Microbiology products - Liofilchem

DIAGNOSTICILIOFILCHEM®Microbiology productsMTSLiofilchem ® MIC Test Strip (MTS)FAQsProposed AnswersLiofilchem ® - MIC Test Strip FAQs © 2012Liofilchem ® and the Liofilchem company logo are registered trademarks of LIOFILCHEM s.r.l.1

DIAGNOSTICILIOFILCHEM®Microbiology productsMTSMTS is Difficult to Use?- MTS is made of a special hard matrix, simply pickable bycommon lab forceps. No expensive equipments needed.- No air bubble under the special matrix strip.- Time saving compared to reference methods for the sameM.I.C. range.- As SIMPLE as setting up a disk test.- SensorTurn makes the plate inoculation preciser.- 5 plates x 5 strips/day takes 10 minutes.Liofilchem ® - MIC Test Strip FAQs © 2012Liofilchem ® and the Liofilchem company logo are registered trademarks of LIOFILCHEM s.r.l.2

DIAGNOSTICILIOFILCHEM®Microbiology productsMTSMTS is Difficult to Read?- >90% of results are easy to read.- The best printing design in the market: compare ourmeasuring lines with those of Etest or MICE.- Use Interpretation Table (contained in the box!), TechnicalSheets, Application Guide.- E-mail the pictures to Liofilchem, use iPhone/iPad App.- Practice makes perfect like everything else.Liofilchem ® - MIC Test Strip FAQs © 2012Liofilchem ® and the Liofilchem company logo are registered trademarks of LIOFILCHEM s.r.l.3

DIAGNOSTICILIOFILCHEM®Microbiology productsMTSMTS Expensive?- Cost effective for exact M.I.C.- M.I.C. is necessary for critical infections.- MTS is not for routine AST, ~5-10% cases require exactM.I.C.- 1 critical isolate x 5 MTS (key drugs) ~ $10/CCU patient.- 5 to 10 CCU patients/day – perspective?- “Storage tube” in the box of MTS! Extra cost for Etest.Liofilchem ® - MIC Test Strip FAQs © 2012Liofilchem ® and the Liofilchem company logo are registered trademarks of LIOFILCHEM s.r.l.5

DIAGNOSTICILIOFILCHEM®Microbiology productsMTS10, 30 or 100 strips/pack!- The widest choice of strips for M.I.C. determination in thesize of the pack: 10, 30 or 100 tests.- If infrequent use, ~20% for QC.- Same antibiotics for many applications.- Build up stock for various MTS over time.Liofilchem ® - MIC Test Strip FAQs © 2012Liofilchem ® and the Liofilchem company logo are registered trademarks of LIOFILCHEM s.r.l.6

DIAGNOSTICILIOFILCHEM®Microbiology productsMTSMTS Same as R Screens?- Screens are non-specific and lack specificity.- Screen positives must be confirmed.- MTS phenotypic ARTs are not screens but confirmatorytests.- For critical specimens screens may waste a crucial day.Liofilchem ® - MIC Test Strip FAQs © 2012Liofilchem ® and the Liofilchem company logo are registered trademarks of LIOFILCHEM s.r.l.7

DIAGNOSTICILIOFILCHEM®Microbiology productsMTSHow to Read MTS ½ Dilution?- Round up to next upper 2-fold value before S, I, Rcategorisation.- Advantage of precise M.I.C. from continuos gradient for PK/PD.- Further details are in the package insert.Liofilchem ® - MIC Test Strip FAQs © 2012Liofilchem ® and the Liofilchem company logo are registered trademarks of LIOFILCHEM s.r.l.8

DIAGNOSTICILIOFILCHEM®Microbiology productsMTSHow to Read the Azole Trailing?- Do a demonstration and show how.- Show MTS gelled plates, ETG etc.- Stress importance of good RPMI. (Liofilchem ref. 11509).- Reference broth dilution have similar trailing for azoles.- Not all strains are problematic.- Practice with strains with known M.I.C.s (QC strains).Liofilchem ® - MIC Test Strip FAQs © 2012Liofilchem ® and the Liofilchem company logo are registered trademarks of LIOFILCHEM s.r.l.11

