Antibiotics Tested by NARMS
NARMS tests isolates to determine their antibiotic susceptibility. This task is accomplished by finding the lowest concentration of a particular antibiotic that will inhibit the growth of the bacteria, which is called the minimum inhibitory concentration (MIC). Currently CDC NARMS routinely tests for susceptibility to 18 antibiotic agents that are in 12 classes of drugs. The names and classes of drugs and the testing methods used for susceptibility testing depend on the type of bacteria being tested:
CLSI Class | Antimicrobial Agent | Years Tested |
Antimicrobial Agent Concentration Range (μg/mL) |
MIC Interpretive Standard (μg/mL) | ||
---|---|---|---|---|---|---|
Susceptible | Intermediate* or S-DD† | Resistant | ||||
Aminoglycosides | Amikacin | 1997–2010 | 0.5–64 | ≤16 | 32 | ≥64 |
Gentamicin | 1996–present | 0.25–16 | ≤4 | 8 | ≥16 | |
Kanamycin | 1996–2013 | 8–64 | ≤16 | 32 | ≥64 | |
Streptomycin‡ | 1996–2013 | 32–64 | ≤32 | N/A* | ≥64 | |
2014–present | 2–64 | ≤16 | N/A* | ≥32 | ||
β–lactam combination agents | Amoxicillin-clavulanic acid | 1996–present | 1/0.5–32/16 | ≤8/4 | 16/8 | ≥32/16 |
Piperacillin-tazobactam§ | 2011–2015 | 0.5–128 | ≤16/4 | 32/4–64/4 | ≥128/4 | |
Cephems | Cefepime†,§ | 2011–2015 | 0.06–32 | ≤2 | 4-8† | ≥16 |
Cefotaxime§ | 2011–2015 | 0.06–128 | ≤1 | 2 | ≥4 | |
Cefoxitin | 2000–present | 0.5–32 | ≤8 | 16 | ≥32 | |
Ceftazidime§ | 2011–2015 | 0.06–128 | ≤4 | 8 | ≥16 | |
Ceftiofur | 1996–2015 | 0.12–8 | ≤2 | 4 | ≥8 | |
Ceftriaxone¶ | 1996–present | 0.25–64 | ≤1 | 2 | ≥4 | |
Cephalothin | 1996–2003 | 2–32 | ≤8 | 16 | ≥32 | |
Folate pathway antagonists | Sulfamethoxazole | 1996–2003 | 16–512 | ≤256 | N/A* | ≥512 |
Sulfisoxazole | 2004–present | 16–256 | ≤256 | N/A* | ≥512 | |
Trimethoprim- sulfamethoxazole |
1996–present | 0.12/2.38–4/76 | ≤2/38 | N/A* | ≥4/76 | |
Macrolides | Azithromycin** | 2011–present | 0.25–32 0.12–16†† |
≤16 | N/A* | ≥32 |
Monobactams | Aztreonam§ | 2011–2015 | 0.06–32 | ≤4 | 8 | ≥16 |
Penems | Imipenem§ | 2011–2015 | 0.06–16 | ≤1 | 2 | ≥4 |
Meropenem | 2016–present | 0.06–4 | ≤1 | 2 | ≥4 | |
Penicillins | Ampicillin | 1996–present | 1–32 | ≤8 | 16 | ≥32 |
Phenicols | Chloramphenicol | 1996–present | 2–32 | ≤8 | 16 | ≥32 |
Quinolones | Ciprofloxacin‡‡ | 1996–present | 0.015–4 | ≤0.06 | 0.12–0.5 | ≥1 |
Nalidixic acid | 1996–present | 0.5–32 | ≤16 | N/A* | ≥32 | |
Tetracyclines | Tetracycline | 1996–present | 4–32 | ≤4 | 8 | ≥16 |
* N/A indicates that no MIC range of intermediate susceptibility exists
†Cefepime MICs above the susceptible range, but below the resistant range are designated by CLSI to be susceptible-dose dependent (S-DD)
‡CLSI breakpoints are not established for streptomycin; interpretive standards used are NARMS-established breakpoints for resistance monitoring and should not be used to predict clinical efficacy. During 1996–2013 resistance was defined as ≥64 µg/mL; the breakpoint was updated to ≥32 µg/mL in 2014. The 2014 breakpoint could not be applied to previous years due to limited concentrations tested.
