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26466 Antimicrobial Susceptibility, Aerobic Bacteria, Varies (ZMMLS)

Antimicrobial Susceptibility, Aerobic Bacteria, Varies (ZMMLS)
Test Code: MISC
Synonyms/Keywords

​​Antibiotic Susceptibility, Bacterial Susceptibility Testing, Extended Spectrum Beta-Lactamase (ESBL), MIC (Minimum Inhibitory Concentration), Minimum Inhibitory Concentration (MIC), Pneumococcus Susceptibility, Streptococcus pneumoniae Susceptibility, Susceptibility Testing, Amikacin, Amoxicillin, Amoxicillin-clavulanate, Ampicillin, Ampicillin-sulbactam, Azithromycin, Aztreonam, Cefaclor, Cefazolin, Cefdinir, Cefepime, Cefixime, Cefotaxime, Cefpodoxime, Ceftaroline, Ceftazidime, Ceftazidime-avibactam, Ceftolozane-tazobactam, Ceftriaxone, Chloramphenicol, Ciprofloxacin, Clarithromycin, Clindamycin, Colistin, Daptomycin, Doxycycline, Ertapenem, Erythromycin, Fosfomycin, Gentamicin, Imipenem, Levofloxacin, Linezolid, Meropenem, Metronidazole, Minocycline, Mupirocin, Nitrofurantoin, Ofloxacin, Oxacillin, Penicillin, Piperacillin, Piperacillin-tazobactam, Quinupristin-dalfopristin, Rifampin, Sulfamethoxazole, Tetracycline, Tigecycline, Tobramycin, Trimethoprim, Trimethoprim-sulfamethoxazole, Vancomycin, Achromobacter, Acinetobacter, Aeromonas, Aggregatibacter, Arcanobacterium, Arthrobacter, Bacillus, Brevibacillus, Brevibacterium, Brevundimonas, Burkholderia, Campylobacter, Cardiobacterium, Citrobacter, Cohnella, Coli, Corynebacterium, CRE, Cronobacter, Dermatobacter, Eikenella, Enterobacter, Enterococcus, Erysipelothrix, ESBL, Escherichia, Gemella, Gonorrhoeae, Gram negative, Gram positive, Haemophilus, Helicobacter, Klebsiella, Kingella, Lactobacillus, Lactococcus, Leifsonia, Leuconostoc, Listeria, Lysinibacillus, Meningitidis, MDR, MDRO, Microbacterium, MRSA, Moraxella, Neisseria, Ochrobactrum, Paenibacillus, Pandoraea, Pasteurella, Pediococcus, Pneumo, Pneumococcus, Proteus, Pseudomonas, Raoultella, Rothia, Salmonella, Serratia, Shewanella, Shigella, Sphingomonas, Sporolactobacillus, Staph, Staphylococcus, Stenotrophomonas, Strep, Streptococcus, Trueperella, Turicella, VISA, Vibrio, Viridans, VRE, Yersinia, Oerskovia, Avibactam-ceftazidime, Avycaz, Meropenem-vaborbactam, Sivextro, Vabormere, Zerbaxa, Lelliottia, Delafloxacin, Omadacycline, H pylori, H. pylori, mecA, Nuzyra, Abiotrophia, Cefiderocol, Enterobacteriales, Granulicatella, Imipenem-relebactam, Lefamulin

Test Components

​When this test is ordered, the reflex tests may be performed at an additional charge.

All aerobically growing bacteria submitted will automatically have susceptibility testing performed and billed as appropriate. Antimicrobial agents appropriate to the organism and specimen source will be tested according to Mayo Clinic's practice and the laboratory's standard operating procedures.

If appropriate, testing for mecA will be performed by polymerase chain reaction (PCR) under MARP1 / mecA, Molecular Detection, PCR (Bill Only). Indications for mecA testing include inadequate growth by phenotypic antimicrobial susceptibility testing, lack of current organism breakpoints for oxacillin or cefoxitin, and assessment of discrepancies between cefoxitin and oxacillin phenotypic testing results.

In the event that an isolate of Helicobacter pylori does not grow from a client sample or does not grow for susceptibility testing, reflex testing for HPCR1 / Helicobacter pylori with Clarithromycin Resistance Prediction, Molecular Detection, PCR (Bill Only) may be added.

Mayo Clinic Laboratories will not perform susceptibility testing on select agents (eg, Bacillus anthracis, Brucella species, Burkholderia mallei, Burkholderia pseudomallei, Francisella tularensis, and Yersinia pestis). Consult with your state health department or the CDC regarding antimicrobial susceptibility testing of such isolates.

