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Table 10. MIC and zone diameter breakpoints for staphylococci Comments 1-3 relate to urinary tract infections (UTI) only. 1 These recommendations are for organisms associated with uncomplicated urinary tract infections only. For complicated infections and infections caused by Staphylococcus aureus and Staphylococcus epidermidis, which are associated with more serious infections, systemic recommendations should be used. 2 If an organism is isolated from multiple sites, for example from blood and urine, interpretation of susceptibility should be made with regard to the systemic site (e.g., if the blood isolate is resistant and the urine isolate susceptible, both should be reported resistant irrespective of the results obtained using interpretative criteria for urine isolates). 3 Direct susceptibility tests on urine samples may be interpreted only if the inoculum gives semi-confluent growth. Table 10. MIC and zone diameter breakpoints for staphylococci MIC breakpoint (mg/L) Interpretation of zone diameters Amikacin for Staphylococcus aureus Amikacin for coagulase-negative staphylococci Gentamicin Tobramycin for Staphylococcus aureus Tobramycin for coagulase- negative staphylococci Neomycin For topical use only. The zone diameter breakpoint distinguishes the "wild type" susceptible population from isolates with reduced susceptibility. Version 11.1 May 2012 Table 10. MIC and zone diameter breakpoints for staphylococci β-Lactams
Most staphylococci are penicillinase-producers. The benzylpenicillin will mostly, but not unequivocally, separate β-lactamase producers. Isolates positive for β-lactamase are resistant to benzylpenicillin, phenoxymethylpenicillin, amino-,carboxy-and ureidopenicillins. Isolates negative for β-lactamase and susceptible to cefoxitin (cefoxitin is used to screen for "methicillin resistance") can be reported susceptible to these drugs. Isolates positive for β-lactamase and susceptible to cefoxitin are susceptible to penicillin- β-lactamase inhibitor combinations and penicillinase-resistant penicillins (oxacillin, cloxacillin, dicloxacillin and flucloxacin). Isolates resistant to cefoxitin are methicillin resistant and resistant to β-lactam agents, including β-lactamase inhibitor combinations, except for cephalosporins with approved anti-MRSA activity and clinical breakpoints. MIC breakpoint (mg/L) Interpretation of zone diameters Ampicillin UTI1-3 Staphylococci exhibiting resistance to oxacillin/cefoxitin Staphylococcus saprophyticus should be regarded as resistant to other penicillins, Cefoxitin Staphylococcus aureus cephalosporins, carbapenems and combinations of β- lactam and β-lactamase inhibitors.
Cefoxitin S. saprophyticus
- - - 10 19 - 20
For coagulase negative staphylococci with cefoxitin (Screen)
zone diameters of 22-26 mm, PCR for mecA is required Cefoxitin coagulase-negative to determine susceptibility for treatment of deep seated infection with any β-lactam. For oxacillin tests on Mueller–Hinton or Columbia agars Some hyper-producers of β-lactamase give zones within the range of 7-14 mm and if possible, should be
checked by a PCR method for mecA or a latex
agglutination test for PBP2a. Increase in oxacillin zone
size in the presence of clavulanic acid is not a reliable
test for hyper-producers of β-lactamase as zones of
inhibition with some MRSA also increase in the
presence of clavulanic acid. Rarely, hyper-producers of
β-lactamase give no zone in this test and would
therefore not be distinguished from MRSA.
For S. saprophyticus there is very little data for
resistant mecA
strains.

With penicillin check for a heaped zone edge which
indicates β-lactamase mediated resistance.
Version 11.1 May 2012 Table 10. MIC and zone diameter breakpoints for staphylococci MIC breakpoint (mg/L) Interpretation of zone diameters Quinolones
MIC breakpoints relate to high-dose therapy (750 mg BD). Ciprofloxacin UTI1-3 Staphylococcus saprophyticus Moxifloxacin 1 Disc diffusion for staphylococci does not give reliable Staphylococcus aureus results. An MIC method should be used to determine susceptibility, positive results requiring confirmation. Coagulase negative Population analysis is the most reliable method for confirming resistance and for distinguishing susceptible, hetero-GISA and GISA isolates. If, on clinical grounds, resistance to vancomycin is Staphylococcus aureus suspected, it is recommended that the organism be Vancomycin
sent to a specialist laboratory, such as Southmead Coagulase negative
Hospital in Bristol1 or the Antibiotic Research Laboratory in Cardiff2. Macrolides, lincosamides and streptogramins
The zone diameter breakpoint relates to an MIC of 1 mg/l as no data for the intermediate category are currently available. Version 11.1 May 2012 Table 10. MIC and zone diameter breakpoints for staphylococci MIC breakpoint (mg/L) Interpretation of zone diameters Macrolides, lincosamides and streptogramins cont.
Erythromycin can be used to determine the susceptibility to azithromycin, clarithromycin and
roxithromycin.
Organisms that appear resistant to erythromycin, but
susceptible to clindamycin should be checked for the
presence of inducible resistance (see
http://www.bsac.org.uk/Resources/BSAC/Testing_for_d
issociated_resistance_in_staphylococc12.pdf. Inducible
clindamycin resistance can be detected only in the
presence of a macrolide antibiotic. If positive, report
as resistant to clindamycin or report as susceptible
with a warning that clinical failure during treatment
with clindamycin may occur by selection of
constitutively resistant mutants and the use of
clindamycin best avoided in severe infection.