§ Broad-spectrum β-lactam antimicrobial agent only tested for non-typhoidal Salmonella isolates displaying ceftriaxone and/or ceftiofur resistance during 2011–2015.
¶ CLSI updated the ceftriaxone interpretive standards in January 2010. NARMS Human Isolate reports for 1996 through 2008 used susceptible ≤8 μg/mL, intermediate 16–32 μg/mL, and resistant ≥64 μg/mL.
**CLSI breakpoints for azithromycin are only established for Salmonella ser. Typhi. Interpretive criteria for Salmonella ser. Typhi are based on MIC distribution data and limited clinical data. The azithromycin interpretive standards used for Salmonella serotypes other than ser. Typhi are NARMS-established breakpoints for resistance monitoring and should not be used to predict clinical efficacy.
††Concentration range used for azithromycin during 2011–2015
‡‡CLSI updated the ciprofloxacin interpretive standards for Salmonella in January, 2012. NARMS Human Isolate Reports for 1996 through 2010 used susceptible ≤1 µg/mL, intermediate 2 µg/mL, and resistant ≥4 µg/mL.
CLSI Class | Antimicrobial Agent | Years Tested |
Antimicrobial Agent Concentration Range (μg/mL) |
MIC Interpretive Standard (μg/mL) | ||
---|---|---|---|---|---|---|
Susceptible | Intermediate* | Resistant | ||||
Aminoglycosides | Amikacin | 1999–2010 | 0.5–64 | ≤16 | 32 | ≥64 |
Gentamicin | 1999–present | 0.25–16 | ≤4 | 8 | ≥16 | |
Kanamycin | 1999–2013 | 8–64 | ≤16 | 32 | ≥64 | |
Streptomycin† | 1999–2013 | 32–64 | ≤32 | N/A* | ≥64 | |
2014–present | 2–64 | ≤16 | N/A* | ≥32 | ||
β–lactam combination agents | Amoxicillin-clavulanic acid | 1999–present | 1/0.5–32/16 | ≤8/4 | 16/8 | ≥32/16 |
Cephems | Cefoxitin | 2000–present | 0.5–32 | ≤8 | 16 | ≥32 |
Ceftiofur | 1999–2015 | 0.12–8 | ≤2 | 4 | ≥8 | |
Ceftriaxone‡ | 1999–present | 0.25–64 | ≤1 | 2 | ≥4 | |
Cephalothin | 1999–2003 | 2–32 | ≤8 | 16 | ≥32 | |
Folate pathway antagonists | Sulfamethoxazole | 1999–2003 | 16–512 | ≤256 | N/A* | ≥512 |
Sulfisoxazole | 2004–present | 16–256 | ≤256 | N/A* | ≥512 | |
Trimethoprim- sulfamethoxazole |
1999–present | 0.12/2.38–4/76 | ≤2/38 | N/A* | ≥4/76 | |
Macrolides | Azithromycin§ (Shigella species other than S. flexneri) |
2011–present | 0.25–32 0.12–16¶ |
≤16 | N/A* | ≥32 |
Azithromycin§ (Shigella flexneri) |
2011–present | 0.25–32 0.12–16¶ |
≤8 | N/A* | ≥16 | |
Penems | Meropenem | 2016–present | 0.06–4 | ≤1 | 2 | ≥4 |
Penicillins | Ampicillin | 1999–present | 1–32 | ≤8 | 16 | ≥32 |
Phenicols | Chloramphenicol | 1999–present | 2–32 | ≤8 | 16 | ≥32 |
Quinolones | Ciprofloxacin** | 1999–present | 0.015–4 | ≤0.25 | 0.5 | ≥1 |
Nalidixic acid | 1999–present | 0.5–32 | ≤16 | N/A* | ≥32 | |
Tetracyclines | Tetracycline | 1999–present | 4–32 | ≤4 | 8 | ≥16 |
* N/A indicates that no MIC range of intermediate susceptibility exists
† CLSI breakpoints are not established for streptomycin; interpretive standards used are NARMS-established breakpoints for resistance monitoring and should not be used to predict clinical efficacy. During 1999–2013 resistance was defined as ≥64 µg/mL; the breakpoint was updated to ≥32 µg/mL in 2014. The 2014 breakpoint could not be applied to previous years due to limited concentrations tested.