Useful For

​Determining the in vitro susceptibility of aerobic bacteria involved in human infections.

Specimen Requirements
Specimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)		Pediatric Minimum Volume
(no repeat)
​Bacterial Isolate Swab
​​E-Swab collection and transport system
​​Flocked swab and 1-mL liquid Amies transport medium in 12 x 80 mm tube
​Entire Specimen
​​
Pure culture of organism from source cultured​
​Agar slant or other appropriate media​​Slant of an actively growing bacterial isolate in pure culture
​​
Collection Processing Instructions

​Organism identification and specimen source (anatomical body site) are required.

​Collection Instructions: Bacterial Isolate Swab:

1. Perform isolation of infecting bacteria

2. Utilize the flocked swab to obtain an adequate sample of pure cultured isolate. Do not submit mixed cultures.

3. Place swab into the transport system containing 1-mL liquid Amies transport medium.

4. If needed, break off end of swab and close the transport tube.

5. Place the transport system into the secondary infectious container for shipment.

6. Each isolate must be submitted under a separate order.

Note: For the following organisms, submit an agar slant or other appropriate media to ensure viability upon arrival to the laboratory; Neisseria gonorrhoeae, Campylobacter sp., Helicobacter pylori and any other fastidious organism.


Collection Instructions:​  Pure culture of organism from source cultured

1. Perform isolation of infecting bacteria.

2. Bacterial organism must be submitted in pure culture, actively growing. Do not submit mixed cultures.

3. Place the agar slant or other appropriate media into the secondary infectious container for shipment.

4. Each isolate must be submitted under a separate order.​
Specimen Stability Information
Specimen TypeTemperature
​Varies ​ ​​Ambient (preferred)
​Frozen
​Refrigerated
Rejection Criteria
Agar plate
Interference

​In vitro susceptibility does not guarantee clinical response. Therefore, the decision to treat with a particular agent should not be based solely on the antimicrobial susceptibility testing result.

Performing Laboratory Information
Performing LocationDay(s) Test Performed
Report AvailableMethodology/Instrumentation
​Mayo Clinic Laboratories​Monday through Friday
​4 to 7 days​Minimal Inhibitory Concentration (MIC) (Agar Dilution or Broth Microdilution or Gradient Diffusion) or Disk Diffusion(if appropriate)
Reference Lab
Mayo Clinic Laboratories
Test Information
Antimicrobial susceptibility testing (AST) determines the minimal inhibitory concentration (MIC) of antimicrobial agents. The MIC is a measurement of the activity of an antimicrobial agent against an organism. It is defined as the lowest concentration of an antimicrobial agent that inhibits growth of the microorganism. Clinical breakpoints are derived from a number of data including:

-The pharmacokinetics/pharmacodynamics of an antimicrobial agent

-The MIC distribution of a large number of isolates

-Clinical outcome data for a patient population treated with the antimicrobial of interest

Antimicrobial susceptibility testing should be performed on pure culture isolates of pathogenic bacteria (or those potentially pathogenic in special situations) grown from specimens that have been appropriately collected so as not to confuse clinically significant isolates with normal or contaminating microbiota. Susceptibility testing is indicated for any organism that contributes to an infectious process warranting antimicrobial chemotherapy if its susceptibility cannot be reliably predicted from the organism's identity.

​The MIC obtained during AST is helpful in indicating the concentration of antimicrobial agent required at the site of infection necessary to inhibit the infecting organism. For each organism-antimicrobial agent combination, the Clinical and Laboratory Standards Institute and/or the European Committee on Antimicrobial Susceptibility Testing provides interpretive criteria for determining whether the MIC should be interpreted as susceptible, susceptible dose dependent, intermediate, nonsusceptible, resistant, or epidemiological cutoff value if applicable.​

Interpretation

A "susceptible" category result and a low minimum inhibitory concentration value indicate in vitro susceptibility of the organism to the antimicrobial tested.

Refer to Reference Values for interpretation of various antimicrobial susceptibility interpretive categories (ie, susceptible, susceptible-dose dependent, intermediate, nonsusceptible, resistant, or epidemiological cutoff value).

