CLSI-Pak Mar 2024

1 Staphylococcus S. aureus complex (S. argenteus), S. schweitzeri haemolyticus

Disk R I S Comments
CLSI For MSSA first line include cephalexin, co-amoxiclav /Amc, cephradine, flucloxacin,
Cefoxitin Screen NA Fox 30 <=21 P67&70
& Table3F
>= 22 Cefazolin, For S. pseudointermedius & schleiferi use oxacillin disk. Zone same as epid below. Table 3G

For CoNS except lugdunensis <=24 >= 25 Same for Staph epidermidis Eucast zone for Staph epid is 28 Staph epid with Ox 1 = 17 Sens and 18 Resistant

Azm or Clr or 15 <=13 14-17 >= 18 Not for Urine

Not Urine or Ery15 <=13 14-22 >= 23 Not for urine Lefamulin
Co-trimoxazole Sxt 25 <=10 11-15 >= 16 Ignore slight growth inside zone.
Tet / Mh Minocycline TE 30 <=14 15-18 >= 19 If Tet is sensitive, then report Dox and Mino sensitive.
Doxy Dox 30 <=12 13-15 >= 16 Bacteriostatic = Not for CSF, brain abscess
Vancomycin MIC MIC >=16 4-8 <= 2 MIC only. Resistance very rare. In VRSA, TLV also Resistant ? Daptomycin MIC Less than 1 is sensitive

CONS MIC >=32 16-8 <= 4 If resistant…. most likely not a Staph ??

Clindamycin Da 2 <=14 15-20 >= 21 If D zone seen. Add ICR Comment. CLSI Table 3I Not in urine/CSF
Heaping = Resistant, Beaching = Sensitive See picture on page 18, β-lactamase
Penicillin p 10 U <=28 ---- >= 29 test Same result for Amoxicillin, Ampicillin, Piperacillin. If Fox is resistant,
then Penicillin is resistant.
Daptomycin MIC <= 1 Not for sputum, BAL, tracheal aspirate
Lzd Confirm resistant cases with MIC. Read with transmitted light (plate held up
Linezolid 30
<=22 23-25 >= 26 to light source). Any discernible growth within the zone of inhibition is indicative of resistance
to the respective agent. Resistance is rare. Tedizolid=Eucast
Chloramphenicol Cap 300 <=12 13-17 >= 18
Ceftaroline NA CPT 30 <=19 20-24 >= 25 NA = Not available in Pakistan Comment: Dose = 600mg/12h
Rifampicin Rif 5 <=16 17-19 >= 20 If Sensitive.... Comment = Rifampicin should not be used alone.
Tedizolid NA Ted 2 <=15 16-18 >= 19 Only for Staph. Aureus NA= Not available in Pakistan
Fusidic Acid FD 10 <=24 - >= 24 Eucast / BSAC Not for Urine
Telavancin NA TLV 30 --- Disk from Hardy

Tigecycline TGC 15 <=19 - >= 19 Eucast Zone given by BSAC is 26 Note = Tigecycline may cause unexplained death and should be avoided.
Amikacin AK 30 - - >= 15 Eucast Do not report routinely.

Teicoplanin MIC >=32 8-16 <= 8 For CONS = 4 Eucast Lefamulin Eucast 23S

Cip or Ofx or Lev Cip 5 <=15 16-20 >= 21 Comment: Cipro sensitivity is based on dosage regimen of 750mg every 12h oral or 400 mg TDS I/V

Lev 5 <=15 16-18 >= 19 Eucast 22R – 24S

Ofl 5 <=14 15-17 >= 18

Moxi Mox 5 <=20 21-23 >= 24 Eucast 28S Oritavancin, Dalbavancin

Gentamicin CN 10 <=12 13-14 >= 15 If Sensitive......Genta Notes. Red = Tier 4 =Tested only on request.
Dr. Nasrullah Malik- Shaukat Khanum Hospital Lahore

For Urine - add

Nitrofurantoin f 300 <=14 15-16 >= 17 Trimethoprim 5

Enoxacin 10 <=14 15-17 >= 18
Norfloxacin 10 <=12 13-16 >= 17
Sulfonamides / Norfloxacin
Sf 300 <=12 13-16 >= 17 Measure the obvious margin. Ignore tiny growth inside.
Staph saprophyticus is almost always sensitive to nitrof, Sxt, & FQ (Cip, Lev, Nor, Lom, Mox,
Novobiocin Diagnostic NV 5 >= 16 Ofl, pef). You may report sensitive without testing.

1. ICR Comment of D Zone = This isolate is presumed to be resistant to clindamycin based on detection of
inducible clindamycin resistance. Clindamycin may still be effective in some patients. Table 3I

2. If Gent Sensitive….Comment = Gentamicin alone will not be effective in this case. It needs to be combined
with another sensitive drug. For Dosages -see Table 2 CLSI
3. If Cipro Sensitive….Comment…..”Avoid ciprofloxacin, as resistance may develop during therapy.”
4. Most important disks are on the top and least important disks are at the bottom. Report upper, suppress lower.
5. Grey shade, has similar results (but not always). To report any error, contact [email protected]
6. Vitek is better than E-strip for MIC. So, for blood, CSF and fluid isolates use Vitek MICs.
7. Please don’t miss to apply or report any GREEN antibiotic. They are First Line. Yellow are Tier 2. Red Tier 3
2. β-haemolytic Strep (S.pyogenes, group C, G, agalactiae) Apply on MHA with 5% sheep blood 4 disks per plate dysgalactiae ?? Mar 24

Disk R I S Comments
Resistance very rare. You may report sensitive without testing. Penicillin sensitive
Penicillin P 10 U >=24 Streptococcus are also sensitive to Ampicillin, Amoxicillin, co-amoxiclav, ampicillin-
sulbactam, cefazolin, cefepime, cephradine, ceftriaxone, cefotaxime, ceftizoxime, imipenem,
meropenem
Ampicillin Amp10 >= 24
Erythromycin Ery 15 <=15 16-20 >= 21 Not for urine, pregnant CLSI 2021
Clindamycin Da 2 <=15 16-18 >= 19 If D zone seen. Add ICR comment. CLSI Table 3H Not in urine/CSF

Tetracycline Tet 30 <=18 19-22 >= 23

FEP or CTX or CRO 30 >= 24
Vancomycin VAN 30 >= 17
Levofloxacin Lev 5 <=13 14-16 >=17
Moxifloxacin Mox 5 <=19 - >=19 Eucast Avoid in CSF

