Key words in vitro I II
Table 1. Methods and reporting values of antimicrobial susceptibility testing and their interpretations Method Report Interpretation Difusion method Disk method Sensitive (S), Intermediate (I), Resistant (R) According to Clinical and Laboratory Standards Institute Etest MIC value (mg/l) Reading of MIC value using axis of inhibition zone and Etest strip Dilution method Agar dilution methods MIC value (mg/l) According to Clinical and Laboratory Standards Institute Microbroth dilution methods MIC value (mg/l) According to Clinical and Laboratory Standards Institute III MIC IV V G μ μ VI μ
Table 2. Comparison between breakpoints of the Clinical and Laboratory Standards Institute, European Committee on Antimicrobial Susceptibility Testing and Japanese Sociery of Chemotherapy and daily dosing in the United States of America, United Kingdom or Japan Antibiotics Clinical and Laboratory Standards Institute (5) European Committee on Antimicrobial Susceptibility Testing (6) S I R S R Sepsis Respiratory tract infection (pneumonia) Japanese Society of Chemotherapy (1 4) Daily dosing Respiratory tract infection (chronic airway infection) Complicated urinary tract infection (cystitis) Complicated urinary tract infection (pyelonephritis) United States of America Piperacillin 64 NA 128 16 16 1 2 2 16 8 12 24 g NA 2 8 g Tazobactam/Piperacillin 64/4 NA 128/4 16 16 1 2 2 16 8 13.5 18 g 9 18 g 9 18 g Ceftazidime 8 16 32 8 8 2 4 4 32 16 2 6 g 1 6 g 1 4 g Cefepime 8 16 32 8 8 2 4 4 32 16 2 4 g NA 1 4 g Cefozopran NA NA NA NA NA 2 4 4 32 16 2 12 g NA 1 4 g Ceftizoxime 8 16 32 64 NA NA 2 4 4 NA NA 2 12 g NA 1 4 g Aztreonam 8 16 32 1 16 2 4 4 NA NA 3 8 g 1 8 g 1 4 g Imipenem 4 8 16 4 8 1 2 2 16 8 2 4 g 1 4 g 1 2 g Meropenem 4 8 16 2 8 1 2 2 32 4 1.5 6 g 1.5 6 g 0.5 3 g Doripenem NA NA NA 1 4 0.5 1 1 16 1 0.25 g 1.5 g 1.5 g 0.5 1.5 g Gentamicin 4 8 16 4 4 NA 2 2 NA NA 420 mg 9 20 mg/kg 80 120 mg Amikacin 16 32 64 8 16 NA 4 4 8 4 900 mg 15 1.5 g 200 400 mg Tobramycin 4 8 16 4 4 NA 2 2 NA NA 420 mg 3 5 mg/kg 120 180 mg Ciprofloxacin 1 2 4 0.5 1 NA 4 4 4 2 400 1,200 mg 400 1,200 mg 600 mg Levofloxacin 2 4 8 1 2 NA 2 2 4 2 250 750 mg 250 500 mg 500 mg NA: not available United Kingdom Japan
Table 3. Criteria for defining drug resistant bacteria in the Japan nosocomial infection surveillance program by the Ministry of Health, Labour and Welfare Organisms MRSA (methicillin resistant Staphylococcus aureus) VRSA (Vancomycin resistant Staphylococcus aureus) VRE (Vancomycin resistant Enterococci) PRSP (Penicillin resistant Streptococcus pneumoniae) MDRP (Multidrug resistant Pseudomonas aeruginosa) Criteria Microbroth dilution method : 4 g/ml for cloxacillin Disk difusion method : 10 mm for cloxacillin or 21 mm for cefoxitin Microbroth dilution method: 16 g/ml for vancomycin Disk difusion method: 14 mm for vancomycin Microbroth dilution method: 16 g/ml for vancomycin Disk difusion method: 14 mm for vancomycin Microbroth dilution method: 0.13 g/ml for penicillin G Disk difusion method: 19 mm for cloxacillin or exception of sensitive for penicillin G and resistance for fluoroquinolones Disk difusion method: carbapenem resistance, 14 mm for amikacin and fluoroquinolone resistant MDRA (Multidrug resistant Acinetobacter spp.) and resistance for fluoroquinolones Disk difusion method: carbapenem resistance, 14 mm for amikacin and fluoroquinolone resistant http://www.nih-janis.jp/section/standard/drugresistancestandard_ver2.0_20101203.pdf : MIC value : diameter of inhibition zone using Kirby-Bauer (KB) disk μ μ β VII VIII IX
Table 4. Reporting criteria for drug resistant bacteria in the act on prevention of infectious diseases and medical care for patients suffering infectious diseases Organisms MRSA (methicillin resistant Staphylococcus aureus) VRSA (Vancomycin resistant Staphylococcus aureus) VRE (Vancomycin resistant Enterococci) PRSP (Penicillin resistant Streptococcus pneumoniae) MDRP (Multidrug resistant Pseudomonas aeruginosa) Criteria Microbroth dilution method : 4 g/ml for oxacillin Disk difusion method : 10 mm for oxacillin Microbroth dilution method: 32 g/ml for vancomycin Microbroth dilution method: 16 g/ml for vancomycin Microbroth dilution method: 0.125 g/ml for penicillin G Disk difusion method: 19 mm for oxacillin and 4 g/ml for ciprofloxacin Disk difusion method: carbapenem resistance, 14 mm for amikacin and 14 mm for ciprofloxacin MDRA (Multidrug resistant Acinetobacter spp.) and 4 g/ml for ciprofloxacin Disk difusion method: carbapenem resistance, 14 mm for amikacin and 14 mm for ciprofloxacin : MIC value : diameter of inhibition zone using Kirby-Bauer (KB) disk X XI
Enterobacter Salmonella