The presence of blood has a marked effect on the activity of Quinupristin-dalfopristin. On the rare occasions when blood needs to be added to enhance the growth of staphylococci, susceptible ≥15 mm, resistant ≤14 mm. Version 11.1 May 2012 Table 10. MIC and zone diameter breakpoints for staphylococci MIC breakpoint (mg/L) Interpretation of zone diameters The zone diameter breakpoint relates to an MIC of 1 mg/l as no data for the intermediate category are currently available. The zone diameter breakpoint relates to an MIC of 0.5 mg/l as no data for the intermediate category are currently available. The zone diameter breakpoint relates to an MIC of 1 mg/l as no data for the intermediate category are currently available. Staphylococci susceptible to tetracycline are also susceptible to doxycycline and minocycline. Some staphylococci resistant to tetracycline may be susceptible to minocycline and doxycycline. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and antimicrobial susceptibility tests on any such isolate must be repeated and if the result is confirmed the isolate must be sent to a reference laboratory. Until there is further evidence regarding clinical response for confirmed isolates with MIC above the current resistant breakpoint they should be reported as resistant. Version 11.1 May 2012 Table 10. MIC and zone diameter breakpoints for staphylococci MIC breakpoint (mg/L) Interpretation of zone diameters Miscellaneous antibiotics
Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and antimicrobial susceptibility tests on any such isolate must be repeated and if the result is confirmed the isolate sent to a reference laboratory. Until there is evidence regarding the clinical response for confirmed isolates with MIC above the current resistant breakpoint they should be reported resistant. Susceptibility testing by disc diffusion is not reliable. Susceptibility should be determined using a broth dilution method with Mueller Hinton broth or by an MIC method on Mueller Hinton agar. For advice on testing susceptibility to co-trimoxazole see Appendix 1. The MIC breakpoint is based on the trimethoprim concentration in a 1:19 combination with sulfamethoxazole. Breakpoints are epidemiological "cut-offs" based on distributions for the "wild type" population. However, there is no clear evidence correlating these breakpoints with clinical efficacy. Trimethoprim UTI1-3 Staphylococcus saprophyticus Fosfomycin Disc content indicates 200 µg fosfomycin/50 µg glucose-6-phosphate Version 11.1 May 2012 Table 10. MIC and zone diameter breakpoints for staphylococci MIC breakpoint (mg/L) Interpretation of zone diameters Miscellaneous antibiotics cont.
Nitrofurantoin UTI1-3 Staphylococcus saprophyticus Rifampicin 0.5 1 = Department of Microbiology, Lime Walk Building, Southmead Hospital Westbury–on-Trym, Bristol, BS10 5NB. 2 = Public Health Wales, Microbiology Cardiff, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW. Version 11.1 May 2012

Source: http://bsac.org.uk/wp-content/uploads/2012/02/Table-10.pdf

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SUPPORT HB 3421 AND SB 1044 SMART METER NO-COST OPT-OUT For PUCT regulated, Cooperative and Municipally Owned Utility Customers In the 79th Texas Legislative Session, Dennis Bonnen authored HB 2129 that requires electric utility providers to consider establishing certain consumer option programs that encourage the reduction of air contaminant emissions. The bill was later amended by the Senate to require the PUC to develop a plan for deployment of advanced meter infrastructure (AMI), "smart meter" data networks. The bill did not create a mandate; however, the PUCT created rules and regulations mandated smart meter installations for Texans. No cost/benefit analysis was done. No human health impact studies were conducted. No input from citizens was received. In a February 2012 letter, Bonnen wrote, "I am greatly concerned that providers are acting beyond the purview of the HB 2129 for forcing smart meter on customers. This was not the intent of the legislation." (See 1-Bonnen) Current investigations in California have exposed significant concerns related to their AMI smart meter implementation. The US Attorney General and the California State Attorney General are investigating Pacific Gas and Electric (PG&E) due to a 2010 gas explosion which killed eight people. During this investigation, 120,000 emails were released revealing collusion and corruption involving California Public Utility Commission (CPUC) Chairman Michael Peevey and PG&E executives. Their emails expose smart meter health issues, over-billing complaints, excessive initial and monthly opt-out fees designed to inhibit individuals from opting out, and the intentional delay of CPUC public hearings until full smart meter deployment was complete. The activities and incriminating statements from the CPUC are relevant to Texas given that PG&E, uses Silver Springs Network AMI and mesh network which is the same technology used by ONCOR (Dallas/Ft Worth and NTX regions), San Antonio's municipally owned CPS Energy, AEP Texas (North/Central Texas) and CenterPoint servicing the Houston area and in millions of homes across Texas. In the 2012 and 2013 Texas Senate Business and Commerce and PUC hearings, Texans testified to the exact same problems being experienced in California. Another smart meter technology used in Texas is from the Sensus Corporation, provider of the FlexNet AMI, which uses "endpoint to base station" signals that transmit two watts of energy per transmission. Citing overheating and fires, in October 2012, 190,000 Sensus meters were removed by Pennsylvania Electric Company. In July 2014, 70,000 Sensus meters were removed in Portland and 105,000 in Saskatchewan Canada resulting in the resignation of SASKPOWER CEO Robert Watson. In addition, Nevada's NV Energy and APS in Arizona are currently being investigated due to recent fires. Silver Springs Network, Sensus and other AMI systems are deployed in over seven million homes across Texas. Billions of taxpayer dollars were spent on an infrastructure that includes smart meters, touting a mere 10-15 year service life, replacing analogs with a 25-30 year service life. Smart meters require perpetual software upgrades as evidenced by Austin Energy's 2013, $60 million software upgrade A multitude of issues and risks associated with the implementation of AMI are outlined in this document including: health, overbilling, cost prohibitive opt-out fees, lack of cost-benefit analysis, customer disinterest in utility usage data, misleading the public, inadequate FCC standards, and failure to disclose public health and safety risks.

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