Linezolid Lnz >= 21 Tedizolid, Oritavancin, Dalbavancin NA

Ceftaroline NA CPT 30 >= 26 Comment: Ceftaroline sensitivity is based on dosage regimen of 600mg every 12h

Telavancin NA TLV 30 >= 15 Disk from Hardy

Daptomycin NA MIC <=1 Not for lower respiratory isolates
Tedizolid NA MIC <=0.5 For S. Pyogenes and agalactiae only.
Chloramphenicol Cap 30 <=17 18-20 >= 21 Not in urine
Dr. Nasrullah Malik- Shaukat Khanum Hospital Lahore

1. Group B streptococci are susceptible to ampicillin, penicillin, and cefazolin, but may be resistant to
erythromycin and clindamycin. When Group B Streptococcus is isolated from a pregnant woman with severe
penicillin allergy (high risk for anaphylaxis), erythromycin and clindamycin (including inducible clindamycin
resistance) should be tested, and only clindamycin should be reported.
2. From top to bottom, antibiotics/disks are most important to least important for testing and reporting.
3. Vitek is better than E-strip. So, for CSF and blood isolates use Vitek MICs.
4. Apply Bacitracin 0.04 units in throat -blood agar plate. For Dosages -see Table 2 CLSI

2B. Corynebacterium Required if isolated from sterile sites in immunocompronised patients. See CLSI M45 Notes = Zones not available

R I S For Corynebacterium diphtheriae – see Eucast

Penicillin P1 <=12 >= 50 Eucast

Cefotaxime MIC >=4 2 <= 1

Gentamicin MIC MIC MIC

Erythromycin MIC >=2 1 <= 0.5 Removed from Eucast

Ceftriaxone MIC >=4 2 <= 1

Cipro / Moxi Cip 5 <=25 >= 25 Eucast

Clinda 2 <=20 >= 20 Eucast Not in urine

Cotrimoxazole MIC >=80 <= 40
Tetracycline Te 30 <=24 >= 24 Eucast

Doxycycline MIC >=16 8 <= 4

Cefepime MIC >=4 2 <= 1
Imipenem MIC >=16 8 <= 4
Meropenem MIC >=16 8 <= 4
Vancomycin Van 5 <=17 >= 17 Eucast

Linezolid Lz 10 <=25 >= 25 Eucast

Daptomycin NA MIC <= 1

Rifampicin Rif 5 <=25 26-29 >= 30 Eucast
3. Streptococcus species viridans, anginosus (milleri) , mutans, salivarius, bovis, mitis, constellatus gallolyticus Granulicatella=CLSI M45 Mar 24

Also Streptococcus vestibularis

Disk R I S
Penicillin 1U 12 0.25-2 18 Eucast Intermediate need to be combined with aminoglycosides.

Ampicillin 2 15 0.5-4 21 Eucast Intermediate need to be combined with AG.

Cefotaxime CTX <=25 26-27 >= 28
Ceftriaxone CRO <=24 25-26 >=27
Vancomycin Van 30 >= 17
Chloramphenicol Cap 30 <=17 18-20 >= 21
Tedizolid NA MIC <= 0.25 For anginosus
Linezolid Lnz 30 >= 21
TLV 30 Disk from Hardy Dalbavancin CLSI
Telavancin NA >=15
Oritavancin NA MIC <=0.25 MIC only.
Erythromycin Ery 15 <=15 16-20 >= 21 Report same result for Azithro and Clarithro – Not in urine
Cefepime FEP 30 <=21 >= 24
Ceftolozane-tazobacatm MIC >=12 20 <=36 MIC only.
Clindamycin Da 2 <=15 16-18 >= 19 Not in urine

Levofloxacin Lev 5 <=13 14-16 >= 17

Dr. Nasrullah Malik- Shaukat Khanum Hospital Lahore

1. Vitek is better than E-strip for MIC. So, for blood and CSF isolates use Vitek MICs.
2. The intermediate category implies clinical efficacy in body sites where the drugs are physiologically
concentrated or when a higher than normal dosage of the antibiotic is used. The response may be
less than the sensitive category.
3. SDD = Higher and/or frequent dosage regimens are recommended. (Appendix E of CLSI)

Not for CSF and Brain abscess = Tetra, Doxy, Imipenem Erta, Mino, Clinda, Azithro, Ery, Cipro, Levo, First and Second
gen cephalosporins (Cephalexin, Cephradine, Cefoxitin,) Co-amox, Cefuroxime, (Avoid/or give as intermediate Cotrimoxazole,
Moxi, Tzp Chloramphenicol, Linezolid) Not in CSF

Direct Primary Sensitivity on CSF

1. For GNR for CSF = CTX, CRO, MEM, CAZ, Cap?, Ami, (Amp for GPR), Mz, Gen? Aztreonam
2. For GPC for CSF = CTX=MIC, CRO=MIC, P=MIC, Vanco needs high dose in CSF Ox 1 for Pneumo Gent120 for Entero Moxi, Rif Lnz

3B. Micrococcus & Kocuria kristinae See CLSI M45 P66/45/15

R I S
Penicillin MIC >=0.25 <= 0.12
Vanco MIC <= 2
Clinda MIC >=4 1-2 <= 0.5
Erythromycin MIC >=8 1-4 <= 0.5

1. Consult CLSI M45 for Abiotrophia, Aerococcus below, Aeromonas below, Bacillus, Campylobacter (Cip,Tet,Ery Eucast), Corynebacterium, Erysipelothrix,
Granulicatella, Gemella, HACEK (Aggregatibacter = Haemophilus aphrophilus/paraphrophilus/segnis, & Actinobacillus) Cardiobacterium, Eikenella, Kingella
below, Helicobacter=Eucast, Lactobacillus, Lactococcus, Leuconostoc, Listeria, Micrococcus, Moraxella, Pasteurella, Pediococcus, Rothia, Vibrio below

Direct sensitivity of GNR in blood = Amp, aztreonam, Caz, Cot, Cro, Tobra
4. Strep pneumoniae on MHA with 5% blood or MH-F agar Mar 24

