User-Friendly Techniques to Identify Resistance Mechanisms in Gram-Negative Bacilli (by ASCLS)

5 P.A.C.E. contact hour(s)

(based on 3 customer ratings)

Paul Schreckenberger, PhD, D(ABMM), F(AAM)

Course provided by ASCLS.

This self-study will consist of 4 sessions. Each session will focus on the origin and action of specific resistance mechanism(s) and discuss the procedures to optimize detection as well as appropriate reporting of this resistance to help guide patient care.

Please download and print the 4 files attached:
- Phenotypic Detection Antibiotic Resistance - 12 Disk Method
- LUMC 12 Disk Reporting Form
- References for ESBL Amp C KPC
- Homework Assigment - Session #4

Before starting this course, review "Phenotypic Detection Antibiotic Resistance - 12 Disk Method"
This procedure will be referenced throughout all 4 Sessions.

AFTER you have completed Session #3 and BEFORE you begin Session #4, answer the questions presented on "Homework Assignment - Session #4" This Assignment is intended to assess your understanding, interpretation and application of the various resistance mechanisms presented in Sessions #1- #3.

See more courses in: Microbiology

Continuing Education Credits

P.A.C.E.® Contact Hours (acceptable for AMT, ASCP, and state recertification) (CACMLE): 5 hour(s)
Course number 108-275-15, approved through 12/31/2017
Florida Board of Clinical Laboratory Personnel Credit Hours - General (Microbiology/Mycology/Parasitology): 5 hour(s)
Course number 20-503160, approved through 12/31/2017

Objectives

  • List the Classes of beta-lactamases and recognize ESBL, AmpC, K1, and metallo - Beta-lactamases and their associated resistance mechanisms by observing: patterns of susceptibility with the 12 disk test method, Hodge Test ETest results.
  • Describe the procedures to set up and read the 12 disk test plate, MBL ETest and Hodge Test.
  • Modify antibiotic interpretations based on the resistance mechanism.
  • Add appropriate interpretive comments to susceptibility reports to aid in physician understanding.
  • Describe the pitfalls of susceptibility testing and interpretations when identifying these resistance mechanisms.
  • List the organisms commonly associated with these resistance mechanisms.
  • Describe additional testing to identify the resistance mechanism, if appropriate.
  • Resolve misidentified or unexpected results.

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(based on 3 customer ratings)

