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Etest®

Improving Therapeutic Decisions

Etest® is a well-established method for antimicrobial resistance testing in microbiology laboratories around the world. Etest® consists of a predefined gradient of antibiotic concentrations on a plastic strip and is used to determine the Minimum Inhibitory Concentration (MIC) of antibiotics, antifungal agents and antimycobacterial agents.

Click here to access the Etest® IVD Product List.

For information on Etest® Ceftaroline, see tabs below.

Downloads:

 

FEATURES AND BENEFITS

Quantitative MIC data is now a prerequisite for the management of critical infections, including sepsis, especially among critical care patients. Etest® for antimicrobial resistance testing is particularly valuable in such situations, when on-scale MICs are needed for treatment decisions.

Etest® is recognized as a cost-effective tool for generating MICs across 15 dilutions. It can also be used in a macromethod format to optimize resistance detection. Over 100 antibiotics are now available in the product range for testing of aerobic bacteria and fastidious organisms such as pneumococci, haemophilus, H. pylori, meningococci, gonococci, anaerobes, fungi and mycobacteria.

USES

  • Provides Minimum Inhibitory Concentrations (MICs) for slow-growing and fastidious organisms that have unique growth requirements and cannot be testing by automated methods
  • Antibiotic susceptibility testing (AST) and resistance mechanism detection
  • Testing robust aerobes, anaerobes, pneumococci, menigococci and fastidious organisms such as the HACEK group, Bordatella and Francisella
  • Detect phenotypic resistance
  • Better antibiotic stewardship
  • Manual antibiotic susceptibility testing for veterinary labs

ETEST® FEATURES & SPECS

Etest® is a well-established method for antimicrobial resistance testing that brings on-scale MIC testing to all microbiology laboratories.

Etest® promotes the rational use of antibiotics by providing results to guide the therapy of individual patients and to validate empiric drug regimens.

It is particularly helpful in determining choice and dosage of antimicrobials in patients with sterile site infections (e.g. endocarditis), severe nosocomial infections, chronic infections (e.g. cystic fibrosis) and immunosuppressed patients.

Etest® is also widely used in resistance surveillance programs and clinical trials.

Storage Container Dimensions (601603)
Height: 90 mm
Diameter: 55 mm
Weight: 30 grams

Downloads:

ETEST® USES

For clinical laboratories:

  • Provides Minimum Inhibitory Concentrations (MICs) for slow-growing and fastidious organisms that have unique growth requirements and cannot be testing by automated methods
  • Antibiotic susceptibility testing (AST) and resistance mechanism detection
  • Testing robust aerobes, anaerobes, pneumococci, menigococci and fastidious organisms such as the HACEK group, Bordatella and Francisella
  • Detect phenotypic resistance

For clinicians and administrators:

  • Provides Minimum Inhibitory Concentrations (MICs) for slow-growing and fastidious organisms that have unique growth requirements and cannot be testing by automated methods
  • Antibiotic susceptibility testing (AST) and resistance mechanism detection
  • Improve antibiotic stewardship
  • Reduce possibility of adverse drug events due to unnecessary therapy
  • Validate susceptibility results and minimize the possibility of erroneous results due to laboratory error
  • Guide antibiotic selection and dosing
  • Improve patient outcome and lower healthcare-associated expenses
  • Decrease hospital length of stay and associated costs of prolonged hospitalization

For Veterinary Labs:

  • Manual antibiotic susceptibility testing

ETEST® PUBLICATIONS

Antifungal susceptibility testing:

Mikkel Krogh-Madsen, Maiken Cavling Arendrup, Lars Heslet, and Jenny Dahl Knudsen. Amphotericin B and Caspofungin Resistance in Candida glabrata Isolates Recovered from a Critically Ill Patient. Clinical Infectious Diseases: 2006 April 1; 42(7): 938-44.

Pseudomonas aeruginosa, Acinetobacter baumannii and Clostridium difficile:

David Landman , Simona Bratu , Sandeep Kochar , Monica Panwar , Manoj Trehan , Mehmet Doymaz , and John Quale. Evolution of antimicrobial resistance among Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae in Brooklyn, NY. JAC Advance Access published on July 1, 2007, DOI 10.1093/jac/dkm129. J. Antimicrob. Chemother. 60: 78-82.