Disk R I S
Penicillin/Ampicillin sensitive Strep pneumo are sensitive to amoxicillin,
Penicillin
amoxicillin/clavulanate, ampicillin/sulbactam, cefaclor, cefdinir, cefotaxime,
Ox 1 >= 20 ceftriaxone, cefpodoxime, Cefprozil, Ceftaroline, Ceftizoxime, cefuroxime, Cefipime,
Not for CSF imipenem, ertapenem, meropenem.(If oxacillin zone ≥ 20 mm, penicillin is sensitive.
If oxacillin zone ≤ 19 mm, penicillin MIC must be done). For CSF only MIC.
See chart last page Eucast Amp5 22S, 19R
Comment: Penicillin sensitivity is based on dosage regimen of 2 million U/4h…… (For Intermediate dose
MIC >=8 4 <= 2 = 18-24 million U/24h)
P I/V, I/M Cefotaxime. ceftriaxone and Meropenem are also likely to be resistant. Consider
For CSF >=0.12 - <= 0.06 combination therapy like Vancomycin with rifampicin or Vanc with cefotaxime or ceftriaxone.
Ceftriaxone/Ceftriaxone MIC >=2 1 <= 0.5 Must for CSF If both P & Cro resistant in CSF give Vanc+Rif
Co-trimoxazole Sxt 25 <=15 16-18 >= 19 Measure the obvious margin. Ignore tiny growth inside.
Erythromycin Ery 5 <=15 16-20 >= 21 Same results for Clari & Azithro Not for urine
Tetracycline Te 30 <=24 25-27 >= 28 If sensitive to Tet, then also report sensitive to Dox and Mino
Doxycycline Dox 30 <=24 25-27 >= 28
Optochin 5 <=7 8-13 >= 14 Only for diagnosis – Not to be reported For intermediate = Bile solubility test

Gemifloxacin Gemi 5 <=19 20-22 >= 23

Levofloxacin Lev 5 <=13 14-16 >= 17 If Levo S, then Gemi & moxifloxacin also S.
Moxifloxacin Moxi 5 <=14 15-17 >= 18 Lefamulin More than 19 is sensitive
Clindamycin Da 2 <=15 16-22 >= 23 If D zone seen. Add ICR Comment. CLSI Table 3H. Not in Urine
Resistance
Vancomycin VAN 30 very rare >=17 Ceftaroline 30 More than 26 is sensitive
Meropenem MIC <= 1 0.25-0.5 >= 0.25 for CSF
Ceftaroline NA CPT 30 - - >= 26 Not for CSF
Cefepime MIC MIC >=4 2 <= 1
Amox/ Co-amoxiclav MIC >=8 4 <= 2
Erta / Imipenem MIC
Cefuroxime MIC MIC >=4 2 <= 1 Lefamulin
Resistance
Linezolid Lnz 30 very rare >=21
Rifampicin Rif 5 <= 16 17-20 >= 19 If Sensitive.... Comment = Rifampicin should not be used alone.
Chloramphenicol Cap Not in Urine
30
<=20 - >= 21
Dr. Nasrullah Malik- Shaukat Khanum Hospital Lahore

1. Comment if Penicillin is sensitive in sputum or BAL = Amoxicillin, ampicillin, cefepime, cefotaxime, ceftriaxone,
cefuroxime, ertapenem, imipenem, and meropenem may be used to treat pneumococcal infections.

4B. Erysipelothrix See CLSI M45 Always resistant to vancomycin

R I S
Penicillin MIC <= 0.12
Ampicillin MIC <= 0.25
Ery MIC >=1 0.5 <= 0.25
Clinda MIC >=1 0.5 <= 0.5
Cipro MIC <= 0.5
Levo MIC <= 0.5
Imipenem MIC <= 0.5
Cefepime MIC <= 1
Cefotaxime MIC <= 1
Ceftriaxone MIC <= 1
Meropenem MIC <= 0.5
5. Enterococcus Mar 24

Disk R I S
For E. faecalis… Penicillin sensitive isolates are also
Penicillin P 10U <=14 >= 15 sensitive to Ampicillin, amoxicillin, amoxicillin/clavulanate,
ampicillin/sulbactam, piperacillin, and piperacillin/tazobactam .
Rare β-lactamase.
Same results for amoxicillin, amoxicillin-clavulanate, ampicillin-sulbactam,
piperacillin, and piperacillin-tazobactam among non–β lactamase-producing
Ampicillin Amp10 <=16 >= 17 enterococci. Same results for imipenem if E. faecalis. (E. faecium is almost always
resistant to ampicillin).

Vancomycin VAN 30 <=14 15-16 >= 17 Read with transmitted light (plate held up to light source) See picture on last page

Gentamicin Table 3K CN 120 <=6 7-9 MIC >= 10 Only for blood, CSF and fluid isolates. If sensitive then add note 4…..see below
Give in CSF
Linezolid Lnz 30 <=20 21-22 U >= 23
Imipenem ? IPM 10 <=21 22-49 >= 50 Eucast See Ampicillin above
Teicoplanin TEC 30 <=10 11-13 >= 14
Daptomycin NA MIC >=8 4 <= 2 Not for respiratory specimens. SDD E.faecium <=2 others <=4

Tigecycline TGC 15 <=19 - >= 19 Eucast Note Disk content – from Hardy Resistance very rare

Telavancin NA TLV 30 >= 15 Disk from Hardy Tedizplid Quinopristin-dalfopristin for Entero.faecium VRE

Erythromycin Ery <=13 14-22 >= 23 Report only if no other drug sensitive. Otherwise suppress. Not for Urine.

Doxycycline Dox 30 <=12 13-15 >= 16 Report only if no other drug sensitive. Otherwise suppress.

Minocycline MH 30 <=14 15-18 >= 19 Report only if no other drug sensitive. Otherwise suppress. Avoid in urine.

Chloramphenicol Cap 30 <=12 13-17 >= 18 Report only if no other drug sensitive. Otherwise suppress.

Dalbavancin MIC Oritavancin

Rifampicin Rif 5 <=16 17-19 >= 20 Not to be used alone

Vanco is not for E. gallinarum and casseliflavus Dr. Nasrullah Malik- Shaukat Khanum Hospital Lahore

For Urine- add

Nitrofurantoin f 300 <=14 15-16 >= 17

Ciprofloxacin Cip 5 <=15 16-20 >= 21
Levofloxacin Lev 5 <=13 14-16 >= 17
Tetracycline Te 30 <=14 15-18 >= 19
Fosfomycin fos 200 <=12 13-15 >= 16

1. Never report Aminoglycosides (except for high-level resistance testing), cephalosporins, clindamycin, and
trimethoprim-sulfamethoxazole. MHA has no folate = False susceptible cotrimoxazole.

2. Do not report any antibiotic other than these.

3. Enterococcus is always resistant to cephalosporins, aminoglycosides?, clindamycin, co-trimoxazole and fusidic
acid.
4. Gentamicin is synergistic with cell wall active agent like ampicillin, penicillin, vancomycin.

