiu p ng ca cc phc iu tr da trn mupirocin n c vi cc chng c gi tr MICs 512. Mc d ti liu ny khng cung cp hng dn
v tiu chun din gii kt qu i vi mupirocin, khoanh giy khuch tn v th nghim sng lc MIC c m t y xc nh i vi nhng chngr
m mupirocin MIC l 512 g/mL.
b. Ti liu tham kho:
Simor AE. Randomized controlled trial of chlorhexidine gluconate for washing intranasal mupirocin, and rifampin and doxycycline versus no treatment
for the eradication of methicillin-resistant Staphylococcus aureus colonization. Clin Infect Dis. 2007; 44: 178-185;
Harbarth S, Dharan S, Liassine N, Herrault P, Auckenthaler R, Pittet D. Randomized, placebo-controlled, double-blind trial to evaluate the efficacy of
mupirocin for eradicating carriage of methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother. 1999; 43:1412-1416; v
Walker ES, Vasquez JE, Dula R, Bullock H, Sarubbi FA. Mupirocin-resistant, methicillin-resistant Staphylococcus aureus; does mupirocin remain
effective? Infect Control Hosp Epidemiol. 2003;24:342-346.
 M100-S21
Bng 2C-S5. Xt nghim sng lc xc nh tnh khng do -Lactamase, khng Oxacillin qua trung gian mecA s dng Cefoxitin, v khng
Clindamycin do kch thch cc chng Staphylococci khng sinh Coagulase (tr Staphylococcus lugdunensis) i vi cc trng hp trong Bng 2C

Xt nghim sng lc -Lactamase Khng Oxacillin qua trung Khng Clindamycin do kch thch (inducible)
gian mecA s dng Cefoxitin
Nhm vi khun Staphylococcia khng sinh Staphylococcia khng sinh Staphylococcia khng sinh coagulase khng vi
coagulase vi MICs ca penicillin coagulase erythromycin v nhy cm hoc khng trung gian vi
0.12 g/mL hoc ng knh vng clindamycin.
c ch 29 mm
Phng php xt Xt nghim da trn Nitrocefin Khoanh giy khuch tn Khoanh giy khuch tn Vi pha long canh thang
nghim
Mi trng NA MHA MHA hoc a thch mu CAMHBb
s dng cho xt nghim
MIC
Nng NA Khoanh giy cefoxitin 30-g Khoanh giy erythromycin Erythromycin 4 g/mL v
khng sinh 15-g v clindamycin 2-g clindamycin 0.5 g/mL
t cch nhau 1526 mm trong cng mt ging
Huyn dch vi Pht trin th pht (v d, khun lc Thao tc khoanh giy khuch Thao tc khoanh giy Thao tc vi pha long canh
khun ranh gii vng c ch xung quanh tn chun khuch tn chun thang chun
khoanh giy oxacillin hoc Hoc
cefoxitin trn mi trng MHA Vng c cy m c
hoc thch mu sau 16-18h nui trn a
cy)
iu kin nui cy Nhit phng 3335 C; hiu kh 35 2 C; hiu kh 35 2 C; hiu kh

(Xt nghim nhit phng

cao hn 35 C c th khng
pht hin MRS.)
Thi gian nui cy Ti a 1h i vi xt nghim da 24h (c th bo co kt qu 16-18h 18-24h
trn nitrocefin hoc tun th hng sau 18h nu khng)
dn ca nh sn xut
Kt qu Xt nghim da trn Nitrocefin: i 24 mm = mecA dng tnh; Nu xut hin vng c ch Bt k s pht trin
t mu vng sang /hng= - c hnh dng khng trn no=khng clindamycin do
lactamase dng tnh 25 mm = mecA m tnh. bn cnh khoanh kch thch
erythromycin (vng ch
 M100-S21
D)=khng clindamycin do Khng pht trin=khng
kch thch khng clindamycin do kch
Khun lc pht trin nh thch
trong vng c ch xung
quanh khoanh giy
clindamycin=khng
clindamycin ( sn c) k
c khi khng xut hin
vng D
Phng php xt Xt nghim da trn Nitrocefin Khoanh giy khuch tn Khoanh giy khuch tn Vi pha long canh thang
nghim

Xt nghim thm v Cc chng staphylococci sinh -
bo co lactamase khng vi penicillin,
amino-, carboxy- v
Ureidopenicillins.
Cefoxitin c s dng i Bo co cc chng khng clindamycin do kch thch vi
din cho khng oxacillin qua dng lu khng clindamycin
trung gian mecA.
Ghi ch Chng ny c cho l khng clindamycin da
Cc chng mecA dng tnh trn s pht hin khng clindamycin do kch thch.
bo co kt qu khng Clindamycin c th vn c hiu qu trn lm sng mt
oxacillin (khng phi s bnh nhn
cefoxitin); cc khng sinh
nhm -lactam khc nn c
bo co l khng hoc khng
bo co.

Bi v s him gp ca cc c
ch khng khc khng phi
qua trung gian mecA, cc
chng mecA m tnh nhng
gi tr MIC l khng (MICs
4 g/mL) nn c bo co l
khng oxacillin. i vi cc
trng hp nhim khun nng
do staphylococci khng sinh
coagulase khng phi S.
epidermidis, xt nghim chn
 M100-S21
on mecA hoc protein biu
hin bi mecA c th p dng
cho cc chng c gi tr MIC
ca oxacillin l 0.5 n 2
g/mL.
xut QC S. aureus ATCC 29213 dng S. aureus ATCC 25923 S. aureus ATCC 25923 S. aureus ATCC
tnh mecA m tnh i vi QC thng qui BAA-976 hoc
(ng knh vng c ch 23- khoanh giy khng sinh; S. aureus ATCC
S. aureus ATCC 25923 m tnh 29 mm) Xem Bng 3A i vi cc 29213 khng pht trin
chng QC b sung.
(hoc tham kho cc xut ca S. aureus ATCC S. aureus ATCC
nh sn xut) 43300 mecA dng tnh BAA-977 pht trin
(ng knh vng c ch 21
mm)
Vit tt: ATCC, tn thng mi ca h thng chng chun theo tiu chun ca Hoa K; CAMHB, canh thang Mueller-Hinton iu chnh cation; MHA,
Thch Mueller-Hinton; MIC, Nng c ch ti thiu, QC, m bo cht lng xt nghim; FDA,Cc qun l an ton thuc v thc phm;

Lu
a. Tr S. lugdunensis, c bao gm trong nhm S. aureus. Xem bng trc.
 M100-S21
Bng 2D. Tiu chun din gii kt qu ng knh vng c ch v nng c ch ti thiu(MIC)vi Enterococcus spp.

iu kin th nghim Cc xut kim sot cht lng ti thiu

(Xem bng 3 v 4: gii hn QC cho php)
Mi trng: Khoanh giy khuch tn: MHA
Canh thang pha long: CAMHA; CAMHB b sung 50 g/mL Khoanh giy khuch tn:
calcium i vi daptomycin\ Staphylococcus aureus ATCC 25923
Pha long trn thch: MHA; pha long trn thch cha c nh
gi vi daptomycin Cc phng php pha long:
Huyn dch vi khun: Phng php tng sinh bng canh thang hoc pha huyn dch vi Enterococcus faecalis ATCC 29212
khun trc tip t khun lc vi mt vi khun tng ng
c chun 0.5 McFarland
iu kin nui cy: 352oC, hiu kh, 16-18h;
Khoanh giy khuch tn: 16-18h
Cc phng php pha long: 16-20h
Tt c cc phng php: 24h
i vi vancomycin

Tham kho Bng 2D-S6 cui Bng 2D i vi cc xut b sung v iu kin xt nghim, bo co v QC.

Lu chung
(1) i vi phng php khoanh giy khuch tn, o ng knh vng c ch (xc nh bng mt thng mp), bao gm c ng knh ca khoanh giy
khng sinh. Soi a trn nn en bng nh sng phn chiu ngoi tr i vi vancomycin, nn c a bng nh sng xuyn qua (cm a trc n
chiu). Vng c ch l vng trong bng mt thng khng quan st thy s pht trin ca vi khun. Khng n s pht trin yu ca cc khun
lc nh li ti m ch c th quan st bng knh hin vi xung quanh mp ca vng c ch. Nu trong vng c ch c th quan st thy s pht trin ca vi
khun, chng t trng hp vi khun khng vancomycin.
(2) CNH BO: i vi Enterococcus spp., cephalosporins, aminoglycosides (tr trng hp khng mc cao), clindamycin, v
trimethoprimsulfamethoxazole c th c tc dng trn in vitro, nhng khng c hiu qu trn lm sng v do khng c bo co v tnh nhy cm.
 M100-S21
(3) Hip ng gia ampicillin, penicillin, hoc vancomycin v mt khng sinh nhm aminoglycoside c th c d on cho Enterococci bng cch s
dng xt nghim sng lc i vi s khng khng sinh nhm aminoglycoside mc cao (gentamicin v streptomycin). Cc khng sinh
aminoglycosides khc khng cn th, v tc dng khng khun ca chng i vi Enterococci khng kh hn gentamicin v streptomycin.
(4) i vi mt s cp vi khun/khng sinh, hin tng khng hoc him khi pht hin chng khng khng cho php xc nh bt k mt kt qu no
ngoi nhy cm. i vi cc chng cho kt qu khng nhy cm, ton b qu trinh phn lp nh danh v tin hnh th nghim nhy cm khng
sinh cn c lm li. (Xem ph lc A).
LU : Cc thng tin c in m l mi hoc c hiu chnh so vi phin bn trc
 M100-S21
Bng 2D. (Tip)
Nhm th Gii hn ng knh Tiu chun din gii kt qu
Hm Lu
nghim/ Khng sinh vng c ch (mm) MIC (g/mL)
lng
bo co S I R S I R
PENICILLINS
A Penicillin 10 v 15 - 14 8 - 16 (5) Ampicillin l i din cho
A Ampicillin 10 g 17 - 16 8 - 16 ampicillin v amoxicillin. Cc kt qu
th nghim vi ampicillin c th c
dng d on tnh nhy cm i
vi amoxicillin-axit clavulanic,
ampicillin-sulbactam, piperacillin, v
piperacillin-tazobactam ca cc chng
Enterococci khng sinh -lactamase.
Tnh nhy cm vi ampicillin c th
c s dng d on tnh nhy
cm vi imipenem, vi cc chng
c khng nh l E. faecalis.

(6) Enterococci nhy cm vi

penicillin th cng c th d on l
nhy cm vi ampicillin, amoxicillin,
ampicillin-sulbactam, amoxicillin-
clavulanate, piperacillin, v
piperacillin-tazobactam i vi cc
chng Enterococci khng sinh men -
lactamase. Tuy nhin, Enterococci
nhy cm vi ampicillin th khng th
suy ra nhy cm vi penicillin. Nu
cn kt qu vi penicillin th cn tin
hnh th nghim.
(7) Rx: Liu php kt hp gia
ampicillin, penicillin, hoc
vancomycin (i vi cc chng nhy
cm), v mt khng sinh nhm
aminoglycoside, thng dng cho cc
 M100-S21
trng hp nhim khun do
enterococcus (cu khun ng rut)
nng, nh vim mng trong tim, tr
trng hp khng mc cao vi c
gentamicin v streptomycin, phi hp
ny c tc dng d bo tc dng
hip ng dit Enterococcus.
(8) Cc chng Enterococci khng
ampicillin hoc penicillin do c ch
sinh men -lactamase rt t c bo
co. Pht hin khng ampicillin hoc
penicillin do c ch sinh men -
lactamase bng phng php khoanh
giy khuch tn thng qui hoc
phng php pha long khng ng
tin cy, nhng c pht hin bng
th nghim trc tip, th nghim -
lactamase da trn nitrocefin. Bi v
cc chng Enterococci -lactamase
dng tnh rt t, xt nghim ny
khng cn tin hnh thng qui, m
ch p dng vi cc trng hp c
la chn. Nu kt qu th nghim -
lactamase dng tnh cho php d
on v tnh khng vi penicillin,
amino-, carboxy-, v ureidopenicillins
(xem Ph lc I).
GLYCOPEPTIDS
B Vancomycin 30 g 17 15-16 14 4 8-16 32 (9) Khi th nghim tnh nhy cm vi
vancomycin ca cc chng
Enterococci, qu trnh nui cy nn
gi trong vng 24h pht hin tnh
trng khng mt cch chnh xc. Cc
chng cho kt qu MIC t 8-16
g/ml, tin hnh cc xt nghim sinh
 M100-S21
vt ha hc nh danh li nh i
trng hp Khng Vancomycin
trong Bng b sung 2D-S6, cui Bng
2D. o ng knh vng c ch di
nh sng xuyn qua, nu c bt k
khun lc no trong vng c ch
chng t c s khng vancomycin.
Cc chng cho kt qu khng trung
gian cn c xt nghim bng
phng php MIC nh m t trong ti
liu M07-A8. Tham kho xt nghim
Khng Vancomycin c m t trong
Bng b sung 2D-S6 cui Bng 2D.
Xem lu (3) v (7).
Inv. Teicoplanin 30 g 14 11-13 10 8 16 32
LIPOPEPTIDES
B Daptomycine - - - - 4 - - (10) Khoanh giy khuch tn khng
nh tin cy i vi daptomycin.
(11) Khng bo co thng qui vi
cc chng phn lp t bnh phm
ng h hp di.
Xem lu (4)
MACROLIDES
O Erythromycin 15 g 23 14-22 13 0.5 1-4 8 (12) Khng bo co thng qui vi
cc chng phn lp t nc tiu.
TETRACYCLINES
(13) Cc chng vi khun nhy cm vi tetracycline cng c th xem nh nhy cm vi doxycycline v minocycline. Tuy nhin, mt s chng khng
hoc khng trung gian vi tetracycline c th vn nhy cm vi doxycycline v/hoc minocycline.
U Tetracycline 30 g 19 15-18 14 4 8 16
O Doxycycline 30 g 16 13-15 12 4 8 16
O Minocycline 30 g 19 15-18 14 4 8 16
FLUOROQUINOLONES
U Ciprofloxacin 5 g 21 16-20 15 1 2 4
 M100-S21
U Levofloxacin 5 g 17 14-16 13 2 4 8
U Norfloxacin 10 g 17 13-16 12 4 8 16
O Gatifloxacin 5 g 18 1517 14 2 4 8 (14) Tiu chun din gii kt qu ch
p dng cho cc chng phn lp t
ng niu
NITROFURANS
U Nitrofurantoin 300 g 17 1516 14 32 64 128
ANSAMYCINS
O Rifampin 5 g 20 17-19 16 1 2 4 (15) Rx: Rifampin khng nn s dng
trong liu php n
FOSFOMYCINS
O Fosfomycin 200 g 16 1315 12 64 128 256 (16) Ch nh i vi cc chng E.
faecalis phn lp t ng tit niu.

(17) S dng phng php pha long

trn thch xc nh MIC. Mi
trng thch nn b sung vi 25
g/mL of glucose-6-phosphate.
Khng nn tin hnh phng php
pha long trong canh thang.

(18) Khoanh khng sinh fosfomycin

hm lng 200-g cha 50 g
glucose-6-phosphate.
PHENICOLS
C Chloramphenicol 30 g 18 1317 12 8 16 32 Xem lu (12)
STREPTOGRAMINS
B Quinupristin- 15 g 19 16-18 15 1 2 4 (19) Ch bo co i vi E. faecalis
dalfopristin khng vancomycin.
OXAZOLIDINONES
B Linezolid 30 g 23 21-22 20 2 4 8
 M100-S21
Vit tt: ATCC, tn thng mi ca h thng chng chun theo tiu chun ca Hoa K; CAMHB, canh thang Mueller-Hinton iu chnh cation; MHA,
Thch Mueller-Hinton; MIC, Nng c ch ti thiu;
 M100-S21
Bng b sung 2D-S5. Cc xt nghim sng lc cc chng Enterococcus spp. khng Aminoglycoside mc cao (HLAR) v khng Vancomycin i
vi cc trng hp trong Bng 2D

Xt nghim Gentamicin HLAR Streptomicin HLAR Khng Vancomycin

sng lc
Phng php Khoanh giy Pha long canh Pha long trn Khoanh giy Pha long Pha long trn Pha long trn thch
xt nghim khuch tn thang thch khuch tn canh thang thch
Mi trng MHA Canh thang BHIa Thch BHIa MHA Canh thang Thch BHIa Thch BHIa
BHIa
Nng khng Khoanh giy Gentamicin 500 Gentamicin Khoanh giy Streptomycin Streptomycin Vancomycin,
sinh gentamicin 120 g/ml 500 g/ml streptomycin 300 1000 g/ml 2000 g/ml 6 g/mL
g g
Huyn dch vi xut phng xut phng 10 L ca xut phng xut 10 L ca 110 L ca huyn dch
khun php khoanh php canh thang huyn dch vi php khoanh giy phng php huyn dch vi vi khun m 0.5
giy khuch tn pha long chun khun m khuch tn chun canh thang khun m McFarland tri trn b
chun 0.5 McFarland pha long 0.5 McFarland mt thch
tri trn b chun tri trn b
mt thch mt thch
iu kin nui 35 2 C; hiu 35 2 C; hiu 35 2 C; 35 2 C; hiu 35 2 C; 35 2 C; 35 2 C; hiu kh
cy kh kh hiu kh kh hiu kh hiu kh
Thi gian nui 16-18h 24h 24h 16-18h 24-48h (nu 24-48h (nu 24h
cy quan st thy quan st thy
nhy cm nhy cm
24h, li) 24h, li)
Kt qu 6 mm = Khng Bt k mt >1 khun lc 6 mm=khng; Bt k khun >1 khun lc >1 khun lc = khng
khun lc no = = khng 7-9 mm=khng lc no = = khng vancomycin (kt lun s
79 mm = khng kt lun; khng b)
Khng kt lun 10 mm =
c; Nhy cm

10 mm = MIC tng quan:

Nhy cm. R = >1000
g/mL
(canh thang) v
MIC tng quan: >2000
 M100-S21
R = >500 g/mL g/mL (thch);
S = 500
g/mL S = 500 g/mL
(canh thang) v
1000
g/mL (thch)
Xt nghim Khng: khng c tc dng hip ng vi cc khng sinh c tc dng ln thnh t bo (v d, ampicillin, Tin hnh xt nghim
thm v bo penicillin, v vancomycin). MIC ca vancomycin v
co th tnh di ng, sinh
Nhy cm: c tc dng hip ng vi cc khng sinh c tc dng ln thnh t bo (v d, ampicillin, sc t phn bit cc
penicillin, v vancomycin) v cng cho kt qu nhy cm. chng khng thuc thu
c theo c chVan A
Nu kt khoanh giy khuch tn vn cha kt lun c: Tin hnh phng php pha long canh thang hoc v VanB vi cc chng
trn thch khng nh. khng trung gian vi
vancomycin theo c
chVanC, v d,
Enterococcus
gallinarum v
Enterococcus
casseliflavus, l cc
chng thng pht trin
trn thch sng lc c
vancomycin. Ngc li
vi cc enterococci nh,
E. casseliflavus v E.
gallinarum vi gi tr
MIC vancomycin 816
g/mL (trung gian) khc
vi Enterococci khng
vancomycin (VRE) i
vi mc ch kim sot
nhim khun.

Cc xut E. faecalis E. faecalis E. faecalis E. faecalis E. faecalis E. faecalis E. faecalis

QC ATCC29212; ATCC29212 ATCC29212 ATCC29212; ATCC29212 ATCC29212 ATCC29212 Nhy
 M100-S21
1623 mm Nhy cm Nhy cm 1420 mm Nhy cm Nhy cm cm
E. faecalis E. faecalis E. faecalis E. faecalis
ATCC51299 ATCC51299 ATCC51299 ATCC51299 E. faecalis
Khng Khng Khng Khng ATCC51299 Khng

Lu
a
BHI = Canh thang no tim; mc d khng sn nhng ti u hn so vi mi trng thch hoc canh thang ng dextrose phosphate.
 M100-S21

Bng 2E. Tiu chun c kt qu ng knh vng c ch v nng c ch ti thiu (MIC) i vi Haemophilus influenzae v H. parainfluenzae

iu kin th nghim Cc xut kim sot cht lng ti thiu

(Xem bng 3A, 3B, 4A v 4B i vi gii hn QC cho php)
Mi trng: Khoanh giy khuch tn:Mi trng th
Haemophillus (HTM) Haemophilus influenzae ATCC 49247
Pha long trn canh thang: canh thang HTM Haemophilus influenzae ATCC 49766
Huyn dch vi khun: Pha huyn dch vi khun trc tip t khun lc vi Escherichia coli ATCC 35218 (khi th vi amoxicillin-
mt vi khun tng ng c chun 0.5 clavulanic axit)
McFarland
iu kin nui cy: 352 oC, 5% CO2, 16-18h
Khoanh giy khuch tn: 5% CO2; 16-18h
Pha long trn canh thang: hiu kh; 20-24h

Lu chung

(1) Heaemophilus spp., trong bng ny ch bao gm H. influenzae v H. parainfluenzae. Vi nhng loi khc thuc tc Haemophilus xem ti liu
CLSI M45 bit v nhng th nghim v bo co khuyn co.
(2) i vi khoanh giy khuch tn, o ng knh vng c ch (v d, xc nh ranh gii vng c ch bng mt thng), bao gm ng knh khoanh
giy.
Soi a mi trng trn nn en vi nh sng phn chiu tr trng hp linezolid, oxacilin v vancomycin nn s dng nh sng xuyn qua. Xc nh
ranh gii vng c ch bng mt thng, khng c s pht trin r rng ca vi khun. B qua s pht trin yu v cc khun lc nh li ti ch c th pht
hin khi soi di knh lp hoc knh hin vi b ca vng c ch. i vi trimethoprim v sulfonamides, cc cht i khng trong mi trng c th
cho php vi khun pht trin nh; do c th b qua s pht trin yu ny (khng qu 20%) v o ng knh vng c ch vi ranh gii xc nh
bng mt thng.
(3) Ch cc kt qu th nghim vi ampicillin, mt trong s khng sinh cephalosporin th h 3, chloramphenicol, v meropenem nn c bo co thng
qui
vi cc chng Haemophilus influenzae phn lp t dch no ty.
 M100-S21
(4) Amoxicillin-clavulanic axit, azithromycin, clarithromycin, cefaclor, cefprozil, loracarbef, cefdinir, cefixime, cefpodoxime, cefuroxime, v
telithromycin l cc khng sinh ng ung c th dng theo kinh nghim iu tr vim ng h hp Haemophilus spp. Kt qu th nghim tnh
nhy cm vi cc khng sinh ny thng khng c ngha i vi tng bnh nhn c th. Tuy nhin cc kt qu ny c ngha i vi cc gim st
v nghin cu dch t hc.
(5) Chun b mi trng HTM: chun b dung dch m hematin bng cch pha 50 mg bt hematin trong 100 mL dung dch NaOH 0.01 mol/L, un nng v
khuy cho n khi tan hon ton. Sau , ly 30ml dung dch hematin cho vao 1L mi trng thch Mueller-Hinton vi 5g dch chit nm men. Sau
khi hp tit trng v lm ngui, b sung thm 3 mL dung dch NAD (50 mg NAD ha tan trong 10 mL nc ct v trng, lc v trng), m bo v
trng.
(6) i vi mt s cp khng sinh/vi khun, cc chng vi khun khng thuc him gp gy kh khn trong vic xc nh mc khng thuc khng gp
hoc t l him gp cc chng khng thuc ngn cn vic xc nh cc kt qu ngoi trng hp nhy cm. i vi cc chng cho kt qu khng
nhy cm, kt qu nh danh vi khun v xc nh mc nhy cm khng sinh cn c xc nh li.