University of Nottingham (2007, July 7). Waging War On The Deadliest Superbug. ScienceDaily. Retrieved February 25, 2009, from http://www.sciencedaily.com­ /releases/2007/07/070703172036.htm

Anaerobes:

Rosenblatt, Jon E., Can We Afford To Do Anaerobic Cultures and Identification? A Positive Point of View.

Streptococci:

Rosser, S. J., Alfa, M. J., Hoban, S., Kennedy, J., Harding, G. K. E Test versus Agar Dilution for Antimicrobial Susceptibility Testing of Viridans Group Streptococci. J. Clin. Microbiol. 1999 37: 26-30

VRSA:

Tenover, Fred C., Weigel, Linda M., Appelbaum, Peter C., McDougal, Linda K., Chaitram, Jasmine, McAllister, Sigrid, Clark, Nancye, Killgore, George, O'Hara, Caroline M., Jevitt, Laura, Patel, Jean B., Bozdogan, Bulent. Vancomycin-Resistant Staphylococcus aureus Isolate from a Patient in Pennsylvania. Antimicrob. Agents Chemother. 2004 48: 275-280

ESBL:

Enno Stürenburg , Ingo Sobottka , Djahesh Noor , Rainer Laufs , and Dietrich Mack. Evaluation of a new cefepime–clavulanate ESBL Etest® to detect extended-spectrum ß-lactamases in an Enterobacteriaceae strain collection. JAC Advance Access published on July 1, 2004, DOI 10.1093/jac/dkh274. J. Antimicrob. Chemother. 54: 134-138.

MIC for critical infections:

Potoski, Brian A., Mangino, Julie E., Goff, Debra A. Clinical Failures of Linezolid and Implications for the Clinical Microbiology Laboratory

VISA:

Walsh, Timothy R., Bolmstrom, Anne, Qwarnstrom, Anette, Ho, Phion, Wootton, Mandy, Howe, Robin A., MacGowan, Alasdair P., Diekema, Dan. Evaluation of Current Methods for Detection of Staphylococci with Reduced Susceptibility to Glycopeptides. J. Clin. Microbiol. 2001 39: 2439-2444

Cystic fibrosis:

Burns, Jane L., Saiman, Lisa, Whittier, Susan, Larone, Davise, Krzewinski, Jay, Liu, Zhenling, Marshall, Steven A., Jones, Ronald N. Comparison of Agar Diffusion Methodologies for Antimicrobial Susceptibility Testing of Pseudomonas aeruginosa Isolates from Cystic Fibrosis Patients. J. Clin. Microbiol. 2000 38: 1818-1822

Pneumococci:

Chaves, Fernando, Campelo, Carolina, Sanz, Francisca, Otero, Joaquin R. Meningitis Due to Mixed Infection with Penicillin-Resistant and Penicillin-Susceptible Strains of Streptococcus pneumoniae. J. Clin. Microbiol. 2003 41: 512-513

Haemophilus spp.:

María Pérez-Vázquez , Federico Román , M. Carmen Varela , Rafael Cantón , and José Campos. Activities of 13 quinolones by three susceptibility testing methods against a collection of Haemophilus influenzae isolates with different levels of susceptibility to ciprofloxacin: evidence for cross-resistance. JAC Advance Access published on January 1, 2003, DOI 10.1093/jac/dkg049. J. Antimicrob. Chemother. 51: 147-151.

VRE:

Alam, M. Rabiul, Donabedian, Susan, Brown, William, Gordon, James, Chow, Joseph W., Zervos, Marcus J., Hershberger, Ellie. Heteroresistance to Vancomycin in Enterococcus faecium. J. Clin. Microbiol. 2001 39: 3379-3381

Gram negative non-Fermenters:

Di Bonaventura, Giovanni, Ricci, Evandro, Della Loggia, Nicoletta, Catamo, Giovanni, Piccolomini, Raffaele. Evaluation of the E Test for Antimicrobial Susceptibility Testing of Pseudomonas aeruginosa Isolates from Patients with Long-Term Bladder Catheterization. J. Clin. Microbiol. 1998 36: 824-826

Gonococci:

Ronald N. Jones , Lalitagauri M. Deshpande , Meredith E. Erwin , Mary S. Barrett , and Mondell L. Beach. Anti-gonococcal activity of gemifloxacin against fluoroquinolone-resistant strains and a comparison of agar dilution and Etest® methods J. Antimicrob. Chemother. 45: 67

ETEST® HOT TOPICS

Etest® Applications and Product News

Applications of current interest pertaining to specific antimicrobials or antifungals are listed below. For additional uses consult the Etest® Application Guide, Etest® Package Inserts, or Publications List in the other tabs.

