Test Id : ZMMLS
Antimicrobial Susceptibility, Aerobic Bacteria, Varies
Useful For
Suggests clinical disorders or settings where the test may be helpful
Determining the in vitro susceptibility of aerobic bacteria involved in human infections
Reflex Tests
Lists tests that may or may not be performed, at an additional charge, depending on the result and interpretation of the initial tests.
| Test Id | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| RMALD | Ident by MALDI-TOF mass spec | No, (Bill Only) | No |
| BLA | Beta Lactamase | No, (Bill Only) | No |
| SUS | Susceptibility | No, (Bill Only) | No |
| HPCR1 | H pylori + Clarithro Resistance PCR | No, (Bill Only) | No |
| MECAB | mecA PCR Test, Bill Only | No, (Bill Only) | No |
Additional Tests
Lists tests that are always performed, at an additional charge, with the initial tests.
| Test Id | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| MIC | Susceptibility, MIC | No, (Bill Only) | Yes |
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
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 MECAB / Methicillin Resistance Gene, mecA Test (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.
The following tables provide a listing of the antimicrobials routinely tested as well as antimicrobials that may be tested upon request. These tables are organized by isolate groups and are not all inclusive. Call 800-533-1710 and ask to speak to the Bacteriology Antimicrobial Susceptibility Testing Laboratory if the organism or antimicrobial of interest are not listed in these tables.
-Aerobic Gram-Negative Bacilli Antimicrobials
-Additional Gram-Negative Bacteria Antimicrobials
-Staphylococcus, Enterococcus, Bacillus, and Related Genera Antimicrobials
-Additional Gram-Positive Bacteria Antimicrobials
For test utilization options, see Helicobacter pylori Diagnostic Algorithm.
Method Name
A short description of the method used to perform the test
Minimal Inhibitory Concentration (MIC) (Agar Dilution or Broth Microdilution or Gradient Diffusion) or Disk Diffusion(if appropriate)
NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.
Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test
Aliases
Lists additional common names for a test, as an aid in searching
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
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
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 MECAB / Methicillin Resistance Gene, mecA Test (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.
The following tables provide a listing of the antimicrobials routinely tested as well as antimicrobials that may be tested upon request. These tables are organized by isolate groups and are not all inclusive. Call 800-533-1710 and ask to speak to the Bacteriology Antimicrobial Susceptibility Testing Laboratory if the organism or antimicrobial of interest are not listed in these tables.
-Aerobic Gram-Negative Bacilli Antimicrobials
-Additional Gram-Negative Bacteria Antimicrobials
-Staphylococcus, Enterococcus, Bacillus, and Related Genera Antimicrobials
-Additional Gram-Positive Bacteria Antimicrobials
For test utilization options, see Helicobacter pylori Diagnostic Algorithm.
Specimen Type
Describes the specimen type validated for testing
Varies
Ordering Guidance
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 Centers for Disease Control and Prevention regarding antimicrobial susceptibility testing of such isolates.
Shipping Instructions
1. See Infectious Specimen Shipping Guidelines
2. Place specimen in a large infectious container and label as an etiologic agent/infectious substance.
Necessary Information
Organism identification and specimen source are required.
ORDER QUESTIONS AND ANSWERS
| Question ID | Description | Answers |
|---|---|---|
| Q00M0070 | Specimen Source (Required) and Organism Identification (Required unless concurrent identification test is ordered) |
Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing
Supplies: Infectious Container, Large (T146)
Container/Tube: Agar slant or other appropriate media
Specimen Volume: Organism in pure culture
Collection Instructions:
1. Perform isolation of infecting bacteria.
2. Organism must be in pure culture, actively growing. Do not submit mixed cultures.
Special Instructions
Library of PDFs including pertinent information and forms related to the test
Forms
If not ordering electronically, complete, print, and send a Microbiology Test Request (T244) with the specimen.
Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected
| Agar plate | Reject |
Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Varies | Ambient (preferred) | ||
| Refrigerated | |||
| Frozen | |||
Useful For
Suggests clinical disorders or settings where the test may be helpful
Determining the in vitro susceptibility of aerobic bacteria involved in human infections
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
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 MECAB / Methicillin Resistance Gene, mecA Test (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.