LU : Cc thng tin c in m l mi hoc c hiu chnh so vi phin bn trc

Bng 2E (Tip)
Nhm th Khng sinh Hm lng ng knh vng c ch im gy MIC tng Lu
nghim/ khoanh giy (mm) ng (g/mL)
bo co S I R S I R
PENICILLINS
A Ampicillin 10 g 22 19-21 18 1 2 4 Xem lu (3)
(7) Kt qu th nghim tnh nhy cm
vi ampicillin nn dng suy ra tnh
nhy cm vi amoxicillin. Trong hu
ht cc trng hp, th nghim trc
tip -lactamase c th pht hin nhanh
s khng ampicillin v amoxicillin.
Phn ln cc chng H. influenzae
khng ampicillin v amoxicillin u
sinh men -lactamase kiu TEM.
Phn ln cc trng hp, xt nghim -
lactamase trc tip c th cho kt qu
nhanh pht hin chng khng ampicillin
v amoxicillin.
(8) S t cc chng H. influenzae
khng sinh -lactamase nhng khng
 M100-S21
ampicillin (BLNAR) c th khng vi
amoxicillin-clavulanic axit, ampicillin-
sulbactam, cefaclor, cefetamet,
cefonicid, cefprozil, cefuroxime, v
loracarbef, mc d c th cho kt qu
nhy cm in vitro.
PHI HP -LACTAM/C CH -LACTAMASE Xem lu (8)
B Ampicillin-sulbactam 10/10 g 20 - 19 2/1 - 4/2 Xem lu (8)

C Amoxicillin- 20/10 g 20 - 19 4/2 - 8/4 Xem lu (4) v (8)

clavulanic axit

O Piperacillin- 100/10 g 21 - - 1/4 - 2/4 Xem lu (8)

tazobactam
CEPHEMS (TIM) (Bao gm cephalosporins I, II, III, v IV. Tham kho Ch thch I) Xem lu (8)
B Cefotaxime hoc 30 g 26 - - 2 - - Xem lu (3) v (6)
B Ceftazidime hoc 30 g 26 - - 2 - -
B Ceftriaxone 30 g 26 - - 2 - -
B Cefuroxime 30 g 20 17-19 16 4 8 16 Xem lu (8)
O Cefonicid 30 g 20 17-19 16 4 8 16 Xem lu (8)
O Cefamandole - - 4 8 16 Xem lu (8)
O Cefepime 30 g 26 - 2 Xem lu (6)
O Ceftizoxime 30 g 26 - 2 Xem lu (6)
CEPHEMS (NG UNG)
C Cefaclor 30 g 20 17-19 16 8 16 32
C Cefprozil 30 g 18 15-17 14 8 16 32
C Cefdinir hoc 5 g 20 - 1 - - Xem lu (4) v (6)
C Cefixime hoc 5 g 21 - 1 - -
C Cefpodoxime 10 g 21 - 2 - -
C Cefuroxime 30 g 20 17-19 16 4 8 16
O Loracarbef 30 g 19 16-18 15 8 16 32 Xem lu (4) v (8)
O Ceftibuten 30 g 28 - 2 Xem lu (6)
Inv. Cefetamet 10 g 18 15-17 14 4 8 16 Xem lu (8)
MONOBACTAMS
C Aztreonam 30 g 26 - - 2 - - Xem lu (6)
 M100-S21
CARBAPENEMS
B Meropenem 10 g 20 - - 0.5 - - Xem lu (3) v (6)
C Ertapenem hoc 10 g 19 - - 0.5 - - Xem lu (6)
C Imipenem 10 g 16 - - 4 - -
MACROLIDES
C Azithromycin 15 g 12 - 4 - - Xem lu (6)
C Clarithromycin 15 g 13 11-12 10 8 16 32
KETOLIDES
C Telithromycin 15 g 15 12-14 11 4 8 16 Xem lu (4)
TETRACYCLINES
C Tetracycline 30 g 29 26-28 25 2 4 8 (9) Cc chng nhy cm vi
tetracycline th c th xem nh nhy
cm vi doxycycline v minocycline
FLUOROQUINOLONES
C Ciprofloxacin hoc 5 g 21 - - 1 - -
C levofloxacin hoc 5 g 17 - - 2 - -
C lomefloxacin hoc 10 g 22 - - 2 - -
C moxifloxacin hoc 5 g 18 - - 1 - -
C ofloxacin 5 g 16 - - 2 - -
Gemifloxacin 5 g 18 - - 0.12 - -
O Gatifloxacin 5 g 18 - - 1 - -
O Grepafloxacin 5 g 24 - - 0.5 - -
O Sparfloxacin - - - - 0.25 - -
O Trovafloxacin 10 g 22 - - 1 - -
Inv. Fleroxacin 5 g 19 - - 2 - -
C CH CON NG FOLATE
A Trimethoprim- 1.25/23.75 16 11-15 10 1/19 4/76
sulfamethoxazole g 0.5/9.5 2/38
PHENICOLS
O Chloramphenicol 30 g 29 26-28 25 2 4 8 Xem lu (3)
(10) Khng bo co thng qui cc
chng phn lp t nc tiu
ANASAMYCINS
C Rifampin 5 g 20 17-19 16 1 2 4 (11) Rx: Rifampin khng nn s dng
trong liu php n
 M100-S21
Vit tt: ATCC, tn thng mi ca h thng chng chun theo tiu chun ca Hoa K; BLNAR -lactamase m tnh, khng ampicillin HTM, mi trng
th nghim Haemophilus; MHA, Thch Mueller-Hinton; MIC, Nng c ch ti thiu, NAD, nicotinamide adenine dinucleotide; QC, m bo cht lng
xt nghim;

Bng 2F. Tiu chun c kt qu ng knh vng c ch v nng c ch ti thiu (MIC) i vi Neisseria
gonorrhoeae

iu kin th nghim Cc xut kim sot cht

lng ti thiu
Mi trng: Khoanh giy khuch tn: Mi trng thch GC (c bn (thch chocolate c bn) (Xem bng 3B v 4C i vi gii
v 1% yu t kch thch tng trng thch hp. Khng yu cu s dng yu t hn QC cho php)
kch thch tng trng cysteine twj do cho phng php khoanh giy khuch tn
Pha long trn thch: Mi trng thch GC c bn v 1% yu t kch thch tng Neisseria gonorrhoeae ATCC
trng thch hp. Yu cu s dng yu t kch thch tng trng cysteine t do 49226
i vi phng php pha long trn thch ca carbapenems v clavulanate. Yu
t kch thch tng trng cha cysteine khng thay i cc kt qu ca cc
khng sinh khc khi s dng xt nghim pha long.
Huyn dch vi khun: Pha huyn dch vi khun trc tip t khun lc vi mt vi khun tng ng
c chun 0.5 McFarland
iu kin nui cy: 361 oC (khng vt qu 37 oC), 5% CO2, tt c cc phng php, 20-24h

Lu chung

(1) i vi khoanh giy khuch tn, o ng knh vng c ch (v d, xc nh ranh gii vng c ch bng mt thng), bao gm ng knh khoanh
giy. Soi a mi trng trn nn en vi nh sng phn chiu tr trng hp linezolid, oxacilin v vancomycin nn s dng nh sng xuyn qua. Xc
nh ranh gii vng c ch bng mt thng, khng c s pht trin r rng ca vi khun. B qua s pht trin yu v cc khun lc nh li ti ch c th
pht hin khi soi di knh lp hoc knh hin vi b ca vng c ch.
(2) Hiu qu lm sng ca cefmetazole, cefotetan, cefoxitin, v spectinomycin trong iu tr cc chng cho kt qu khng trung gian vi cc khng sinh
ny hin cha r.
(3) Th nghim khoanh giy khuch tn i vi N. gonorrhoeae, kt qu khng trung gian vi mt khng sinh no chng t hoc k thut c vn v
cn lp li th nghim hoc thiu kinh nghim lm sng trong iu tr cc chng vi khun vi cc vng c ch ny. L do sau thng gp cc trng
 M100-S21
hp i vi cefmetazole, cefotetan, cefoxitin, v spectinomycin. Cc chng khng trung gian vi cc loi khng sinh khc c t l c kh nng iu tr
lm sng c ghi nhn thp hn (85 to 95%) so vi cc chng nhy cm c t l l >95%.

(4) Mi trng s dng cho N. gonorrhoeae bao gm thch GC (thch chocolate c bn) b sung thm 1% yu t thch tng trng thch hp (1.1 g L-
cysteine, 0.03 g guanine HCL, 3 mg thiamine HCL, 13 mg PABA, 0.01 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 [trong 1 L H2O]) c b sung sau khi hp tit trng.

(5) i vi mt s cp vi khun/khng sinh, hin tng khng hoc him khi pht hin chng khng khng cho php xc nh bt k mt kt qu no
ngoi nhy cm. i vi cc chng cho kt qu khng nhy cm, ton b qu trinh phn lp nh danh v tin hnh th nghim nhy cm khng
sinh cn c lm li (Xem Ph lc A).
LU : Cc thng tin c in m l mi hoc c hiu chnh so vi phin bn trc
 M100-S21

Bng 2F.
Nhm th Khng sinh Hm ng knh vng c ch Tiu chun din gii kt Lu
nghim/ lng (mm) qu MIC(g/mL)
bo co S I R S I R
PENICILLINS
C Penicillin 10 UI 47 27-46 26 0.06 0.12-1 2 Xem lu (3)

(6) Th nghim dng tnh vi -

lactamase chng t chng khng vi
penicillin, ampicillin, and amoxicillin.

(7) Th nghim -lactamase s pht hin

mt dng khng penicillin ca N.
gonorrhoeae v cng c th s dng
cung cp thng tin v dch t hc. Cc
chng c c ch khng qua trung gian
chromosome ch c th pht hin bng
phng php khoanh giy khuch tn v
MIC pha long trn thch.

(8) Gonococci vi khoanh giy khng sinh

penicillin 10-n v v ng knh vng
c ch 19 mm thng l chng sinh -
lactamase. Tuy nhin, th nghim -
lactamase vn c a dng hn cc
phng php th nghim tnh nhy cm
khc v chnh xc v nhanh pht
hin cc chng khng penicillin qua trung
gian plasmid.
CEPHEMS (NG TIM) (Bao gm cephalosporins I, II, III, v IV. Tham kho
Ch thch I)
C Cefotaxime 30 g 31 - - 0.5 - - Xem lu (5)
 M100-S21
C hoc 30 g 35 - - 0.25 - -
ceftriaxone
C Cefoxitin 30 g 28 24-27 23 2 4 8 Xem lu (2)
C Cefuroxime 30 g 31 26-30 25 1 2 4 Xem lu (3)
O Cefepime 30 g 31 0.5 - Xem lu (5)
O Cefmetazole 30 g 33 2832 27 2 4 8 Xem lu (2)
O Cefotetan 30 g 26 2025 19 2 4 8 Xem lu (2)
O Ceftazidime 30 g 31 0.5 - Xem lu (5)
O Ceftizoxime 30 g 38 0.5 - Xem lu (5)
CEPHEMS (NG UNG)
C Cefixime hoc 5 g 31 - - 0.25 - - Xem lu (5)
C Cefpodoxime 10 g 29 - - 0.5 - -
Inv. Cefetamet 10 g 29 - - 0.5 - - Xem lu (5)
TETRACYCLINES
(9) Cc chng nhy cm vi tetracycline cng c xem nh nhy cm vi doxycycline v minocycline
C Tetracycline 30 g 38 31-37 30 0.25 0.5-1 2 (10) Gonococci vi khoanh giy
tetracycline 30-g ng knh vng c
ch 19 mm thng chng t l chng
N. Gonorrhoeae khng tetracycline qua
trung gian plasmid (TRNG). Nhng chng
ny nn khng nh li bng phng php
pha long (MIC 16 g/mL).
FLUOROQUINOLONES
C Ciprofloxacin 5 g 41 28-40 27 0.06 0.12 1
C hoc 5 g 31 25-30 24 0.25 0.5 2
ofloxacin 0.51
O Enoxacin 10 g 36 32-35 31 0.5 1 2
O Gatifloxacin 5 g 38 34-37 33 0.125 0.25 0.5
O Grepafloxacin 5 g 37 28-36 27 0.06 0.12 1
0.5
O Lomefloxacin 10 g 38 27-37 26 0.12 0.251 2
O Trovafloxacin 10 g 34 - 0.25 - Xem lu (5)
Inv. Fleroxacin 5 g 35 29-34 28 0.25 0.5 1
AMINOCYCLITOLS
 M100-S21
C Spectinomycin 100 g 18 15-17 14 32 64 128 Xem lu (2)
Vit tt: ATCC, tn thng mi ca h thng chng chun theo tiu chun ca Hoa K; MIC, Nng c ch ti thiu, NAD, nicotinamide adenine
dinucleotide; QC, m bo cht lng xt nghim; PABA, para-aminobenzoic axit; QC, kim sot cht lng; TRNG, tetracycline-resistant Neisseria
gonorrhoeae,

Bng 2G. Tiu chun din gii qu ng knh vng c ch v nng c ch ti thiu (MIC) i vi Streptococcus pneumoniae

iu kin th nghim Cc xut kim sot cht lng ti thiu

(Xem bng 3B v 4B i vi gii hn QC cho php)
Mi trng: Khoanh giy khuch tan: MHA vi 5% mu cu
Pha long canh thang: CAMHB vi LHB (2.5 n 5% Streptococcus pneumoniae ATCC 49619
v/v) (Xem M07-A8 hng dn chun b LHB)
Huyn dch vi khun: Pha huyn dch vi khun trc tip t khun lc vi mt
vi khun tng ng c chun 0.5 McFarland
iu kin nui cy: 352 oC
Khng sinh : 5% CO2, 20-24h
Pha long: hiu kh, 20-24h

Lu chung

(1) i vi khng sinh , o ng knh vng c ch (v d, xc nh ranh gii vng c ch bng mt thng), bao gm ng knh khoanh giy. Soi a
mi trng trn nn en vi nh sng phn chiu tr trng hp linezolid, oxacilin v vancomycin nn s dng nh sng xuyn qua. Xc nh ranh
gii vng c ch bng mt thng, khng c s pht trin r rng ca vi khun. B qua s pht trin yu v cc khun lc nh li ti ch c th pht hin
khi soi di knh lp hoc knh hin vi b ca vng c ch. i vi trimethoprim v sulfonamides, cc cht i khng trong mi trng c th cho
php vi khun pht trin nh; do c th b qua s pht trin yu ny (khng qu 20%) v o ng knh vng c ch vi ranh gii xc nh bng
mt thng.

(2) Amoxicillin, ampicillin, cefepime, cefotaxime, ceftriaxone, cefuroxime, ertapenem, imipenem, v meropenem c th c dng iu tr vim phi;
tuy nhin, trn thc t khng tin hnh th nghim tnh nhy cm bng phng php khoanh giy khuch tn vi cc loi khng sinh ny do phng
php khoanh giy khuch tn khng ng tin cy. Tc dng in vitro c pht hin tt nht bng phng php MIC.
 M100-S21
(3) Penicillin v cefotaxime hoc ceftriaxone hoc meropenem cn c th bng phng php MIC ng tin cy (v d nh c m t trong ti liu
CLSI-M7-A8) v bo co thng qui vi cc chng S. pneumonia phn lp t dch no ty . Cc chng ny cn tin hnh th nghim vi vancomycin
bng phng php MIC hoc khoanh giy khuch tn.

(4) i vi mt s cp vi khun/khng sinh, hin tng khng hoc him khi pht hin chng khng khng cho php xc nh bt k mt kt qu no
ngoi nhy cm. i vi cc chng cho kt qu khng nhy cm, ton b qu trinh phn lp nh danh v tin hnh th nghim nhy cm khng
sinh cn c lm li (Xem Ph lc A).
LU : Cc thng tin c in m l mi hoc c hiu chnh so vi phin bn trc
 M100-S21

Bng 2G. (Tip)

Nhm th Khng sinh Hm ng knh vng c ch im gy MIC tng Lu
nghim/ lng (mm) ng (g/mL)
bo co S I R S I R
PENICILLINS

(5) i vi chng khng vim mng no (khng phn lp t dch no ty hoc bnh nhn khng c biu hin vim mng no), gi tr MIC penicillin c
th d on tnh nhy cm vi cc khng sinh nhm -lactams khc nh sau:
Penicillin MIC 0.06 g/mL (hoc ng knh vng c ch ca oxacillin ng knh 20 mm) cho thy chng nhy cm vi ampicillin (ung v
tim), amoxicillin, amoxicillin-clavulanic axit, ampicillin-sulbactam, cefaclor, cefdinir, cefditoren, cefepime, cefotaxime, cefprozil, ceftizoxime,
ceftriaxone, cefuroxime, cefpodoxime, ertapenem, imipenem, loracarbef, v meropenem.

Penicillin MIC 2 g/mL chng t chng nhy cm vi: amoxicillin, amoxicillin-clavulanic axit, cefepime, cefotaxime, ceftriaxone, v ertapenem.

Xem lu (3)

A Penicillin 1 g 20 - - - - - (6) Cc chng ph cu vi khoanh giy

oxacillin
A Penicillin tim
(khng vim
oxacillin ng knh 20 mm hoc vi
penicillin MIC 0.06 g/mL c th xem
nh nhy cm vi penicillin.Cc chng vi
ng knh oxacillin 19 mm nn c
xc nh MIC ca penicillin v cefotaxime
hoc ceftriaxone hoc meropenem bi v
ng knh 19 mm thng xy ra vi cc
chng khng, khng trung gian hoc nhy
cm vi penicillin. Cc chng ny khng
nn bo co kt qu l khng vi penicillin
khi cha tin hnh xt nghim MIC
penicillin.
- - - - 2 4 8 (7) Rx: Liu penicillin tim tnh mch t
nht 2 triu n v mi 4h ngi ln c
 M100-S21
mng no) chc nng thn bnh thng (12 triu n
v mi ngy) c th c dng iu tr
bnh nhm vim phi khng vim mng
no do cc chng c MIC penicillin 2
g/mL. Cc chng khng trung gian vi kt
qu MIC 4 g/mL c th cn liu 18 n 24
triu n v mi ngy.

(8) i vi cc chng khng phi phn lp

t dch no ty, bo co c i vi c 2
trng hp th hin vim mng no v
khng th hin vim mng no.
A Penicillin tim - - - - 0.06 - 0.12 (9) Rx: S dng penicillin iu tr vim
(vim mng no) mng no cn liu ti a penicillin tim
tnh mch (v d, t nht 3 triu n v mi
4h ngi ln c chc nng thn bnh
thng).

(10) i vi cc chng phn lp t dch

no ty, ch bo co cc trng hp th
hinvim mng no.
A Penicillin - - - - 0.06 0.12-1 2
(penicillin V
ung)
C Amoxicillin - - - - 2 4 8
(khng vim 2/1 4/2 8/4
C mng no)
Amoxicillin-
clavulanic
axit (khng vim
mng no)
CEPHEMS (NG UNG) (Bao gm cephalosporins th h I, II, III, IV. Tham kho Ph lc I)
 M100-S21
O Cefepime (vim - - - - 0.5 1 2 (11) i vi cc chng phn lp t Dch
mng no) no ty, ch bo co cho cc trng hp th
hin vim mng no. Khng c ch nh
ca FDA v vic s dng cefepime trong
iu tr vim mng no.
B Cefepime (khng - - - - 1 2 4 (12) Hoa K, ch cc trng hp th hin
vim mng no) khng vim mng no v bao gm ghi ch
khng vim mng no trong bo co.

B Cefotaxime (vim - - - - 0.5 1 2 (13) i vi cc chng phn lp t Dch

B mng no) - - - - 0.5 1 2 no ty, ch bo co vi cc trng hp th
Ceftriaxone (vim hin vim mng no.
mng no)
(14) Rx: S dng cefotaxime hoc
ceftriaxone liu ti a trong iu tr vim
mng no.

Xem lu (3).
B Cefotaxime - - - - 1 2 4 (15) i vi cc chng khng phn lp t
B (khng vim - - - - 1 2 4 Dch no ty, bo co th hin cho c vim
mng no) mng no v khng vim mng no.
Ceftriaxone
(khng vim
mng no)
C Cefuroxime - - - - 0.5 1 2
(ng tim)
CEPHEMS (UNG)
C Cefuroxime - - - - 1 2 4
(ung)
O Cefaclor - - - - 1 2 4
O Cefdinir - - - - 0.5 1 2
O Cefpodoxime - - - - 0.5 1 2
O Cefprozil - - - - 2 4 8
O Loracarbef - - - - 2 4 8
CARBAPENEMS
 M100-S21
B Meropenem - - - - 0.25 0.5 1 Xem lu (3)
C Ertapenem - - - - 1 2 4
C Imipenem - - - - 0.12 0.25 1
0.5
GLYCOPEPTIDES
B Vancomycin 30 g 17 - - 1 - - Xem lu (3) v (4)
MACROLIDES
(16) Tnh nhy cm v khng vi azithromycin, clarithromycin v dirithromycin c th c d on bng s dng erythromycin.
(17) Khng bo co thng qui vi cc chng phn lp t tit niu.
A Erythromycin 15 g 21 16-20 15 0.25 0.5 1
O Azithromycin 15 g 18 14-17 13 0.5 1 2
O Clarithromycin 15 g 21 17-20 16 0.25 0.5 1
O Dirithromycin 15 g 18 14-17 13 0.5 1 2
KETOLIDES
B Telithromycin 15 g 19 16-18 15 1 2 4

TETRACYCLINES
B Tetracycline 30 g 23 19-22 18 2 4 8 (18) Cc chng nhy cm vi tetracycline
th c th xem nh nhy cm vi
doxycycline v minocycline
FLUOROQUINOLONES
B Gemifloxacin 5 g 23 20-22 19 0.12 0.25 0.5
B Levofloxacin 5 g 17 14-16 13 2 4 8
B Moxifloxacin 5 g 18 15-17 14 1 2 4
B Ofloxacin 5 g 16 13-15 12 2 4 8
O Gatifloxacin 5 g 21 18-20 17 1 2 4
O Grepafloxacin 5 g 19 16-18 15 0.5 1 2
O Sparfloxacin 5 g 19 16-18 15 0.5 1 2
O Trovafloxacin 10 g 19 16-18 15 1 2 4
THUC C CH CON NG FOLATE
A Trimethoprim- 1.25/23.75 19 16-18 15 0.5/9.5 1/19 4/76
sulfamethoxazole g 2/38
PHENICOLS
C Chloramphenicol 30 g 21 - 20 4 - 8 Xem lu (17)
 M100-S21
ANASAMYCINS
C Rifampin 5 g 19 17-18 16 1 2 4 (19) Rx: Rifampin khng nn s dng n
c trong iu tr
LINCOSAMIDES
B Clindamycin 2 g 19 16-18 15 0.25 0.5 1 Xem lu (17)
STREPTOGRAMINS
O Quinupristin- 15 g 19 16-18 15 1 2 4
dalfopristin
OXAZOLIDINONES
C Linezolid 30 g 21 - - 2 - - Xem lu (4)
Vit tt: ATCC, tn thng mi ca h thng chng chun theo tiu chun ca Hoa K; CAMHB, canh thang Mueller-Hinton iu chnh cation; FDA,
LHB, Mu nga ly gii; MHB, Canh thang Mueller-Hinton; MIC, Nng c ch ti thiu (Nng khng sinh ti thiu c ch vi khun);Cc qun l an
ton thuc v thc phm; QC, m bo cht lng xt nghim;
 M100-S21
Bng 2H-1. Tiu chun din gii ng knh vng c ch v MIC i vi Streptococcus spp. tan huyt beta

iu kin th nghim Cc xut kim sot cht lng ti

thiu
Mi trng: Khng sinh : MHA b sung 5% mu cu (Xem bng 3Bv 4B v gii hn QC cho
Pha long canh thang: CAMHB vi LBH (2.5 n 5% v/v); CAHMB cn php)
c b sung 50 g/mL calcium i vi daptomycin (xem M07-A8 hng
dn chun b LHB) Streptococcus pneumoniae ATCC 49619
Pha long trn thch MHA vi thch mu cu (5% v/v) (khi xt nghim
khng sinh sulfonamide, nn dng LHB); pha long trn thch cha nh
gi vi daptomycin
Huyn dch vi khun: Pha huyn dch vi khun trc tip t khun lc vi mt vi khun tng
ng c chun 0.5 McFarland
iu kin nui cy: 352 oC,
Khng sinh : 5% CO2, 20-24h
Cc phng php pha long: hiu kh; 20-24h (CO2, nu cn thit cho vi
khun pht trin khi pha long trn thch)

Lu chung

(1) i vi phng php khoanh giy khuch tn, o ng knh vng c ch (bng mt thng), bao gm ng knh khoanh giy khng sinh. Ranh
gii vng c ch c xc nh l vng trong bng mt thng khng quan st thy s pht trin ca vi khun. M np a thch, o ng knh
vng c ch t pha trn b mt thch bng nh sng phn chiu. B qua s pht trin yu ca cc khun lc nh li ti mp ng knh vng c ch
m ch c th quan st bng knh lp hoc knh hin vi.
(2) i vi bng ny, nhm tan huyt beta bao gm cc chng Streptococci khun lc ln nhm A, sinh m (S. pyogenes), nhm C, hoc G v cc
chng nhm B (S. agalactiae). Cc chng khun lc nh tan huyt beta nhm A, C, F, hoc G (S. anginosus, nh danh trc l S. milleri) c
xem l mt phn ca nhm viridans, do p dng tiu chun c kt qu cho nhm viridans vi cc chng ny (xem Bng 2H-2).
(3) Penicillin v Ampicillin l cc khng sinh c la chn cho iu tr nhim trung gy ra bi cc cu khun tan huyt beta (-hemolytic
streptococcal infection). Th nghim tnh nhy cm khng sinh (khng sinh ) ca penicillin v cc khng sinh -lactam khc (c FDA ph
chun) vi cc cu khun tan mu beta khng cn thit phi thc hin thng quy. Bi v, cc chng khng nhy cm (MIC ca penicill > 0,12
v ampicillin > 0,25 g/ml) l rt him trong bt c cu khun tan mu beta no v cha c bo co no cho Streptococcus pyogenes.Trong
trng hp thc hin khng sinh pht hin bt c mt chng cu khun tan mu beta l khng nhy cm, ton b qu trnh nh danh,
khng sinh phi c thc hin li. Nu qu trnh xc nhn l ng, bo co ti cc trung tm dch t (tham kho Ph lc A c thm
hng dn)
 M100-S21
(4) Tiu chun din gii kt qu cho cu khun tan mu beta (Streptococcus spp. -hemolytic group) c xut da trn biu phn b khng sinh
ca rt nhiu loi khc nhau, dc ng hc ca khng sinh, cc ti liu cng b trc v kinh nghim lm sng ca tng thnh vin trong
tiu y ban. Hin ti, cha c mt thu thp h thng cc s liu lm sng cho nhiu khng sinh trong nhm.
(5) i vi mt s cp vi khun/khng sinh, hin tng khng hoc him khi pht hin chng khng khng cho php xc nh bt k mt kt qu no
ngoi nhy cm. i vi cc chng cho kt qu khng nhy cm, ton b qu trinh phn lp nh danh v tin hnh th nghim nhy cm khng
sinh cn c lm li (Xem Ph lc A).

LU : Cc thng tin c in m l mi hoc c hiu chnh so vi phin bn trc

 M100-S21
Bng 2H-1 (Tip)

Nhm th Khng sinh Hm Gii hn ng knh vng Gii hn nng c Lu

nghim/bo lng c ch (mm) ch ti thiu (g/mL)
co
S I R S I R
PENICILLINS
(6) i vi cc nhm vi khun sau y, nu vi khun nhy cm vi penicillin th c th xem nh nhy cm vi cc khng sinh c lit k sau y m
khng th nghim li. i vi Streptococci tan huyt beta (Nhm A, B, C, G): ampicillin, amoxicillin, amoxicillin-clavulanic axit,
ampicillin-sulbactam, cefazolin, cefepime, cephradine, cephalothin, cefotaxime, ceftriaxone, ceftizoxime, imipenem, ertapenem, v meropenem. Ring i
vi Streptococci nhm A: cefaclor, cefdinir, cefprozil, ceftibuten, cefuroxime, cefpodoxime, and cephapirin.