5B. Moraxella catarrhalis See CLSI M45

R I S
Penicillin Amc 30 <=23 >= 24
Azithro & Moxi Azm 15 >= 26 Resistance is rare.
Clarithro & Ceftriaxone clr 15 >= 24 Resistance is rare.
Erythro Ery 15 <=20 >= 23 Resistance is rare.
Cefotaxime MIC >=1 <=2
Ceftriaxone MIC <=2
Te 30 Eucast 26 S
Tetra & Levo <=24 25-28 >= 29
Clinda MIC >=4 1-2 <= 0.5 Cipro 31 Co-amoxiclav 19 Mino 25 Eucast
Cotrimoxazole Sxt 25 <=10 >= 13 Levo 29, Moxi 26, Cro 24, Mero 33, Imp 29, Eucast
6. Enterobacterales E. coli, Klebsiella, Enterobacter, Citrobacter, Arizona, Proteus, Morganella, Providencia, Hafnia, Serratia, Yersinia, Edwardsiella, Kluyvera Mar 24

Disk R I S
Ampicillin Amp 10 <=13 14-16 >= 17 Same results for Amoxicillin.
Gentamicin CN 10 <=14 15-17 >= 18
Cefotaxime or CTX 30 <=22 23-25 >= 26 No need to test or report for ESBL. Comment: sensitivity is based on dosage
regimen of 1g/8h Both may become ineffective after few days ?
Ceftriaxone CRO30 <=19 20-22 >= 23 Comment: Ceftriaxone sensitivity is based on dosage regimen of 1g/24h

Amox-clavulanate Amc30 <=13 14-17 >= 18

Amp-sulbactam Sam20 <=11 12-14 >= 15
Pipra-tazobactam Tzp110 <=20 21-24 >= 25
Cefazolin Cz 30 <=19 20-22 >= 23 Comment: Cefazolin sensitivity is based on dosage regimen of Dose = 2g/8h

Ciprofloxacin Cip 5 <=21 22-25 >= 26 IV 400 BD, Oral 500 BD For Salmonella 21-30 is intermediate
Levofloxacin Lev 5 <=16 17-20 >= 21 Ofloxacin, Moxi zones in Eucast = 22-24 750 OD
Cotrimoxazole Sxt 25 <= 10 11-15 >= 16
19-24
Cefepime Fep 30 <=18
SDD >= 25 Not if carbapenemase producer. Tier 1 for few Comment: Cefipime dosage regimen of 1g/12h

Cefotetan NA CTT 30 <=12 13-16 >= 16

Cefoxitin NA FOX 30 <=14 15-17 >= 18 NA = Not available in Pakistan Comment = Cefoxitin sensitivity is based on dosage regimen of 8g/24h

Cefuroxime oral Cxm 30 <=14 15-22 >= 23

Cefuroxime I/V CXM 30 <=14 15-17 >= 18 Cefuroxime Sensitivity is based on dosage regimen of 1.5g/8h

Amikacin AK 30 <=16 17-19 >= 20

Imipenem IPM 10 <=19 20-22 >= 23 (If sensitive……Give Intermediate in brain abscess ) Sensitivity is based on dosage regimen of 1g/8h

Meropenem MEM 10 <=19 20-22 >=23 Sensitivity is based on dosage regimen of 1g/8h

Ertapenem ETP 10 <=18 19-21 >= 22 Sensitivity is based on dosage regimen of 1g/24h

Tetracycline Te 30 <=11 12-14 >= 15 If sensitive to Tet, report Dox and Mino also sensitive.
Tobramycin TOB10 <=12 13-16 >= 17
Doripenem NA DOR 10 <=19 20-22 >= 23 Sensitivity is based on dosage regimen of 500mg/8h

Cefiderocol 30 <=8 9-15 >= 16

Ceftazidime-Avibactam 30-20 <=20 -- >= 21
Meropenem-Vaborbactam 20-10 <=14 15-17 >= 18 Not if OXA-48+ Plazomicin 30

Cefoperazone Cfp 75 <=15 16-20 >= 21

Chloramphenicol Cap 30 <=12 13-17 >= 18
Tigecycline For E.coli&Citrobact TGC 15 <=15 16-17 >= 18 For E. coli and C.koseri only. Eucast Disk from hardy -- Note disk content 15

Colistin MIC >=4 <=2 ECV See CLSI Table 3D Eucast <=2 is Sensitive

Fosfomycin I/V For Ec FOS 200 <=24 -- >= 24 For E. coli only Eucast = For Enterobacteriales other than E.coli use MIC.

Ceftazidime CAZ 30 <=17 18-20 >= 21 May become ineffective after few days Comment: Sensitivity is based on dosage regimen of 1g/8h

Aztreonam NA ATM 30 <=17 18-20 >= 21

Ceftolozane-tazobactam 30-10 <=18 19-21 >= 22
19-24
Ceftaroline NA CPT 30 <=18
SDD >= 25 May become ineffective after few days Comment: Sensitivity is based on dosage regimen of 600 mg/12h

Dr. Nasrullah Malik- Shaukat Khanum Hospital Lahore

1. From top to bottom, antibiotics/disks are most important to least important for testing and reporting.
2. Direct sensitivity of GNR directly from positive blood culture broth = Amp, aztreonam, Caz, Cot, Cro, Tobra Table 3E
3. Enterobacter, Citrob freundii, Serratia may develop resistance to cephalosporins during therapy.

6B . Listeria See CLSI M45

Penicillin P 1 <=13 - >= 13 Eucast

Ampicillin IV Amp 2 <=16 <=16 Eucast See Disk content For CFS ….should be combined with Genta

Cotrimoxazole Sxt 25 <=29 - >= 29 Eucast

Meropenem MEM <=26 - >= 26 Eucast

Erythromycin Ery 15 <=25 - >= 25 Eucast Not in CSF

7. Salmonella / Shigella* panel 6 Disks per plate Mar 24

Disk R I S May use blood culture broth for direct disk diffusion ? See CLSI table 3F-1, 3F-2

Ampicillin * Amp 10 <=13 14-16 >= 17 Avoid amoxicillin for Shigella.