Etest® DPC: Confirmatory Daptomycin Susceptibility Testing For Non-Susceptable S. Aureus and Enterococcus Isolates.

Daptomycin susceptibility testing can be challenging, especially at lower concentrations owing to the large size of the molecule, and the requirement for free Ca2+ cations for activity. A recent report1 has indicated that some automated broth microdilution systems may overcall non-susceptibility (NS) to daptomycin of Enterococcus and S. aureus isolates. CLSI recommends that once the identity and susceptibility are confirmed and if the susceptibility is unusual in your institution, that the susceptibility of NS isolates be confirmed by a second method2.

Confirmatory daptomycin susceptibility testing may be conveniently performed using Etest® daptomycin strips. In addition, Etest® provides an on-scale MIC determination, bringing added value to pharmacists and physicians who need MICs to determine optimal antibiotic therapy.

Etest® daptomycin strips are overlaid with a constant level of calcium equivalent to 40 μg/mL to allow their use with standard Mueller-Hinton agar plates. Please note that per CLSI disk diffusion testing is NOT recommended for daptomycin3.

Please find below ordering information for Etest® daptomycin testing products. If your laboratory does not currently use Etest®, an Etest® Specialist will be happy to facilitate implementation and training in your laboratory. Please contact us at the numbers provided below.

Specifications

Antibiotic code:

  DPC

MIC range:

 0.016 - 256 μg/mL1)

Antibiotic group:

 Lipopeptide

 

 

Strains(N) (EA)*

%Essential Agreement**

Performance

 

 

Gram positive aerobes

506

97

Streptococcus spp.

337

97

Notes
* Overlaid with a constant level of calcium equivalent to 40 μg/mL. Etest® DPC must be used with Mueller Hinton agar. See important observation 4 below.
** EA = % of MIC values within ± 1 dilution of the reference method.

 

FDA MIC Quality Control Ranges (μg/mL)

Staphylococcus aureus

ATCC® 29213

0.25 - 1

Enterococcus faecalis

ATCC 29212

1 - 4

S. pneumoniae

ATCC 49619

0.064 - 0.5

CLSI® MIC Interpretive Standards (μg/mL)†

 

Susceptible

Intermediate

Resistant

Staphylococci††

≤ 1

-

-

Enterococci ††)

≤ 4

-

-

Streptococcus spp. ††

≤ 1

-

-

Notes
† Please consult the footnotes in the latest CLSI tables for further comments and clarification. Interpretive criteria may be different.
†† The absence of resistant strains precludes defining any result category other than “susceptible”. Strains yielding results suggestive a “nonsusceptible” category should be submitted to a reference laboratory for further testing.

 

Ordering Information

Order Number

Etest® Product

Quantity

535050

DAPTOMYCIN DPC 256 US F30

30

535058

DAPTOMYCIN DPC 256 US F100

100

Etest® Daptomycin package insert

Etest® Daptomycin package supplement

Contact Information

bioMérieux US Customer Service

Tel: (800) 682 2666
Fax: (800) 968 9494
Web: www.biomerieux-usa.com

Order Online

bioZone

References

1 Discrepancies between Daptomycin Susceptibility Results by Microscan Panel PC29 and by E test in Staphyloccocus aureus and Enterococci Elizabeth L. Palavecino and Candace H. Schoppe. Wake Forest School of Medicine, Winston-Salem, North Carolina, Poster abstract presented at the 51st annual IDAAC meeting, 2011. Abtract URL:
http://m.core-apps.com/TriStar-ICAAC11/abstract/9bd9d4e89691ff5649b4f0f841e5f9ae
2 CLSI (M100-S22, Appendix A), Clinical and Laboratory Standards Institute. 2012. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Second Informational Supplement, p 163. CLSI, Wayne, Pennsylvania.
3 CLSI (M100-S22, Table 2D), Clinical and Laboratory Standards Institute. 2012. Performance standards for Antibiotic susceptibility testing, Twenty-Second Informational Supplement. p. 92. CLSI, Wayne, Pennsylvania.