A Penicillin hoc 10 n v 24 - - 0.12 - - Xem lu (5)

A ampicillin 10 g 24 - - 0.25 - - (7) Cc chng Streptococci tan mu c MIC
penicillin ln hn 0.12 g/mL hoc MIC
ampicillin ln hn 0.25 g/mL cha c
theo di; gi cc chng ny n phng xt
nghim cao hn.
CEPHEMS (NG TIM) (Bao gm cephalosporins I, II, III, v IV. Tham kho Bng ch gii I) Xem lu (5) v (6)
B Cefepime hoc 30 g 24 - - 0.5 - -
B cefotaxime hoc 30 g 24 - - 0.5 - -
B ceftriaxone 30 g 24 - - 0.5 - -
CARBAPENEMS Xem lu (5) v (6)
O Ertapenem - - - - 1 - -
O Meropenem - - - - 0.5 - -
GLYCOPEPTIDES
B Vancomycin 30 g 17 - - 1 - - Xem lu (5).
LIPOPEPTIDES
C Daptomycin - - - - 1 - - (7) Daptomycin khng c php bo co
vi nhng chng phn lp c t ng
h hp di.
Xem lu (5).
MACROLIDES
(8) Mc nhy cm v khng vi azithromycin, clarithromycin, v dirithromycin c th c suy lun t kt qu xt nghim vi erythromycin.
 M100-S21
(9) Khng bo co thng qui vi cc chng phn lp t ng tit niu.
A Erythromycin 15 g 21 16-20 15 0.25 0.5 1 (10) Rx: Khng sinh d phng cho
Streptococci nhm B l penicillin hoc
ampicillin. i vi ph n d ng penicillin
nguy c qu mn thp th c th dng
cefazolin, nu nguy c qu mn cao th c th
dng clindamycin hoc erythromycin.
Streptococci nhm B nhy cm vi ampicillin,
penicillin, v cefazolin, c th khng vi
clindamycin v/hoc erythromycin. Khi mt
chng streptococcus nhm B phn lp t ph
n mang thai, d ng vi penicillin (nguy c
qu mn cao) th nn xt nghim vi
clindamycin v erythromycin v bo co kt
qu.
O Azithromycin 15g 18 14-17 13 0.5 1 2
O Clarithromycin 15g 21 17-20 16 0.25 0.5 1
O Dirithromycin 15g 18 14-17 13 0.5 1 2
TETRACYCLINES
O Tetracycline 30 g 23 19-22 18 2 4 8 (11) Cc chng nhy cm vi tetracycline th
cng nhy cm vi doxycycline v
minocycline.
FLUOROQUINOLONES
C Levofloxacin 5 g 17 14-16 13 2 4 8
C Ofloxacin 5 g 16 13-15 12 2 4 8
O Gatifloxacin 5 g 21 18-20 17 1 2 4
O Grepafloxacin 5 g 19 16-18 15 0.5 1 2
O Trovafloxacin 10 g 19 16-18 15 1 2 4
PHENICOLS
C Chloramphenicol 30 g 21 18-20 17 4 8 16 Xem lu (9)

LINCOSAMIDES
A Clindamycin 2 g 19 16-18 15 0.25 0.5 1 Xem lu (9) v (10).

(12) Khng clindamycin kch thch c th

 M100-S21
c pht hin bng phng php khoanh
giy khuch tn vi s xut hin ca vng D.
v phng php vi pha lonh Xem Bng 2H-
1-S7 v Phn 12 ti liu M02-A10 v Phn 13
ti liu M07-A8.
STREPTOGRAMINS
C Quinupristin- 15 g 19 16-18 15 1 2 4 (13) Bo co i vi S. pyogenes.
dalfopristin
OXAZOLIDINONES
C Linezolid 30 g 21 - - 2 - - Xem lu (5)
Vit tt: ATCC, tn thng mi ca h thng chng chun theo tiu chun ca Hoa K; CAMHB, canh thang Mueller-Hinton iu chnh cation; FDA,
LHB, Mu nga ly gii; MHB, Canh thang Mueller-Hinton; MIC, Nng c ch ti thiu (Nng khng sinh ti thiu c ch vi khun);Cc qun l an
ton thuc v thc phm; QC, m bo cht lng xt nghim;
 M100-S21
Bng b sung 2H-1-S7. Th nghim sng lc khng clindamycin kch thch cho Streptococus spp tan mu beta trong bng 2H-1
Th nghim sng lc Khng clinidamycin khch thch
Nhm vi khun Cc Streptococcus spp tan mu beta khng erythromycin v nhy cm hoc khng trung gian vi clindamycina

Phng php xt nghim Khoanh giy khuch tn Vi pha long canh thang
Mi trng MHA b sung thm mu cu (5%) hoc TSA b CAMHB vi LHB (2,5-5%)
sung thm mu cu (5%)
Nng khng sinh Hai khoanh giy khng sinh erythromycin 15 g 1 g/mL erythromycin v 0,5 g/mL clindamycin trong cng
v clindamycin 2 g, t cch nhau 12 mm mt ging
Huyn dch vi khun Phng php khoanh giy khuch tn chun c Phng php vi pha long canh thanh chun c khuyn
khuyn co co
iu kin nui cy 352 C; 5% CO2 352 C; hiu kh.
Thi gian nui cy 20-24 gii 20-24 gii
Kt qu Nu xut hin vng c ch c hnh dng khng Bt k s pht trin no=khng clindamycin do kch thch
trn bn cnh khoanh erythromycin (vng ch
D)=khng clindamycin do kch thch Khng pht trin=khng khng clindamycin do kch thch
Khun lc pht trin nh trong vng c ch xung
quanh khoanh giy clindamycin=khng
clindamycin ( sn c) k c khi khng xut hin
vng D
Xt nghim thm v Bo co Bo co cc chng khng clindamycin do kch thch vi dng lu khng clindamycin

Ghi ch Chng ny c cho l khng clindamycin da trn s pht hin khng clindamycin do kch thch.
Clindamycin c th vn c hiu qu trn lm sng mt s bnh nhn
xut kim sot cht Streptococcus pneumoniae ATCC 49619 Streptococcus pneumoniae ATCC 49619
lng S. aureus ATCC BAA-976 hoc
S. aureus ATCC 29213 khng pht trin
S. aureus ATCC BAA-977 pht trin
Vit tt: ATCC, tn thng mi ca h thng chng chun theo tiu chun ca Hoa K; CAMHB, canh thang Mueller-Hinton iu chnh cation; MHA,
Thch Mueller-Hinton; MIC, Nng c ch ti thiu, QC, m bo cht lng xt nghim; LHB, Mu nga ly gii; TSA, Tryptic soy agar (thch trit xut
u tng)
a
S khc bit lm sng c to ra gia chng Streptococcus spp khng clindamycin khch thch vi cc chng khc trong nhm hin cha
r rng. Thc hin th nghim sng lc khng clindamycin khch thch khng cn thit vi mi chng khng erythromycin v nhy vi
clindamycin. Tuy nhin, tt c cc chng phn lp c t cc nhim trng bi nhim cn phi c thc hin th nghim. Khi phn lp c
Streptococcus nhm B t ph n c thai d ng vi penicillin nng (nguy c cao vi qu mn) clindamycin v erythromycin phi c lm khng
sinh v bo co (xem lu [10] trong bng 2H-1)
 M100-S21

Bng 2H-2. Tiu chun c ng knh vng c ch v MIC i vi Streptococcus spp. Nhm Viridans

iu kin th nghim Cc xut kim sot cht lng

ti thiu
Mi trng: Khoanh giy khuch tn: MHA b sung 5% mu cu (Xem bng 3B v 4B v gii hn
Pha long canh thang: CAMHB vi LBH (2.5 n 5%); CAHMB cn c b QC cho php)
sung 50 g/mL calcium i vi daptomycin (xem M07-A8 hng dn chun b
LHB) Streptococcus pneumoniae ATCC
Pha long trn thch MHA vi thch mu cu (5%) (khi xt nghim khng sinh 49619
sulfonamide, nn dng LHB); pha long trn thch cha nh gi vi daptomycin
Huyn dch vi khun: Pha huyn dch vi khun trc tip t khun lc vi mt vi khun tng ng
c chun 0.5 McFarland
iu kin nui cy: 352 oC,
Khng sinh : 5% CO2, 20-24h
Cc phng php pha long: hiu kh; 20-24h (CO2, nu cn thit cho vi khun
pht trin khi pha long trn thch)

Lu chung

(1) i vi phng php khoanh giy khuch tn, o ng knh vng c ch (bng mt thng), bao gm ng knh khoanh giy khng sinh. Ranh
gii vng c ch c xc nh l vng trong bng mt thng khng quan st thy s pht trin ca vi khun. M np a thch, o ng knh
vng c ch t pha trn b mt thch bng nh sng phn chiu. B qua s pht trin yu ca cc khun lc nh li ti mp ng knh vng c ch
m ch c th quan st bng knh lp hoc knh hin vi.

(2) Cc chng Streptococci nhm viridans bao gm 5 nhm ph (gm rt nhiu loi trong mi nhm): nhm mutans, nhm salivariusnhm bovis, nhm
anginosus (trc y gi l nhm S. milleri) v nhm. mitis. nhm anginosus bao gm cc chng tan huyt beta khun lc nh vi nhm khng
nguyn A, C, F, hoc G. Thng tin chi tit v tng loi, tham kho cc ti liu vi sinh lm sng gn y.

(3) Tiu chun c kt qu cho cc Streptococci spp nhm viridansc xut da trn biu phn b khng sinh ca rt nhiu loi khc nhau,
dc ng hc ca khng sinh, cc ti liu cng b trc v kinh nghim c lm sng ca tng thnh vin trong tiu y ban. Hin ti, cha c
mt thu thp h thng cc s liu lm sng cho nhiu khng sinh trong nhm.
 M100-S21
(4) i vi mt s cp vi khun/khng sinh, hin tng khng hoc him khi pht hin chng khng khng cho php xc nh bt k mt kt qu no
ngoi nhy cm. i vi cc chng cho kt qu khng nhy cm, ton b qu trinh phn lp nh danh v tin hnh th nghim nhy cm khng
sinh cn c lm li (Xem Ph lc A).

LU : Cc thng tin c in m l mi hoc c hiu chnh so vi phin bn trc

 M100-S21
Bng 2H-2 (Tip)

Nhm Khng sinh Hm Gii hn ng knh vng Gii hn nng c ch ti Bn lun

lng c ch (mm) thiu (g/mL)
S I R S I R
PENICILLINS
A Penicillin - - - - 0,12 0,25-2 4 (5) Khoanh giy khuch tn khng
A Ampicillin 0,25 0,5-4 8 cho kt qu ng tin cy i vi
penicillin v ampicillin.
(6) Streptococci nhm viridans phn
lp t cc vng v khun (v d, dch
no ty, mu, xng) cn xt nghim
tnh nhy cm vi penicillin bng
phng php MIC.
(7) Rx: Cc chng khng trung gian
vi penicillin v ampicillin c th s
phi phi hp vi mt khng sinh
nhm aminoglycoside trong iu tr.
CEPHEMS (NG TIM) (Bao gm cephalosporins I, II, III, v IV. Tham kho Bng ch gii I)
B Cefepime 30 g 24 22-23 21 1 2 4
B Cefotaxime 30 g 28 26-27 25 1 2 4
B Ceftriaxone 30 g 27 25-26 24 1 2 4
CARBAPENEMS
O Ertapenem - - - - 1 - - Xem lu (4)
O Meropenem - - - - 0.5 - - Xem lu (4)
GLYCOPEPTIDES
B Vancomycin 30 g 17 - - 1 - - Xem lu (4).
LIPOPEPTIDES
O Daptomycin - - - - 1 - - (8) Phng php khoanh giy
khuch tn khng cho kt qu ng
tin cy i vi daptomycin.
(9) Daptomycin khng c php
bo co vi nhng chng phn lp
t ng h hp di.
Xem lu (4).
 M100-S21
MACROLIDES
(10) Mc nhy cm v khng vi azithromycin, clarithromycin, v dirithromycin c th c suy lun t kt qu xt nghim vi erythromycin.
(11) Khng bo co thng qui vi cc chng phn lp t ng tit niu.
C Erythromycin 15 g 21 16-20 15 0.25 0.5 1
O Azithromycin 15g 18 14-17 13 0.5 1 2
O Clarithromycin 15g 21 17-20 16 0.25 0.5 1
O Dirithromycin 15g 18 14-17 13 0.5 1 2
TETRACYCLINES
O Tetracycline 30 g 23 19-22 18 2 4 8 (12) Cc chng nhy cm vi
tetracycline th cng nhy cm vi
doxycycline v minocycline.
FLUOROQUINOLONES
C Levofloxacin 5 g 17 14-16 13 2 4 8
C Ofloxacin 5 g 16 13-15 12 2 4 8
O Gatifloxacin 5 g 21 18-20 17 1 2 4
O Grepafloxacin 5 g 19 16-18 15 0.5 1 2
O Trovafloxacin 10 g 19 16-18 15 1 2 4
PHENICOLS
C Chloramphenicol 30 g 21 18-20 17 4 8 16 Xem lu (11)

LINCOSAMIDES
C Clindamycin 2 g 19 16-18 15 0.25 0.5 1 Xem lu (11)
STREPTOGRAMINS
O Quinupristin- 15 g 19 16-18 15 1 2 4
dalfopristin
OXAZOLIDINONES
C Linezolid 30 g 21 - - 2 - - Xem lu (4)
Vit tt: ATCC, tn thng mi ca h thng chng chun theo tiu chun ca Hoa K; CAMHB, canh thang Mueller-Hinton iu chnh cation; FDA,
LHB, Mu nga ly gii; MHB, Canh thang Mueller-Hinton; MIC, Nng c ch ti thiu (Nng khng sinh ti thiu c ch vi khun);Cc qun l an
ton thuc v thc phm; QC, m bo cht lng xt nghim;
 M100-S21
Bng 2I. Tiu chun c ng knh vng c ch v MIC i vi Neisseria meningitidis

iu kin th nghim Cc xut kim sot cht lng ti thiu

Mi trng: Khoanh giy khuch tn: MHA vi 5% mu cu
Pha long canh thang: CAMHB b sung 2.5 n 5% LHB
(xem M07-A8 hng dn chun b LHB)
Pha long trn thch: MHA b sung 5% mu cu Huyn
dch vi khun: Pha huyn dch vi khun trc tip
t khun lc sau tng sinh 20-24h trn thch s c la nui
cy 35 oC; 5% CO2 vi mt vi khun tng ng
c chun 0.5 McFarland. Tuy nhin, huyn dch vi khun
c 0.5 McFarland t thch mu cu s cha t hn
khong 50% CFU/ml. Huyn dch ny phi m khi pha
dung dch pha long cui trc khi cy vo cc tup, nh
phng php m khun lc
iu kin nui cy: 352 oC, 5% CO2, 20-24h
(Xem bng 3A, 3B, 4A v 4B v gii hn QC cho php)
Streptococcus pneumoniae ATCC 49619
Khoanh giy khuch tn: trong 5% CO2 i vi v hoc
i v
Phng php vi pha long canh thang: hiu kh hoc 5%
CO2 (tr QC i vi azithromycin bt buc phi nui cy
trong iu kin hiu kh).
E. coli ATCC 25922
Khoanh giy khuch tn, vi pha long canh thang, pha
long trn thch( trong iu kin hiu kh hoc 5%
CO2) i vi ciprofloxacin, nalidixic axit, minocycline v
sulfisoxazole.

Lu chung
Quan trng: Cc thng tin y v cnh bo an ton, tham kho ti liu An ton sinh hc trong Phng xt nghim Vi sinh v Y sinh. Ti bn ln th 5.
Washington, DC: Vn phng In n Chnh ph lin bang Hoa K; 2007. http://www.cdc.gov/OD/ohs/biosfty/bmbl5/bmbl5toc.htm.

(1) Cnh bo: Thao tc tt c cc xt nghim khng sinh i vi N. meningitidis trong t an ton sinh hc (BSC). Thao tc pha huyn dch vi khun N.
meningitidis bn ngoi t an ton sinh hoc c nguy c phi nhim v mc bnh vim mng no do no m cu cao. T l mc bnh vim mng no
cu mc phi phng xt nghim do ri ro ngh nghip ti 50%. Phi nhim vi cc ht nh hoc kh dung N. meningitidis l cc nguy c ch yu
gy nhim khun mc phi phng xt nghim. Cn tun th cht ch cc qui trnh bo v trnh cc ht nh v kh dung N. meningitidis trong qu
trnh thao tc vi sinh (bao gm c xt nghim khng sinh ) i vi cc chng N. meningitides.

(2) Cc cnh bo c xut: Cc bnh phm cn nui cy v nh danh N. meningitidis, khng lin quan n bnh nhim trng xm ln, c th thao
tc trong nhng trang thit b an ton sinh hc cp 2 (BSL-2), tun th cht ch thc hnh chun BSL-2, cc thao tc v cc thit b an ton. Tt c
cc chng N. meningitidis phn lp t cc v tr v khun nn thao tc trong BSC. Nu khng c BSC, hn ch cc bc phi thao tc bng tay vi
cc chng ny, hn ch nhum Gram hoc xc nh nhm huyt thanh bng dung dch nc mui phenol ha, mc o bo h v eo gng tay. Tun
 M100-S21
th theo thc hnh theo an ton sinh hc cp 3 (BSL-3), cc thao tc v thit b cp tng ng i vi cc bnh phm c nguy c sinh kh dung v
cc ht nh cao hoc cc bc c th to ra chng vi nng hoc lng ln. Nu BSL-2 hoc BSL-3 khng sn c ti phng xt nghim, gi mu
n phng xt nghim cao hn c cc thit b t nht mc BSL-2.

(3) Cc cn b phng xt nghim c nguy c phi nhim thng xuyn vi cc ht kh dung N. meningitidis cn c xem xt tim phng theo
khuyn co ca Trung tm Kim sot v Phng bnh (CDC) Hi ng t vn tim chng (www.cdc.gov). Vic tim chng c th gip gim nguy c,
tuy nhin khng loi b ht c nguy c nhim khun, bi v hiu qu di 100% v khng c hiu qu bo v i vi cc chng nhm huyt thanh
B, l nguyn nhn thng gp gy nhim khun mc phi phng xt nghim.

(4) i vi phng php khoanh giy khuch tn, o ng knh vng c ch (v d, xc nh ranh gii vng c ch bng mt thng), bao gm ng
knh khoanh giy. Soi a mi trng trn nn en vi nh sng phn chiu tr trng hp linezolid, oxacilin v vancomycin nn s dng nh sng
xuyn qua. Xc nh ranh gii vng c ch bng mt thng, khng c s pht trin r rng ca vi khun. B qua s pht trin yu v cc khun lc
nh li ti ch c th pht hin khi soi di knh lp hoc knh hin vi b ca vng c ch. i vi trimethoprim v sulfonamides, cc cht i khng
trong mi trng c th cho php vi khun pht trin nh; do c th b qua s pht trin yu ny (khng qu 20%) v o ng knh vng c ch
vi ranh gii xc nh bng mt thng.

(5) Cc tiu chun c kt qu c da trn biu phn b khng sinh vi nhiu khng sinh, dc ng ca khng sinh, cc ti liu cng b, v
kinh nghim ca tng thnh vin trong tiu y ban Cha c mt thu thp h thng cc s liu lm sng ca nhiu khng sinh trong bng ny.

(6) i vi mt s cp vi khun/khng sinh, hin tng khng hoc him khi pht hin chng khng khng cho php xc nh bt k mt kt qu no
ngoi nhy cm.. i vi cc chng cho kt qu khng nhy cm, kt qu nh danh vi khun v xc nh mc nhy cm khng sinh cn c
xc nh li. (Xem Ph lc A).

(7) i vi azithromycin, tiu chun c kt qu bc u c xy dng s dng kt qu MIC c xc nhbng nui cy trong iu kin hiu kh i
vi cc tnh ton dc ng hc.

LU : Cc thng tin c in m l mi hoc c hiu chnh so vi phin bn trc

Nhm th Khng sinh Hm ng knh vng c ch im gy MIC tng Lu

nghim/ lng (mm) ng (g/mL)
bo co S I R S I R
PENICILLINS
C Penicillin - - - 0.06 0.12 0.5 (8) Khoanh giy khuch tn vi ampicillin
C Ampicillin - - - 0.12 0.25 2 v penicillin cho kt qu khng ng tin cy
 M100-S21
0.251 i vi Neisseria meningitidis. Nn dng
phng php MIC i vi cc chng ny
CEPHEMS
C Cefotaxime hoc 30 g 34 - - 0.12 - - Xem lu (6)
C Ceftriaxone 30 g 34 - - 0.12 - - Xem lu (6)
CARBAPENEMS
C Meropenem 10 g 30 - - 0.25 - - Xem lu (6)
MACROLIDES
C Azithromycin 15 g 20 - - 2 - - Xem lu (6) v (7).
(9) C th ch thch hp dng trong d
phng cc trng hp tip xc vi
meningococcal. Tiu chun din gii ny
khng p dng i vi bnh nhn vim
mng no m xm ln.
TETRACYCLINES
C Minocycline 30 g 26 - - 2 - - Xem lu (6) v (9)
FLUOROQUINOLONES
(10) i vi mc ch gim st, MIC ca axit nalidixic 8 g/mL hoc ng knh vng c ch 25 mm ng ngha vi gim nhy cm vi
fluoroquinolone.
C Ciprofloxacin 5 g 35 33-34 32 0.03 0.06 0.12 Xem lu (9)
C Levofloxacin - 0.03 0.06 0.12
THUC C CH CON NG FOLATE
C Sulfisoxazole - - - - 2 4 8 Xem lu (9)
C Trimethoprim- 1.25/ 30 26-29 25 0.12/ 0.25/ 0.5/ (11) y l khoanh giy c a dng trong
sulfamethoxazole 23.75 g 2.4 4.75 9.5 pht hin s khng sulfonamide.
Trimethoprim-sulfamethoxazole dng d
on tnh nhy cm v khng vi
Trimethoprim-sulfamethoxazole v
sulfonamides. Sulfonamides c th ch thch
hp dng trong d phng cc trng hp
tip xc vi no m cu
PHENICOLS
C Chloramphenicol 30 g 26 20-25 19 2 4 8 (12) Khng bo co thng qui cc chng
phn lp t ng niu
ANASAMYCINS
 M100-S21
C Rifampin 5 g 25 20-24 19 0.5 1 2 Xem lu (9).
Vit tt: ATCC, tn thng mi ca h thng chng chun theo tiu chun ca Hoa K; AST, th nghim nhy cm khng sinh; BSC, t an ton sinh hc;
BSL2, An ton sinh hc cp 2; BSL3, An ton sinh hc cp 3; CAMHB, canh thang Mueller-Hinton iu chnh cation; LHB, Mu nga ly gii;
MHB, Canh thang Mueller-Hinton; MIC, Nng c ch ti thiu (Nng khng sinh ti thiu c ch vi khun); QC, m bo cht lng xt nghim;
CDC, Trung tm kim sot v phng nga dch bnh (Hoa K); CFU, n v khun lc;
 M100-S21
Bng 2 J. Tiu chun din gii kt qu cho vi khun k kh
iu kin th nghim Khuyn co QC ti thiu (xem bng 4D v 4E cho khong gi
tr QC cho php)
Mi trng: Pha long canh thang: canh thang Brucella c b sungb
sungb sung hemin, Vitamin K1 v mu nga ly gii Bacteroides fragilis ATCC 25285
Pha long trn thch: Thch Brucella c b sungb sungb Bacteroides thetaiotaomicron ATCC 29714
sung hemin, Vitamin K1 v mu nga ly gii Clostridium diffcile ATCC 700057
Huyn dch vi khun: Thch: 105 cfu trong mt im Eubacterium lentum ATCC 43055
Canh thang: 106 cfu/mL Kim tra 2 chng vi pha long trn thch; kim tra mt
iu kin nui cy: 44-48 gii trong 36 oC, k kh chng duy nht vi pha long canh thang

Lu chung
(1) Khong khng trung gian c xc nh bi s kh khn trong vic c cc im mt v nhm cc gi tr MIC hoc gn nhng nng
ranh gii. Ni thng tin kh dng, nhng hng dn din gii c da trn thng tin dc ng hc, khong phn b ca MIC, v nhng
nghin cu v hiu qu lm sng. t c nng khng sinh cao nht c th trong cc p se v/hoc cc m ti mu km, iu phi i
mt thng xuyn trong nhim trng loi ny, liu lng ti a cho php ca cc khng sinh c khuyn co cho cc php iu tr nhim
trng k kh. Khi liu lng ti a c s dng cng vi nhng liu php h tr ph hp, n c tin rng nhng chng vi MIC trong
khong nhy cm thng p ng vi phc , v nhng chng vi MIC trong khong khng trung gian c th p ng, nhng s p ng ca
bnh nhn cn phi c theo di. Cc liu php h tr nh cc th thut dn lu v ct lc, l cc k quan trng cho iu tr nhim trung k
kh hiu qu.
LU : Cc thng tin c in m l mi hoc c hiu chnh so vi phin bn trc
Nhm th Khng sinh Tiu chun din gii MIC Lu
nghim/bo (g/mL)
co S I R
Penicillin
C Ampicillin 0,5 1 2 (2) Cc thnh vin ca nhm Bacteroides fragilis c cho l
khng. Cc vi khun k kh Gram-m khc c th cn c sng
lc -lactamase bng test nhanh, nu c th, bo co l khng
penicillin, ampicillin, v amoxicillin. Nhng nng khng sinh
cao hn trong mu t c: nhim trung gy ra bi cc chng
khng sinh -lactamase vi MIC cao hn (2-4 g/mL vi khong
ngh dng thuc y ) c th iu tr c. Cc im gii hn
ca amoxicillin c cn nhc tng ng vi cc im gii
hn ca ampicillin. Nhng thng tin ca cc nghin cu in vitro
 M100-S21
cha hon thin ch ra rng hai khng sinh ny c tc dng
tng t nhau chng li vi khun k khi khi tin hnh MIC, tuy
nhin, cc im gii hn cho amoxicillin cha c thit lp.
C Mezlocillin 32 64 128
C Penicillin 0,5 1 2 Xem lu (2)
C Piperacillin 32 64 128 (3) Nhng gi tr MIC s dng c thch mu Brucella hoc thch
Wilkins Chalgren (mi trng chun c) c cho l tng
ng, da trn nhng t liu in vitro c cng b v mt
th nghim hp tc lin trung tm cho nhng khng sinh ny.
(4) Nhng gi tr MIC cho thch hoc canh thang vi pha long c
cho l tng ng
C Ticarcillin 32 64 128
Phi hp -lactama v c ch -lactamase
A Amoxicillin-clavulanic 4/2 8/4 16/8 Xem lu (3)
acid
A Ampicillin-sulbactam 8/4 16/8 32/16 Xem lu (3) v (4)
A Piperacillin-tazobactam 32/4 64/4 128/4 Xem lu (3)
A Ticarcillin-clavulanic 32/2 64/2 128/2 Xem lu (3)
acid
Cephem (ng tim) (bao gm cephalosporin I, II, III, v IV, tham kho ph lc I.)
C Cefemetazole 16 32 64
C Cefoperazole 16 32 64
C Cefotaxime 16 32 64
C Cefotetam 16 32 64 Xem lu (3)
C Cefoxitin 32 64 128 Xem lu (3) v (4)
C Ceftriaxole 16 32 64 Xem lu (3)
Carbapenem
A Ertapenem 4 8 16 Xem lu (4)
A Imipenem 4 8 16 Xem lu (3)
A Meropenem 4 8 16 Xem lu (3)
Tetracycline
C Tetracycline 4 8 16
Fluoroquinolone
Moxifloxacin 2 4 8
 M100-S21
Lincosamide
A Clindamycin 2 4 8 Xem lu (3) v (4)
Phenicol
Chloramphenicol 8 16 32 Xem lu (3) v (4)
Nitroimidazole
A Metronidazole 8 16 32 Xem lu (3) v (4)
Vit tt: MIC, Nng c ch ti thiu (Nng khng sinh ti thiu c ch vi khun);
 M100-S21
Bng 3A. Khoanh giy khuch tn: Gii hn cho php i vi cc chng kim tra cht lng (chng QC) ca cc chng d nui cy (S dng mi
trng Mueller-Hinton khng b sung cc thnh phn khc)