‡ CLSI updated the ceftriaxone interpretive standards in January, 2010. NARMS Human Isolate reports for 1999 through 2008 used susceptible ≤8 μg/mL, intermediate 16-32 μg/mL, and resistant ≥64 μg/mL.
§ CLSI interpretive standards for azithromycin are only established for Shigella sonnei and Shigella flexneri. In December 2015, CLSI established epidemiological cutoff values (ECVs) for Shigella species sonnei and flexneri. The ECVs should not be used as clinical breakpoints and CLSI uses the terms “wild-type” and “non-wild-type” instead of susceptible and resistant, respectively, to reflect the nature of the populations of bacteria in each group and to highlight that these categories are not to be used to predict clinical efficacy. The azithromycin interpretive standards used for other Shigella species are NARMS-established breakpoints for resistance monitoring and should not be used to predict clinical efficacy.
¶ Concentration range used for azithromycin during 2011–2015.
** CLSI updated the ciprofloxacin interpretive standards for Shigella in January, 2019. NARMS Human Isolate Reports for 1996 through 2015 used susceptible ≤1 µg/mL, intermediate 2 µg/mL, and resistant ≥4 µg/mL.
CLSI Class | Antimicrobial Agent | Years Tested |
Antimicrobial Agent Concentration Range (μg/mL) |
MIC Interpretive Standard (μg/mL) | ||
---|---|---|---|---|---|---|
Susceptible | Intermediate* | Resistant | ||||
Aminoglycosides | Amikacin | 1997–2010 | 0.5–64 | ≤16 | 32 | ≥64 |
Gentamicin | 1996–present | 0.25–16 | ≤4 | 8 | ≥16 | |
Kanamycin | 1996–2013 | 8–64 | ≤16 | 32 | ≥64 | |
Streptomycin† | 1996–2013 | 32–64 | ≤32 | N/A* | ≥64 | |
2014–present | 2–64 | ≤16 | N/A* | ≥32 | ||
β–lactam combination agents | Amoxicillin-clavulanic acid | 1996–present | 1/0.5–32/16 | ≤8/4 | 16/8 | ≥32/16 |
Cephems | Cefoxitin | 2000–present | 0.5–32 | ≤8 | 16 | ≥32 |
Ceftiofur | 1996–2015 | 0.12–8 | ≤2 | 4 | ≥8 | |
Ceftriaxone‡ | 1996–present | 0.25–64 | ≤1 | 2 | ≥4 | |
Cephalothin | 1996–2003 | 2–32 | ≤8 | 16 | ≥32 | |
Folate pathway antagonists | Sulfamethoxazole | 1996–2003 | 16–512 | ≤256 | N/A* | ≥512 |
Sulfisoxazole | 2004–present | 16–256 | ≤256 | N/A* | ≥512 | |
Trimethoprim- sulfamethoxazole |
1996–present | 0.12/2.38–4/76 | ≤2/38 | N/A* | ≥4/76 | |
Macrolides | Azithromycin§ | 2011–present | 0.25–32 0.12–16¶ |
≤16 | N/A* | ≥32 |
Penems | Meropenem | 2016–present | 0.06–4 | ≤1 | 2 | ≥4 |
Penicillins | Ampicillin | 1996–present | 1–32 | ≤8 | 16 | ≥32 |
Phenicols | Chloramphenicol | 1996–present | 2–32 | ≤8 | 16 | ≥32 |
Quinolones | Ciprofloxacin** | 1996–present | 0.015–4 | ≤0.25 | 0.5 | ≥1 |
Nalidixic acid | 1996–present | 0.5–32 | ≤16 | N/A* | ≥32 | |
Tetracyclines | Tetracycline | 1996–present | 4–32 | ≤4 | 8 | ≥16 |