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Course Outline

  • PowerPoint Slides
      • Author - Paul Schreckenberger, PhD, D(ABMM), F(AAM)
      • Session #1 - ESBLs, K1 BL, & Introduction to the 10 Disk Method
      • Welcoming Remarks
      • Financial Disclosures
      • Learning Objectives
      • Materials included with your course
      • Detecting Antibiotic Resistance - Is there a problem?
      • Automated Systems
      • Detection of ESBL by semiautomated microbiology systems & manual detection procedures
      • Comparison ESBL Detection Methods
      • Do Mechanisms Count?
      • Do Mechanisms Count?
      • Role of the Microbiology Lab
      • Penicillins and Cephalosporins
      • The beta-lactam family of antibiotics
      • Penicillins: Benzyl-penicillin
      • Penicillins: Methicillin
      • Extended-Spectrum Penicillins and 1st Generation Cephalosporins
      • 2nd, 3rd, & 4th Generation Cephalosporins and Monobactams
      • Cephamycins
      • Carbapenems
      • Mode of Action of Beta-lactams in Gram-negatives
      • Definition of betalactamase
      • Beta-lactamase Classes
      • ESBLs
      • AmpC Beta-lactamases
      • KPCs
      • Extended Spectrum Beta-lactamases - TEM and SHV
      • Extended Spectrum Beta-lactamases - CTX-M and OXA
      • Extended Spectrum Beta-lactamases - Resistance
      • Organisms with Extended Spectrum Beta-lactamases
      • CLSI Confirmatory Test
      • Combination Disk (CLSI) Method
      • CLSI Method - E. coli with ESBL
      • Double Disk Potentiation Method - 10 Disk Test
      • 12 Disk Test
      • FDA-Approved Commercial Tests
      • CLSI Reporting Recommendation
      • Treatment of ESBL + Organisms with Cephalosporins
      • Pitfalls of ESBL Testing: Effects of Inoculum
      • Pitfalls of ESBL Testing: Effects of Inoculum, cont.
      • ESBLs in Organisms other than E. coli & Klebsiella spp.
      • Prevalence of ESBLs at LUMC
      • Pitfalls of ESBL Testing - Recommendations
      • Pitfalls of ESBL Testing: CTX-M
      • Pitfalls of ESBL Testing: CTX-M
      • ESBL Genotypes
      • Vitek Report: E. coli with ESBL
      • E. coli with CTX-M ESBL
      • Post-Analytic Comment
      • Revised Cephalosporin Breakpoints - Enterobacteriaceae
      • Revised Cephalosporin Breakpoints - Enterobacteriaceae (MIC)
      • Enterobacteriaceae - Evaluated but NOT Revised Breakpoints
      • Cephalosporin Breakpoints Following EUCAST & CLSI Revisions
      • Enterobacteriaceae epidemiologic cut-off values: wild types
      • Enterobacteriaceae - Revised Breakpoints (disk)
      • CLSI Guidance - ESBL Testing
      • Why labs should continue ESBL testing on all isolates
      • Why labs should continue ESBL testing on all isolates, cont.
      • Another Complication
      • Pitfalls of ESBL Testing: K1 BL for K. oxytoca
      • Vitek Report: ESBL + Klebisella oxytoca
      • Double-Disk Potentiation Method: K. oxytoca with chromosomal K1 BL
      • MicroScan MIC Panel Results: K. oxytoca with K1 BL
      • END OF SESSION #1
      • SESSION #2 - AmpC BL, Organisms Possessing both ESBL & AmpC
      • Introductory Remarks
      • Learning Objectives
      • The Beta-lactam family of antibiotics
      • AmpC Beta-lactamases: Characteristics
      • AmpC Beta-lactamases: Inducible
      • AmpC Beta-lactamases: Antibiotic Inducer Potential
      • Induction of AmpC
      • Uninduced AmpC
      • Induced AmpC
      • E. cloacae expressing induced chromosomal AmpC
      • E. cloacae with mutational derepressed AmpC
      • Derepressed AmpC
      • E. cloacae derepressed mutant expressing AmpC
      • Over-run by Mutants
      • E. cloacae with Mutant Colonies
      • Mutant's Progeny Over-Runs
      • AmpC Beta-Lactamase: Constitutive Production
      • AmpC Beta-Lactamase: Antibiotic Selectors for Mutants
      • Two 10-Disk Plates: E. cloacae with Inducible AmpC & AmpC Derepressed Mutant
      • Inducible Beta-Lactamases: Recommendations
      • Chromosomal AmpC that is NOT expressing High Level Resistance
      • AmpCs in E. coli
      • AmpCs in E. coli, cont.
      • E. coli Cefoxitin resistant AmpC hyperproducer
      • Plasmid-Mediated AmpCs
      • Plasmid-Mediated AmpCs
      • When to Suspect AmpC PLasmid
      • Vitek Report: E. coli with AmpC?
      • 10 Disk - E. coli with plasmid-mediated AmpC
      • Reporting Plasmid AmpCs in E. coli
      • Pitfalls of ESBL Testing
      • How to determine if both AmpC & ESBLs are present
      • Chromosomal AmpC that is Suspicious for ESBL
      • E. cloacae with chromosomal AmpC & ESBL
      • Amended AST Results for E. cloacae with ESBL
      • Chromosomal AmpC that is NOT Suspicious for ESBL
      • E. cloacae with chromosomal AmpC derepressed mutant and ESBL
      • Detection of ESBL in Enterobacter Isolates
      • Amended AST Report for Chromosomal AmpC that is NOT Suspicous for ESBL
      • Citrobacter freundii with ESBL
      • Evaluation of a New Cefepime-Clavulanate ESBL ETest
      • Differences between ESBL and AmpC Beta Lactamases
      • Some wrinkles . . . .
      • END OF SESSION #2
      • SESSION #3 - CRE, Detection of KPC, NDM, NMCA, & Oxa-type Carbapenemases
      • Introductory Remarks
      • Learning Objectives
      • Carbapenems
      • Carbapenem Resistance in Enterobacteriaceae
      • Need to Distinguish Between Mechanisms of Carbapenem Resistance - Why?
      • Need to Distinguish Between Mechanisms of Carbapenem Resistance - Why?
      • Carbapenemases in U.S.
      • Strategy for Lab Detection of Carbapenemases
      • Ertapenem Etest and Imipenem Disk Test with Break-Through Colonies
      • Modified Hodge Test
      • Carba NP Test for Carbapenemase Production