Escherichia Staphylococcus Pseudomonas Escherichia

Khng sinh Hm lng khoanh giy coli aureus aeruginosa coli
ATCC a 25922 ATCC 25923 ATCC27853 ATCC 35218bc
Amikacin 30 g 19-26 20-26 18-26 -
Amoxicillin-clavulanic axit 20/10 g 18-24 28-36 - 17-22
Ampicillin 10 g 16-22 27-35 - 6
Ampicillin-sulbactam 10/10 g 19-24 29-37 - 13-19
Azithromycin 15 g - 21-26 - -
Azlocillin 75 g - - 24-30 -
Aztreonam 30 g 28-36 - 23-29 -
 M100-S21
Carbenicillin 100 g 23-29 - 18-24 -
Cefaclor 30 g 23-27 27-31 - -
Cefamandole 30 g 26-32 26-34 - -
Cefazolin 30 g 21-27 29-35 - -
Cefdinir 5 g 24-28 25-32 - -
Cefditoren 5 g 22-28 20-28 - -
Cefepime 30 g 31-37 23-29 24-30 -
Cefetamet 10 g 24-29 - - -
Cefixime 5 g 23-27 - - -
Cefmetazole 30 g 26-32 25-34 - -
Cefonicid 30 g 25-29 22-28 - -
Cefoperazone 75 g 28-34 24-33 23-29 -
Cefotaxime 30 g 29-35 25-31 18-22 -
Cefotetan 30 g 28-34 17-23 - -
Cefoxitin 30 g 23-29 23-29 - -
Cefpodoxime 10 g 23-28 19-25 - -
Cefprozil 30 g 21-27 27-33 - -
Ceftaroline 30 g 26-34 26-35 - -
Ceftazidime 30 g 25-32 16-20 22-29 -
Ceftibuten 30 g 27-35 - - -
Ceftizoxime 30 g 30-36 27-35 12-17 -
Ceftobiprole 30 g 30-36 26-34 24-30 -
Ceftriaxone 30 g 29-35 22-28 17-23 -
Cefuroxime 30 g 20-26 27-35 - -
Cephalothin 30 g 15-21 29-37 - -
Chloramphenicol 30 g 21-27 19-26 - -
Cinoxacin 100 g 26-32 - - -
Ciprofloxacin 5 g 30-40 22-30 25-33 -
Clarithromycin 15 g - 26-32 - -
Clinafloxacin 5 g 31-40 28-37 27-35 -
Clindamycind 2 g - 24-30 - -
Colistin 10 g 11-17 - 11-17 -
 M100-S21
e
Daptomycin 30 g - 18-23 - -
Dirithromycin 15 g - 18-26 - -
Doripenem 10 g 27-35 33-42 28-35 -
Doxycycline 30 g 18-24 23-29 - -
Enoxacin 10 g 28-36 22-28 22-28 -
Ertapenem 10 g 29-36 24-31 13-21 -
Erythromycind 15 g - 22-30 - -
Faro pe nem 5 g 20-26 27-34 - -
Fleroxacin 5 g 28-34 21-27 12-20 -
Fosfomycinf 200 g 22-30 25-33 - -
Garenoxacin 5 g 28-35 30-36 19-25 -
Gatifloxacin 5 g 30-37 27-33 20-28 -
Gemifloxacin 5 g 29-36 27-33 19-25 -
Gentamicing 10 g 19-26 19-27 16-21 -
Grepafloxacin 5 g 28-36 26-31 20-27 -
Iclaprim 5 g 14-22 25-33 - -
Imipenem 10 g 26-32 - 20-28 -
Kanamycin 30 g 17-25 19-26 - -
Levofloxacin 5 g 29-37 25-30 19-26 -
Linezolid 30 g - 25-32 - -
Lomefloxacin 10 g 27-33 23-29 22-28 -
 M100-S21
Bng 3A (Tip)

Escherichia Staphylococcus Pseudomonas Escherichia

Khng sinh Hm lng khoanh giy coli aureus aeruginosa coli
ATCC 25922 a ATCC 25923 ATCC27853 ATCC 35218b
Loracarbef 30 g 23-29 23-31 - -
Mecillinam 10 g 24-30 - - -
Meropenem 10 g 28-34 29-37 27-33 -
Methicillin 5 g - 17-22 - -
Mezlocillin 75 g 23-29 - 19-25 -
Minocycline 30 g 19-25 25-30 - -
Moxalactam 30 g 28-35 18-24 17-25 -
Moxifloxacin 5 g 28-35 28-35 17-25 -
Nafcillin 1 g - 16-22 - -
Nalidixic axit 30 g 22-28 - - -
Netilmicin 30 g 22-30 22-31 17-23 -
Nitrofurantoin 300 g 20-25 18-22 - -
Norfloxacin 10 g 28-35 17-28 22-29 -
Ofloxacin 5 g 29-33 24-28 17-21 -
Oxacillin 1 g - 18-24 - -
Penicillin 10 n v - 26-37 - -
Piperacillin 100 g 24-30 - 25-33 12-18
Piperacillin-tazobactam 100/10 g 24-30 27-36 25-33 24-30
Polymyxin B 300 n v 13-19 - 14-18 -
Quinupristin-dalfopristin 15 g - 21-28 - -
Razupenem 10 g 21-26 -j - -
Rifampin 5 g 8-10 26-34 - -
Sparfloxacin 5 g 30-38 27-33 21-29 -
Streptomycing 10 g 12-20 14-22 - -
Sulfisoxazolei 250 g hoc 300 g 15-23 24-34 - -
 M100-S21
Teicoplanin 30 g - 15-21 - -
Telavancin 30 g - 16-20 - -
Telithromycin 15 g - 24-30 - -
Tetracycline 30 g 18-25 24-30 - -
Ticarcillin 75 g 24-30 - 21-27 6
Ticarcillin-clavulanic axit 75/10 g 24-30 29-37 20-28 21-25
Tigecycline 15 g 20-27 20-25 9-13 -
Tobramycin 10 g 18-26 19-29 19-25 -
Trimethoprimi 5 g 21-28 19-26 - -
Trimethoprim-sulfamethoxazolei 1.25/23.75 g 23-29 24-32 - -
Trospectomycin 30 g 10-16 15-20 - -
Trovafloxacin 10 g 29-36 29-35 21-27 -
Ulifloxacin (prulifloxacin)h 5 g 32-38 20-26 27-33 -
Vancomycin 30 g - 17-21 - -
Vit tt: MHI, Thch Muller-Hinton

LU : Cc thng tin c in m l mi hoc c hiu chnh so vi phin bn trc

Lu

a. ATCC l tn thng mi ca h thng chng chun theo tiu chun ca M.

b. V cc chng ny d mt plasmid, yu cu cy chuyn v gi chng cn thn; tham kho ti liu M02-A10, Phn 15.4.
c. Chng QC c khuyn co khi tin hnh lm khng sinh vi phc hp -lactama/c ch -lactamase
d. Khi th nghim phng php khoanh giy khuch tn vi khng sinh erythromycin v clindamycin, S. aureus ATCC BAA-977 (khng qua trung
gian ermA) v S. aureus ATCCBAA-976 (c ch khng qua bm y macrolide qua trung gian msrA) l cc chng chun c xut s dng
vi mc ch nh gi cht lng b sung (v d, o to, nh gi nng lc hoc nh gi th nghim). S. aureus ATCCBAA-977 nn dng
khng nh tnh khng clindamycin do kch thch (v d, th nghim vng D dng tnh), trong khi S. aureus ATCC BAA-976 khng nn dng
khng nh tnh khng clindamycin do kch thch. S. aureus ATCC 25923 khng nn s dng cho kim sot cht lng thng qui (v d, hng
tun, hng ngy) i vi khng sinh erythromycin v clindamycin s dng thch Mueller-Hinton tiu chun.
e. Mt s l thch Mueller-Hinton thiu calcium v to vng c ch nh.
f. Khoanh giy fosfomycin hm lng 200 g cha 50 g glucose-6-phosphate.
g. kim sot gii hn khoanh giy khng sinh gentamicin hm lng 120 g v streptomycin hm lng 300 g, s dng chng Enterococcus
faecalis ATCC 29212 (gentamicin:16 n 23 mm; streptomycin: 14 n 20 mm).
 M100-S21
h. Ulifloxacin l cht chuyn ha c hot tnh ca khng sinh ang th nghim lm sng prulifloxacin. Ch dng ulifloxacin trong th nghim tnh nhy
cm khng sinh.
i. Nhng khng sinh ny c th b nh hng nu nng thymidine v thymine vt qu ngng. Xem M2-A9, Phn 7.1.4 hng dn x l cc vn
trong kim sot cht lng.
j. Razupenem c kim tra bng S. aureus ATCC 25923 c th to ra vng c ch kp (hai vng c ch c to ra). c c kt qu
QC chnh xc, s dng S. aureus ATCC 29213 (khng c vng c ch kp) vi gii hn chp nhn l 33-39 mm.
 M100-S21

Bng 3B. Gii hn cho php i vi cc chng kim tra cht lng dng trong kim sot chnh xc ca phng php khoanh giy khuch tn
ca cc chng kh nui cy

Haemophilus Haemophilus Neisseria Streptococcus

Hm lng
Khng sinh influenzae influenzae gonorrhoeae pneumoniae
ATCC 49247 ATCC 49766 ATCC49226 ATCC 49619a
Amoxicillin-clavulanic axitb 20/10 g 15-23 - - -
Ampicillin 10 g 13-21 - - 30-36
Ampicillin-sulbactam 10/10 g 14-22 - - -
Azithromycin 15 g 13-21 - - 19-25
Aztreonam 30 g 30-38 - - -
Cefaclor 30 g - 25-31 - 24-32
Cefdinir 5 g - 24-31 40-49 26-31
Cefditoren 5 g 25-34 - - 27-35
Cefepime 30 g 25-31 - 37-46 28-35
Cefetamet 10 g 23-28 - 35-43 -
Cefixime 5 g 25-33 - 37^5 16-23
Cefmetazole 30 g 16-21 - 31-36 -
Cefonicid 30 g - 30-38 - -
Cefotaxime 30 g 31-39 - 38-48 31-39
Cefotetan 30 g - - 30-36 -
Cefoxitin 30 g - - 33-41 -
Cefpodoxime 10 g 25-31 - 35-43 28-34
Cefprozil 30 g - 20-27 - 25-32
Ceftaroline 30 g 29-39 - - 31-41
Ceftazidime 30 g 27-35 - 35-43 -
Ceftibuten 30 g 29-36 - - -
Ceftizoxime 30 g 29-39 - 42-51 28-34
Ceftobiprolec 30 g 28-36 30-38 - 33-39
Ceftriaxone 30 g 31-39 - 39-51 30-35
Cefuroxime 30 g - 28-36 33-41 -
Cephalothin 30 g - - - 26-32
Chloramphenicol 30 g 31-40 - - 23-27
 M100-S21
Ciprofloxacin 5 g 34-42 - 48-58 -
Clarithromycin 15 g 11-17 - - 25-31
Clinafloxacin 5 g 34-43 - - 27-34
Clindamycin 2 g - - - 19-25
Daptomycind 30 g - - - 19-26
Dirithromycin 15 g - - - 18-25
Doripenem 10 g 21-31 - - 30-38
Enoxacin 10 g - - 43-51 -
Ertapenem 10 g 20-28 27-33 - 28-35
Erythromycin 15 g - - - 25-30
Faropenem 5 g 15-22 - - 27-35
Fleroxacin 5 g 30-38 - 43-51 -
Garenoxacin 5 g 33-41 - - 26-33
Gatifloxacin 5 g 33-41 - 45-56 24-31
Gemifloxacin 5 g 30-37 - - 28-34
Grepafloxacin 5 g 32-39 - 44-52 21-28
Iclaprim 5 g 24-33 - - 21-29
Imipenem 10 g 21-29 - - -
Levofloxacin 5 g 32-40 - - 20-25
Linezolid 30 g - - - 25-34
Lomefloxacin 10 g 33-41 - 45-54 -
Loracarbef 30 g - 26-32 - 22-28
Meropenem 10 g 20-28 - - 28-35
Moxifloxacin 5 g 31-39 - - 25-31
Nitrofurantoin 300 g - - - 23-29
Norfloxacin 10 g - - - 15-21
Ofloxacin 5 g 31-40 - 43-51 16-21
Oxacillin 1 g - - - <12e
Penicillin 10 n v - - 26-34 24-30
Piperacillin-tazobactam 100/10 g 33-38 - - -
Quinupristin-dalfopristin 15 g 15-21 - - 19-24
Razupenem 10 g 24-30 - - 29-36
Rifampin 5 g 22-30 - - 25-30
 M100-S21
Bng 3B (Tip)

Haemophilus Haemophilus Neisseria Streptococcus

Khng sinh Hm lng influenzae influenzae gonorrhoeae pneumoniae
ATCC 49247a ATCC 49766 ATCC49226 ATCC 49619b
Sparfloxacin 5 g 32-40 - 43-51 21-27
Spectinomycin 100 g - - 23-29 -
Telavancin 30 g - - - 17-24
Telithromycin 15 g 17-23 - - 27-33
Tetracycline 30 g 14-22 - 30-42 27-31
Tigecycline 15 g 23-31 - 30-40 23-29
Trimethoprim-sulfamethoxazole 1.25/23.75 g 24-32 - - 20-28
Trospectomycin 30 g 22-29 - 28-35 -
Trovafloxacin 10 g 32-39 - 42-55 25-32
Vancomycin 30 g - - - 20-27

Cc iu kin th nghim khoanh giy khuch tn i vi cc chng phn lp t lm sng v tin hnh kim sot cht lng

Streptococci v
Chng Haemophilus influenzae Neisseria gonorrhoeae
Neisseria meningitidis

Thch GC base v 1 % yu t kch thch tng

Mi trng th nghim cho trng thch hp. Khng yu cu s dng MHA b sung 5% mu cu loi
Mi trng
Haemophilus (HTM) cht kch thch tng trng phi cystein i vi b t huyt
phng php khoanh giy khuch tn.
Huyn dch vi khun Trc tip t khun lc Trc tip t khun lc Trc tip t khun lc

iu kin nui cy 5% C02; 16 - 18 h; 35 C 5% C02; 20 - 24 h; 35 C 5% C02; 20 to 24 h; 35 oC

Vit tt: HTM, mi trng th nghim Haemophilus; MHA, thch Mueller-Hinton

LU : Cc thng tin c in m l mi hoc c hiu chnh so vi phin bn trc
Lu
 M100-S21
a) Mc d thiu mt tiu chun din gii kt qu khoanh giy khuch tn cho S. pneumonia vi tng nhm -lactama, Streptococcus pneumoniae
ATCC49619 l chng c ch nh cho kim sot cht lng tt c cc th nghim khoanh giy khuch tn i vi Streptococcus spp.
b) Khi th nghim Haemophilus trn mi trng HTM, cc gii hn cho php i vi chng kim tra cht lng E. coli ATCC 35218 l 17 n 22
mm i vi amoxicillin-clavulanic axit khi iu kin hiu kh.
c) H. influenzae ATCC 49247 hoc 49766 c th s dng trong kim sot cht lng thng qui.

d) Mt s l thch Mueller-Hinton thiu calcium v to vng c ch nh.

e) kim tra cht lng khoanh giy khng sinh oxacillin s dng chng chun Staphylococcus aureus ATCC 25923, vi ng knh vng c ch
chp nhn c l 18-24mm.
 M100-S21
Bng 3C. Khoanh giy khuch tn: Hng dn tham kho v tn sut th nghim kim tra cht lng
Bng ny tm tt cc xut v tn sut cho vic kim tra cht lng thng qui khi s dng cc chng chun ATCC khuyn co bi CLSI i vi cc
th nghim tnh nhy cm khng sinh (AST). Ch p dng i vi cc khng sinh cn th 20-30 ngy cho tha mn kt qu mong i.

S ngy lin tip cn tin hnh th nghim

QCa
iu chnh th nghim 1 5 20 hoc 30 Lu
Khoanh giy khng sinh
S dng cho mt l hng mi X
S dng cho nh sn xut mi X
Mi trng (a thch c chun b)
S dng cho mt l hng mi X
S dng cho nh sn xut mi X
Chun b huyn dch vi khun
S dng cc phng php chun b huyn dch vi khun/chun ha X V d:
thit b o c c hng dn kim sot cht lng ring Chuyn vic iu chnh
c bng mt thng sang
phng php o c
bng thit bc hng dn
kim sot cht lng ca
hng.
 M100-S21
Chuyn vic chun b huyn dch vi khun/chun ha mt phng X V d:
php ph thuc vo k thut ca ngi tin hnh. Chuyn vic iu chnh
c bng mt thng sang
mt phng php khc m
khng dng thit b o
c.

o vng c ch
Thay i phng php o ng knh vng c ch X V d:
Thay v phng php o
ng knh vng c ch
thng thng bng mt
thng sang dng my o
t ng.
Ngoi ra, tin hnh cc
nghin cu t nh gi.

Thit b/phn mm (v d, my c ng knh vng c ch t ng)

Cc phn mm cp nht nh hng n kt qu AST X Kim sot tt c cc thuc,

khng ch nhng thuc
lin quan trong vic iu
chnh phn mm.
 M100-S21
Sa cha thit b nh hng n kt qu AST X Ph thuc vo vic sa
cha (v d: cc b phn
quan trng nh thit b o
c) c th cn tin
hnh cc th nghim b
sung (v d, nm ngy).

LU 1: Khi c thm bt k khng sinh MI no, cn th nghim kim sot cht lng 20-30 ngy lin tc tha mn iu kin th nghim (xem M02-
A10, Phn15.7) trc khi s dng.

LU 2: QC c th tin hnh trc hoc ng thi vi cc th nghim trn chng bnh phm. Kt qu ca bnh phm c th c bo co trong ngy
nu kt qu kim tra cht lng nm trong gii hn cho php.

LU 3: Cn tun th cc hng dn v qui nh ca nh sn xut cng nh nhng quy nh ca tng ca tng labo.

LU 4: i vi cc trng hp kt qu nm ngoi gii hn, tham kho M02-A10, Phn 15.8.

LU 5: Canh thang v nc mui sinh l pha huyn dch vi khun khng cn kim tra cht lng thng qui.

Lu

a. Khng c b qua vic kim tra cht lng thng qui hng tun hoc hng ngy.
 M100-S21
Bng 3D. Khoanh giy khuch tn: Hng dn x l cc vn v kim sot cht lng
Bng ny cung cp cc hng dn x l s c cc trng hp kim sot cht lng nm ngoi gii hn cho php ca cc th nghim nhy cm khng sinh
s dng mi trng thch Mueller-Hinton. c thm thng tin chi tit tham kho M02-A10,
Phn 15 v Qun l Cht lng v Qun l m bo Quy trnh. Cc trng hp kt qu th nghim nm ngoi gii hn cho php, trc ht, cn phi tin
hnh li th nghim khng sinh . Nu vn khng c khc phc, hng dn x l s c ny cung cp mt s bin php b sung cho cc trng hp
kt qu ca th nghim kim sot cht lng nm ngoi gii hn, Ngoi ra, nu vn khng gii quyt c vn , cn thng bo cho nh sn xut v cc
vn ca sn phm.

Lu chung

(1) Duy tr chng QC: trnh cy chuyn nhiu ln. Cy chuyn chng QC mi t dng stock sang ng d tr. Nu s dng chng ng kh, tun th hng
dn ca nh sn xut. Gi chng gc E. coli ATCCa 35218 v K. pneumoniae ATCC 700603 -60 C hoc thp hn v chun b chng dng chia nh
cho s dng hng tun.

Khng sinh Chng kim tra cht lng Quan st Nguyn nhn c th Bn lun/Hnh ng
Aminoglycosides Bt k Vng c ch qu nh pH mi trng qu thp Khong pH cho php
= 7.2-7.4. Trnh C02
v lm gim pH

Aminoglycosides Bt k Vng c ch qu ln pH mi trng qu cao Khong pH cho php =

7.2-7.4
Aminoglycosides P. aeruginosa ATCC 27853 Vng c ch qu nh Ca++ v/hoc Mg++ qu S dng l mi trng
cao mi thay th

Aminoglycosides P. aeruginosa ATCC 27853 Vng c ch qu ln Ca++ v/hoc Mg++ qu S dng l mi trng
thp mi thay th
Amoxicillin-clavulanic axit E. coil ATCC 35218 Vng c ch qu nh Axit clavulanic b bin S dng l khoanh
tnh. Khoanh giy mt hiu giy khng sinh mi.
lc. Kim tra iu kin
bo qun v ton b
bao gi.
 M100-S21
Ampicillin E. coli ATCC 35218 Vng c ch qu ln Mt plasmid m ha Xem lu (1) v duy tr
enzyme beta-lactamase chng kim tra cht
lng QC.

Nhm Beta-lactam Bt k Ban u vng c ch Khoanh giy khng sinh mt S dng l khoanh
c th chp nhn hiu lc giy mi. Kim tra
c nhng sau b iu kin bo qun v
gim v c th nm ton b bao gi.
ngoi gii hn. Imipenem, axit
clavulanic, v
cefaclor l cc khng
sinh d b bin tnh.

Aztreonam K. pneumoniae ATCC 700603 Vng c ch qu rng Mt plasmid m ha Xem bn lun (1) v
Cefotaxime enzyme beta-lactamase duy tr chng kim tra
Cefpodoxime cht lng QC.
Ceftazidime
Ceftriaxone

Cefotaxime/clavulanic axit K. pneumoniae ATCC 700603 Xt nghim khng nh Mt plasmid m ha enzyme Xem bn lun (1) v duy
Ceftazidime/clavulanic axit ESBL m tnh beta-lactamase tr chng kim tra cht
lng QC.

Penicillins Bt k Vng c ch qu rng pH mi trng qu thp Khong pH cho php =

7.2-7.4. Trnh trong
iu kin CO2, thng
to pH thp hn.
Penicillins Bt k Vng c ch qu nh pH mi trng qu cao Khong pH cho php =
7.2-7.4
 M100-S21

Carbenicillin P. aeruginosa ATCC 27853 Vng qu nh Cc chng QC tr nn Xem bn lun (1) v duy
khng thuc sau khi cy tr chng kim tra cht
chuyn nhiu ln. lng QC.

Ticarcillin-clavulanic axit E. coli ATCC 35218 Vng c ch qu nh Axit clavulanic b bin S dng l khoanh
tnh. Khoanh giy mt hiu giy mi. Kim tra
lc. iu kin bo qun v
ton b bao gi.
Clindamycin S. aureus ATCC 25923 Vng c ch qu nh pH mi trng qu thp Khong pH cho php =
7.2-7.4.. Trnh trong iu
kin C0 2, thng to
pH thp hn.
Clindamycin S. aureus ATCC 25923 Vng c ch qu rng pH mi trng qu cao Khong pH cho php=
7.2-7.4

Daptomycin S. aureus ATCC 25923 Vng c ch qu nh Ca++ trong mi trng qu S dng l mi trng
thp mi thay th
Macrolides S. aureus ATCC 25923 Vng c ch qu nh pH mi trng qu thp Khong pH cho php =
7.2-7.4. Trnh trong
iu kin CO2 , thng
to pH thp hn.
Macrolides S. aureus ATCC 25923 Vng c ch qu rng pH mi trng qu cao Khong pH cho php =
7.2-7.4
 M100-S21
Bng 3D. (Tip)

Khng sinh Chng kim tra cht lng Quan st Nguyn nhn c th Bn lun/Hnh ng
Quinolones Bt k Vng c ch qu nh pH mi trng qu thp Khong pH cho php
= 7.2-7.4. Trnh C0 2,
thng cho pH thp
Quinolones Bt k Vng c ch qu ln pH mi trng qu cao hn
Khong pH cho php =
7.2-7.4
Tetracyclines Bt k Vng c ch qu ln pH mi trng qu Khong pH cho php
thp = 7.2-7.4. Trnh C0 2,
thng cho pH thp
Tetracyclines Bt k Vng c ch qu nh pH mi trng qu cao Khong pH cho php =
7.2-7.4
Tetracyclines Bt k Vng qu nh Hm lng Ca++ v/hoc S dng l mi
Mg++ qu cao. trng mi thay th.

Tetracyclines Bt k Vng qu ln Hm lng Ca++ v/hoc S dng l mi trng

Mg++ qu thp. mi mi thay th.