* N/A indicates that no MIC range of intermediate susceptibility exists
†CLSI breakpoints are not established for streptomycin; interpretive standards used are NARMS-established breakpoints for resistance monitoring and should not be used to predict clinical efficacy. During 1996–2013 resistance was defined as ≥64 µg/mL; the breakpoint was updated to ≥32 µg/mL in 2014. The 2014 breakpoint could not be applied to previous years due to limited concentrations tested.
‡ CLSI updated the ceftriaxone interpretive standards in January, 2010. NARMS Human Isolate Reports for 1996 through 2008 used susceptible ≤8 µg/mL, intermediate 16-32 µg/mL, and resistant ≥64 µg/mL.
§CLSI breakpoints are not established for azithromycin and E. coli; interpretive standards used are NARMS-established breakpoints for resistance monitoring and should not be used to predict clinical efficacy.
¶ Concentration range used for azithromycin during 2011–2015
** CLSI updated the ciprofloxacin interpretive standards for E. coli in January, 2019. NARMS Human Isolate Reports for 1996 through 2015 used susceptible ≤1 µg/mL, intermediate 2 µg/mL, and resistant ≥4 µg/mL.
CLSI Class | Antimicrobial Agent | Years Tested | Antimicrobial Agent Concentration Range (μg/mL) |
MIC Interpretive Standard (μg/mL)† | |||
---|---|---|---|---|---|---|---|
C. jejuni | C. coli | ||||||
Susceptible | Resistant | Susceptible | Resistant | ||||
Aminoglycosides | Gentamicin | 1998–present | 0.12–32 0.016–256* |
≤2 | ≥4 | ≤2 | ≥4 |
Ketolides | Telithromycin‡ | 2005–present | 0.015–8 | ≤4 | ≥8 | ≤4‡ | ≥8‡ |
Lincosamides | Clindamycin | 1997–present | 0.03–16 0.016–256* |
≤0.5 | ≥1 | ≤1 | ≥2 |
Macrolides | Azithromycin | 1998–present | 0.015–64 0.016–256* |
≤0.25 | ≥0.5 | ≤0.5 | ≥1 |
Erythromycin | 1997–present | 0.03–64 0.016–256* |
≤4 | ≥8 | ≤8 | ≥16 | |
Phenicols | Chloramphenicol | 1997–2004 | 0.016–256* | ≤16 | ≥32 | ≤16 | ≥32 |
Florfenicol | 2005–present | 0.03–64 | ≤4 | ≥8 | ≤4 | ≥8 | |
Quinolones | Ciprofloxacin | 1997–present | 0.015–64 0.002–32* |
≤0.5 | ≥1 | ≤0.5 | ≥1 |
Nalidixic acid | 1997–present | 4–64 0.016–256* |
≤16 | ≥32 | ≤16 | ≥32 | |
Tetracyclines | Tetracycline | 1997–present | 0.06–64 0.016–256* |
≤1 | ≥2 | ≤2 | ≥4 |
* Etest dilution range used before 2005
† MIC interpretative standard is based on epidemiological cutoff values established by the European Committee on Antimicrobial Susceptibility Testing (EUCAST – last accessed on 7/21/2017). This approach was adopted in 2012 and applied to all years. EUCAST uses the terms “wild-type” and “non-wild-type” instead of susceptible and resistant, respectively, to reflect the nature of the populations of bacteria in each group and to highlight that these categories are not to be used to predict clinical efficacy.
