➡️AMINOGLYCOSIDES
Breakpoints for gentamicin, tobramycin, and amikacin are based on population distributions of various species, PK/PD target attainment analyses with an end point of net bacterial stasis and limited clinical data.
Breakpoints for gentamicin, tobramycin, and amikacin are based on population distributions of various species, PK/PD target attainment analyses with an end point of net bacterial stasis and limited clinical data.
Clinical outcomes data for aminoglycosides as MONOtherapy for systemic infections are limited and have resulted in worse treatment outcomes (for infections outside of the urinary tract) compared with other therapies.
COMBINATION therapy for most indications other than UTIs should be considered.
CONSULTATION with an infectious diseases specialist is recommended.
CONSULTATION with an infectious diseases specialist is recommended.
👉Gentamicin
Enterobacterales - Revised breakpoints*
Disk diffusion
(15, 13-14, 12 ⏩ 18, 15-17, 14)
& MIC (4, 8, 16 ⏩ 2, 4, 8)
*based on 7 mg/kg IV q24h
📛P.aeruginosa
Deleted Disk diffusion & MIC breakpoints for
Enterobacterales - Revised breakpoints*
Disk diffusion
(15, 13-14, 12 ⏩ 18, 15-17, 14)
& MIC (4, 8, 16 ⏩ 2, 4, 8)
*based on 7 mg/kg IV q24h
📛P.aeruginosa
Deleted Disk diffusion & MIC breakpoints for
👉Tobramycin
Enterobacterales - Revised breakpoints*
Disk diffusion
(15, 13-14, 12 ⏩ 17, 13-16, 12)
& MIC (4, 8, 16⏩ 2, 4, 8)
P.aeruginosa - Revised breakpoints*
Disk diffusion
(15, 13-14, 12 ⏩ 19, 13-18, 12)
& MIC (4, 8, 16⏩ 1, 2, 4)
*based on 7 mg/kg IV q24h
Enterobacterales - Revised breakpoints*
Disk diffusion
(15, 13-14, 12 ⏩ 17, 13-16, 12)
& MIC (4, 8, 16⏩ 2, 4, 8)
P.aeruginosa - Revised breakpoints*
Disk diffusion
(15, 13-14, 12 ⏩ 19, 13-18, 12)
& MIC (4, 8, 16⏩ 1, 2, 4)
*based on 7 mg/kg IV q24h
👉Amikacin
Enterobacterales - Revised breakpoints*
Disk diffusion
(17, 15-16, 14 ⏩ 20, 17-19, 16)
& MIC (16, 32, 64 ⏩ 4, 8, 16)
P.aeruginosa = U designation
*based on 15 mg/kg IV q24h
Enterobacterales - Revised breakpoints*
Disk diffusion
(17, 15-16, 14 ⏩ 20, 17-19, 16)
& MIC (16, 32, 64 ⏩ 4, 8, 16)
P.aeruginosa = U designation
*based on 15 mg/kg IV q24h
👉Plazomicin
Enterobacterales - added breakpoints*
Disk diffusion (18, 15-17, 14) & MIC (2, 4, 8)
*based on 15 mg/kg IV q24h
Enterobacterales - added breakpoints*
Disk diffusion (18, 15-17, 14) & MIC (2, 4, 8)
*based on 15 mg/kg IV q24h
➡️ PIPERACILLIN-TAZOBACTAM
P.aeruginosa - Revised breakpoints*
Disk diffusion
(21, 15-20, 14 ⏩ 22, 18-21, 17)
& MIC (16, 32-64, 128 ⏩ 16, 32, 64)
*based on 4.5g q6h over 30 min or over 3h
P.aeruginosa - Revised breakpoints*
Disk diffusion
(21, 15-20, 14 ⏩ 22, 18-21, 17)
& MIC (16, 32-64, 128 ⏩ 16, 32, 64)
*based on 4.5g q6h over 30 min or over 3h
➡️ CEFIDEROCOL
The accuracy and reproductibility of Cefiderocol testing results by Disk diffusion and broth microdilution are markedly affected by iron concentration and inoculum preparation and may vary by disk and media manufacturer.
The accuracy and reproductibility of Cefiderocol testing results by Disk diffusion and broth microdilution are markedly affected by iron concentration and inoculum preparation and may vary by disk and media manufacturer.
Depending on the type of variance observed, false-resistant or false-susceptible results may occur.
Discussion with prescribers and antibiomicrobial stewardship members regarding the potential for inaccuracies is recommended.
Discussion with prescribers and antibiomicrobial stewardship members regarding the potential for inaccuracies is recommended.
➡️ Selective CASCADE reporting (💕)
Each laboratory should consider developing selective and/or cascade reporting rules in consultation with the antimicrobioal stewardship team and other relevant institutional stakeholders.
Selective and cascade reporting is done to encourage appropriate antimicrobial agent use.
Selective and cascade reporting is done to encourage appropriate antimicrobial agent use.
Former Tables 1A-1C regarding suggested groupings of antimicrobial agents approved by the US FDA for clinical use that should be considered for testing and reporting by microbiology laboratories
= Replaced by new Tables 1A through 1P
= Replaced by new Tables 1A through 1P
The positioning of drugs in Tables 1A through 1P can be used to guide development of selective and/or cascade reporting rules.
Tables 1A through 1P : Test/report Tiers and Additional Designations
Tables 1A through 1P : Test/report Tiers and Additional Designations
Tier 1 : Antimicrobial agents that are appropriate for routine, primary testing and reporting
Tier 2: Antimicrobial agents that are appropriate for routine, primary testing but may be reported following cascade reporting rules established at each institution
Tier 2: Antimicrobial agents that are appropriate for routine, primary testing but may be reported following cascade reporting rules established at each institution
Tier 3 : Antimicrobial agents that are appropriate for routine, primary testing in intestitutions that serve patients at high-risk of MDROs but should only be reported following cascade reporting rules established at each institution.
Titer 4: Antimicrobial agents that may warrant testing and reporting by clinician request if antimicrobial agents in other tiers are not optimal because of various factors
➡️ Disk diffusion directly from Positive blood culture broth
Addition of breakpoints for
-Amp at 8-10h
-Cipro at 8-10h and 16-18h
-Mero at 8-10h and 16-18h
No change in Tobramycin breakpoints
Addition of breakpoints for
-Amp at 8-10h
-Cipro at 8-10h and 16-18h
-Mero at 8-10h and 16-18h
No change in Tobramycin breakpoints
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