Outreach CPTs
CPTModifier
(if needed)		QuantityDescriptionComments
​87077​​​Ident by MALDI-TOF mass spec​if appropriate
​87185​​​Beta lactamase​if appropriate
​87186​​​Antimicrobial Susceptibility, Aerobic Bacteria, MIC - per organism for routine battery​if appropriate
​87181​​​Susceptibility per drug and per organism for drugs not in routine battery​if appropriate
​87513
​​​H pylori + Claritho Resistance PCR
​if appropriate
​87150​​​mecA PCR​if appropriate
Synonyms/Keywords

​​Antibiotic Susceptibility, Bacterial Susceptibility Testing, Extended Spectrum Beta-Lactamase (ESBL), MIC (Minimum Inhibitory Concentration), Minimum Inhibitory Concentration (MIC), Pneumococcus Susceptibility, Streptococcus pneumoniae Susceptibility, Susceptibility Testing, Amikacin, Amoxicillin, Amoxicillin-clavulanate, Ampicillin, Ampicillin-sulbactam, Azithromycin, Aztreonam, Cefaclor, Cefazolin, Cefdinir, Cefepime, Cefixime, Cefotaxime, Cefpodoxime, Ceftaroline, Ceftazidime, Ceftazidime-avibactam, Ceftolozane-tazobactam, Ceftriaxone, Chloramphenicol, Ciprofloxacin, Clarithromycin, Clindamycin, Colistin, Daptomycin, Doxycycline, Ertapenem, Erythromycin, Fosfomycin, Gentamicin, Imipenem, Levofloxacin, Linezolid, Meropenem, Metronidazole, Minocycline, Mupirocin, Nitrofurantoin, Ofloxacin, Oxacillin, Penicillin, Piperacillin, Piperacillin-tazobactam, Quinupristin-dalfopristin, Rifampin, Sulfamethoxazole, Tetracycline, Tigecycline, Tobramycin, Trimethoprim, Trimethoprim-sulfamethoxazole, Vancomycin, Achromobacter, Acinetobacter, Aeromonas, Aggregatibacter, Arcanobacterium, Arthrobacter, Bacillus, Brevibacillus, Brevibacterium, Brevundimonas, Burkholderia, Campylobacter, Cardiobacterium, Citrobacter, Cohnella, Coli, Corynebacterium, CRE, Cronobacter, Dermatobacter, Eikenella, Enterobacter, Enterococcus, Erysipelothrix, ESBL, Escherichia, Gemella, Gonorrhoeae, Gram negative, Gram positive, Haemophilus, Helicobacter, Klebsiella, Kingella, Lactobacillus, Lactococcus, Leifsonia, Leuconostoc, Listeria, Lysinibacillus, Meningitidis, MDR, MDRO, Microbacterium, MRSA, Moraxella, Neisseria, Ochrobactrum, Paenibacillus, Pandoraea, Pasteurella, Pediococcus, Pneumo, Pneumococcus, Proteus, Pseudomonas, Raoultella, Rothia, Salmonella, Serratia, Shewanella, Shigella, Sphingomonas, Sporolactobacillus, Staph, Staphylococcus, Stenotrophomonas, Strep, Streptococcus, Trueperella, Turicella, VISA, Vibrio, Viridans, VRE, Yersinia, Oerskovia, Avibactam-ceftazidime, Avycaz, Meropenem-vaborbactam, Sivextro, Vabormere, Zerbaxa, Lelliottia, Delafloxacin, Omadacycline, H pylori, H. pylori, mecA, Nuzyra, Abiotrophia, Cefiderocol, Enterobacteriales, Granulicatella, Imipenem-relebactam, Lefamulin

Test Components

​When this test is ordered, the reflex tests may be performed at an additional charge.

All aerobically growing bacteria submitted will automatically have susceptibility testing performed and billed as appropriate. Antimicrobial agents appropriate to the organism and specimen source will be tested according to Mayo Clinic's practice and the laboratory's standard operating procedures.

If appropriate, testing for mecA will be performed by polymerase chain reaction (PCR) under MARP1 / mecA, Molecular Detection, PCR (Bill Only). Indications for mecA testing include inadequate growth by phenotypic antimicrobial susceptibility testing, lack of current organism breakpoints for oxacillin or cefoxitin, and assessment of discrepancies between cefoxitin and oxacillin phenotypic testing results.

In the event that an isolate of Helicobacter pylori does not grow from a client sample or does not grow for susceptibility testing, reflex testing for HPCR1 / Helicobacter pylori with Clarithromycin Resistance Prediction, Molecular Detection, PCR (Bill Only) may be added.

Mayo Clinic Laboratories will not perform susceptibility testing on select agents (eg, Bacillus anthracis, Brucella species, Burkholderia mallei, Burkholderia pseudomallei, Francisella tularensis, and Yersinia pestis). Consult with your state health department or the CDC regarding antimicrobial susceptibility testing of such isolates.

