Policy # MI AST Quality Manual

1 Department of Microbiology Quality Manual Policy # MI_AST Page 1 of 162 Version: CURRENT Section: Bacteriology procedures Subject title : Antimicrobial Susceptibility Manual Prepared by QA Committee Issued by: Laboratory Manager Revision Date: 5/5/2022 Approved by Laboratory Director: Microbiologist-in-Chief Next Review Date: 5/5/2024 Uncontrolled When Printed UNIVERSITY HEALTH NETWORK/MOUNT SINAI HOSPITAL, DEPARTMENT OF MICROBIOLOGY NOTE: This document is Uncontrolled When Printed. Any documents appearing in paper form that do not state "CONTROLLED COPY " in red print are not controlled and should be checked against the document (titled as above) on the server prior to use. Management System\UHN_Mount Sinai Hospital Microbiology\Standard Operating procedures \Bacteriology procedures \ TABLE OF CONTENTS TABLE OF CONTENTS.

2 1 WHEN TO TEST .. 6 Criteria for Susceptibility 6 WHAT TO TEST:.. 7 Enterobacterales .. 7 E. coli O:157 .. 8 Salmonella typhi .. 8 Salmonella species other than S. typhi .. 8 Shigella 8 Vibrio species .. 8 Acinetobacter species .. 8 Pseudomonas aeruginosa .. 8 Pseudomonas sp., Plesiomonas sp. and other afermenters (8) .. 9 Aeromonas species .. 9 Stenotrophomonas maltophilia .. 9 Burkholderia cepacia Complex including [1]: .. 9 Haemophilus species .. 9 Helicobacter pylori .. 10 Moraxella catarrhalis .. 10 Neisseria gonorrhoeae .. 10 Neisseria meningitides .. 10 Other fastidious Gram negatives ( HACEK (9) group, Pasteurella species) .. 10 Campylobacter species .. 10 Gram Positive: .. 10 Staphylococcus aureus .. 10 Coagulase-negative Staphylococcus NOT Staphylococcus lugdunensis.

3 11 Department of Microbiology Quality Manual Policy # MI_AST Page 2 of 162 Version: CURRENT Section: Bacteriology procedures Subject title : Antimicrobial Susceptibility Manual UNIVERSITY HEALTH NETWORK/MOUNT SINAI HOSPITAL, DEPARTMENT OF MICROBIOLOGY NOTE: This document is Uncontrolled When Printed. Any documents appearing in paper form that do not state "CONTROLLED COPY in red print are not controlled and should be checked against the document (titled as above) on the server prior to use. Management System\UHN_Mount Sinai Hospital Microbiology\Standard Operating procedures \Bacteriology procedures \ Staphylococcus lugdunensis/ .. 12 Micrococcus species .. 12 Aerococcus species .. 12 Enterococcus species .. 12 Streptococcus pneumoniae.

4 13 Group A, B, C, G Streptococcus .. 13 Streptococcus bovis, viridans Streptococcus .. 13 Streptococcus anginosus group and small colony- -haemolytic Streptococcus .. 14 Listeria species .. 14 Corynebacterium species .. 14 Bacillus 14 Nocardia 14 Anaerobes .. 14 14 Filamentous Fungus 1 .. 14 WHAT TO REPORT: .. 15 Urine Gram Positive Susceptibility Reporting 1 Staphylococcus species, MRSA .. 15 Urine Gram Positive Susceptibility Reporting 2 Enterococcus species, Streptococcus species, Aerococcus species .. 17 Urine - Gram Negative Susceptibility Reporting .. 19 Enterics .. 21 Respiratory and Miscellaneous Non-Sterile Sites - Gram Positive Susceptibility Reporting 1 Staphylococcus .. 22 Respiratory and Miscellaneous Non-Sterile Sites - Gram Positive Susceptibility Reporting 2 Enterococcus, Streptococcus, Corynebacterium , Bacillus , viridans Streptococcus22, Listeria , Aerococcus species 21.

5 24 Respiratory and Miscellaneous Non-Sterile Sites - Gram Negative Susceptibility Reporting 1 Enterobacterales, Acinetobater species, Pseudomonas aeruginosa, Aeromonas species .. 26 Respiratory and Miscellaneous Non-Sterile Sites - Gram Negative Susceptibility Reporting 2 Haemophilus species, M. catarrhalis, S. maltophilia, B. cepacia, Pseudomonas species (other than P. aeruginosa), fastidious gram-negative bacteria, non-fermenters, Neisseria meningitides, H. pylori.. 28 Department of Microbiology Quality Manual Policy # MI_AST Page 3 of 162 Version: CURRENT Section: Bacteriology procedures Subject title : Antimicrobial Susceptibility Manual UNIVERSITY HEALTH NETWORK/MOUNT SINAI HOSPITAL, DEPARTMENT OF MICROBIOLOGY NOTE: This document is Uncontrolled When Printed.