Sulfonamides E. faecalis ATCC 29212 Vng c ch 20 mm Mi trng cha thymidine S dng l mi

Trimethoprim hm lng qu cao. trng mi thay th.
Trimethoprim-
sulfamethoxazole
 M100-S21
Nhiu loi Bt k Nhiu vng c ch qu Huyn dch vi khun qu Pha li s dng c
rng long chun 0.5 McFarland
Li trong chun b huyn hoc thit b o c
dch vi khun tiu chun ha khc.
Mi trng qu mng Kim tra hn dng v
Mi trng MHA khng iu kin bo qun nu
m bo v dinh dng. dng bari sulfate
S dng a thch c
dy 4mm
Kim tra l MHA thay
th
Nhiu loi Bt k Nhiu vng c ch qu Huyn dch vi khun qu Pha li s dng c
nh m c. chun 0.5 McFarland
Li chun b huyn dch vi hoc thit b o c
khun. tiu chun ha khc.
mi trng qu dy. Kim tra hn dng v
Mi trng MHA khng iu kin bo qun nu
m bo v dinh dng dng bari sulfate
S dng a thch c
dy 4mm
Kim tra l MHA thay
th

Nhiu loi Bt k Mt hoc nhiu vng c Li o c ng knh Kim tra bc c i

ch qu nh hoc qu vng c ch. vi li o c v li
ln Li ghi kt qu ghi kt qu.
Khoanh giy km cht Xt nghim li. Nu
lng ngu nhin kt qu xt nghim li
Khoanh giy khng c nm ngoi gii hn v
p hon ton vo b mt khng c li, tin hnh
thch sa li.
 M100-S21
Nhiu loi S. pneumoniae ATCC 49619 Vng qu ln. Khun Khun lc cy chuyn qu Cy chuyn chng
lc khng c dn u c hoc cha nhiu vi chun v lp li xt
khun khng hot ng nghim QC hoc pha
(ng-nonviable). a cy chng chun t ng d
chuyn ch nn t 18-20h. tr chng QC

Nhiu loi Bt k Mt chng QC ngoi gii S dng mt chng QC c Kim tra li chng ny
hn, nhng cc chng th l tt hn cho vic xc khng nh kt qu
khc nm trong vi cng nhli v QC lp li. nh gi chng
mt loi khng sinh thay th vi cc MIC
bit. Tin hnh bc sa
li vi vn chng
QC/khng sinh

Nhiu loi Bt k Hai chng QC nm ngoi Vn v khoanh khng S dng l khoanh

gii hn vi cng mt sinh khng sinh thay th.
khng sinh Kim tra iu kin
bo qun v ton b
bao gi
Nhiu loi Bt k Cc vng b chng ln Qu nhiu khoanh khng Khng qu 12 khoanh
nhau sinh trn mt a khng sinh trn a
150mm v khng qu
5 khoanh khng sinh
trn i 100mm; i
vi mt s vi khun
kh mc c th cho
vng c ch ln hn
th s khoanh khng
sinh cng t hn.
Vit tt: ESBL, khng betalactama ph rng; MHA, thch Mueller-Hinton; MIC, nng c ch ti thiu; QC, kim sot cht lng.
 M100-S21
Bng 4A. MIC: Gii hn cho php i vi cc chng chun kim tra cht lng c s dng m bo tnh chnh xcvi cc chng d nui cy
(Mi trng Mueller-Hinton khng b sung mu hoc cc cht dinh dng [ iu chnh cation vi canh thang])

Staphylococcus Enterococcus Escherichia Pseudomonas Escherichia

Khng sinh aureus faecalis coli aeruginosa coli
ATCC 29213a ATCC 29212 ATCC 25922 ATCC 27853 ATCC 35218 b,c
Amikacin 1-4 64-256 0.5-4 1-4 -
Amoxicillin-clavulanic axit 0.12/0.06-0.5/0.25 0.25/0.12-1.0/0.5 2/1-8/4 - 4/2-16/8
Ampicillin 0.5-2 0.5-2 2-8 - -
Ampicillin-sulbactam - - 2/1-8/4 - 8/4-32/16
Azithromycin 0.5-2 - - - -
Azlocillin 2-8 1-4 8-32 2-8 -
Aztreonam - - 0.06-0.25 2-8 -
Besifloxacin 0.015-0.06 0.06-0.25 0.06-0.25 1-4 -
Carbenicillin 2-8 16-64 4-16 16-64 -
Cefaclor 1-4 - 1-4 - -
Cefamandole 0.25-1 - 0.25-1 - -
Cefazolin 0.25-1 - 1-4 - -
Cefdinir 0.12-0.5 - 0.12-0.5 - -
Cefditoren 0.25-2 - 0.12-1 - -
Cefepime 1-4 - 0.015-0.12 1-8 -
Cefetamet - - 0.25-1 - -
Cefixime 8-32 - 0.25-1 - -
Cefmetazole 0.5-2 - 0.25-1 >32 -
Cefonicid 1^ - 0.25-1 - -
Cefoperazone 1-4 - 0.12-0.5 2-8 -
Cefotaxime 1-4 - 0.03-0.12 8-32 -
Cefotetan 4-16 - 0.06-0.25 - -
Cefoxitin 1-4 - 2-8 - -
Cefpodoxime 1-8 - 0.25-1 - -
Cefprozil 0.25-1 - 1-4 - -
Ceftaroline 0.12-0.5 0,25-2 d 0.03-0.12 - -
Ceftazidime 4-16 - 0.06-0.5 1-4 -
Ceftibuten - - 0.12-0.5 - -
Ceftizoxime 2-8 - 0.03-0.12 16-64 -
 M100-S21
Ceftobiprole 0.25-1 0.06-0.5 0.03-0.12 1-4 -
Ceftriaxone 1-8 - 0.03-0.12 8-64 -
Cefuraxime 0.5-2 - 2-8 - -
Cephalothin 0.12-0.5 - 4-16 - -
Chloramphenicol 2-16 4-16 2-8 - -
Cinoxacin - - 2-8 - -
Ciprofloxacine 0.12-0.5 0.25-2 0.004-0.015 0.25-1 -
Clarithromycin 0.12-0.5 - - - -
Clinafloxacin 0.008-0.06 0.03-0.25 0.002-0.015 0.06-0.5 -
Clindamycinf 0.06-0.25 4-16 - - -
Colistin - - 0.5-2 0.5-4 -

Dalbavancine 0.03-0.12 0.03-0.12 - - -

Daptomycinf 0.12-1 1-4 - - -
Dirithromycin 1-4 - - - -
Doripenem 0.015-0.06 1-4 0.015-0.06 0.12-0.5 -
Doxycycline 0.12-0.5 2-8 0.5-2 - -
Enoxacin 0.5-2 2-16 0.06-0.25 2-8 -
Ertapenem 0.06-0.25 4-16 0.004-0.015 2-8 -
Erythromycind 0.25-1 1-4 - - -
Faropenem 0.03-0.12 - 0.25-1 - -
Fidaxomicin 2-16 1-4 - - -
Fleroxacin 0.25-1 2-8 0.03-0.12 1-4 -
Fosfomycini 0.5-4 32-128 0.5-2 2-8 -
Garenoxacin 0.004-0.03 0.03-0.25 0.004-0.03 0.5-2 -
Gatifloxacin 0.03-0.12 0.12-1.0 0.008-0.03 0.5-2 -
Gemifloxacin 0.008-0.03 0.015-0.12 0.004-0.015 0.25-1 -
Gentamicinj 0.12-1 4-16 0.25-1 0.5-2 -
Grepafloxacin 0.03-0.12 0.12-0.5 0.004-0.03 0.25-2.0 -
Iclaprim 0.06-0.25 0.004-0.03 1-4 - -
Imipenem 0.015-0.06 0.5-2 0.06-0.25 1-4 -
Kanamycin 1-4 16-64 1-4 - -
Levofloxacin 0.06-0.5 0.25-2 0.008-0.06 0.5-4 -
Linezolid 1-4 1-4 - - -
Lomefloxacin 0.25-2 2-8 0.03-0.12 1-4 -
 M100-S21
Bng 4A. (Tip)
Khng sinh Staphylococcus Enterococcus Escherichia Pseudomonas Escherichia
aureus faecalis coli aeruginosa coli
ATCC 29213a ATCC 9212 ATCC 25922 ATCC 27853 ATCC 35218b
Loracarbef 0.5-2 - 0.5-2 >8 -
Mecillinam - - 0.03-0.251 - -
Meropenem 0.03-0.12 2-8 0.008-0.06 0.25-1 -
Methicillin 0.5-2 >16 - - -
Mezlocillin 1-4 1-4 2-8 8-32 -
Minocyclinee 0.06-0.5 1-4 0.25-1 - -
Moxalactam 4-16 - 0.12-0.5 8-32 -
Moxifloxacin 0.015-0.12 0.06-0.5 0.008-0.06 1-8 -
Nafcillin 0.12-0.5 2-8 - - -
Nalidixic axite - - 1-4 - -
Netilmicin <0.25 4-16 < 0.5-1 0.5-8 -
Nitrofurantoin 8-32 4-16 4-16 - -
Norfloxacin 0.5-2 2-8 0.03-0.12 1-4 -
Ofloxacin 0.12-1 1-4 0.015-0.12 1-8 -
Oritavancing 0.015-0.12 0.008-0.03 - - -
Oxacillin 0.12-0.5 8-32 - - -
Penicillin 0.25-2 1-4 - - -
Piperacillin 1-4 1-4 1-4 1-8 -
Piperacillin-tazobactam 0.25/4-2/4 -4/4 1/4-4/4 1/4-8/4 0.5/4-2/4
Polymyxin B - - 0.25-2 0.25-2 -
Quinupristin-dalfopristin 0.25-1 2-8 - - -
Razupenem 0.008-0.03 0.25-1 0.06-0.5 - -
Rifampin 0.004-0.015 0.5-4 4-16 16-64 -
Sparfloxacin 0.03-0.12 0.12-0.5 0.004-0.015 0.5-2 -
Sulfisoxazolee,m 32-128 32-128 8-32 - -
Sulopenem 0.015-0.12 2-8 0.015-0.06 - -
 M100-S21
Teicoplanin 0.25-1 0.25-1 - - -
Telavancin 0.12-1 0.12-0.5 - - -
Telithromycin 0.06-0.25 0.015-0.12 - - -
Tetracycline 0.12-1 8-32 0.5-2 8-32 -
Ticarcillin 2-8 16-64 4-16 8-32 -
Ticarcillin-clavulanic axit 0.5/2-2/2 16/2-64/2 4/2-16/2 8/2-32/2 8/2-32/2k
Tigecyclineo 0.03-0.25 0.03-0.12 0.03-0.25 - -
Tobramycin 0.12-1 8-32 0.25-1 0.25-1 -
Trimethoprimm 1-4 0.12-0.5 0.5-2 >64 -
Trimethoprim- < 0.5/9.5 < 0.5/9.5 < 0.5/9.5 8/152-32/608 -
sulfamethoxazole
Trospectomycin 2-16 2-8 8-32 - -
Trovafloxacin 0.008-0.03 0.06-0.25 0.004-0.015 0.25-2 -
Ulifloxacin (prulifloxacin)l - - 0.004-0.015 0.12-0.5 -
Vancomycinp 0.5-2 1-4 - - -

Vit tt: AST, th nghim tnh nhy cm khng sinh (khng sinh ); HTM, mi trng th nghim cho Haemopilus; LHB, mu nga ly gii; MHB, canh
thang Mueller-Hinton.
LU 1: Cc gi tr MIC ny thu c t mt s phng xt nghim tham chiu (phng xt nghim chun thc) bng cc phng php vi pha long.
Nu bn hoc t hn 4 nng c th nghim, vic kim sot cht lng c th kh khn hn.
LU 2: Thng tin in m l mi hoc c iu ch so vi phin bn trc.

Lu

a. ATCC l tn thng mi ca h thng chng chun theo tiu chun ca M.

b. Yu cu cy chuyn v gi chng cn thn v cc chng ny c th mt plasmid; tham kho ti liu M07-A8, Phn 16.4.
c. Chng chun c khuyn co s dng khi tin hnh th nghim vi khng sinh phc hp betalactam/khng betalactamase
d. Chng ny ch c coi nh l chng chun b sung v khng cn thit phi tin hnh th nghim kim tra cht lng thng quy
e. Gii hn kim tra cht lng i ca E. coli ATCC 25922 vi ciprofloxacin, nalidixic axit, minocycline, v sulfisoxazole khi th nghim trong mi
trng CAMHB b sung 2.5 n 5% mu nga ly gii, trong iu kin hiu kh hoc 5% CO2 (khi th nghim vi N. meningitides) ging vi th
nghim c m t trong Bng 4A.
f. Khi erythromycin v clindamycin cng mt ging pht hin khng clindamycin do khch thch, S. aureus ATCC BAA-977 (khng qua trung
gian ermA) v S. aureus ATCCBAA-976 (c ch khng qua bm y macrolide qua trung gian msrA) l cc chng chun c xut s dng vi
mc ch nh gi cht lng. S. aureus ATCCBAA-977 th hin tnh khng vi clindamycin do kch thch (pht trin c trong ging), trong khi
S. aureus ATCC 29213 v S. aureus ATCC BAA-976 khng th hin tnh khng clindamycin do kch thch (khng pht trin trong ging).
 M100-S21
g. Nhng gii hn QC phn nh cc gi tr ca MIC thu c khi s dng mi trng canh thang Mueller-Hinton c b sung 0.002% polysorbate 80.
h. Nhng gii hn QC phn nh cc gi tr MIC thu c khi s dng mi trng canh thang Mueller-Hinton c b sung canxi t nng cui
cng l 50 g/mL. Phng php pha long trn thch khng c gi tr vi daptomycin.
i. Phng php xc nh MIC c ph duyt l pha long trn thch. Mi trng thch cn b sung 25 g/mL glucose-6-phosphate. Khng nn
tin hnh th nghim pha long trong mi trng canh thang.
j. i vi cc chng chun cho th nghim sng lc khng aminoglycoside mc cao i vi Enterococci, xem Bng 2D-S6 cui Bng 2D.
k. Th nghim ny ch nn tin hnh bng pha long trn thch.
l. Ulifloxacin l cht chuyn ha c hot tnh ca khng sinh ang th nghim (cha c chp thun) prulifloxacin. Ch s dng ulifloxacin trong xt
nghim tnh nhy cm khng sinh
m. Th nghim rt ph thuc cht lng mi trng, c bit l i vi Enterococci
n. Cc gii hn kim tra cht lng i vi E. coli ATCC 35218 khi s dng mi trng th nghim Haemophilus (HTM) l 16/2 n 64/2 g/mL.
o. i vi th nghim vi pha long ca tigecycline, khi cc bc MIC c chun b, mi trng phi c chun b mi trong ngy s dng. Mi
trng khng qu 12h tnh t lc cc bc MIC c chun b; tuy nhin cc panel c th gi ng lnh cho ln s dng tip theo.
p. i vi cc chng chun th nghim sng lc vancomycin ca cc chng Enterococci, xem Bng 2D-S6 cui Bng 2D.
 M100-S21
Bng 4B. Gii hn cho php i vi cc chng kim tra cht lng c s dng kim tra s chnh xc ca nng c ch ti thiu (g/mL) ca
cc chng kh mc (Pha long trn canh thang)

Haemophilus Haemophilus Sfreptococcus

Khng sinh influenzae influenzae pneumoniae
ATCC 49247 ATCC 49766 ATCC 49619
Amoxicillina - - 0.03-0.12
Amoxicillin-clavulanic axita 2/1-16/8 - 0.03/0.015-0.12/0.06
Ampicillin 2-8 - 0.06-0.25
Ampicillin- sulbactam 2/1-8/4 - -
Azithromycin 1-4 - 0.06-0.25
Aztreonam 0.12-0.5 - -
Besifloxacin 0.015-0.06 - 0.03-0.12
Cefaclor - 1-4 1-4
Cefamandole - 0.25-1 -
Cefdinir - 0.12-0.5 0.03-0.25
Cefditoren 0.06-0.25 - 0.015-0.12
Cefepime 0.5-2 - 0.03-0.25
Cefetamet 0.5-2 - 0.5-2
Cefixime 0.12-1 - -
Cefmetazole 2-16 - -
Cefonicid - 0.06-0.25 -
Cefotaxime 0.12-0.5 - 0.03-0.12
Cefotetan - - -
Cefoxitin - - -
Cefpirome 0.25-1 - -
Cefpodoxime 0.25-1 - 0.03-0.12
Cefprozil - 1-4 0.25-1
Ceftaroline 0.03-0.12 - 0.008-0.03
Ceftazidime 0.12-1 - -
Ceftibuten 0.25-1 - -
Ceftizoxime 0.06-0.5 - 0.12-0.5
Ceftobiproleb 0.12-1 0.016-0.06 0.004-0.03
Ceftriaxone 0.06-0.25 - 0.03-0.12
Cefuroxime - 0.25-1 0.25-1
 M100-S21
Cephalothin - - 0.5-2
Chloramphenicol 0.25-1 - 2-8
Ciprofloxacinc 0.004-0.03 - -
Clarithromycin 4-16 - 0.03-0.12
Clinafloxacin 0.001-0.008 - 0.03-0.12
Clindamycin - - 0.03-0.12
Dalbavancind - - 0.008-0.03
Daptomycine - - 0.06-0.5
Dirithromycin 8-32 - 0.06-0.25
Doripenem - 0.06-0.25 0.03-0.12
Doxycycline - - 0.015-0.12
Enoxacin - - -
Ertapenem - 0.015-0.06 0.03-0.25
Erythromycin - - 0.03-0.12
Faropenem - 0.12-0.5 0.03-0.25
Fleroxacin 0.03-0.12 - -
Garenoxacin 0.002-0.008 - 0.015-0.06
Gatifloxacin 0.004-0.03 - 0.12-0.5
Gemifloxacin 0.002-0.008 - 0.008-0.03
Gentamicin - - -
Grepafloxacin 0.002-0.015 - 0.06-0.5
Iclaprim 0.12-1 - 0.03-0.12
Imipenem - 0.25-1 0.03-0.12
Levofloxacin 0.008-0.03 - 0.5-2
Linezolid - - 0.25-2
Lomefloxacin 0.03-0.12 - -
Loracarbef - 0.5-2 2-8
Meropenem - 0.03-0.12 0.06-0.25
Metronidazole - - -
Moxifloxacin 0.008-0.03 - 0.06-0.25
Nalidixic axitc - - -
 M100-S21
Bng 4B. (Tip)

Haemophilus Haemophilus Sfreptococcus

Khng sinh influenzae influenzae pneumoniae
ATCC 49247a ATCC 49766 ATCC 49619
Nitrofurantoin - - 4-16
Norfloxacin - - 2-8
Ofloxacin 0.015-0.06 - 1-4
Oritavancind - - 0.001-0.004
Penicillin - - 0.25-1
Piperacillin-tazobactam 0.06/4-0.5/4 - -
Quinupristin-dalfopristin 2-8 - 0.25-1
Razupenem - 0.008-0.03 0.008-0.06
Rifampin 0.25-1 - 0.015-0.06
Sparfloxacin 0.004-0.015 - 0.12-0.5
Spectinomycin - - -
Telavancin - - 0.004-0.03
Telithromycin 1-4 - 0.004-0.03
Tetracycline 4-32 - 0.06-0.5
Tigecyclinef 0.06-0.5 - 0.015-0.12
Trimethoprim- 0.03/0.59- - 0.12/2.4-
sulfamethoxazole 0.25/4.75 - 1/19
Trospectomycin 0.5-2 - 1-4
Trovafloxacin 0.004-0.015 - 0.06-0.25
Vancomycin - 0.12-0.5
 M100-S21
Cc iu kin th nghim i vi cc chng bnh phm v chng chun kim tra cht lng
Chng vi khun Haemophilus influenzae Streptococcus pneumoniae v Neisseria menigitidis
Streptococci,
Mi trng Canh thang pha long: Canh thang Canh thang pha long: Canh thang Canh thang pha long: Canh thang
th nghim Mueller-Hinton iu chnh Mueller-Hinton iu chnh cation vi
Haemophilus (HTM) cation vi mu nga ly gii (2.5- mu nga ly gii (2.5-5% v/v)
5% v/v)
Huyn dch vi khun Pha trc tip t khun lc Pha trc tip t khun lc Pha trc tip t khun lc

iu kin nui cy 35 C; hiu kh; 20-24 hours 35 C; hiu kh; 20-24 hours 5% CO2; 20-24 gi; 35 oC
(Chng chun S. pneumoniae ATCC 49619,
5% CO2 hoc hiu kh, ngoi tr vi
azithromycin ch duy nht iu kin hiu
kh)
Vit tt: CAMHB, canh thang Mueller-Hinton iu chnh cation; HTM, mi trng th nghim cho Haemopilus; LHB, mu nga ly gii; MHB, canh thang
Mueller-Hinton; MIC, nng c ch ti thiu.
LU 1: Thng tin in m l mi v iu chnh so vi phin bn trc
LU 2: i vi cc gii hn pha long 4 ln, cc kt qu nu cch xa gii hn cho php th nn kim tra li. nh gi hiu lc kim tra cht lng vi d
liu t cc chng kim tra cht lng khc.

Ghi ch

a. Gii hn kim sot cht lng vi E. coli ATCC 35218 khi th nghim trn HTM l 4/2 n 16/8 g/mL i vi amoxicillin-clavulanic axit v
256 g/mL i vi amoxicillin; th nghim vi amoxicillin c th gip khng nh cc chng vn duy tr c kh nng sinh enzyme -lactamase.
b. S dng H. influenzae ATCC 49247 hoc 49766 i vi th nghim kim tra cht lng thng qui.
c. Gii hn kim tra cht lng i vi E. coli ATCC 25922 vi ciprofloxacin, nalidixic axit, minocycline, v sulfisoxazole khi th nghim trn mi
trng CAMHB vi 2.5-5% mu nga ly gii, nui cy iu kin hiu kh hoc 5% CO2 (vi th nghim cho N. meningitides) ging nh lit k
trong Bng 4A.
d. Gii hn QC phn nh MIC t c khi mi trng canh thang Mueller-Hinton c b sung 0.002% polysorbate 80.
e. Gii hn QC phn nh MICs t c khi mi trng canh thang Mueller-Hinton c b sung canxi t nng cui 50 g/mL. Pha long trn
thch khng hiu lc i vi daptomycin.
f. i vi th nghim vi pha long ca tigecycline, khi cc bc MIC c chun b, mi trng phi c chun b mi trong ngy s dng. Mi
trng khng qu 12h tnh t lc cc bc nng c chun b; tuy nhin cc panel c th gi ng lnh cho ln s dng tip theo.
 M100-S21
Bng 4C. Gii hn cho php i vi cc chng kim tra cht lng s dng kim tra chnh xc ca cc nng c ch ti thiu (MICs)
(g/mL) ca Neisseria gonorrhoeae bng phng php pha long trn thch

Neisseria
Khng sinh gonorrhoeae
ATCC 49226 a
Amoxicillin -
Cefdinir 0.008-0.03
Cefepime 0.015-0.06
Cefetamet 0.015-0.25
Cefixime 0.004-0.03
Cefmetazole 0.5-2
Cefotaxime 0.015-0.06
Cefotetan 0.5-2
Cefoxitin 0.5-2
Cefpodoxime 0.03-0.12
Ceftazidime 0.03-0.12
Ceftizoxime 0.008-0.03
Ceftriaxone 0.004-0.015
Cefuroxime 0.25-1
Ciprofloxacin 0.001-0.008
Clarithromycin -
Doxycycline -
Enoxacin 0.015-0.06
Erythromycin -
Fleroxacin 0.008-0.03
Gatifloxacin 0.002-0.015
Gentamicin -
Grepafloxacin 0.004-0.03
Lomefloxacin 0.008-0.03
Meropenem -
Metronidazole -
Moxifloxacin 0.008-0.03
Ofloxacin 0.004-0.015
Penicillin 0.25-1
 M100-S21
Sparfloxacin 0.004-0.015
Spectinomycin 8-32
Telithromycin -
Tetracycline 0.25-1
Traspectomycin 1-4
Trovafloxacin 0.004-0.015

Cc iu kin th nghim i vi cc chng bnh phm v chng chun kim tra cht lng

Chng vi khun Neisseria gonorrhoeae

Mi trng Pha long trn thch: thch GC c bn v 1% yu t kch thch tng trng. S dng cht b tr phi cystein i vi
phng php pha long trn thch vi carbapenems v clavulanate. Yu t kch thch cha cysteine khng thay i
mt cch ng k kt qu th nghim pha long vi cc loi khng sinh khc.

Huyn dch vi khun Pha trc tip t khun lc, t c tng ng c chun 0.5 McFarland

iu kin nui cy 36 1o C (khng vt qu 37 C); 5% C0 2; 20-24 gi

LU 1: Thng tin in m lm mi v iu chnh so vi phin bn trc.