Etest® Fosfomycin For Susceptibility Testing

Fosfomycin (Monurol) is an older antibiotic which is an option for treating uncomplicated urinary tract infections from E. coli and E. faecalis1. Fosfomycin may frequently be administered as a single oral dose1, and is economical relative to many alternative therapies2.

Fosfomycin exhibits time‐dependent killing; optimal killing is achieved when the free drug concentration is above the organism’s MIC (%fT>MIC) for 40‐50% of the dosing interval3. According to the manufacturer, fosfomycin susceptibility “should not be determined by broth dilution methods”1.

Convenient and provides an MIC to optimize therapy
Etest® Fosfomycin (Etest® FM) represents a convenient alternative method for fosfomycin sensitivity testing which provides an MIC, allowing clinicians to optimize antibiotic therapy. Etest® measures susceptibility to fosfomycin in the concentration range of 0.064 ‐ 1024 μg/ml. Etest® FM is cleared in the U.S. for non‐fastidious Gram negative and Gram positive aerobes5.

No special media required
Some agar methods require supplementation with glucose‐6‐phosphate to minimize error rates4 Etest® FM gradient strips contain a constant concentration of glucose‐6‐phosphate along the antibiotic dilution range, allowing standard media for the organism being tested to be used, i.e. Mueller‐Hinton agar plates.

Sample studies involving Etest® Fosfomycin
Shrestha NK, et al. Scand J Infect Dis 2003;35: 12–14.
Falagas et al., Int J Antimicrob Agents. 2010 Mar;35(3):240‐3.

Etest® Fosfomycin Specifications

Antibiotic code:

FM

MIC range:

0.064 ‐ 1024 (μg/mL)1

 

Etest® Fosfomycin MIC Quality Control Ranges (μg/mL) 1

Staphylococcus aureus

ATCC® 29213

0.25 ‐ 2

Enterococcus faecalis

ATCC 29212

16 ‐ 64

Escherichia coli

ATCC 25922

0.5 ‐ 2

Pseudomonas aeruginosa

ATCC 27853

2 ‐ 8

 

CLSI MIC Interpretive Standards (μg/mL)

 

Susceptible

Intermediate

Resistant

Aerobes

≤ 64

128

≥ 256

 

Ordering information

 

Quantity

Part number

Etest® FOSFOMYCIN FM 1024 US, Blister pack

30

529140

Etest® FOSFOMYCIN FM 1024 US, Blister pack

100

529148

 

Fosfomycin References
1 Monurol Package Insert. St. Louis: Forest Laboratories, Inc.; 1997.
2 Fosfomycin: Uses and Criteria. The Nebraska Medical Center
3 Pfausler B, et al. Antimicrob Chemother. 2004; 53: 848‐52
4 Pfaller et al. (1993) Diagnostic Microbiology and Infectious Disease, 17:67‐70
5 Etest® Fosfomycin Package Supplement; available from the bioMérieux USA technical library. Search 529140 or use the Guided Search to locate fosfomycin

Ordering Contact Information

Healthcare 800‐682‐2666
Order online

Etest® Application Guide

For information about the many uses of Etest®, by organism, download the Etest® Application Guide here.

Etest® Technical Library

  • Please navigate to Technical Library at top left or at www.mybiomerieux.com (requires login).
  • To access Etest® related documents, select Guided Search by reagents;
  • Click the “+” by Etest®; click the “+” beside the desired Etest® product area, for example “Antimicrobial Susceptibility Testing”.
  • In the ensuing list of Available Products, select the product of interest.
  • The Etest® package insert is Package Insert US ‐ 15203 ‐ x ‐ en ‐ Etest® ‐ AST.pdf. Supplementary Inserts specific to each antimicrobial are also available.
  • For the Etest® Application Guide, selected Guided Search by reagents; click the “+” by “Etest® Add Tech Doc”, select “410440 ‐ 410440 ETEST® Additional Technical Documents and Search Instructions” , then “Supplementary Inserts ‐ 16273 ‐ A ‐ en ‐ EAG ‐ Etest® Application Guide.pdf”.