Co-trimoxazole * Sxt25 <=10 11-15 >= 16 Disregard faint or hazy growth

CRO or CTX 30 <= - >= See zones on Page 6 above For Extraintestinal Salmonella Spp.
Cip 5 <=21 22-25 >= 26 For Salmonella 20 21-30 31 same results for Levo/Oflo
or Lev * 5 <=16 17-20 >= 21
Chloramphenicol CAP 30 <=12 13-17 >= 18 Not for urine
Azithromycin Azm 15 <=12 >= 13 For Shigella, if zone is hazy perform MIC.
Erta, Imip,Mero <= 19 20-22 >= 23 For Erta….18 and 22
Pefloxacin Pef 5 <=21 - >= 26 For Salmonella, If Cipro disk is not available use Pefloxacin
Dr. Nasrullah Malik- Shaukat Khanum Hospital Lahore

1. For Salmonella and Shigella never report 1st- and 2nd-generation cephalosporins, Cefoxitin, Cefotetan, and
aminoglycosides.
8 Urine GNR except Pseudomonas Mar 24

Disk R I S
Ampicillin Amp10 <=13 14-16 >= 17 Same results for amoxicillin
Cefazolin Kz 30 <=14
P 36
>= 15 Sensitive results same for cefaclor, cefdinir?, cefpodoxime?, cefprozil,
CLSI 20
cefuroxime?, cephalexin, and loracarbef for E.c., K.p, Proteus in uncomplicated UTI
Co-trimoxazole Sxt 25 <=10 11-15 >= 16
Nitrofurantoin f 300 <=14 15-16 >= 17 Not for Proteus
Ciprofloxacin Cip 5 <=15 16-20 >= 21
Levofloxacin Lev 5 <=13 14-16 >=17
Norfloxacin nor 10 <=12 13-16 >= 17
Sulfisoxazole Sf 300 <=12 13-16 >= 17
Co-amoxiclav Amc 30 <=13 14-17 >= 18
Amp-sulbactam Sam 20 <=11 12-14 >= 15
Tet or Dox Te 30 <=11 12-14 >= 15 If sensitive to Tet, report Dox and Mino also sensitive.
Tazobactam-pipracillin TZP 110 <=20 21-24 U >= 25
CTX 30 <=22 23-25 >= 26 No need to test or report for ESBL. Comment: D = 1g/8h
CTX or CRO
CRO30 <=19 20-22 >= 23 Comment: Ceftriaxone Sensitivity is based on dosage regimen of 1g/24h

Amikacin AK 30 <=14 15-16 >= 17

Tobramycin Tob 10 <=16 - >= 16
Nalidixic Acid na 30 <=13 14-18 >= 19
IPM or MEM or DOR 100 <=19 20-22 >=23 Comment : Sensitivity is based on dosage regimen of 1g/8h

FEP or CPO 30 <=18 19-24 >= 25

GEN 10 <=12 13-14 >= 15
Fosfomycin for E. coli fos 200 <=12 13-15 >= 16 For E. Coli only See picture below

Trimethoprim w5 <=10 11-15 >= 16

Dr. Nasrullah Malik- Shaukat Khanum Hospital Lahore

1. From top to bottom, antibiotics/disks are most important to least important for testing and reporting.
2. Disk names in CAPITAL letters are injections, in small letters are tablet or capsule.
3. Don’t forget to report intermediate group.
4. Rows with grey shade have similar results, but not always.
5. Comment = Imipenem sensitivity is based on dosage regimen of 1g every 8h.
6. Please don’t miss to apply or report any GREEN antibiotic = Tier 1.
7. Proteus mirabilis is always resistant to ampicillin, tetra, tigecycline and nitrofurantoin. P. vulgaris also to
cefazolin and cefuroxime.
8. Avoid in urine = Erythro, Azithro, Clarithro, Mino, Cap, Clinda, Not in urine Not for urine
9 Pseudomonas aeruginosa Comamonas Shewanella?? Mar 24

Disk R I S
Pipra-tazobactam TZP 110 <=17 18-21U >= 22 Comment: Pip-taz sensitivity is based on dosage regimen of 3g/6h

Cefepime FEP 30 <=14 15-17 U >=18 Comment: Cefepime sensitivity is based on dosage regimen of 1g/8h or 2g/12h

Ciprofloxacin Cip 5 <=18 19-24U >= 25 For Eucast 26 is sensitive with dose 750 BD 400 IV tds
Levofloxacin Lev 5 <=14 15-21U >= 22 For Eucast 18 is sensitive 750 OD
Ceftazidime CAZ30 <=14 15-17U >= 18 Comment: Ceftazidime sensitivity is based on dosage regimen of 1g/6h or 2g/8h

Amikacin in Urine AK 30 <=14 15-16U >=17 For urine only.

Tobramycin TOB 10 <=12 13-19U >= 19
Imipenem IPM 10 <=15 16-18U >= 19 Comment: Imipenem Sensitivity is based on dosage regimen of 1g/8h or 500mg/6h

Meropenem MEM10 <=15 16-18U >= 19 Comment: Meropenem sensitivity is based on dosage regimen of 1g/8h

Doripenem NA DOR10 <=15 16-17U >= 19 Comment: Doripenem sensitivity is based on dosage regimen of 500mg/8h

Ceftazidime-Avibactam 30-20 <=20 - >= 21 Imipenem-relebactam

Cefiderocol <=12 13-17U >=18

40
Ceftolozane-tazobactam NA <=16 17-20 >= 21 Disk available from Hardy Cat # Z9341
Colistin MIC >= 4 <=2 See CLSI Table 3D Eucast <=2 is Sensitive

Norfloxacin Urine only Nor 10 <=12 13-16 >= 17 In Urine only

Aztreonam ATM30 <=15 16-21U >= 22 Comment: Aztreonam sensitivity is based on dosage regimen of 1g/6h or 2g/8h

Dr. Nasrullah Malik- Shaukat Khanum Hospital Lahore

1. Please don’t miss to apply and report any GREEN antibiotic = Tier 1.
2.
10 Acinetobacter Mar 24

Disk R I S
Ampicillin-sulbactam Sam20 <=11 12-14 >= 15
Ciprofloxacin Cip 5 <=15 16-20 >= 21
Levofloxacin Lev 5 <=13 14-16 >= 17 Eucast zone = 20R-23S Sulbactam-durlobacatam

Ceftazidime CAZ30 <=14 15-17 >= 18

Gentamicin CN 10 <=12 13-14 >= 15
Tobramycin TOB10 <=12 13-14 >=15
Minocycline Mh 30 <=12 13-15 >= 16
Doripenem NA DOR10 <=14 15-17 >= 18 Eucast = 21-24 xx Comment: Doripenem sensitivity is based on dosage regimen of 500mg/8h

Imipenem IPM10 <=18 19-21 >= 22 Comment: Imipenem sensitivity is based on dosage regimen of 500mg/6h

Meropenem MEM10 <=14 15-17 >= 18 Comment: Meropenem sensitivity is based on dosage regimen of 1g/8h or 500mg/6h