‡ A telithromycin ECV for Campylobacter coli is not currently published by EUCAST. We apply the previously published Cdc-pdf
CLSI Class | Antimicrobial Agent | Years Tested | Antimicrobial Agent Concentration Range (μg/mL) |
MIC Interpretive Standard (μg/mL) | ||
---|---|---|---|---|---|---|
Susceptible | Intermediate* | Resistant | ||||
Aminoglycosides | Gentamicin | 2013–present | 0.25–16 0.064–1024† |
≤4 | 8 | ≥16 |
Kanamycin | 2009–2012 | 0.016–256† | No CLSI or NARMS breakpoints | |||
Streptomycin | 2009–2012; 2015–present |
2–64 0.064–1024 |
No CLSI or NARMS breakpoints | |||
β–lactam combination agents | Amoxicillin-clavulanic acid | 2015–present | 1/0.5–32/16 | ≤8/4 | 16/8 | ≥32/16 |
Cephems | Cefotaxime | 2013–2014 | 0.016–256† | ≤1 | 2 | ≥4 |
Cefoxitin | 2015–present | 0.5–32 | ≤8 | 16 | ≥32 | |
Ceftazidime | 2013–2014 | 0.016–256† | ≤4 | 8 | ≥16 | |
Ceftiofur | 2015 | 0.12–8 | No CLSI or NARMS breakpoints | |||
Ceftriaxone | 2015–present | 0.25–64 | No CLSI or NARMS breakpoints | |||
Cephalothin | 2009–2012 | 0.016–256† | No CLSI or NARMS breakpoints | |||
Folate pathway antagonists | Sulfisoxazole | 2015–present | 16–256 | No CLSI or NARMS breakpoints | ||
Trimethoprim-sulfamethoxazole | 2009–present | 0.12/2.38–4/76 0.002–32† |
≤2/38 | N/A* | ≥4/76 | |
Macrolides | Azithromycin | 2015–present | 0.25–32 0.12–16‡ |
See footnote§ | ||
Penems | Imipenem¶ | 2013–2014 | 0.002–32† | ≤1 | 2 | ≥4 |
Meropenem | 2016–present | 0.06–4 | ≤1 | 2 | ≥4 | |
Penicillins | Ampicillin | 2009–present | 1–32 0.016–256† |
≤8 | 16 | ≥32 |
Phenicols | Chloramphenicol | 2009–present | 2–32 0.016–256† |
No CLSI or NARMS breakpoints | ||
Quinolones | Ciprofloxacin | 2009–present | 0.015–4 0.002–32† |
≤1 | 2 | ≥4 |
Nalidixic acid | 2009–present | 0.5–32 0.016–256† |
No CLSI or NARMS breakpoints | |||
Tetracyclines | Tetracycline | 2009–present | 4–32 0.016–256† |
≤4 | 8 | ≥16 |
*N/A indicates that no MIC range of either intermediate or resistant susceptibility exists
† Etest dilution range used before 2015
‡ Concentration range used for azithromycin in 2015
§CLSI has only established a susceptible breakpoint (≤2 µg/mL) for azithromycin and cautions that the utility of this interpretation for Vibrio species other than V. cholerae is uncertain due to limited clinical or in vitro MIC data. Because of this, NARMS will not apply any interpretive criteria to azithromycin MICs for non-cholerae Vibrio until further data are available.
¶ CLSI updated the imipenem interpretive standards in October, 2015. The previous breakpoints were susceptible ≤4 µg/mL, intermediate 8 µg/mL, and resistant ≥16 µg/mL.