6 Any documents appearing in paper form that do not state "CONTROLLED COPY in red print are not controlled and should be checked against the document (titled as above) on the server prior to use. Management System\UHN_Mount Sinai Hospital Microbiology\Standard Operating procedures \Bacteriology procedures \ Spinal Fluids Gram Positive Susceptibility Reporting .. 30 Spinal Fluids Gram Negative Susceptibility Reporting 1 Enterobacterales and Acinetobacter spp., Salmonella species including S. typhi, Shigella species .. 32 Spinal Fluids Gram Negative Susceptibility Reporting 2 Pseudomonas aeruginosa, Pseudomonas spp. (other than P. aeruginosa), fastidious Gram-negative bacteria, non-fermenters, M. catarrhalis, N. meningitidis, Stenotrophomonas maltophilia, Burkholderia cepacia, Haemophilus species.

7 34 Blood and other Sterile Sites - Gram Positive Susceptibility Reporting 1 Staphylococcus aureus, Staphylococcus lugdunensis, Enterococcus, Other CNST from sterile sites .. 35 Blood and other Sterile Sites - Gram Positive Susceptibility Reporting 2 - S. pneumoniae, viridans Streptococcus, Streptococcus bovis, S. anginosus group, Group A, B, C, G Streptococcus, Listeria species, Corynebacterim species, Bacillus species .. 37 Blood and other Sterile Sites - Gram Negative Susceptibility Reporting -1 - Enterobacterales and Acinetobacter spp., Salmonella species including S. typhi, Shigella species .. 39 Blood and other Sterile Sites - Gram Negative Susceptibility Reporting - 2 - Pseudomonas aeruginosa, Pseudomonas spp. (other than P. aeruginosa), fastidious gram-negative bacteria, non-fermenters, M.

8 Catarrhalis, N. meningitidis, Stenotrophomonas maltophilia, Burkholderia cepacia, Haemophilus species.. 41 Antimicrobial Related LIS Canned Messages .. 42 Comment Template for Infrequently tested Antibiotics .. 53 APPENDIX A. VERIFICATION OF UNUSUAL RESULTS .. 58 Verification of Antimicrobial Susceptibility Test Results and Confirmation of Organism Identification .. 58 APPENDIX B. AGENTS NEVER TO BE REPORTED BY SITE .. 63 I. How to Detect MRSA/BORSA .. 64 Routine Bench .. 64 Screening Bench .. 65 II. How to Detect VISA/hVISA/VRSA .. 66 Routine Bench .. 66 III. How to detect 67 Routine Bench .. 67 Screening Bench .. 67 IV. How to detect ESBL .. 68 Routine Bench .. 68 Screening Bench .. 68 V. How to detect CRE: .. 69 Routine Bench .. 69 Department of Microbiology Quality Manual Policy # MI_AST Page 4 of 162 Version: CURRENT Section: Bacteriology procedures Subject title : Antimicrobial Susceptibility Manual UNIVERSITY HEALTH NETWORK/MOUNT SINAI HOSPITAL, DEPARTMENT OF MICROBIOLOGY NOTE: This document is Uncontrolled When Printed.

9 Any documents appearing in paper form that do not state "CONTROLLED COPY in red print are not controlled and should be checked against the document (titled as above) on the server prior to use. Management System\UHN_Mount Sinai Hospital Microbiology\Standard Operating procedures \Bacteriology procedures \ Screening Bench .. 69 CARBAPENEMASE TESTING FLOWCHART .. 71 Infection Control CRE Screen Flowchart .. 71 Identification of Carbapenemase Producing isolates from Clinical Samples Flowchart .. 73 Carbapenemase Testing Reporting .. 74 Direct Specimen PCR Reporting .. 74 For IC Screen & Clinical Culture Reporting Acinetobacter spp .. 74 For IC Screen & Clinical Culture Reporting .. 74 CPO Reporting Canned Messages .. 77 APPENDIX D. SUSCEPTIBILITY TESTING METHODOLOGIES.

10 79 I - Disk Diffusion .. 79 II Double Disk Diffusion for Erythromycin and Clindamycin on Staphylococcus species, -haemolytic Streptococci Groups A, B, C, G and Streptococcus pneumoniae .. 84 III - Double Disk Test for ESBL Confirmation .. 90 Figure 1. KB-ESBL Template .. 92 Figure 2. Infection Control KB-ESBL Template .. 93 IV - Beta-Lactamase Testing .. 98 V - Oxacillin Screen Plate .. 101 VI PBP2 MRSA Screen .. 106 VII - Serum Bacteriostatic and Bactericidal Titres .. 109 VIII - Broth Macrodilution and Agar 112 IX - Broth Microdilution MIC .. 113 X - Etest .. 115 ETEST Procedure Summary .. 118 Staphylococcus aureus set up all of the following if Vitek MIC =>2 mg/L OR Growth on Vancomycin Screen .. 118 Coagulase- negative-Staphylococcus or Enterococcus set up if Vitek vancomycin = I or R OR Growth on Vancomycin Screen118 Other organisms.