For new users, please request a login; logins are returned during business hours.

ETEST® SINGLE PACK

Self-contained, individually wrapped Etest® strips with desiccant.

bioMérieux is pleased to announce the introduction of Etest® Single Packs. Etest® Single Pack is a new packaging option that provides the following benefits:

  • One strip per package eliminates the need to store opened strips
  • Easy to open with one hand - simply remove strip with forceps or manual applicator device (see Figure 1)
  • Standardized storage conditions (-20°C to +8°C for all antimicrobials)
  • Desiccant within each Single Pack helps ensure stability
  • Clear, concise labeling on each Single Pack
  • One lot number on outer box and Single Packs
  • Available in boxes of 30 strips

The new packaging are available in quantities of 30 (“Single-pack 30”, or “S30”). These ordering units replace the 30-strip quantity in foam packing (F30). Please note that the F30 packaging will be phased out in the month after the new packaging for that antibiotic is introduced.

Etest® Now Available in Single Pack Packaging

Additional Etest® products will be available later in the year. Further releases are planned for all F30 packaging in 2014 and 2015.

View 2012 Schedule Here
View 2013 Schedule Here

For an up-to-date list of Etest® products available:

1.) Go to the bioMérieux-USA online catalog by clicking on the icon below (Catalog will open in a new tab).

2.) In the center dialog box, use the pull-down menu to select Etest®.

3.) Enter the name of the antibiotic of the Etest® you are interested in in the right-hand dialog.

Available products will be listed below, and can be exported to a PDF using the icons below. Hint: click on the heading Product Description and then Product Type to alphabetize the list.

 

Ordering Contact Information

Healthcare 800‐682‐2666
 

ETEST® CEFTAROLINE

Etest Ceftaroline Ordering Information

Determine susceptibilities to Teflaro® (Ceftaroline fosamil) with Etest® CPT

Teflaro® (ceftaroline fosamil) is an IV cephalosporin indicated for community acquired bacterial pneumonia (CABP) and acute bacterial skin and skin structure infections (ABSSSI)1,2 including methicillin-resistant Staphylococcus aureus (MRSA). Etest® CPT can be used to determine ceftaroline fosamil susceptibilities and provide minimum inhibitory concentrations (MICs) for Staphylococcus aureus.

Susceptibility testing with Etest® CPT provides:

  • Broad testing range: 0.002 – 32 µg/mL.
  • Provides an MIC to guide optimal antibiotic therapy and assess the local distribution of isolates.
  • Susceptibilities to S. aureus for CABP and ABSSSI.

Assess ceftaroline fosamil susceptibilities of S. aureus in your institution with Etest® CPT

Specifications3:

  • Antibiotic code: CPT
  • MIC range: 0.002 – 32 µg/mL
  • Antibiotic group: Cephalosporin

Performance3

Strains (N)

% Essential Agreement (EA)

Staphylococcus aureus   

434

99.8

 

MIC Quality Control Ranges (µg/mL)

Staphylococcus aureus

ATCC® 29213™

  0.125 - 0.5

 

FDA Interpretive Standards

 

Susceptible

Intermediate

Resistant

S. aureus*

≤ 1

-

-

Note: The absence of resistant strains precludes defining any results other than “susceptible”. Strains yielding results suggestive of a “non-susceptible” category should be submitted to a reference laboratory for further testing.

Ceftaroline is bactericidal against S. aureus due to its affinity for penicillin binding protein 2a (PBP2a).1

For bactericidal agents, the Etest® MIC endpoint should be read at complete inhibition of growth.3

Ordering Information:

Quantity

Part Number

Etest®  CEFTAROLINE CPT 32, Blister Pack

30

537540

Etest®  CEFTAROLINE CPT 32, Blister Pack

100

537548

To order Etest® CPT, contact your bioMérieux Microbiology Specialist, Etest® Specialist, or call us at 1-800-682-2666.

References:
1 SeeTeflaro® prescribing information, available at /sites/subsidiary_us/files/teflaro_pi.pdf. Downloaded August 27, 2012.
2 Teflaro® official site: http://www.teflaro.com/.
3 Etest® CPT package supplement, available at http://www.mybiomerieux.com. Instructions on accessing the Technical Library may be found here.

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