Ordering Applications
Ordering ApplicationDescription
​​Cerner
​MISC
Order Name: Antimicrobial Susceptibility, Aerobic Bacteria, Varies (ZMMLS)
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Specimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)		Pediatric Minimum Volume
(no repeat)
​Bacterial Isolate Swab
​​E-Swab collection and transport system
​​Flocked swab and 1-mL liquid Amies transport medium in 12 x 80 mm tube
​Entire Specimen
​​
Pure culture of organism from source cultured​
​Agar slant or other appropriate media​​Slant of an actively growing bacterial isolate in pure culture
​​
Collection Processing

​Organism identification and specimen source (anatomical body site) are required.

​Collection Instructions: Bacterial Isolate Swab:

1. Perform isolation of infecting bacteria

2. Utilize the flocked swab to obtain an adequate sample of pure cultured isolate. Do not submit mixed cultures.

3. Place swab into the transport system containing 1-mL liquid Amies transport medium.

4. If needed, break off end of swab and close the transport tube.

5. Place the transport system into the secondary infectious container for shipment.

6. Each isolate must be submitted under a separate order.

Note: For the following organisms, submit an agar slant or other appropriate media to ensure viability upon arrival to the laboratory; Neisseria gonorrhoeae, Campylobacter sp., Helicobacter pylori and any other fastidious organism.


Collection Instructions:​  Pure culture of organism from source cultured

1. Perform isolation of infecting bacteria.

2. Bacterial organism must be submitted in pure culture, actively growing. Do not submit mixed cultures.

3. Place the agar slant or other appropriate media into the secondary infectious container for shipment.

4. Each isolate must be submitted under a separate order.​
Specimen Stability Information
Specimen TypeTemperature
​Varies ​ ​​Ambient (preferred)
​Frozen
​Refrigerated
Rejection Criteria
Agar plate
Interference

​In vitro susceptibility does not guarantee clinical response. Therefore, the decision to treat with a particular agent should not be based solely on the antimicrobial susceptibility testing result.

Useful For

​Determining the in vitro susceptibility of aerobic bacteria involved in human infections.

Test Components

​When this test is ordered, the reflex tests may be performed at an additional charge.

All aerobically growing bacteria submitted will automatically have susceptibility testing performed and billed as appropriate. Antimicrobial agents appropriate to the organism and specimen source will be tested according to Mayo Clinic's practice and the laboratory's standard operating procedures.

If appropriate, testing for mecA will be performed by polymerase chain reaction (PCR) under MARP1 / mecA, Molecular Detection, PCR (Bill Only). Indications for mecA testing include inadequate growth by phenotypic antimicrobial susceptibility testing, lack of current organism breakpoints for oxacillin or cefoxitin, and assessment of discrepancies between cefoxitin and oxacillin phenotypic testing results.

In the event that an isolate of Helicobacter pylori does not grow from a client sample or does not grow for susceptibility testing, reflex testing for HPCR1 / Helicobacter pylori with Clarithromycin Resistance Prediction, Molecular Detection, PCR (Bill Only) may be added.

Mayo Clinic Laboratories will not perform susceptibility testing on select agents (eg, Bacillus anthracis, Brucella species, Burkholderia mallei, Burkholderia pseudomallei, Francisella tularensis, and Yersinia pestis). Consult with your state health department or the CDC regarding antimicrobial susceptibility testing of such isolates.

Interpretation

A "susceptible" category result and a low minimum inhibitory concentration value indicate in vitro susceptibility of the organism to the antimicrobial tested.

Refer to Reference Values for interpretation of various antimicrobial susceptibility interpretive categories (ie, susceptible, susceptible-dose dependent, intermediate, nonsusceptible, resistant, or epidemiological cutoff value).

For more information visit:
Performing Laboratory Information
Performing LocationDay(s) Test Performed
Report AvailableMethodology/Instrumentation
​Mayo Clinic Laboratories​Monday through Friday
​4 to 7 days​Minimal Inhibitory Concentration (MIC) (Agar Dilution or Broth Microdilution or Gradient Diffusion) or Disk Diffusion(if appropriate)
Reference Lab
Mayo Clinic Laboratories
For billing questions, see Contacts
Outreach CPTs
CPTModifier
(if needed)		QuantityDescriptionComments
​87077​​​Ident by MALDI-TOF mass spec​if appropriate
​87185​​​Beta lactamase​if appropriate
​87186​​​Antimicrobial Susceptibility, Aerobic Bacteria, MIC - per organism for routine battery​if appropriate
​87181​​​Susceptibility per drug and per organism for drugs not in routine battery​if appropriate
​87513
​​​H pylori + Claritho Resistance PCR
​if appropriate
​87150​​​mecA PCR​if appropriate
For most current information refer to the Marshfield Laboratory online reference manual.