The following tables provide a listing of the antimicrobials routinely tested as well as antimicrobials that may be tested upon request. These tables are organized by isolate groups and are not all inclusive. Call 800-533-1710 and ask to speak to the Bacteriology Antimicrobial Susceptibility Testing Laboratory if the organism or antimicrobial of interest are not listed in these tables.
-Aerobic Gram-Negative Bacilli Antimicrobials
-Additional Gram-Negative Bacteria Antimicrobials
-Staphylococcus, Enterococcus, Bacillus, and Related Genera Antimicrobials
-Additional Gram-Positive Bacteria Antimicrobials
For test utilization options, see Helicobacter pylori Diagnostic Algorithm.
Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
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.
Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Susceptibility results are reported as minimal inhibitory concentration (MIC) in mcg/mL. Breakpoints (also known as clinical breakpoints) are used to categorize an organism as susceptible, susceptible-dose dependent, intermediate, resistant, or nonsusceptible according to breakpoint setting organizations, either the Clinical and Laboratory Standards Institute (CLSI) or the European Committee on Antimicrobial Susceptibility Testing (EUCAST), as applicable.
In some instances, an interpretive category cannot be provided based on available data; therefore, the following comment will be included on the report: There are no established interpretive guidelines for agents reported without interpretations.
For information regarding CLSI and EUCAST susceptibility interpretations, see Susceptibility Interpretative Category Definitions.
Interpretation
Provides information to assist in interpretation of the test results
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).
Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
In vitro susceptibility does not guarantee clinical response.
Clinical Reference
Recommendations for in-depth reading of a clinical nature
1. Jorgensen JH, Ferraro MJ. Antimicrobial susceptibility testing: a review of general principles and contemporary practices. Clin Infect Dis. 2009;49(11):1749-1755
2. Jenkins SG, Schuetz AN. Current concepts in laboratory testing to guide antimicrobial therapy. Mayo Clin Proc. 2012;87(3):290-308
3. Procop GW, Church DL, Hall GS, et al: Antimicrobial susceptibility testing. In: Koneman's Color Atlas and Textbook of Diagnostic Microbiology. 7th ed. Wolters Kluwer Health; 2017:1074-1171
Method Description
Describes how the test is performed and provides a method-specific reference
An agar dilution method is used for routine testing. The agar dilution method employs the use of antimicrobial agents incorporated in agar plates. The antimicrobial is added to agar in various concentrations depending upon levels attainable in serum, urine, or both. A standardized suspension of the organism is applied to the agar plates, which are incubated for a minimum of 16 to 18 hours at 35 degrees C. Complete inhibition of all but one colony or a very fine residual haze represents the end point.(Clinical and Laboratory Standards Institute [CLSI]: Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically. 11th ed. CLSI standard M07.CLSI; 2018)
Daptomycin and tigecycline are tested by agar gradient diffusion.(Clinical and Laboratory Standards Institute [CLSI]. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically. 11th ed. CLSI standard M07. CLSI; 2018; package insert: Etest Biomerieux;15203E-EN-2016/07, 07/2016)
Cefiderocol is tested by disk diffusion.(Clinical and Laboratory Standards Institute [CLSI]. Performance Standards for Antimicrobial Disk Susceptibility Tests. 13th ed. CLSI standard M02. CLSI; 2018)
PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information
Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.
Monday through Friday
Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.
Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location
Indicates the location of the laboratory that performs the test
Fees :
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.
- Authorized users can sign in to Test Prices for detailed fee information.
- Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
- Prospective clients should contact their account representative. For assistance, contact Customer Service.
Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.
This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.
CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
CPT codes are provided by the performing laboratory.
CPT codes are provided by the performing laboratory.
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)
87150-H pylori + Clarithro Resistance PCR (if appropriate)
87150-mecA PCR (if appropriate)
LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.
| Test Id | Test Order Name | Order LOINC Value |
|---|---|---|
| ZMMLS | Susceptibility, Aerobic, MIC | 50545-3 |
| Result Id | Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
|---|---|---|
| ZMMLS | Susceptibility, Aerobic, MIC | 21070-8 |