LU 2: i vi cc gii hn pha long 4 ln, cc kt qu nu cch xa gii hn cho php th nn kim tra li. nh gi hiu lc kim tra cht lng vi d
liu t cc chng kim tra cht lng khc.
 M100-S21
Bng 4D. MIC: Gii gii hn cho cc chng kim sot cht lng i vi cc vi khun k kh (phng php pha long trn thch)
Clostridium
Bacteroides Bacteroides Eubacterium
difficle
Khng Sinh fragilis thetaiotaomicron lentum ATCC
ATCC
ATCC 25285 ATCC 29714 43055a
700057
Amoxicillin-clavulanic 0.25/0.125 0.25/0.125
0.5/0.252/1 NRa, b
acid (2:1) 1/0.5 1/0.5
Ampicilin 16-64 16-64 1-4 _b
Ampicillin-sulbactam 0.5/0.254/2
0.5/0.252/1 0,5/0,25-2/1 0.25/0.1252/1
(2:1)
b
Cefmetazole 832 32-128 _ 4-16
Cefoperazone 32-128 32-128 _b 32-128
Cefotaxime 8-32 16-64 _b 64-256
b
Cefotetam 4-16 32-128 _ 32128
Cefoxitin 4-16 8-32 _b 4-16
Ceftizoxime NRa 4-16 _b 16-64
Ceftriaxone 32-128 64-256 _b NRa
Chloramphenicol 28 416 _b _b
b
Clinafoloxacin 0,03-0,125 0,06-0,5 _ 0.030.125
Clindamycin 0,5-2 2-8 2-8 0,06-0,25
Doripenem _b _b 0,5-4 _b
b
Ertapenem 0,06-0,25 0,25-1 _ 0,5-2
Faropenem 0,03-0,25 0,12-1 _b 1-4
Fidaxomixin _b _b 0,06-0,25 _b
Garenoxacin 0,06-0,5 0,25-1 0,5-2 1-4
Imipenem 0,03-0,125 0,125-0,5 _b 0,125-0,5
Linezolid 2-8 2-8 1-4 0,5-2
Moropenem 0,03-0,25 0,125-0,5 0,5-4 0,125-1
Metronidazole 0,25-1 0,5-2 0,125-0,5 _b
b
Mezlocillin 16-64 8-32 _ 8-32
Moxifloxacin 0,125-0,5 1-4 1-4 0,125-05
Nitazoxanide _b _b 0,06-0,5 _b
Penicillin 8-32 8-32 1-4 _b
Piperacillin 2-8 8-32 4-16 8-32
 M100-S21
Piperacillin-tazobactam 0,125/4-0,5/4 4/4-16/4 4/4-16/4 4/4-16/4
Ramoplanin _b _b 0,125-0,5 _b
Razupenem 0,015-0,12 0,06-0,25 0,06-0,25 0,06-05
b
Rifaximin _ _b 0,0039-0,0156 _b
Sulopenem _b 0,06-0,5 1-4 0,5-2
Tetracycline 0,125-0,5 8-32 _b _b
Ticarcilin 16-64 16-64 16-64 16-64
Ticarcillin-clavulanate NRa 0,5/2-2/2 16/2-64/2 16/2-64/2
Tygecycline 0,12-1 0,5-2 0,125-1 0,06-0,5
Tinidazole _b _b 0,125-0,5 _b
b
Tizoxanide _ _b 0,06-0,5 _b
b
Vancomycin _ _b 0,5-4 _b
Vit tt: MIC, Nng c ch ti thiu; QC, kim sot cht lng;
Ch 1: Thng tin in m l mi v c s iu chnh so vi phin bn trc
Ch 2: n v l microgram trn mililite (g/mL) ngoi tr cho penicillin

Ch thch
a. NR chng t rng khng c gi tr MIC no c khuyn co vi cc cp vi khun/khng sinh. Trong nhng trng hp c th, nhng n
lc xc nh khong gi tr gii hn cho QC chng t rng rt nhiu khong gi tr rng thu c (amoxicillin-clavulanic acid vi E.
lentum ATCC 43055; ceftriaxone vi E. lentum ATCC 43055; ceftriaxole vi B. fragilis ATCC 25285; v ticarcillin-clavulanic vi B.
fragilis ATCC 25285). Theo nh trn, nhng cp vi khun/khng sinh khng ph hp cho QC.
b. K hiu-b chng t rng khng c mt nghin cu no v QC c tin hnh bng cc phng php c khuyn co gn y.
M100-S21
 M100-S21
Bng 4E. MIC: Gii gii hn cho cc chng kim sot cht lng (QC) i vi cc vi khun k kh (phng php vi pha long canh thang)
Khng Sinh Bacteroides Bacteroides Clostridium Eubacterium
fragilis thetaiotaomicron difficle ATCC lentum ATCC
ATCC 25285 ATCC 29714 700057 43055 a
c
Amoxicillin-clavulanic 0.25/0.125 0.25/0.1251/0.5 _ NRa
acid (2:1) 1/0.5
Ampicillin-sulbactam 0.5/0.252/1 0.5/0.252/1 _c 0.5/0.252/1
(2:1)
Cefotetan 18 16128 _c 1664
Cefoxitin 28 864 _c 216
Ceftizoxime NRa NRa _c 832
Chloramphenicol 4-16 8-32 _c 4-16
Clindamycin 0,5-2 2-8 _c 0,06-0,25
Doripenem 0,12-0,5 0,12-1 _c NRa
Doxyciline 0,12-0,5 2-8 _c 2-16
Ertapenem 0,06-0,5 0,5-2 _c 0,5-4
Faropenem 0,015-0,06 0,12-1 _c 0,5-2
c
Garenoxacin 0,06-0,25 0,25-2 _ 0,5-2
Imipenem 0,03-0,25 0,25-1 _c 0,25-2
Linezolid 2-8 2-8 _c 0,5-2
Meropenem 0,03-0,25 0,06-0,5 _c 0,125-1
Metronidazole 0,25-2 0,5-4 _c 0,125-0,5
Moxifloxacin 0,12-0,5 1,0-8 _c 0,12-0,5
Penicillin 8-32 8-32 _c NRa
c
Piperacillin 4-8 8-64 _ 8-32
c
Piperacillin-tazobactam 0,03/4-0,25/4 2/4-16/4 _ 8/4-32/4
Razupenem 0,03-0,25 0,12-0,5 0,06-0,5 0,12-0,5
Sulopenem NRa 0,03-0,25 0,5-2 0,25-1
Ticarcillin-clavulanate 0,06/2-0,5/2 0,5/2-2/2 _c 8/2-32/2
Tygecyclineb 0,06-0,5 0,25-1 0,03-0,12 NRa
Vit tt: MIC, Nng c ch ti thiu
Ch 1: Nhng thng tin c in m l mi hoc c iu chnh so vi phin bn trc
Ch 2: Vi gii pha long bc 4, nhng kt qu ngoi xa gii hn cho php cn phi nghi ng. nh gi li gi tr ca nng khng bng
thng tin t cc chng QC khc.
 M100-S21
Ch thch
a. NR th hin khong gii hn cho php ca cc chng QC cha c xc lp thnh cng mc d c nhiu l lc nghin cu
b. i vi th nghim vi pha long ca tigecycline, khi cc bc MIC c chun b, mi trng phi c chun b mi trong ngy s dng.
Mi trng khng qu 12h tnh t lc cc bc nng c chun b; tuy nhin cc panel c th gi ng lnh cho ln s dng tip theo.
c. K hiu _ th hin rng khng mt nghin cu no tin hnh bi nhng phng php c khuyn co gn y.
M100-S21
 M100-S21
Bng 4F. MIC:- Hng dn tham kho v tn sut kim sot cht lng

Bng ny tm tt cc xut v tn sut cho vic kim tra cht lng thng qui khi s dng cc chng chun ATCC khuyn co bi CLSI i vi cc
th nghim tnh nhy cm khng sinh (AST). Ch p dng i vi cc khng sinh cn th 20-30 ngy cho tha mn kt qu mong i.
.

S ngy lin tip cn tin hnh th

nghim QCa

iu chnh th nghim 1 5 20 hoc 30 Lu

Th nghim MIC
S dng cho mt l hng mi X
M rng gii hn pha long X V d: chuyn gii hn ngng
sang cc bc MIC m rng gii
hn

Gim gii hn pha long X V d: Chuyn MIC m rng

gii hn sang cc bc gii hn
ngng

S dng phng php mi (cng cng ty) X V d:

Chuyn t mt thng sang thit
b c t ng cc bc.
Chuyn t tng sinh qua m sang
th nghim MIC nhanh
Thc hin cc nghin cu nh
gi hiu lc t ch ti phng xt
nghim.
Thay i nh sn xut test MIC X Thc hin cc nghin cu nh
gi hiu lc t ch ti phng xt
nghim.
 M100-S21
Thay i nh sn xut mi trng canh thang hoc X
thch

Chun b huyn dch vi khun

S dng cc phng php chun b huyn dch vi X V d:
khun/chun ha c bng cc phng php Chuyn vic iu chnh c
c hng dn kim sot cht lng bng mt thng sang phng
php o quang c hng dn kim
sot cht lng.

Chuyn vic chun b huyn dch vi khun/chun X V d:

ha sang mt phng php ph thuc vo k thut Chuyn vic iu chnh c
ca ngi tin hnh. bng mt thng sang mt
phng php khc m khng
dng o quang.

Thit b/phn mm (v d, my c ng knh vng c ch t ng)

Cc phn mm cp nht nh hng n kt qu
AST
Sa cha thit b nh hng n kt qu AST
X Kim sot tt c cc thuc,
khng ch nhng thuc lin
quan trong vic iu chnh
phn mm.
X Ph thuc vo vic sa cha (v
d: cc b phn nh thit b o
quang) c th cn tin hnh cc
th nghim b sung (v d, nm
ngy).

LU 1: Khi c thm bt k khng sinh MI no, cn th nghim kim sot cht lng 20-30 ngy lin tc (xem M07-A8, Phn
16.7.2) trc khi s dng.
 M100-S21
LU 2: QC c th tin hnh trc hoc ng thi vi cc chng bnh phm. Kt qu ca bnh phm c th c bo co trong ngy nu kt qu
kim tra cht lng nm trong gii hn cho php.

LU 3: Cn tun th cc hng dn v qui nh ca nh sn xut.

LU 4: Cc gii hn QC MIC cho php i vi th nghim nhy cm khng sinh c ph duyt bi FDA c th khng vi gii hn QC CLSI.
Ngi s dng nn tun th hng dn ca tng phng php.
LU 5: i vi cc trng hp kt qu nm ngoi gii hn, tham kho M07-A8, Phn 16.9.

LU 6: Canh thang, nc v nc mui sinh l pha huyn dch vi khun khng cn kim tra cht lng thng qui.

Lu

a. Khng c b qua vic kim tra cht lng thng qui hng tun hoc hng ngy.
 M100-S21
Bng 4G. Hng dn x l cc vn v kim sot cht lng MIC
Bng ny cung cp cc hng dn v nguyn nhn v x l s c cc trng hp kim sot cht lng nm ngoi gii hn cho php ca cc th nghim
nhy cm khng sinh s dng mi trng canh thang CAMHB vi pha long. Tham kho M07-A8, MIC, Phn 16, Hng dn kim sot cht lng v Quy
trnh m bo cht lng,. Cc trng hp kt qu nm ngoi gii hn trc ht cn phi tin hnh lp li th nghim. Nu vn khng c gii quyt,
hng dn x l s c cung cp mt s bin php b sung cho cc trng hp kt qu kim sot cht lng nm ngoi gii hn, Ngoi ra, nu vn khng
gii quyt c vn , cn thng bo cho nh sn xut v cc vn ca sn phm.

Lu chung

(1) Duy tr chng QC: trnh cy chuyn nhiu ln. Cy chuyn chng QC mi t ng d tr (dng lu gi). Nu s dng chng ng kh, tun th hng
dn ca nh sn xut. Gi chng gc E. coli ATCCa 35218 and K. pneumoniae ATCC 700603 -60 C hoc thp hn v chun b chng dng s
dng hng tun.

Chng kim tra cht

Khng sinh Quan st Nguyn nhn c th Lu /Khc phc
lng
Aminoglycosides Bt k MIC qu cao pH mi trng qu thp Khong pH cho php = 7.2-
7.4. Trnh C0 2 v to ra pH
thp hn
Aminoglycosides Bt k MIC qu thp pH mi trng qu cao Khong pH cho php = 7.2-7.4

Aminoglycosides P. aeruginosa MIC qu cao Ca++ v/hoc Mg ++ qu Gii hn cho php = Ca++ 20-25
ATCC 27853 cao mg/L
Mg++ 10-12.5 mg/L
Aminoglycosides P. aeruginosa MIC qu thp Ca++ v/hoc Mg ++ qu Gii hn cho php = Ca++ 20-25
ATCC 27853 thp mg/L
Mg++ 10-12.5 mg/L
Amoxicillin- E. coil ATCC MIC qu cao Axit clavulanic b bin tnh. S dng l khoanh giy
clavulanic axit 35218 Khoanh giy mt hiu lc. khng sinh mi. Kim tra
iu kin bo qun v ton b
bao gi.
 M100-S21
Nhm Beta-lactam Bt k MIC ban u c th Khoanh giy khng sinh b S dng l khoanh giy mi.
chp nhn c nhng gim hiu lc Kim tra iu kin bo qun
sau b tng v c th v ton b bao gi. Imipenem,
nm ngoi gii hn. axit clavulanic, v cefaclor l
cc khng sinh d b bin tnh.

Aztreonam K. pneumoniae MIC qu thp Mt plasmid m ha enzyme Xem lu chung (1) v duy tr
Cefotaxime ATCC 700603 beta-lactamase mt cch ngu chng kim tra cht lng QC.
Cefpodoxime nhin
Ceftazidime
Ceftriaxone
Ceftriaxone
Cefotaxime/clavulanic K. pneumoniae Th nghim khng nh Mt plasmid m ha enzyme Xem lu chung (1) v duy tr
axit ATCC 700603 ESBL m tnh beta-lactamase mt cch ngu chng kim tra cht lng QC.
Ceftazidime/clavulanic nhin
axit
Carbapenems P. aeruginosa ATCC MIC qu cao Nng Zn++ trong mi S dng l mi trng mi thay
27853 trng qu cao th.

Carbapenems P. aeruginosa ATCC MIC qu cao Cc khng sinh b gim tc S dng l mi trng mi thay
27853 dng th. Kt qu imipenem lp li 4
g/mL vi P. aeruginosa ATCC
27853 c th phn nh s gim
cht lng ca khng sinh.
 M100-S21
Penicillins S. aureus MIC qu cao Cc chng QC c kh nng Lp li th nghim cn thn v
ATCC 29213 sinh -lactamase; qu thi iu chnh thi gian
gian c th dn n tng MICs

Penicillins Bt k MIC qu thp pH mi trng qu thp Khong pH cho php = 7.2-7.4.

Trnh C02 v to ra pH thp hn.

Penicillins Bt k MIC qu cao pH mi trng qu cao Khong pH cho php = 7.2-7.4

Carbenicillin P. aeruginosa MIC qu cao Cc chng QC tr nn khng Xem lu (1) v duy tr chng
ATCC 27853 thuc sau khi cy chuyn kim tra cht lng QC.
nhiu ln.

Ticarcillin-clavulanic E. coli MIC qu cao Axit clavulanic b bin tnh. S dng l khoanh giy mi.
axit ATCC 35218 Khoanh giy mt hiu lc. Kim tra iu kin bo qun
v ton b bao gi.

Clindamycin S. aureus MIC qu cao pH mi trng qu thp Khong pH cho php= 7.2-7.4.
ATCC 25923 Trnh trong iu kin C0 2, thng
E. faecalis to pH thp hn.
ATCC 29212
 M100-S21
Bng 4G. (Tip)
Chng kim tra cht
Khng sinh Quan st Nguyn nhn c th Lu /Khc phc
lng
Clindamycin S. aureus MIC qu thp pH mi trng qu cao Gii hn pH cho php = 7.2-7.4

ATCC 29213
E. faecalis
ATCC 29212
Daptomycin S. aureus MICs qu cao Hm lng Ca++ qu thp Gii hn hm lng Ca++ cho
ATCC 29213 Hm lng Ca++ qu thp php 50 g/mL trong CAMHB
E. faecalis MICs qu thp iu chnh nng Ca++ hoc
ATCC 29212 s dng l mi trng mi
thay th.
Macrolides v S. aureus MIC qu cao pH mi trng qu thp Khong pH cho php= 7.2-7.4.
Ketolides ATCC 29213 Trnh trong iu kin C0 2, thng
E. faecalis to pH thp hn.
ATCC 29212
Macrolides v S. aureus MIC qu thp pH mi trng qu cao Khong pH cho php= 7.2-7.4.
Ketolides ATCC 29213
E. faecalis
ATCC 29212
Quinolones Bt k MIC qu cao pH mi trng qu thp Khong pH cho php= 7.2-7.4.
Trnh trong iu kin C0 2, thng
to pH thp hn.
Quinolones Bt k MIC qu thp pH mi trng qu cao Gii hn pH = 7.2-7.4

Tetracyclines Bt k MIC qu thp pH mi trng qu thp Gii hn pH = 7.2-7.4

Tetracyclines Bt k MIC qu cao pH mi trng qu cao Gii hn pH = 7.2-7.4

Tetracyclines Bt k MIC qu cao Hm lng Ca++ v/hoc Gii hn cho php = Ca++ 20-
Mg++ qu cao 25 mg/L Mg++10-12.5 mg/L
 M100-S21
++
Tetracyclines Bt k MIC qu thp Hm lng Ca v/hoc Gii hn cho php = Ca++ 20-
Mg++ qu thp 25 mg/L Mg++10-12.5 mg/L

Tigecycline Bt k MIC qu cao CAMHB khng c Bc pha long vi chng

chun b mi chun phi c s dng
hoc lu gi nhit
ng trong vng 12 khi
CAMHB c chun b

Nhiu loi Bt k Nhiu gi tr MICs Huyn dch vi khun qu Lp li s dng thit b o

qu thp trong (long); li trong qu c chun McFarland 0.5 hoc
trnh chun b huyn dch vi thit b chun ha c. Kim
khun tra hn dng v iu kin bo
qun nu dng ng barium
sulfate hoc latex. Kim tra cc
bc trong chun b huyn dch
v qui trnh pha huyn dch.
Thc hin phng php cy m
khun lc trc khi v sau khi
(E. coli ATCC 25922 gn
xp x 5 x 105 CFU/mL).
Nhiu loi Bt k Nhiu gi tr MICs CAMHB khng ti u S dng l mi trng thay th
qu cao hoc qu thp
 M100-S21
Nhiu loi Bt k Nhiu gi tr MICs Huyn dch vi khun qu c Lp li s dng thit b o c
qu cao hoc qu thp chun McFarland 0.5 hoc thit b
chun ha c. Kim tra hn
dng v iu kin bo qun nu
dng ng barium sulfate hoc
latex. Kim tra cc bc trong
chun b huyn dch v qui trnh
pha huyn dch. Thc hin
phng php cy m khun lc
trc khi v sau khi (E. coli
ATCC 25922 gn xp x 5 x 105
CFU/mL).
Nhiu loi Bt k Nhiu ging b b qua Ngoi nhim. Lp li th
Huyn dch vi khun khng nghim QC. S
m bo hoc pha trn huyn dng l mi
dch khng ph hp. Nng trng mi thay
thuc trong cc ging khng th.
chnh xc. Th tch mi
trng trong cc ging khng
chnh xc.
Nhiu loi Bt k Mt s im MIC qu C th do li c kt qu/li Kim tra bc c kt qu
cao hoc qu thp sao chp S dng l thay th
 M100-S21
Bng 4G. (Tip)
Chng kim tra
Khng sinh Quan st Nguyn nhn c th Bn lun/Hnh ng
cht lng
Nhiu loi S. pneumoniae Nhiu gi tr Huyn dch vi khun Cy chuyn chng QC v lp li
ATCC 49619 MICs qu thp c chun b t a th nghim QC; hoc cy chng
cy chuyn qu c. Ch mi QC t ng d tr.
nn s dng a trong S dng l mi thay th.
vng 18-24h. MHB v
LHB khng ti u.

Nhiu loi Bt k Mt chng QC C th chng QC ny tt Xc nh xem chng QC nm

nm ngoi gii hn chng khc trong trong gii hn c thch hp lm
hn, nhng cc vic kim tra cht lng ch s vi khng sinh th nghim
chng khc nm (v d, P. aeruginosa hay khng. Lp li th nghim
trong gii hn i ATCC 27853 tt hn vi chng ny khng nh li
vi cng mt loi E. coli ATCC 25922 kt qu.
khng sinh. i vi imipenem. nh gi cc chng thay th vi
cc gi tr MIC bit.
Thc hin vic x l s c bt
u t vn cp chng
QC/khng sinh.

Nhiu loi Bt k Hai chng QC Phn nh vn v Thc hin vic x l s c bt

nm ngoi gii khng sinh. u.
hn i vi cng C th y l mt li h
mt loi khng thng
sinh.
 M100-S21
Nhiu loi Bt k Mt kt qu QC nm Nu khng sinh thng khng
ngoi gii hn, c bo co, khng cn th
nhng khng sinh nghim lp li m c th s dng
khng c bo co cc kim sot ph hp khc thay
s dng trn bnh th khng sinh c kt qu nm
nhn (v d, khng ngoi gii hn ny
c trong liu php
iu tr c s dng
trong bnh vin)

Vit tt: CAMHB, Canh thang Mueller-Hinton iu chnh cation; CFU, n v khun lc; ESBL, Khng betalactamase ph rng; LHB, mu cu ly gii;
MHB, canh thang Mueller-Hinton; MIC, Nng c ch ti thiu: QC, qun l cht lng
 M100-S21
Bng 5A. Dung mi v cht ha tan chun b dung dch khng sinh

Khng sinh Dung mi ha tan Cht ha tan

Amikacin Nc
Amoxicillin m Phosphate, pH 6.0, 0.1 mol/L m Phosphate, pH 6.0, 0.1 mol/L
Amoxicillin-clavulanic acid m Phosphate, pH 6.0, 0.1 mol/L m Phosphate, pH 6.0, 0.1 mol/L
Ampicillin m Phosphate, pH 8.0, 0.1 mol/L m Phosphate, pH 6.0, 0.1 mol/L
Azithramycin 95% ethanol hoc axit acetic bnge,f Mi trng canh thang
Azlocillin Nc
Aztreonam Saturated solution sodium bicarbonate Nc
Besitloxacin Methanol Nc
Carbenicillin Nc
Cefaclor Nc
Cefadroxil m Phosphate, pH 6.0, 0.1 mol/L Nc
Cefamandole Nc
Cefazolin m Phosphate, pH 6.0, 0.1 mol/L m Phosphate, pH 6.0, 0.1 mol/L
Cefdinir m Phosphate, pH 6.0, 0.1 mol/L Nc
Cefditoren m Phosphate, pH 6.0, 0.1 mol/L Nc
Ceepime m Phosphate, pH 6.0, 0.1 mol/L m Phosphate, pH 6.0, 0.1 mol/L
Cefetamet m Phosphate, pH 6.0, 0.1 mol/L VVater
Cefixime m Phosphate, pH 7.0, 0.1 mol/L m Phosphate, pH 7.0, 0.1 mol/L
Cefmetazole Nc
Cefonicid Nc
Cefoperazone Nc
Cefotaxime Nc
Cefotetan DMSO e Nc
Ceoxitin Nc
Cepodoxime 0.10% (11.9 mmol/L) dung dch Natri bicarbonate Nc
Cefprozil Nc
Ceftaroline DMSO chim 30% th tch tng, sau xc nh th tch vi mui 0.85% nc mui sinh l

Ceftazidime Natri carbonated Nc

Ceftibuten 1/10 voi DMSO Nc
Ceftizoxime Nc
Ceftobiprale DMSO thm axit acetic bng e,h Nc, vortex mnh
Ceftraxone Nc
Cefuroxime m Phosphate, pH 6.0, 0.1 mol/L m Phosphate, pH 6.0, 0.1 mol/L
Cephalexin m Phosphate, pH 6.0, 0.1 mol/L Nc
 M100-S21
Cephalothin m Phosphate, pH 6.0, 0.1 mol/L Nc
Cephapirin m Phosphate, pH 6.0, 0.1 mol/L Nc
Cephradine m Phosphate, pH 6.0, 0.1 mol/L Nc
Chloramphenicol 95% ethanol Nc
Cinoxacin 1/2 th tch nc, thm 1 mol/L NaOH, nh git ha tan Nc
Ciprofloxacin Nc
Clarithromycin Methanole or glacial acetic axite,f m Phosphate, pH 6.5, 0.1 mol/L
Clavulanic axit m Phosphate, pH 6.0, 0.1 mol/L m Phosphate, pH 6.0, 0.1 mol/L
Clinatloxacin Nc
Clindamycin Nc
Colistina Nc Nc
Dalbavancin DMSO DMSOg,
Daptomycin Nc Nc
 M100-S21
Bng 5A. (Tip)

Khng sinh Dung mi ha tan Cht ha tan

Dirithromycin Axit acetic bngf Nc
Doripenem 0.85% nc mui sinh l 0.85% nc mui sinh l
Doxycycline Nc
Enoxacin 1/2 th tch nc, nh git 0.1 mol/L NaOH ha tan Nc
Ertapenem m phosphate, pH 7.2, 0.01 mol/L m phosphate, pH 7.2, 0.01 mol/L
Erythromycin 95% ethanol hoc axit acetic bnge,f Nc
Faropenem Nc Nc
Fidaxomicin DMSO Nc
Fleroxacin 1/2 th tch nc, nh git 0.1 mol/L NaOH ha tan Nc
Garenoxacin Nc (kt hp khuy)
Gatitloxacin Nc (kt hp khuy)
Gemiloxacin Nc
Gentamicin Nc
lclaprim DMSOg Nc
Imipenem m Phosphate, pH 7.2, 0.01 mol/L m Phosphate, pH 7.2, 0.01 mol/L
Kanamycin Nc
Levofloxacin 1/2 th tch nc, nh git 0.1 mol/L NaOH ha tan Nc
Linezolid Nc
Linopristin-tlopristin DMFk Nc
Lomefloxacin Nc
Loracarbet Nc
Mecillinam Nc
Meropenem Nc
Methicillin Nc
Metronidazole DMSOe Nc
Mezlocillin Nc
Minocycline Nc
Moxalactam 0.04 mol/L HOI ( yn 1.5 n 2 h) m Phosphate, pH 6.0, 0.1 mol/L
b
(diammonium salt)
Moxiloxacin Nc
Mupirocin Nc Nc
Nafcillin Nc
 M100-S21
Nalidixic axit 1/2 th tch nc, nh git 0.1 mol/L NaOH ha tan dissolve
Netilmicin Nc
Nitazoxanide DMSOc,l DMSOc,l
Nitrofurantoinc m Phosphate, pH 8.0, 0.1 mol/L m Phosphate, pH 8.0, 0.1 mol/L
Norfloxacin 1/2 th tch nc Nc
Ofloxacin 1/2 th tch nc Nc
i
Oritavancin 0.002% polysorbate-80 in wate 0.002% polysorbate-80 trong nci
Oxacillin Nc
Penicillin Nc
Piperacillin Nc
Polymyxin B Nc Nc
Quinupristin-dalfopristin Nc
Ramoplanin Nc Nc
Razupenem m Phosphate, pH 7.2, 0.01 mol/L m Phosphate, pH 7.2, 0.01 mol/L
Rifampin Methanole (nng ti a = 640 g/mL) Nc (kt hp khuy)
Rifaximin Methonol 0,1 M m phosphate, pH 7,4 +0,45% Natri
dodecyl sulfonate
Sparfloxacin Nc
Spectinomycin Nc
Streptomycin Nc

Bng 5A. (Tip)

Khng sinh Dung mi ha tan Cht ha tan

Sulbactam Nc
Sultonamides 1/2 th tch nc nng v mt lng ti thiu 2.5 mol/L NaOH ha tan Nc

Sulopenemj 0.01 M m phosphate, pH 7.2, vortex ha tan 0.01 M m phosphate, pH 7.2

Tazobactam Nc
Teicoplanin Nc Nc
Telavancin DMSOg Nc
Telithromycin Axit acetic bngf Nc
Tetracycline Nc
Ticarcillin m Phosphate , pH 6.0, 0.1 mol/L m Phosphate, pH 6.0, 0.1 mol/L
 M100-S21
Ticarcillin-clavulanic acid m phosphate, pH 6.0, 0.1 mol/L m Phosphate, pH 6.0, 0.1 mol/L
Tigecycline Nc Nc
Tinidazole DMSOe, l Nc
Tizoxanide DMSOe, l DMSOe, l
Tobramycin Nc
Trimethoprim 0.05 mol/L lacticehoc axit hydrochlorice, 10% th tch cui Nc (c th cn un nng)

