Amendment to the NordicAST 7.0 breakpoint table 24th of March 2017

EUCAST 7.1 breakpoint table was published in 13^th of March 2017. The changes between version 7.0 and 7.1 are marked in light blue in the EUCAST breakpoint table. http://www.eucast.org/clinical_breakpoints/

The changes from v 7.0 which concern the NordicAST breakpoint table are listed below. NordicAST recommend that local procedures are updated with these changes as soon as possible. The changes will be implemented in version 8.0 of the NordicAST table.

1. Staphylococcus spp.

- Cefoxitin screen for S. epidermidis (zone diameter) revised to S≥25mm and R<25mm.

-Cefoxitin screen for S. pseudintermedius removed and replaced with oxacillin (S≥20, R<20 mm).

A new comment formulated: Cefoxitin screen for methicillin resistance in S. pseudintermedius is less predictive of the presence of mecA than in other staphylococci. Use the oxacillin 1 µg disk with zone diameter breakpoints S≥20, R<20 mm to screen for methicillin resistance.

2. Dosages

-Amoxicillin-clavulanic acid standard and high dose revised. They should be:

Standard dose: (1 g amoxicillin + 0.2 g clavulanic acid) x 3 iv

Oral dosage under discussion

High dose: (2 g amoxicillin + 0.2 g clavulanic acid) x 3 iv

Oral dosage under discussion

Additional correction:

1. Streptococcus pneumoniae

- The norfloxacin (screen) breakpoint  was changed from 12mm to 11mm in the NordicAST 7.0 breakpoint table but the comment was unfortunately not changed accordingly. The comment on fluoroquinolones should be (changes in bold):

SE: Norfloxacin kan användas som screen för kinolonresistens. Isolat karakteriserade som norfloxacin S kan rapporteras S för  levofloxacin och moxifloxacin. Isolat med norfloxacinzon < 11 mm skall tolkas efter resistensbestämning av den aktuella kinolonen. Om norfloxacin < 11 mm och känslig för annan testad kinolon kan följande varningskommentar bifogas: "Isolatet har resistensmekanismer mot kinoloner. Risk för resistensutveckling under behandling föreligger".

NO: Norfloksacin kan benyttes som screeningmiddel for kinolonresistens. Isolater som kategoriseres som norfloksacin S kan rapporteres S for levofloksacin og moxifloksacin. Isolater med norfloksacin < 11 mm skal tolkes etter resistensbestemmelse av det aktuelle kinolonet. Hvis norfloksacin < 11 mm og følsomt for annet testet kinolon kan følgende advarende kommentar medfølge svaret: "Isolatet har resistensmekanismer mot kinoloner. Risiko for resistensutvikling under behandling foreligger".