Cotrimoxazole Sxt 25 <=10 11-15 >= 16 Eucast 11R – 14S

Tazo-Pipracillin TZP 110 <=17 18-20 >= 21

Cefepime FEP 30 <=14 15-17 >= 18
Amikacin AMI30 <=14 15-16 >= 17 Eucast 17R – 19S

Cefiderocol 30 >=15
Colistin MIC >= 4 <=2 CLSI Table 3D Eucast <=2 is Sensitive

Doxycycline Dox 30 <=9 10-12 >= 13 If tet Sensitive then Dox also sensitive, Report tet in urine
Cefotaxime CTX 30 <=14 15-22 >= 23
Ceftriaxone CRO 30 <=13 14-20 >=21
Dr. Nasrullah Malik- Shaukat Khanum Hospital Lahore

For Urine

Tetra Te 30 <=11 12-14 >= 15 If sensitive, then report Doxy and mino also sensitive

1. Disks with “CAPITAL letters” are injections. With “small” are oral.
2. Grey shade have mostly similar results, (but not always).
3. Comment = Imipenem sensitivity is based on dosage regimen of 500mg every 6hr.
4. Do not report colistin or Polymixin B by disk diffusion (no zones available).
5. Acinetobacter is always resistant to Amp, Amox, AMC, ATM, Erta, Fos, Cap
6. Please don’t miss to apply or report any GREEN antibiotic = Tier 1.
11. Pseudomonas spp. /Fastidious non-enterobacterales Alcaligenes Mar 24

R I S May use blood culture broth for direct disk diffusion ? See CLSI table 3F-1, 3F-4

Gentamicin MIC MIC >=16 8 <= 4

Tobramycin MIC MIC >=16 8 <= 4
Ceftazidime MIC >=32 16 <= 4
Cotrimoxazole MIC >=80 <= 40
Pipracillin-tazo MIC <=128/4 18- >= 16/4
Cipro MIC >=4 2 <= 1
Levo MIC >=8 4 <= 2
Imipenem MIC >=16 8 <= 4
Meropenem MIC >=16 8 <= 4
Aztreonam NA MIC >=32 16 <= 8
Amikacin MIC >=64 32 <= 16
Cefepime MIC >=8 16 <= 32
Chloramphenicol MIC <=32 16 >= 8 Not in urine
Cefotaxime MIC >=64 16-32 <= 8
Ceftriaxone MIC >=64 16-32 <= 8
Dr. Nasrullah Malik- Shaukat Khanum Hospital Lahore

For Urine

Norfloxacin E-strip <=16 8 >= 4

Sulphonamides E-strip <=512 - >= 256
Tetracycline E-strip >=16 8 <= 4 See above

1. Vitek is better than E-strip for MIC. So for blood and CSF isolates use Vitek.
12. Burkholderia cepacia Zones removed from CLSI
Mar 24

Disk R I S
Co-trimoxazole Sxt 25 <=10 11-15 >= 16 Only MIC wef 2024
Meropenem MEM 10 <=15 16-19 >=20 Only MIC wef 2024
Ceftazidime CAZ 30 <=17 18-20 >= 21 Only MIC wef 2024
Minocycline Mh 30 <=14 15-18 >= 19 Only MIC wef 2024
Levofloxacin MIC >=8 4 <=2 MIC only
Chloramphenicol MIC >=32 16 <=8 Not in urine
Dr. Nasrullah Malik- Shaukat Khanum Hospital Lahore

1. Add CLSI notes

2. Burkholderia cepacia is resistant to Ampicillin, Amoxicillin, Piperacillin, Ticarcillin, Amp-sulbactam, Co-
amoxiclav, Tazobactam-piperacillin, Cefotaxime, Ceftriaxone, cefpirome, Aztreonam, Imipenem, Ertapenem,
Colistin, Tobramycin, , Gentamicin, Amikacin, Fosfomycin
3. For Burkholderia pseudomallei AMC, CAZ, MEM, IMP, Tet, Cot, Cap = See Eucast
13. Haemophilus Apply on HTM agar (Oxoid CM0898B) 4 Disks per plate Mar 24

Disk R I S
Ampicillin Amp 10 <=18 19-21 >= 22 Same results for amoxicillin. In CSF β-lactamase test.
Amp-sulbactam Sam 20 <=19 >= 20 Not for CSF ?
Co-amoxiclav MIC >=8/4 4/2 <=2/1
Resistance
CTX or CAZ or CRO 30 very rare >= 30 Resistance very rare Eucast 32 S in CSF
Co-trimoxazole Sxt 25 BLNAR strains of H. influenzae should be considered resistant to CoAmox, amp-
<=10 11-15 >= 16 sulbactam, cefaclor, cefamandole, cefuroxime, and pipracillin-tazobactam,
Resistance
Cip or Lev or Mox Cip 5 very rare - >= 17
Chloramphenicol Cap 30 <=25 24-28 >= 29 Not in urine
Resistance
Meropenem MEM 10 very rare >= 20 in CSF
Erta /Imipenem 10 >= 19 Erta 19….Imi 16
Resistance
Azith or Azm 15 very rare >= 12
Clarith clr 15 <=10 11-12 >= 13
Cefuroxime Cxm 30 <=16 17-19 >= 20 Only parenteral may be given in serious cases. Not for CSF.

Aztreonam AZT 30 - - >= 26 Ceftolozane-tazobactam for Hi

Tetracycline Te 30 <=25 24-28 >= 29 Eucast 25 S Lefamulin 20

Ceftaroline NA CPT 30 >= 30 Never report in CSF

Rifampicin Rif 5 <=16 17-19 >= 20 Only for prophylaxis
Cefdinir, Cefixime, Cefpodoxime

Cefaclor, Cefprozil
Dr. Nasrullah Malik- Shaukat Khanum Hospital Lahore

1. Apply Bacitracin 10 units in sputum on chocolate agar plate.

13B. Neisseria gonorrheae on GC agar (Oxoid CM0367B with suppliment) 4 Disks per plate

Disk R I S
Ceftriaxone CRO 30 >= 35
Cefixime Cfm 5 <= - >= 31
Ciprofloxacin Cip 5 <=27 28-40 >= 41
Azithromycin Azt 15 >= 30 1 g single dose
Tetracycline Te 30 <=30 31-37 >= 38
Dr. Nasrullah Malik- Shaukat Khanum Hospital Lahore
14. CSF / Niesseria meningitidis Use MHA with 5% sheep blood agar Take all lab safety precautions like use of BSC. Better use N95 mask. Get
vaccination for N. meningitidis. 2 Disks per plate Mar 24