Trimethoprim (nu lactate) Nc

Trospectomycin Nc
Ulifloxacin DMSOg Nc
(prulitloxacin)
Vancomycin Nc

LU : Thng tin in m l mi hoc c iu chnh so vi phin bn trc

Ghi ch

a. Colistin s dng trong th nghim tnh nhy cm khng sinh l colistin sulfate, khng phi colistin methane sulfonate (sulfomethate).
b. Mui diammonium ca maxalactam rt n nh, nhng gn nh ton b l dng ng phn R tinh khit. Moxalactam s dng trn lm sng l hn
hp ca hai dng ng phn R v S vi t l 1:1. Do , mui c ha tan trong 0,04 mol/l HCl v trong 1,5 n 2h chuyn hon ton b dng
ng phn S sang dng ng phn R.
c. Phng php thay th, nitrofurantoin c th ha tan trong dimethyl sulfoxide (DMSO).
d. Natri carbonate (Na2CO3) khan c dng vi lng chnh xc l 10% ceftazidime. Natri carbonate c ha tan trong nc. Khng sinh c ha
tan trong dung dch natri carbonate, b sung nc t th tch va . Dung dch ny c s dng cng sm cng tt, c th bo qun ti a 6h
nhit khng qu 25 oC.
e. Cc hp cht ny c th c c tnh. Cn tun th cc hng dn an ton ca nh sn xut trc khi s dng cc vt liu ny.
f. i vi axit acetic bng, s dng th tch nc, sau nh git axit acetic bng cho n khi ha tan hon ton, khng vt qu 2.5 L/mL.
g. Dung dch ban u ca dalbavancin nn bt u t nng khng qu 1600 g/mL. Nng trung gian 100x nn pha long bng DMSO. T l pha
long cui cng 1:100 nn pha trc tip vo mi trng CAMHB c b sung 0.002% (v/v) polysorbate-80, do nng cui cng ca DMSO
trong mi tup s khng ln hn 1%. Xem Bng 7A.
h. i vi mi ceftobiprole 1,5 mg, thm 110 L hn hp 10:1 MDSO v axit acetic bng. Vortex mnh trong 1 pht, sau vortex lin tc trong vng
15 pht. Thm nc ct va 1.0ml.
i. Dung dch ban u ca oritavancin nn bt u t nng khng qu 1600 g/mL trong 0,002% polysorbate-80 trong nc. Nng trung gian
100x oritavancin nn c chun b trong 0,002 polysorbate-80 trong nc. T l pha long cui cng 1:100 nn pha trc tip vo mi trng
CAMHB c b sung 0,002% polysorbate-80 (v/v), do nng cui cng ca polysorbate-80 trong mi tup s l 0,002%.
 M100-S21
j. Cn pha MI mi ngy s dng.
k. Dimethylformamide (DMF) t 25% th tch cui/nc
l. Nng cui cng ca DMSO khng c php vt qu 1%. N c th c chun b theo quy trnh sau: 1) chun b dung dch d trc
nng cao hn nng d tr d nh 10 ln (v d, chun b nng 12.800 g/mL hn l 1280 g/mL); 2) thm 1,8 mL nc kh
trng vo mi ging thch; 3) thm 0,2 mL khng sinh pha long vo mi ging thch.
 M100-S21
Bng 5B. Chun b dung dch m ca cc khng sinh vi hot tnh c biu hin theo n v

Khng sinh Tinh cht (tham kho) Tnh ton cho g/mg V d
(1)
Potassium 0,625 g/n v Nhn hot tnh c biu hin theo n n v hot tnh/mg x 0.625 g/n v = Hot tnh
Penicillin G v/mg vi 0.625 g/n v. g/mg (v d, 1592 n v/mg x 0,625 g/n v =
995 g/mg)

Sodium 0,6 g/n v(1) Nhn hot tnh c biu hin theo n n v hot tnh /mg x 0.6 g/n v = Hot tnh
Penicillin G v/mg vi 0.6 g/n v. g/mg
Polymyxin B 10 000 n v/mg = Nhn hot tnh c biu hin theo n (v
nd,
v 1477 n /mg
hot tnh v/mg 0,6g/n
x x0.1 g/nvv= =Hot
886.2
tnh
10 n v/g = v/mg vi 0.1 g/n v. g/mg
(2)
0.1 g/n v (v d,
Chia hot tnh c biu hin theo n n v 8120 n /mg
hot tnh v/mg x 0,1
/ 10 ng/n
v/g =vHot
= 812tnh
g/mg)

v/mg vi 10 n v/g g/mg

Colistin sulfatea 30000 n v/mg = Nhn hot tnh c biu hin theo n (v
nd,
v 8120 n /mg
hot tnh v/mg 10 n g/n v = Hot
x /0.03333
30 n v/g = 0.03333 g/n v/mg vi 0.03333 g/n v. tnh g/mg
(2)
v (v d, 20277 n v/mg x 0,03333 g/n v = 676
Chia hot tnh c biu hin theo n n v hot tnh /mg / 30 n v/g = Hot tnh
v/mg vi 30 n v/g g/mg
(v d, 20277 n v/mg / 30 n
v/g = 676 g/mg)
 M100-S21
(3)
Streptomycin 785 n v/mg Chia s n v c a ra cho 785. S ([S n v hiu lc/mg] / [785 n v/mg]) x (850
thu c % bt tinh khit. Nhn % ny M9/m9) = Hiu lc g/mg [v d, (751 n v/mg / 785
vi 850, l lng streptomycin tinh n v/mg) x 850 g/mg = 813 g/mg]
sch nht. Con s ny s tng ng Nu bt cha 2,8% nc:
vi hot tnh trong g/mg 813 x (1-0.028) = hiu lc
813 x 0.972 = 790 g/mg

Ghi ch
a
Khng s dng colistin methanesulfonate i vi th nghim nhy cm khng sinh in vitro.

Ti liu tham kho i vi Bng 5A:

1. Kucers A, Crowe SM, Grayson ML, Hoy JF. Penicillin G. The Use of Antibiotics. 5th ed. Oxford, UK: Butterworth-Heinemann; 1997:3-70.
2. Kucers A, Crowe SM, Grayson ML, Hoy JF. Polymyxins. The Use of Antibiotics. 5th ed. Oxford, UK: Butterworth-Heinemann; 1997:667-675.
3. United States Department of Agriculture, OPHS, Laboratory QA/QC Division. Bioassay for the detection, identification and quantitation of
antimicrobial residues in meat and poultry tissue. 2004;1-58, vol. MLG 34.01.
 M100-S21
Bng 5C. Chun b dung dch v mi trng i vi cc khng sinh phi hp

Khng sinh T l phi hp Pha ch V d

Amoxicillin-axit T l 2:1 Pha ch nng ban u vi nng ban u 128/64 mt ng, chun b ng d tr
clavulanic axit (amoxicillin:clavulanic axit). 10x) vi t l 2:1 ratio v c nng 10x ca amoxicillin 2560 g/mL v 1280 g/mL
pha long cc mc nng i vi clavulanic axit. Sau phi hp mt lng tng
cn ng vi mi ng pha long ban u, m sau s t c
mt phi hp c nng 1280/640 g/mL. Pha long 1:10 vi
canh thang t c nng cui cng mong mun trong
mi ging.

Ampicillin- T l 2:1 Ging vi amoxicillin-

suibactam (ampicillin:sulbactam). clavulanic axit.

Piperacillin- Nng c nh ca Chun b nng ban u i vi nng ban u 128/4, chun b nng ng d tr
tazobactam tazobactam 4g/mL. 10x ca piperacillin mc ca piperacillin 2560 g/mL v pha long gim dn 2 ln
gp i nng cn v pha theo th t t c nng cui cng trong danh sch. Pha
long gim dn 2 ln theo dung dch ng d tr tazobactam 80 g/mL. Thm th tch
th t. Thm mt th tch tng ng tazobactam 80 g/mL vo mi tup piperacillin
tng ng tazobactam 80 pha long. V d, 5 mL dung dch 2560 g/mL piperacillin +
g/mL vo mi tup. 5 mL of 80 g/mL tazobactam = 10 mL of 1280/40 g/mL
piperacillin-tazobactam. Pha long 1:10 vi canh thang thu
c nng cui cng trong mi tup.
 M100-S21
Ticarcillin-clavulanic Nng c nh Chun b nng ban u i vi nng ban u 128/4, chun b dung dch ng d tr
axit clavulanic axit t 2 10x ca ticarcillin mc cao 10x ca ticarcillin 2560 g/mL v pha long gim dn 2 ln
g/mL. gp i nng cn v pha theo th t t nng thp nht cui cng mong mun. Pha
long gim dn 2 ln theo dung dch ng d tr clavulanic axit 40 g/mL. Sau thm
th t. Thm mt lng th mt th tch tng ng clavulanic axit 40 g/mL vo mi
tch tng ng clavulanic tup ticarcillin pha long. V d, 5 mL dung dch ticarcillin
axit 40 g/mL vo mi tup 2560 g/mL + 5 mL clavulanic axit 40 g/mL = 10 mL
pha long. ticarcillin-clavulanic axit 1280/20 g/mL. Pha long 1:10 trong
canh thang t nng cui cng mong mun.
 M100-S21
Bng 5C. (Tip)

Khng sinh T l phi hp Pha ch V d

Trimethoprim- T l 1:19 Chun b nng ban u i vi nng ban u 8/152, chun b nng 10x ca
sulfamethoxazole (trimethoprim: 10x ca trimethoprim 1600 trimethoprim 160 g/mL. Chun b nng ban u
sulfamethoxazole) g/mL (hoc 1280 g/mL 10x ca sulfamethoxazole 3040 g/mL. Thm mt th
sau s pha long t tch tng ng trimethoprim 160 g/mL v
nng 160 g/mL). Chun sulfamethoxazole 40 g/mL vo tup pha long ban u
b nng ban u 10x ca v sau pha long gim dn 2 ln theo th t. V d, 5
sulfamethoxazole a log2 ca mL trimethoprim 160 g/mL v 5 mL sulfamethoxazole
1520 g/mL (v d, 1520, 3040 g/mL = 10 mL trimethoprim-sulfamethoxazole
3040, hoc 6080 g/mL) ph 80/1520. Pha long 1:10 vi canh thang t nng
thuc vo nng ban u cui cng mong mun.
mong mun.

Quinupristin- Khng cn pha ch v bt

daltopristin khng sinh dng phi
Linopristin- hp
Aopristin

LU : pha nng trung gian ca cc khng sinh, s dng cng thc C1 x V1 = C2 x V2, trong , C1 l nng ca dung dch m (thng l 1280
g/mL hoc ln hn); V1 l th tch cn tnh to nng trung gian; C2 l nng trung gian mong mun; v g/mL V2 l th tch dung dch trung gian
cn pha.

V d: pha 20ml dung dch 40 g/mL t dung dch m 1280 g/mL

 M100-S21
C1 x V1 = C2 x V2
1280 g/mL x V1 = 40 g/mL x 20 mL
V1 = 40 g/mL 20 mL
1280 g/mL

V1 = 0.625 mL

Do , thm 0,625 ml dung dch m 1280 g/mL vo 19,375 ml dung mi pha long (thng l nc) thu c 20ml dung dch 40 g/mL.
 M100-S21

Bng 6A. H thng cc dung dch khng sinh s dng trong th nghim tnh nhy cm bng phng php pha long trn thch
Dung dch khng sinh
Bc Nng Ngun Th tch Pha long Nng trung Nng cui cng 1:10 Log2
(g/mL) (mL) (mL) gian (g/mL) pha long trn thch
(g/mL)
5120 ng d tr - - 5120 512 9
1 5120 ng d tr 2 2 2560 256 8
2 5120 ng d tr 1 3 1280 128 7
3 5120 ng d tr 1 7 640 64 6
4 640 Bc 3 2 2 320 32 5
5 640 Bc 3 1 3 160 16 4
6 640 Bc 3 1 7 80 8 3
7 80 Bc 6 2 2 40 4 2
8 80 Bc 6 1 3 20 2 1
9 80 Bc 6 1 7 10 1 0
10 10 Bc 9 2 2 5 0.5 -1
11 10 Bc 9 1 3 2.5 0.25 -2
12 10 Bc 9 1 7 1.25 0.125 -3

LU : Bng ny c Ericsson HM, Sherris JC iu chnh. Th nghim nhy cm khng sinh. Bo co nghin cu hp tc quc t. Acta Pathol Microbiol
Scand. 1971; 217 (suppl B):1-98.
 M100-S21
Bng 7A. H thng cc dung dch khng sinh s dng trong th nghim tnh nhy cm bng phng php pha long trn canh thang
Dung dch khng sinh
Bc Nng Ngun Th tcha CAMHBb Nng cui cng Log 2
+ a =
(g/mL) (mL) Th tch (mL) (g/mL)
1 5120 ng d tr 1 9 512 9
2 512 Bc 1 1 1 256 8
3 512 Bc 1 1 3 128 7
4 512 Bc 1 1 7 64 6
5 64 Bc 4 1 1 32 5
6 64 Bc 4 1 3 16 4
7 64 Bc 4 1 7 8 3
8 8 Bc 7 2 2 4 2
9 8 Bc 7 1 3 2 1
10 8 Bc 7 1 7 1 0
11 1 Bc 10 1 1 0.5 -1
12 1 Bc 10 1 3 0.25 -2
13 1 Bc 10 1 7 0.125 -3
LU : Bng ny c Ericsson HM, Sherris JC iu chnh. Th nghim nhy cm khng sinh. Bo co nghin cu hp tc quc t. Acta Pathol Microbiol
Scand. 1971; 217 (suppl B):1-90.
Ghi ch
a. Cc th tch bt k c th tnh ton da trn bng ny, ph thuc vo s lng xt nghim cn tin hnh.
b. iu chnh cation, nu cn thit, thc hin trc bc ny.
 M100-S21
Bng 7B. Chun b dung dch cc khng sinh khng tan trong nc s dng trong th nghim tnh nhy cm bng phng php pha long trn
canh thang
Dung dch khng sinh
Cht ha tan Nng trung
(mL) gian (g/mL)
Nng Th tch (v d, Nng cui cng 1:100
Bc (g/mL) Ngun (mL) DMSO ) * = = (g/mL) Log2
1 1600 ng d tr 1600 16 4
2 1600 ng d tr 0.5 0.5 800 8.0 3
3 1600 ng d tr 0.5 1.5 400 4.0 2
4 1600 ng d tr 0.5 3.5 200 2.0 1
5 200 Bc 4 0.5 0.5 320 1.0 0
6 200 Bc 4 0.5 1.5 160 0.5 -1
7 200 Bc 4 0.5 3.5 80 0.25 -2
8 25 Bc 7 0.5 0.5 40 0.125 -3
9 25 Bc 7 0.5 1.5 20 0.0625 -4
10 25 Bc 7 0.5 3.5 10 0.03 -5
11 3.1 Bc 10 0.5 0.5 5 0.016 -6
12 3.1 Bc 10 0.5 1.5 2.5 0.008 -7
13 3.1 Bc 10 0.5 3.5 1.25 0.004 -8
14 0.4 Bc 13 0.5 0.5 0.2 0.002 -9
*
Dimethyl sulfoxide
 M100-S21
Ph lc A. Nhng ngh cho th nghim xc nhn vi cc kt qu nh danh v khng sinh cho kt qu l Khng (R), Trung gian (I) v khng
nhy cm (NS)
Mc ph bin v ngha ca kt qu khng v nhng bc lm xc
nh kt qua
Nhm I Nhm II Nhm III
C th ph bin,
Khng c bo co Khng ph bin mi
nhng thng c
hoc gn nh cha bao trung tm nghin cu
cho l nhng vn v
gi c bo co (labo)
mt dch t hc
Cc bc tin hnh:
Xc nhn li m Xc nhn li m Xc nhn li m
(bnh nhn hoc (bnh nhn hoc (bnh nhn hoc
bnh phm) v bnh phm) v bnh phm) v
khng sinh (xem khng sinh (xem khng sinh (xem
ch thch a). ch thch a) nu kt ch thch a) nu kt
Vi khun hoc nhm vi c im kiu hnh khng c Bo co ti khoa qu ny khng ph qu khng ph bin
khun pht hin a chng nhim khun. bin trung tm ca trung tm ca bn.
Gi ti phng xt bn. Vic xc nhn li tin
nghim ca cc trung Vic xc nhn li tin hnh cng khoa
tm Y t Cng cng. hnh cng khoa chng nhim nu nh
Lu gi chng. chng nhim nu nh quy trnh bo co c
Chu : c l s ph hp quy trnh bo co bit hoc cc bc
nu cnh bo ti khoa c bit hoc cc lm k cng hn
chng nhim khun bc lm k cng c t ra.
trc sau thc hin hn c t ra.
th nghim xc nhn Cng vi trung tm
dch t hc trong
vng tin hnh xc
inh chng no s
c bo co vo
thi im bo co.
Bt k Enterobacteriaceae Carbapenem I hoc Rb X
Amikacin, gentamicin, v X
tobramycin - R
Escherichia coli Cephalosporin ph rng I hoc Rb X
 M100-S21
Klebsiella spp.
Proteus mirabilis
Salmonella spp.d Cephalosporin th h III v/hoc X
fluoroquinolone R
 M100-S21
Ph lc A. (Tip)
Acinetobacter baumannii Colistin/polymycin R X
Carbapenem I hoc R X
Pseudomonas aeruginosa Colistin/polymycin I hoc R X
Amikacin, gentamicin, v tobramycin R X
Carbapenem I hoc R
Stenotrophomonas Trimethoprim-sulfamethoxazole I hoc X
maltophilia R
Haemophilus influenza Carbapenem NS X
Cephalosporin ph rngc NS
Fluoroquinolone NS
Amoxicillin-clavulanic acid R X
Ampicillin R v -lactamase m tnh
Neisseria gonorrhoeae Cephalosporin ph rngc NS X
FluoroquinoloneI hoc R X
Neisseria meningitides Ampicillin hoc penicillin R X
Cephalosporin ph rngc NS
Meropenem NS
Minocycline NS
Ampicillin hoc penicillin I X
Azithromycin NS
Rifampin I hoc R
Chloramphenicol I hoc R X
Fluoroquinolone I hoc R
Enterococcus spp. Daptomycin NS X
Linezolid R
Vancomycin R X
Aminoglycoside nng cao R
Staphylococcus aureus Vancomycin MIC 8 g/mLe X
Daptomycin NS X X
Linezolid R
Quinupristin-dalfopristin I hoc R
Vancomycin MIC = 4 g/mL
Oxacillin R X
 M100-S21
Ph lc A. (Tip)
Staphylococcus coagulase m Daptomycin NS X
tnh Linezolid R
Quinupristin-dalfopristin I or R
Vancomycin I hoc Rf
Streptococcus pneumonia Linezolid NS X
Vancomycin NS
Fluoroquinolone I or R X
Imipenem or meropenem I or R
Quinupristin-dalfopristin I or R
Rifampin I or R
Using nonmeningitis breakpoints: X
Amoxicillin or penicillin R
Cephalosporin ph rngc R
Streptococcus, tan mu g Ampicillin or penicillin NS X
Cephalosporin ph rngc NS
Daptomycin NS
Ertapenem hoc meropenem NS
Linezolid NS
Vancomycin NS
Quinupristin-dalfopristin I hoc R X
Streptococcus, nhm viridans Daptomycin NS X
Ertapenem or meropenem NS
Linezolid NS
Quinupristin-dalfopristin I hoc R
Vancomycin NS
Vit tt: I, Khng trung gian; MIC, Nng c ch ti thiu; NS, Khng nhy cm; R, Khng; CoNS, Staphylococcus coagulase m tnh.
Khng nhy cm: L mt cch din gii kt qu dng cho mt s chng vi khun ch c tiu chun c kt l nhy cm. Bi v him hoc
khng c cc trng hp khng xy ra cc chng vi khun ny. Cc chng vi khun c gi tr MIC cao hn hoc c ng knh vng c
ch thp hn gi tr nhy cm cn c bo co l khng nhy cm.
LU 1: Mt chng cho kt qu khng nhy cm khng c ngha l chng thc s c c ch khng. iu ny c th do cc chng, c gi
tr MIC ln hn gi tr nhy cm, thiu c ch khng. C ch khng ny c th gp phi trong nhm phn b t nhin rng sau thi im
xy dng gi tr nhy cm.
 M100-S21
LU 2: i vi cc chng cho kt qu khng nhy cm, phn lp nh danh v th nghim nhy cm khng sinh cn c khng nh
li (Xem ch thch a).
a. m bo rng kt qu ca th nghim khng sinh v nh danh vi khun l chnh xc v d lng gi. Cn nhc cc bc sau:
1. Kim tra li nhng trong qu trnh gh chp s sch, nhim bn, bc thang pha long b thiu ging, a nui cy, card.
2. Kim tra nhng bo cao trc trn cng mt bnh nhn xc nh chng vi khun tng c phn lp v xc nh sm.
3. Thc hin li ton b qu trnh nh dang v khng sinh bng phng php ban u m bo th nghim cho kt qu c tnh lp
li. (Vi nhm I v II, chn lc mt s chng b qua bc 3 tin hnh lun bc 4 v 5. Vi nhm III, lm li th nghim hoc/v cc
th nghim xc nh c l khng cn thit nu kt qu khng c xc nh bi trung tm ca bn.)
4. Xc nhn li qu trnh nh danh c thc hin bng mt phng php khc trong cng mt labo hoc c tin hnh ti labo tham
chiu.
5. Xc nhn li kt qu khng sinh bng mt phng php khc (v d cng mt labo hoc ti labo tham chiu). Phng php th hai
c l l phng php chun thc ca CLSI (v d: vi pha long canh thang, pha long trn thch, hoc khoanh giy khuch tn) hoc
mt phng php c thng mi ha c ph chun bi FDA.
b. MIC ca Imipebem cho cc chng Proteus spp., Providencia spp., v Morganella morganii cho xu hng cao hn (v d, MIC trong khong
gi tr Khng trung gian v Khng mi) so vi MIC ca doripenem. Nhng chng ny c MIC cao hn bi nhng c ch khc ngoi c ch
to ra carbapenemase.
c. Cephalosporin ph rng = cephalosporin th h III v IV (xem ph lc III).
d. trnh ln cc trung tm dch t chc nng kt qu khng sinh cho Salmonella spp. m khng trung gian hoc khng vi cephalosporin
th h III v/hoc khng trung gian hoc khng fluoroquinolone hoc khng vi nalidixic acid.
e. Rt him khi gp. Ch c gi tr chng nhim khun v dch t, tin hnh theo cc khuyn co ca nhm I nhc nh khoa chng nhim
khun v cc c quan c chc nng dch t.
f. C mt vi chng Staphylococcus coagulase m tnh (CoNS) khi tin hnh th nghim MIC ca vancomycin ri vo khong gi tr khng
trung gian. Tri ngc li, c rt t CoNS khng vancomycin.
 M100-S21
g. Xc nhn li rng nhm C v G l nhm c khun lc ln khng phi l khun lc nh khng in hnh. Nhm C v G c khun lc nh
khng in hnh bao gm nhm viridians.
 M100-S21
Ph lc B. Khng ni ti-Enterobacteriaceae
Khng ni ti c nh ngha l khng khng sinh mang tnh cht vn c hoc bm sinh (khng phi thu nhn c). c im ny phn nh
dng khng khng sinh t nhin ca phn ln hoc gn nh ton b cc vi khun. Khng ni ti l ph bin, lm cho th nghim khng sinh tr
ln khng cn thit. V d nh cc loi Citrobacter khng ni ti vi ampicillin.
Bng sau c th hu dng bi 3 l sau: 1) cung cp mt phng php nh gi tnh chnh xc ca cc phng php th nghim; 2) h tr cho vic
nhn dng cc c im kiu hnh ph bin; v 3) ph hp vi vic nh gi cc thng tin khng sinh tch ly. Trong bng, ch R xut hin
tng cp vi khun / khng sinh c ngha l chng th nghim phi khng. Mt t l phn trm nh (1-3%) c th biu hin nhy do phng php
khng chun, t bin hoc mc khng c biu hin mc thp.
Kt qu khng sinh cho l nhy phi c xem li vi s thn trng. m bo rng kt qu khng sinh v nh danh chnh xc v tin cy.
Xem Ph lc A, ch a.