      • EPI-CRE
      • Rosco Diagnostica IMI/EDTA Disks & MBL ETest bioMerieux
      • KPC - Questions
      • Enterobacteriaceae - Revised Carbapenem Breakpoints (MIC)
      • Enterobacteriaceae - Revised Carbapenem Breakpoints (disk - mm)
      • MHT & EDTA Inhibition Test on isolates that test NS to carbapenems
      • Case 1 - Patient History
      • Case 1: Urine Culture
      • Case 1: Vitek Report
      • Case 1: MIC Results
      • Case 1: 10-Disk Plate
      • Case 1: Modified Hodge Test
      • And the Answer is . . . .
      • Carbapenemases in the U.S.
      • Case 1 - Patient Report
      • Case 2: Blood Culture
      • Case 2: Modified Hodge Test
      • And the Answer is . . .
      • Case 2: Chromosomal AmpC (Derepressed mutant) + Porin mutation
      • Case 2: Blood Culture - 10 Disk Test
      • Case 2 - Patient Report
      • Case 3: Patient History
      • Case 3: MicroScan Report
      • Case 3: 12 Disk Test
      • Case 3: Modified Hodge Test
      • And the Answer is . . .
      • Case 3: Class A - SME Carbapenemase
      • What is unique about SME compared to KPC?
      • Case 3: Final Report with Post-Analytic Comment
      • Case 4: Patient History
      • Case 4: MicroScan Report
      • Case 4: ID Consult
      • Case 4: 12 Disk Test
      • Case 4: Modified Hodge Test
      • Case 4: E. cloacae - MBL Etest, Colistin Disk and Tigecycline Etest
      • And the Answer is . . .
      • Case 4: Class A - NMC-A Carbapenemase
      • IMI/NMC-A Enzymes
      • Case 4 - Patient Report
      • Case 5: Patient History
      • Case 5 - MicroScan Report
      • Case 5 - 12 Disk Test
      • Case 5 - Modified Hodge Test
      • Case 5 - IMI/EDTA Disks & MBL ETest
      • And the Answer is . . .
      • Case 5: Class B - NDM-1 Metallo-Beta-Lactamase
      • NDM-1: New Class B Metallo-Betalactamases
      • Case 5 - MicroScan Report
      • Enterobacteriaceae: Revised Carbapenem Breakpoints (MIC)
      • Case 5 - Patient Report
      • Class D - OXA-48 Carbapenemases
      • OXA-48 Carbapenemases
      • Imipenem vs. Proteeae
      • Imipenem Disclaimers
      • CDC Definition of CRE
      • CDC Definition of CRE
      • CDC Definition of CRE
      • Detect and Protect
      • Recommendations
      • Directions for Homework Assignment
      • Instructions for Completing "Unknown Exercises"
      • Hodge Test Examples
      • 10-Disk Plate Example
      • AST Report Form Example
      • Unknown #1 - E. cloacae
      • AST Report Form for E. cloacae
      • END OF SESSION #3
      • SESSION #4 - Appropriate AST Reporting, Procedures to Detect & Resolve Misidentified or Unexpected Results
      • Introductory Remarks
      • Learning Objectives
      • Answers for Hodge Tests, MBL Etests, and EDTA Disk Tests
      • Hodge Test
      • Hodge Test: #18 - S. marcescens
      • MBL ETest & EDTA Disks: #18 - S. marcescens
      • Hodge Test: #20 - E. coli
      • MBL ETest: #20 - E. coli
      • Hodge Test: #21 - P. stuartii
      • MBL EDTA Disks: #21 - P. stuartii
      • Hodge Test: #22 - K. pneumoniae
      • MBL ETest & EDTA Disks: #22 - K. pneumoniae
      • 10 & 12 Disk Results
      • Unknown #1 - E. cloacae
      • Unknown #1: AST Results for E. cloacae
      • Unknown #2 - K. pneumoniae
      • Unknown #2: AST Results for K. pneumoniae
      • Unknown #3 - E. coli
      • Unknown #3: AST Results for E. coli
      • Unknown #6 -K. oxytoca
      • Unknown #6: AST Results for K. oxytoca
      • Unknown #11 - E. cloacae
      • Unknown #11: AST Results for E. cloacae
      • Unknown #17 - E. coli
      • Unknown #17: AST Results for E. coli
      • Unknown #18 - S. marcescens
      • Unknown #18: AST Results for S. marcescens
      • Unknown #20: E. coli
      • Unknown #20: AST Results for E. coli
      • Unknown #21: P. stuartii
      • Unknown #21: AST Results for P. stuartii
      • Unknown #22 - K. pneumoniae
      • Unknown #22: AST Results for K. pneumoniae
      • Recommendations
      • Resources for understanding specific natural & acquired resistance
      • Resource for using phenotype tests to detect mechanisms of resistance
      • Breakpoint Revision Reminders
      • FDA and CLSI (2014) Breakpoints for GNR
      • Reporting Using New CLSI/FDA Breakpoints
      • Reporting Using New CLSI/FDA Breakpoints, cont.
      • Reporting Using New CLSI/FDA Breakpoints - Validation Study
      • Reporting Using New CLSI/FDA Breakpoints - Verification Study
      • Reporting Using New CLSI/FDA Breakpoints - Test Isolates
      • Reporting Using New CLSI/FDA Breakpoints - Analysis of Data
      • Reporting Using New CLSI/FDA Breakpoints - Validating Panels
      • Q and A
      • END OF SESSION #4

Additional Information

This self-study will consist of 4 sessions. Each session will focus on the origin and action of specific resistance mechanism(s) and discuss the procedures to optimize detection as well as appropriate reporting of this resistance to help guide patient care.
 
Please download and print the 4 files attached:
  - Phenotypic Detection Antibiotic Resistance - 12 Disk Method
  - LUMC 12 Disk Reporting Form
  - References for ESBL Amp C KPC
  - Homework Assigment - Session #4
   
Before starting this course, review "Phenotypic Detection Antibiotic Resistance - 12 Disk Method"
This procedure will be referenced throughout all 4 Sessions.
 
AFTER you have completed Session #3 and BEFORE you begin Session #4, answer the questions presented on "Homework Assignment - Session #4"   This Assignment is intended to assess your understanding, interpretation and application of the various resistance mechanisms presented in Sessions #1- #3. 

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