Disk R I S
Ampicillin MIC MIC <= MIC >= Also for Listeria only
Cefotaxime CTX >=34 Zones for N. m
Ceftriaxone CRO >=34 Zone for N.m.
Aztreonam NA ATM <= >= See zones on page 6 or 9
Meropenem MEM <= >= 30 Zone for N. m. Eucast 20 is sensitive for Psudomonas
Amikacin AMI See zones on page 6 or 9 Not in CLSI
Chloramphenicol Cap 30 <=19 20-25 >=26 Zones for N.m Not in CLSI
Ceftazidime CAZ For Pseudomonas see Page 9
Azithromycin Azm 15 >=20 Comment =For prophylaxis of N.m. contacts only.
Minocycline Da 30 >=20 Comment = For prophylaxis of N.m. contacts only.
Co-trimoxazole Sxt 30 <=25 26-29 >= 30 Comment = For prophylaxis of N.m. contacts only.
Rifampicin Rif 5 <=19 20-24 >= 25 Comment = For prophylaxis of N.m. contacts only.
For Neisseria meningitides Cap, Rif, CTX or CRO, MEM, (For contacts Cipro, Mino, Azithro) ….See CLSI

14B . Pasteurella multocida See CLSI M45

Disk R I S
Amoxil MIC <= >= Eucast….Co-Amox = 15 S
Ampicillin Amp 10 <= - >= 27
P 10 <= - >= 25 Eucast zone for P1 is 17

Amc 30 <= - >= 27

CTX 30 <= - >= 34 Eucast 26 S
Mox 5 <= - >= 28
Cip/Lev 5 <= - >= 28 Eucast 27 S
Te 30 <= - >=23 Eucast ….24 S
Dox 30 <= - >= 23
Ery15 <=24 - >= 27
Azm 15 <= - >= 20
Sxt Cot >= 24 Eucast 23 S

14C Vibrio See CLSI M45

Disk R I S For Vibrio cholerae = Amp, Azith, Cap, Cot, Tet, Dox
Tazo-Pip TZP 110 <=17 18-20 >= 21 For other vibrio = CTX, CAZ,Cip, Levo, Tet, Dox
Ampicillin Amp 10 <=13 14-16 >=17 ***
Sam 20 <=11 12-14 >= 15
Co-amox Amc 30 <=13 - >= 18
CFP 30 <=14 15-17 >= 18
CTX 30 <=22 23-25 >=26 Also Cefepime
Fox 30 <=14 15-17 >=18
CAZ 30 <=17 18-20 >=21 Cotrimoxazole 21 Eucast
IPM 10 <=19 20-22 >= 23
MEM 10 <=19 20-22 >= 23 Eucast 24
AK 30 <=14 15-16 >= 17
CN 10 <=12 - >= 15
Te 30 <=11 - >= 15 *** Eucast 20
Cip 5 <=15 - >= 21 Eucast 23 Pefloxacin 22
Lev 5 <=15 - >=17 Eucast 23
Ofl 5 <=12 - >= 16 Also Azithro
Sxt 25 <=10 - >=16 ***
15. Aeromonas, Plesiomonas shigelloides See CLSI M45 Mar 24

Disk R I S
Tazobactam-pipracillin Tzp 110 <=17 18-20 >= 21
Tetracycline Te <=11 12-14 >= 15
Ciprofloxacin Cip 5 <=15 16-20 >= 21 **
Levofloxacin Lev 5 <=13 14-16 >= 17 **
Co-trimoxazole Sxt 25 <=10 11-15 >= 16 **
Cefazolin Kz 30 <= >= 30 Comment: Cefazolin sensitivity is based on dosage regimen of 1g/8h

Cefepime ** FEP 30 <=18 19-24 >= 25

Cefotaxime CTX 30 <=22 23-25 >= 26 Comment: Sensitivity is based on dosage regimen of 1g/8h

Ceftriaxone CRO 30 <=19 20-22 >= 23 Comment: Sensitivity is based on dosage regimen of 1g/24h

Tetracycline Te 30 <=11 12-14 >= 15

Comment: Sensitivity is based on dosage regimen of 1g/8h
Ceftazidime ** CAZ 30 <=17 18-20 >= 21
Imipenem IPM 10 <=19 20-22 >= 23
Meropenem MEM 10 <=19 20-22 >= 23
Ertapenem ETP 10 <=18 19-21 >= 22
Chloramphenicol Cap 30 <=12 13-17 >= 18
Comment: Sensitivity is based on dosage regimen of 1g/8h
Aztreonam ** ATM 30 <=17 18-20 >= 21
Amikacin AK 30 <=14 15-16 >= 17
Cefuroxime/Cefoxitin CXM 30 <=14 15-17 >= 18 Parentral only
Genta CN 10 <=12 13-14 >= 15
<= - >= 1 MIC
Dr. Nasrullah Malik- Shaukat Khanum Hospital Lahore

1. Aeromonas is always resistant to ampicillin.

15B . Lactobacillus See CLSI M45 Mostly resistant to vanco

R I S
Penicillin MIC <= 8
Ampicillin MIC <= 8
Ery MIC >=8 1-4 <= 0.5
Clinda MIC >=2 1 <= 0.5
Genta MIC >=16 8 <= 4
Vanco MIC >=16 4-8 <= 2
Imipenem MIC >=2 1 <= 0.5
Not for Respiratory samples
Dapto NA <= 4
Linezo <= 4
16 Anaerobes Bifidobacterium, Propionibacterium, Actinomyces, Staph saccharolyticus. Peptoniphilus, Finegoldia, Parvimonas, Mar 24

R I S Must see Eucast

Amox-Clavulunate MIC >=24 12 <= 6
Amp-sulbactam MIC >=48 24 <= 12
MIC Must see Eucast
Pipra-tazobactam >=132 68 <= 36
Clindamycin MIC >=8 4 <= 2
Ertapenem MIC >=16 8 <= 4
MIC Must see Eucast
Meropenem >=16 8 <= 4
Imipenem MIC >=16 8 <= 4
MIC Must see Eucast
Metronidazole >=32 16 <= 8
Cefotetan NA MIC >=64 32 <= 16
MIC Must see Eucast
Cefoxitin NA >=64 32 <= 16
Imipenem-relebactam
Ceftriaxone MIC >=64 32 <= 16
Ampicillin / Amoxicillin MIC >=2 1 <= 0.5 Same result for Amoxicillin. Suppress reporting in Bacteroides & GNR
Penicillin MIC >=2 1 <= 0.5 Suppress reporting in Bacteroides & GNR
Moxifloxacin MIC >=8 4 <= 2
Chloramphenicol MIC >=32 16 <= 8 For GNR only
Tetracycline MIC >=16 8 <= 4 For GPC only
Dr. Nasrullah Malik- Shaukat Khanum Hospital Lahore

16B. Bacillus Required if isolated from sterile sites in immunocompronised patients.