Cefoxitin, Cefotetan

Cephalosporin II:
Cephalosporin I:

Nitrofurantoin
Cephamycins:

Tetracyclines

Polymyxin B
Amoxicillin-

Cephalothin

Cefuroxime
Piperacillin
clavulanate

Ampicillin-
Ampicillin

Ticarcillin
sulbactam

Cefazolin,

Colistin
Citrobacter freundii R R R R R R
Citrobacter koseri R R R R R
Enterobacter aerogenes R R R R R R
Enterobacter cloacae R R R R R R
Escherichia coli Khng c khng -lactam ni ti nhng chng ny
Escherichia hermannii R
Hafnia alvei R R R R
Klebsiella pneumoniae R R R R R R R
Morganella morganii R R R R R R R
Proteus mirabilis Khng c khng -lactam ni ti nhng chng ny
Proteus penneri R R R R R R
Proteus vulgaris R R R R R R
Providencia rettgeri R R R R R R
Providencia stuartii R R R R R R
Salmonella v Shigella spp. Khng c khng -lactams ni ti nhng chng ny: xem Bng 2 A,ch (6) cho bo co
Serratia marcescens R R R R R R R R
 M100-S21
Yersinia enterocolitica R R R R
Cephalosporin th h III, cefepime, aztreonam, ticarcillin-clavulanate, piperacillin-tazobactam, v carbapenems khng c trong danh sch, v
khng c khng ni ti vi Enterobacteriaceae.
 M100-S21
Ph lc C. Cc chng kim sot cht lng i vi cc th nghim tnh nhy cm khng sinh

Chng QC c im chng Khoanh giy MIC Xt nghim sng lc Khc

khuch tn

E. faecalis Vi khun gram- Thch Vancomycin HLAR nh gi mi

ATCC 29212 dng d mc trng ph hp
i vi xt
nghim MIC
cho sulfonamide
hoc
trimethoprimd
nh gi s ph
hp ca nng
cation trong mi
l mi trng
canh thang pha
Mueller-Hinton
i vi
daptomycin
 M100-S21
E. taecalis Khng vi Thch Vancomycin HLAR

ATCC 51299 vancomycin
(VanB) v
aminoglycosides
mc cao

E. coli -Lactamase m tnh Vi khun gram- Vi khun gram-m

ATCC 25922 m d mc d mc
Neisseria Neisseria
meningitidis meningitidis
Cc khng sinh s
dng cho vi khun
dng trong khng
b sinh hc
E. coli Cha plasmid m Phi hp - Phi hp -

ATCC 35218 ha TEM-1 - lactam/cht c lactam/cht c ch
lactamase (khng- ch -lactamase -lactamase
a, b, e,f
ESBL)

H. influenzae BLNAR (beta- Haemophilus spp. Haemophilus spp.

ATCC 49247 lactamase m tnh,
khng ampicillin)
 M100-S21
H. influenzae Nhy cm vi Haemophilus Haemophilus spp.
ATCC 49766 Ampicillin spp. (c th d (c th d lng
lng gi hn gi hn i vi mt
i vi mt s s khng sinh
khng sinh lactams chn lc)
lactams chn
lc)
H. pylori H. pylori

ATCC 43504

K. pneumoniae Cha SHV-18 Sng lc ESBL Sng lc ESBL

ATCC 700603 ESBLb,e,f v xt nghim v xt nghim
khng nh khng nh
N. gonorrhoeae CMRNG (N. N. gonorrhoeae N. gonorrhoeae
ATCC 49226 gonorrhoeae khng
penicillin qua trung
gian chromosom
 M100-S21
P. aeruginosa Cha -lactamase Vi khun Vi khun gram- nh gi hm
ATCC 27853 c AmpC do kch gram m d m d mc lng cation ph
thch mc Cc khng sinh s hp trong mi
dng cho vi khun l/m canh thang
dng trong khng Mueller-Hinton
b sinh hc v khoanh giy
khuch tn i
vi xt nghim
gentamicin MIC
v khng sinh

S. aureus -Lactamase m tnh Vi khun gram

ATCC 25923 mecA m tnh dng d mc
t c gi tr trong xt
nghim MIC do nhy
cm vi hu ht cc
khng sinh

Ph lc C. (Tip)
Chng QC c im chng Khng sinh MIC Xt nghim sng lc Khc
 M100-S21
S. aureus Cc chng sinh - Vi khun gram Thch Oxacillin nh gi hm
ATCC 29213 lactamase yu m d mc lng cation ph
mecA m tnh Cc khng sinh s hp trong mi
dng cho vi l/m canh thang
khun dng trong Mueller-Hinton
khng b sinh hc i daptomycin

S. aureus Khng Oxacillin, Xt nghim vi Xt nghim MIC vi Thch Oxacillin

ATCC 43300 mecA dng tnh khoanh giy Cefoxitin
Cefoxitin
S. aureus Khng mupirocin mc Xt nghim sng Xt nghim sng lc

ATCC BAA-1708 cao qua trung gian lc khng khng mupirocin mc
mup/A mupirocin mc cao
cao
S. pneumoniae Khng trung gian vi S. pneumoniae S. pneumoniae

ATCC 49619 penicillin bi c ch bin Streptococcus Streptococcus spp.
i protein gn penicillin spp. N. meningitidis
N. meningitidis Cc khng sinh s
dng cho vi
khun dng trong
khng b sinh hc
 M100-S21
g
Cc chng QC b sung
E. faecalis MIC ca ceftaroline
ATCC 29212

E. faecalis Thay th E. faecalis

ATCC 33186 ATCC 29212 nh
gi mi trng ph
hp i vi xt
nghim MIC cho
sulfonamide hoc
trimethoprimd

H. influenzae nh gi mi l m mi
ATCC 10211 trng HTM v kh
nng pht trin ca vi
khun
 M100-S21
b
K. pneumoniae Chng sinh KPC Xt nghim xc

ATCC BAA-1705 Xt nghim Hodge nh kiu hnh
dng tnh cc chng sinh
carbapenemase
(xt nghim
K. pneumoniae Khng carbapenems Xt nghim

ATCC BAA-1706 bi cc c ch khc xc nh kiu
carbapenemase hnh cc
Xt nghim Hodge chng sinh
m tnh carbapenemas
e (xt nghim
Hodge iu
S. aureus Cha khng chnh)gi xt
nh QC xem Bng 2C-

ATCC BAA-976 marcrolide duy nht nghim gn S4, 2C-S5, 3A, v 4A
qua trung gian msrA ng vi khoanh
giy khng sinh
erythromycin v
clindamycin
(Xt nghim
vng D m tnh)
 M100-S21
S. aureus Cha khng qua trung nh gi xt QC thng qui i vi

ATCC BAA-977 gian ermA nghim gn ng xt nghim clindamycin
vi khoanh giy bng phng php MIC
khng sinh Xem Bng 2C-S4, 2C-
erythromycin v S5, 3A, v 4A
clindamycin (Xt
nghim vng D
dng tnh)

Ph lc C. (Tip)

Ghi ch

a. E. coli ATCC 35218 c xut lm chng chun i vi phi hp c ch -lactamase, nh cc phi hp cha axit clavulanic, sulbactam, hoc
tazobactam. Chng ny cha plasmid m ha -lactamase (khng ESBL); do khng vi nhiu khng sinh khng bn vi penicillinase nhng
nhy cm vi cc phi hp khng sinh -lactam/cht c ch -lactamase. Chng chun phi cha plasmid ny; tuy nhin plasmid c th mt trong
qu trnh bo qun nhit m. m bo plasmid vn cn, kim tra chng vi khng sinh nhm -lactam n (hoc ampicillin, amoxicillin,
piperacillin, hoc ticarcillin) v kim tra vi khng sinh phi hp -lactam/cht c ch -lactamase (v d, amoxicillin-clavulanate). Nu chng mt
plasmid, chng s nhy cm vi khng sinh -lactam dng n c, v chng s khng c gi tr lm chng chun, cn s dng chng chun
E. coli ATCC 35218 mi.
b. Cn lu vic duy tr chng (v d, cy chuyn) v bo qun (v d, -60oC hoc thp hn) c bit quan trng i vi cc chng chun E. coli
ATCC35218, K. pneumoniae ATCC 700603, v K. pneumoniae ATCC BAA-1705, bi v d mt plasmid m ha -
lactamase or carbapenemase. Mt plasmid dn n kt qu QC nm ngoi gii hn cho php, v d nh gim MICs ca E. coli ATCC
35218 i vi cc khng sinh nhm penicillin khng bn vi enzyme (v d, ampicillin, piperacillin, v ticarcillin), gim MICs ca K. pneumoniae
ATCC 700603 vi cephalosporins v aztreonam, v xt nghim Hodge m tnh gi (MHT) i vi K. pneumoniae ATCC BAA-1705.
c. Tr nn khng thuc khng sinh nhm -lactam sau khi cy chuyn nhiu ln. Hn ch bng cch cy chuyn chng mi t ng d tr t nht
hng thng hoc bt c khi no xut hin s khng thuc.
d. Cc im gii hn cn d c (Trn hoc bng 80% khun lc so vi chng chun) nu mi trng c cc mc thymidine chp nhn c.
e. Rasheed JK, Anderson GJ, Yigit H, et al. Characterization of the extended-spectrum beta-lactamase reference strain, Klebsiella pneumoniae K6
(ATCC 700603), which produces the novel enzyme SHV-18. Antimicrob Agents Chemother. 2000;44:2382-2388.
 M100-S21
f. Queenan AM, Foleno B, Gownley C, Wira E, Bush K. Effects of inoculum and beta-lactamase activity in AmpC- and extended-spectrum beta-
lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae clinical isolates tested by using NCCLS ESBL methodology. J Clin
Microbiol. 2004;42:269-275.
g. Cc chng chun c kim tra thng xuyn (v d, hng ngy hoc hng tun) m bo h thng hot ng tt v cc kt qu ri vo cc gii
hn c bit c lit k trong M100. Cc chng chun c xut trong ti liu ny cn c th nghim theo phng php khoanh giy
khuch tn hoc MIC tham kho CLSI nh c trnh by y. i vi h thng xt nghim thng mi, tt c cc qui trnh QC cn tun th
theo cc khuyn co ca nh sn xut. Cc chng chun QC b sung c dng nh gi cc c tnh ca mt xt nghim hoc h thng xt
nghim trong cc tnh hung la chn c th hoc c th thay th chng QC. V d, Haemophilus influenzae ATCC10211 kh mc hn H.
influenzae ATCC 49247 hoc H. influenzae ATCC 49766, v c dng m bo HTM c th h tr tt (cung cp dinh dng) cho s pht
trin ca cc chng H. influenzae v H. parainfluenzae phn lp t lm sng. Cc chng QC b sung c th c cc c tnh nhy cm hoc khng
c bit i vi mt hoc mt s xt nghim c lit k trong ti liu M02-A10 v M07-A8. Chng c th c dng nh gi xt nghim
mi, tp hun cho ngi mi, nh gi nng lc. Cc chng chun QC b sung khng cn thit cho vo trong chng trnh QC AST hng ngy
hoc hng tun.
 M100-S21
Ph lc D. Bo co th nghim tnh nhy cm khng sinh ly tin i vi cc vi khun nhm Bacteroides fragilis

Cc chng c phn lp t cc bnh vin Hoa K

01/01/2007-31/12/2009a

Metronidazoleb
Moxifloxacin
Clindamycin
Piperacillin-

Meropenem
tazobactam
Ampicillin-

Ertapenem
sulbactam

Imipenem
Cefoxitin
S chng

Cc vi
khun k
kh

% Nhy %S %R %S %R %S % %S % %S % %S %R % % %S % %S %R
cm (%S) R R R S R R
v % Khng
(%R)c
gi tr gii
hn g/mL 8/4 32/16 32/4 128/4 16 64 4 16 4 16 4 16 2 8 2 8 8 32
B. fragilis 872 89 4 98 1 85 6 96 2 98 2 97 2 64 28 53 38 100 0
B. 342 86 3 92 2 32 13 96 2 99 0 99 1 27 56 44 34 100 0
thetaiotaomi
cron

B. ovatus 67 93 2 93 2 37 15 98 0 100 0 100 0 54 39 43 39 100 0

B. vulgatus 70 67 6 100 0 83 4 98 2 98 2 98 2 49 51 43 46 100 0
B. uniformis 60 87 2 91 0 42 13 97 0 100 0 98 2 35 52 35 50 100 0
B. eggerthii 58 95 0 93 0 98 2 100 0 100 0 100 0 29 55 28 55 100 0
Parabactero 111 69 11 91 2 41 16 97 0 100 0 100 0 30 41 54 38 100 0
ides
 M100-S21
distasonis
Nhm B. 708 83 4 93 1 40 12 97 1 99 0 99 1 33 42 43 40 100 0
fragilis
group
khng k
B. fragilis
Nhm B. 1580 86 4 95 2 65 9 97 1 98 1 98 1 50 39 49 39 100 0
Fragilis (c
7 loi c
lit k)
a
S liu c xy dng t cc chng ring l phn lp t bnh phm, gi n ba phng xt nghim tham kho: Tufts New England Medical Center, Boston,
MA; Loyola University Medical Center, Maywood, IL; and R.M. Alden Research Laboratory, Culver City, CA. Xt nghim c tin hnh bng phng
php pha long trn thch
b
Khng vi metronidazole him khi xy ra.
c
Khng trung gian khng c trnh by, nhng c th thu c bng cch tr %S v %R mi khng sinh
 M100-S21

Ph lc E. Bo co th nghim tnh nhy cm khng sinh ly tin i vi cc vi khun k kh khng bao gm nhm Bacteroides fragilis
Cc chng c phn lp t cc bnh vin Hoa K
01/01/2007-31/12/2009a
Cc vi khun

Metronidazoleb
Moxifloxacin
Clindamycin
k kh

Piperacillin-

Meropenem
tazobactam
Ampicillin-

Ertapenem
sulbactam

Imipenem

ampicillin
Penicillin/
Cefoxitin
S chng

% Nhy cm %S %R %S %R %S % %S % %S % % %S % %S % %S % %S %
(%S) v % R R R R R R R R
Khng (%R)c
Gi tr gii 32/4 16 64 4 16 4 16 16 2 2 8 2 8 8 32
hn g/mL 8/4 32/1 128/4 0,5
6
Prevotella 173 98 1 99 1 99 1 100 0 100 0 1 40 49 66 30 59 24 100 0
spp.
Fusobacteriu 44 100 0 100 0 100 0 100 0 100 0 0 100 0 100 0 95 5 100 0
m
nucleatumnec
rophorum
Cu khun 168 98 1 100 0 100 0 100 0 100 0 0 96 3 78 20 82 11 98 1
Gram dng
k khe
Veillonella 28 100 0 61 7 100 0 100 0 100 0 0 57 28 89 7 79 14 86 11
spp.b
P. acnes 34 100 0 100 0 100 0 100 0 100 0 0 100 0 91 3 100 0 3 97
Clostridium 73 100 0 100 0 100 0 100 0 100 0 0 100 0 96 0 99 1 100 0
perfringens
C. difficilec 56 100 0 100 0 0 100 100 0 20 18 0 0 79 5 79 78 22 100 0
 M100-S21
Cc 43 100 0 100 0 47 26 100 0 100 0 0 79 9 56 21 74 12
100 0
Clostridium
spp. khc
a
S liu c xy dng t cc chng ring l phn lp t bnh phm, gi n ba phng xt nghim tham chiu: Tufts New England Medical
Center, Boston, MA; Loyola University Medical Center, Maywood, IL; and R.M. Alden Research Laboratory, Culver City, CA. Xt nghim c
tin hnh bng phng php pha long trn thch
b
s lng c cng tnh ly tin t hn so vi ti liu CLSI M39 khuyn co vi 30 chng
c
C. difficile c phn lp t bnh phm phn; nhng kt qu ny khng bo hm cho tc dng nhim trung ngoi ng tiu ha. MIC ca
Vancomycin vi cc chng ny < 4 g/mL.
d
Khng trung gian khng c trnh by, nhng c th rt ra bng cch tr %S v %R mi khng sinh
e
Cu khun Gram dng k kh bao gm cc loi: Peptococcus, Peptostreptococcus, Finegoldia, Peptoniphilus, v Anaerococcus.
Bng ch thch I (Phn 1). -Lactams: Nhm v phn nhm v tn gc

Nhm khng sinh Phn nhm khng sinh Cc khng sinh c th; tn gc

Penicillinse Penicillina Penicillin

Aminopenicillina Amoxicillin
Ampicillin
a
Ureidopenicillina Azlocillin
Mezlocillin
Piperacillin
a
Carboxypenicillin Carbenicillin
Ticarcillin
b
Cc penicillin bn vi Penicillinase Cloxacillin
Dicloxacillin
Methicillin
Nafcillin
Oxacillin
Amidinopenicillin Mecillinam
 M100-S21
Phi hp -Lactam/c ch Amoxicillin-axit clavulanic
-lactamase Ampicillin-sulbactam
Piperacillin-tazobactam
Ticarcillin- axit clavulanic

Cephems (ng tim) Cephalosporin I c, e Cefazolin

Cephalothin
Cephapirin
Cephradine
c, e
Cephalosporin II Cefamandole
Cefonicid
Cefuroxime (ng tim)
Cephalosporin III c, e Cefoperazone
Cefotaxime
Ceftazidime
Ceftizoxime
Ceftriaxone
Cephalosporin IV c, e Cefepime

Cephalosporins c hot tnh khng MRSA Ceftaroline

Ceftobiprole
Cephamycind Cefmetazole
Cefotetan
Cefoxitin
Oxacephem Moxalactam
 M100-S21
e
Cephems (ng ung) Cephalosporin Cefaclor
Cefadroxil
Cefdinir
Cefditoren
Cefetamet
Cefxime
Cefpodoxime
Cefprozil
Ceftibuten
Cefuroxime (oral)
Cephalexin
Cephradine

Carbacephem Loracarbef
e
Monobactams Aztreonam
Penems Carbapenem Doripenem
Ertapenem
Imipenem
Meropenem
Razupenem
Penem Faropenem
Sulopenem

a
Khng bn vi penicillinase; b thy phn bi penicilinase do t cu sinh ra.
b
Khng b thy phn bi penicillinase t cu.
 M100-S21
c
Cephalosporin th h I, II, III, IV i khi c vit l 1, 2, 3, 4 tng ng. Cephalosporin th h III, IV cng c gi l cephalosporin ph rng. Thut
ng ny khng m ch hot tnh khng vi khun gram m sinh ESBL.
d
Mc d thng c qui l khng sinh cephalosporin th h 2, cephamycin khng c bao gm vi cc khng sinh cephalosporin khc khi cp n cc
chng sinh ESBL.
e
i vi tt c cc chng sinh ESBL, c kt qu v bo co khng vi cc khng sinh trong nhm hoc phn nhm ny.
 M100-S21
Bng ch thch I (Phn 2). Cc khng sinh khc-lactams: Nhm v phn nhm, tn gc

Nhm khng sinh Phn nhm khng sinh Cc khng sinh c th; Tn gc

Aminocyclitols Spectinomycin
Trospectinomycin
Aminoglycosides Amikacin
Gentamicin
Kanamycin
Netilmicin
Streptomycin
Tobramycin
Ansamycins Rifampin
Quinolones Quinolone Cinoxacin
Garenoxacin
Nalidixic acid
Ruoroquinolone Besifloxacin
Ciprofloxacin
Clinafloxacin
Enoxacin
Fleroxacin
Gatifloxacin
Gemifloxacin
Grepafloxacin
Levofloxacin
 M100-S21
Lomefloxacin
Moxifloxacin
Norfloxacin
Ofloxacin
Sparfloxacin
Trovafloxacin
UliAoxacin (prulifloxacin)
c ch con ng chuyn ha folate lclaprim
Sulfonamides
Trimethoprim
Trimethoprim-sulfamethoxazole
Fosfomycins Fosfomycin
Glycopeptides Glycopeptide Vancomycin
Lipoglycopeptide Dalbavancin
Oritavancin
Teicoplanin
Telavancin
Glycylcyclines Tigecycline
Ketolides Telithromycin
Lincosamides Clindamycin
Lipopeptides Daptomycin
Polymyxins Colistin
Polymyxin B
Marcrocyclic Fidaxomicin
 M100-S21
Macrolides Azithromycin
Clarithromycin
Dirithromycin
Erythromycin
Nitrofurans Nitrofurantoin
Nitroimidazoles Metronidazole
Oxazolidinones Linezolid
Phenicols Chloramphenicol
Pseudomonic acid Mupirocin
Streptogramins Linopristin-flopristin
Quinupristin-dalfopristin
Tetracyclines Doxycycline
Minocycline
Tetracycline
 M100-S21
Bng ch thch II. Ch vit tt/ng dng/Phn nhm i vi cc khng sinh c lit k trong M100-S20

Khng sinh Ch vit tta ng dng b Phn nhm

PO IM IV Cc b
Amikacin AN, AK, Ak, X X Aminoglycoside
AMI, AMK
Amoxicillin AMX, Amx, AMOX, X Penicillin
AC
Amoxicillin-clavulanic AMC, Amc, A/C, AUG, X -Lactam/c ch -
axit Aug, XL, AML lactamase

Ampicillin AM, Am, AMP X X X Penicillin

Ampicillin-sulbactam SAM, A/S, X -Lactam/c ch -

AMS, AB lactamase
Azithromycin AZM, Azi, AZI, AZ X X Macrolide
Azlocillin AZ, Az, AZL X X Penicillin
Aztreonam ATM, AZT, Azt, AT, X Monobactam
AZM
Besitloxacin BES X Fluoroquinolone
Carbenicillin (mui CB, Cb, BAR X X X Penicillin
indanyl)
Carbenicillin
Cefaclor CEC, CCL, Cfr, FAC, X Cephem
CF
 M100-S21
Cefadroxil CFR, FAD X Cephem
Cefamandole MA, CM, Cfm, FAM X X Cephem
Cefazolin cz, CFZ, Cfz, FAZ, KZ X X Cephem
Cefdinir CDR, Cdn, DIN, CD, X Cephem
CFD
Cefditoren CDN X Cephem
Cefepime FEP, Cpe, PM, CPM X X Cephem
Cetetamet CAT, FET X Cephem
Cetixime CFM, FIX, Cfe, IX X Cephem
Cefmetazole CMZ, CMZS, CMT X X Cephem
Cefonicid CID, Cfc, FON, CPO X X Cephem
Cefoperazone CFP, Cfp, CPZ, PER, X X Cephem
FOP, CP
Cetotaxime CTX, TAX, Cft, FOT, CT X X Cephem
Cefotetan CTT, CTN, ctn, CTE, X X Cephem
TANS, CN
Cefoxitin FOX, cx, Cfx, FX X X Cephem
Cefpodoxime CPD, Cpd, POD, PX X Cephem
Cefprozil CPR, CPZ, FP X Cephem
Ceftaroline CPT X Cephem
Ceftazidime CAZ, Caz, TAZ, TZ X X Cephem
Ceftibuten CTB, TIB, CB X Cephem
Ceftizoxime ZOX, CZX, Cz, Cz, X X Cephem
CTZ, TIZ
Ceftobiprole BPR X Cephem
 M100-S21
Ceftriaxone CRO, CTR, FRX, Cax, X X Cephem
AXO, TX
Cefuroxime (ung) CXM, CFX, X X X Cephem
Ceturoxime (tim) ROX, Crm,
FUR, XM
Cephalexin CN, LEX, CFL X Cephem
Cephalothin CF, Cf, CR, CL, CEP, X Cephem
CE, KF
 M100-S21
Bng ch thch II. (Tip)

Khng sinh Tn vit tta ng dngb Nhm

PO IM IV Ti ch
Cephapirin CP, HAP X X Cephem
Cephradine RAD, CH X Cephem

Chloramphenicol C, CHL, CL X X Phenicol

Cinoxacin CIN, Cn X Quinolone

Ciprotloxacin CIP, Cp, Cl X X Fluoroquinolone

Clarithromycin CLR, CLM, CLA, X Macrolide
Clinafloxacin CFN, CLX, LF X X Fluoroquinolone
Clindamycin CC, CM, CD, Cd, CLI, DA X X X Lincosamide
Colistin CL, CS, CT X Lipopeptide
Dalbavancin DAL X Glycopeptide
Daptomycin DAP X Lipopeptide
Dicloxacillin DX, DIC X Penicillin
Dirithromycin DTM, DT X Macrolide
Doripenem DOR X Carbapenem
Ertapenem ETP X X Carbapenem
Erythromycin E, ERY, EM X X Macrolide
Faropenem FAR, FARO X Penem
Fidaxomicin FDX X Macrocyclic
Fleroxacin FLE, Fle, FLX, FO X X Ruoroquinolone
Fosfomycin FOS, FF, FO, FM X Fosfomycin
Garenoxacin GRN X X Quinolone
Gatitloxacin GAT X X Fluoroquinolone
 M100-S21
Gemitloxacin GEM X Ruoroquinolone
Gentamicin GM, Gm, CN, GEN X X Aminoglycoside
Grepatloxacin GRX, Grx, GRE, GP X Fluoroquinolone

lclaprim ICL X c ch con ng Folate

Imipenem IPM, IMI, Imp, IP X Carbapenem
Kanamycin K, KAN, HLK, KM X X Aminoglycoside
Levofloxacin LVX, Lvx, LEV, X X Fluoroquinolone
LEVO, LE

Linezolid LNZ, LZ, LZD X X Oxazolidinone

Linopristin- LFE X Streptogramin
Lometloxacin LOM, Lmf X Ruoroquinolone

Loracarbef LOR, Lor, LO X Cephem

Mecillinam MEC X Penicillin
Meropenem MEM, Mer, MERO, MRP, X Carbapenem
Methicillin DP, MET, ME, se X X Penicillin
Metronidazole MTZ X X Nitroimidazole
Mezlocillin MZ, Mz, MEZ X X Penicillin
Minocycline MI, MIN, Min, MN, MNO, X X Tetracycline
Moxalactam MOX X X Cephem
Moxitloxacin MXF X X Fluoroquinolone
Mupirocin MUP, MOP, MU X Axit pseudomonic

Nafcillin NF, NAF, Nai X X Penicillin

Nalidixic acid NA, NAL X Quinolone
Netilmicin NET, Nt, NC X X Aminoglycoside
 M100-S21
Nitrofurantoin F/M, FD, Fd, FT, X Nitrofurantoin
NIT, NI, F

Norfloxacin NOR, Nxn, NX X Fluoroquinolone

Ofloxacin OFX, OFL, OA, OF X X X Fluoroquinolone

Oritavancin ORI X Lipoglycopeptide

Oxacillin OX, Ox, OXS, OXA X X X Penicillin

 M100-S21
Bng ch gii II. (Tip)

Khng sinh Tn vit tta ng dng b Nhm

PO IM IV
Penicillin p, PEN, PV X X X Penicillin
Piperacillin PIP, Pl, PP, Pi X X Penicillin
Piperacillin-tazobactam TZP, PTZ, P/T, PTc X -Lactam/c ch -lactamas

Polymyxin B PB X Lipopeptide
Quinupristin-dalfopristin SYN, Syn, QDA, RP X Streptogramin
Razupenem RZM X Carbapenem
Ritampin RA, RIF, Rif, RI, RD X X Ansamycin
Sparfloxacin SPX, Sfx, SPA, SO X Ruoroquinolone
Spectinomycin SPT, SPE, SC X X Aminocyclitol
Streptomycin S, STR, StS, X X Aminoglycoside
Streptomycin synergy SM, ST2000,
HLS
Sulfonamides SSS, S3 X X i lp con ng Folate (ch i
vi mt s PO)
Sulopenem SLP, SULO X X Penem
Teicoplanin TEO, TPN, Tei, X X Glycopeptide
TEI, TP, TPL

Telavancin TLV X Glycopeptide

Telithromycin TEL X Ketolide
Tetracycline TE, Te, TET, TC X X Tetracycline

Ticarcillin TIC, TC, TI, Ti X X Penicillin

 M100-S21
Ticarcillin-clavulanic acid TIM, Tim, T/C, TCC, TLc X -Lactam/c ch -lactamase
Tigecycline TGC X Glycylcycline
Tobramycin NN, TM, TO, To, TOB X X Aminoglycoside
Trimethoprim TMP, T, TR, w X c ch con ng folate

Trimethoprim-sulfamethoxazole SXT, SxT, T/S, TS, COT X X c ch con ng folate

Trospectinomycin X X Aminocyclitol
Trovaloxacin TVA, Tva, TRV, TV X X Ruoroquinolone
Ulifloxacin (prulifloxacin) PRU X Fluoroquinolone
Vancomycin VA, Va, VAN X X Glycopeptide

PO = mi OS (ung); IM = tim bp; IV= Tim tnh mch.

a
Cc ch vit tt c s dng cho mt hoc nhiu sn phm chn on Hoa K. Nu khng c sn phm chn on no c sn, ch vit tt l ca nh
sn xut.
b
Sn c Hoa K.
 M100-S21
Ph lc III. Danh sch cc ch vit tt dng cho hn mt khng sinh Hoa K, cc sn phm chn on

Ch vit tt Khng sinh

AZM Azithromycin
AZ Azithromycin
CB, Cb C Ceftibuten
CFR, Cfr C Cefaclor
CF, Cf C Cefaclor
CM Clindamycin
CFM, Cfm C Cefixime
CZ, Cz C Ceftizoxime
CD, Cd C Clindamycin
CPZ Cefprozil
CP, Cp C Cephapirin
CN, Cn C Cephalexin
CFX, Cfx C Cefoxitin
CL Cephalothin
CH Clarithromycin
DX Doxycycline
FO Fleroxacin
SC Spectinomycin
SO Sparfloxacin
TC Tetracycline