R I S
Ampicillin MIC >=.25 <= .12
Penicillin MIC >=.25 <= .12
Erythromycin 15 <=24 - >= 24 *** Eucast
Tetracycline MIC >=16 8 <= 4
Ciprofloxacin 5 <=23 - >= 50 *** Eucast
Levofloxacin 5 <=23 - >= 50 *** Eucast
Clinda 2 <=17 - >= 17 *** Eucast
Co-trimoxazole MIC >=80 <= 40
Cefazolin MIC >=32 16 <= 8
Cefotaxime MIC
Gentamicin MIC
Pipra-tazobactam MIC
Doripenem NA MIC
Ceftriaxone MIC
Amikacin MIC
Imipenem 10 <=12 13-17 >= 30 *** Eucast
Meropenem 10 <=12 13-17 >= 25 *** Eucast
Clindamycin MIC
Vancomycin 5 <=10 - >= 10 *** Eucast
Linezolid 2 <=22 - >= 22 *** Eucast
17. Stenotrophomonas maltophilia Mar 24

Disk R I S
Co-trimoxazole Sxt 25 <=10 11-15 >= 16 See picture below Disregard the haze // Comment=Should not be used alone.
Minocycline Mh 30 <=20 21-25 >= 26
Levofloxacin Lev 5 <=13 14-16 >= 17 Note = Not to be used alone.
Chloramphenicol MIC >=32 16 <=8 Not in urine
Cefiderocol 30 - - <=15
Ceftazidime MIC >=32 16 <=8 Vitek - if E-strip not available.
Dr. Nasrullah Malik- Shaukat Khanum Hospital Lahore

1. Add CLSI notes.

2. Disk name = Capital letters are injections, small letters are tablet or capsule.
3. Stenotrophomonas is always resistant to Amp, Amox, Pip, Ticar, Una, AMC, Sam, TZP, CTX, CRO, ATM, IPM,
MEM, AK, TOB, GEN, FOS

1. To report any error, contact [email protected]

References

1. CLSI. Performance standards for Antimicrobial Susceptibility Testing; Thirty first Informational Suppliment.
M100-S31. 2024. Wayne, PA, Clinical and Laboratory Standards Institute.
2. The European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of
MICs and zone diameters.Version 13.0, http://www.eucast.org. 2024.
3. CLSI. Performance standards for Antimicrobial Susceptibility Testing of infrequently isolated or fastidious
bacteria; Third edition. 2016. M45 Wayne, PA, Clinical and Laboratory Standards Institute.
4. Ellen Jo Baron Richard B Thomson Jr. editor. Manual of Clinical Microbiology. 11th ed. Washington DC: ASM
Press; 2015.
5. British society for antimicrobial chemotherapy BSAC Version 14.0 , 2015
Rare Isolates Mar 24

For Nocardia = Cot, IMP, MEM, Lnz, Amika, Mino, CRO Zones not standardized.

For Streptomyces Ami,LNZ,Mino,IMP, Clar, Amc Bacillus anthracis =See Eucast

For Comamonas testosteroni = CTX, CRO, IMP, MEM, Cot

Streptomyces usually responds to amikacin, linezolid or minocycline.

1. For Gardnerella Amp, Amox, Amc, Cephalospirins, Mz, Clinda /// For Actinotignum Coamox, Imp, Mero, Ctx, Cro, Vanc
2. For Elizabethkingia meningoseptica (Chryseobacterium meningosepticum) test only Cot, Cipro/Levo and TZP.
Zones are not available. For Ralstonia…Use panels 12 & 17. Add notes “likely to be”.
3. For Achromobacter report only IMP/MEM/TzP/Cot…See Eucast= Brucella=Cip/Lev/Gent/Cro/,Streptom,Dox, tet, Cot, Rif
4. For Sphingomonas report Tetra/Cap/Cot/Ami/Gen/Cip/Levo/Vanc . Zones not standardized.
5. Rhodotorula mucilaginosa .....Amphotericin B, Fluconazole, Itraconazole (Globicatella S=P, Amox,Cap,Levo R= Cro)
6. Clostridium septicum ….. Van, MZ, IMP, MEM Saccharomyces cerevisiae is a yeast.
7. Ochrobactrum anthropi ………Amika/Genta/Cipro/Levo/Tetra/Imipenem/Cotri
8. Bordetella …….. Co-amoxiclav, Ery, Doxy, Cipro, Levo, Cot,
9. For Prevotella ……Clinda, Amp-sulbacatm, pip-taz, Erta/Imp/Mero, fox, Cap, Dox,
10. Pandoraea ……… amikacin, ciprofloxacin, trimethoprim- sulfumethoxazole, gentamicin, piperacillin tetracycline and imipenem.

For Penicillin in Staph - Beaching/Heaping Zone 29 not 26

Enterococcus Vs Vanco Eucast zone is 12 As per CLSI Use Vanco 30 disk and Zone size 17
Oxacillin in Strep pneumoniae

Aerococcus (MIC of …P, CTX, CRO, MEM, VAN, Cip, Lev, Tet, Cot, Lnz) See CLSI-M45 Mar 24

Disk R I S
P1 <=21 - >= 21 Eucast
Amp 2 <=26 - >= 26 Eucast

MEM10 <=31 - >=31 Eucast

Cip 5 <=21 - >= 21 Eucast For urine only
Van 5 <=16 - >= 16 Eucast

Rif 5 <=25 - >= 25 Eucast

Nit 100 <=16 - >=16 Urine only

Kingella kingae see CLSI M45 Mar 24

Disk R I S
Eucast
Penicillin P1 <=25 - >= 25
Eucast
CTX 5 <=27 - >= 27
Eucast
CRO30 <=30 - >= 30
Eucast
CXM 30 <=29 - >= 29
Eucast
MEM 10 <=30 - >= 30
Eucast
Cip/Lev Cip 5 <=28 - >= 28
Eucast
Ery 15 <=20 - >= 20
Rif 5 <=20 - >= 20 Eucast
Cot 25 <=28 - >= 28 Eucast
Tetracycline Te 30 <=28 - >= 28 Eucast
Cascade Reporting