DIAGNOSTICILIOFILCHEM®Microbiology productsMTSImportance of RPMI Brand?- RPMI brands can differ in quality.- Some brands give least trailing.- QC each brand/lot before use.- Refer to MTS QC recommendations.Liofilchem ® - MIC Test Strip FAQs © 2012Liofilchem ® and the Liofilchem company logo are registered trademarks of LIOFILCHEM s.r.l.12

DIAGNOSTICILIOFILCHEM®Microbiology productsMTSMTS for Anaerobes- Provide synergy package of service: CLSI documents,media, anaerobe chambers, QC strains, ETM etc.- Do a demonstration/set up at lab.- Start with QC validation to familiarise.Liofilchem ® - MIC Test Strip FAQs © 2012Liofilchem ® and the Liofilchem company logo are registered trademarks of LIOFILCHEM s.r.l.13

DIAGNOSTICILIOFILCHEM®Microbiology productsMTSAnaerobes Difficult to Test?- CLSI recommends anaerobe testing.- Start with CCU/critical infections.- MTS turn-around time 24 to 48 h.- Do yearly M.I.C. surveillance to validate hospital specificempiric regimens.- Anaerobic infections life-threathening.Liofilchem ® - MIC Test Strip FAQs © 2012Liofilchem ® and the Liofilchem company logo are registered trademarks of LIOFILCHEM s.r.l.14

DIAGNOSTICILIOFILCHEM®Microbiology productsMTSWhy MTS for Blood Cultures?- M.I.C.s needed for critical infections & CCU patients.- Blood & CSF isolates are critical.- MTS detects resistance.- MTS provides on scale M.I.C. values.- Direct MTS M.I.C. with blood and CSF specimen cansave a crucial day.Liofilchem ® - MIC Test Strip FAQs © 2012Liofilchem ® and the Liofilchem company logo are registered trademarks of LIOFILCHEM s.r.l.15

DIAGNOSTICILIOFILCHEM®Microbiology productsMTSOx 1μg Equivalent to MTS?- Oxacillin disk for S or R screen only.- S. pneumoniae - low specificity!- MTS gives M.I.C. to beta-lactam used.- Direct M.I.C. without screen step will win crucial time forCCU patients.- M.I.C. testing recommended by CLSI and EUCAST.- Different M.I.C. break-points for meningitis and nonmeningitisinfections.Liofilchem ® - MIC Test Strip FAQs © 2012Liofilchem ® and the Liofilchem company logo are registered trademarks of LIOFILCHEM s.r.l.16

DIAGNOSTICILIOFILCHEM®Microbiology productsWhy MHA + 2% NaClfor MTS OX and Not for Disk?MTS- MTS is not a disk method.- CLSI recommends MHA + 2 % NaCl for Oxacillin MICtesting.- MTS uses M.I.C. method recommendations.- Refer to the MTS pack insert.- NaCl increases osmolarity and enhances oxacillinresistance expression/detection.Liofilchem ® - MIC Test Strip FAQs © 2012Liofilchem ® and the Liofilchem company logo are registered trademarks of LIOFILCHEM s.r.l.17

DIAGNOSTICILIOFILCHEM®Microbiology productsMTSGISA not a Problem Yet- Do we really know?- Current AST methods lack sensitivity for GISA/hGISAdetection.- CCU patients on long term vancomycin therapy – why noearlier resolution?- Many published references verify clinical existence andrelevance!Liofilchem ® - MIC Test Strip FAQs © 2012Liofilchem ® and the Liofilchem company logo are registered trademarks of LIOFILCHEM s.r.l.18

DIAGNOSTICILIOFILCHEM®Microbiology productsNo Problems with Imipenem -Always in QCMTS- In QC does not mean quality compliance for clinicaltesting (see references).- May get false R if imipenem deteriorated.- Stability problems not picked up by QC.- Cannot afford to loose imipenem due to flase R – a keydrug for CCU!- CDC recommends using MTS to verify questionableimipenem results.Liofilchem ® - MIC Test Strip FAQs © 2012Liofilchem ® and the Liofilchem company logo are registered trademarks of LIOFILCHEM s.r.l.19

DIAGNOSTICILIOFILCHEM®Microbiology productsWhich Pen G Strip to Use:High or Low?MTS- Low M.I.C. range for fastidious and highly susceptibleorganisms.- If high prevalence of PISP and PRP, use high range strip.- High range for anaerobes and Gram-positive aerobes.Liofilchem ® - MIC Test Strip FAQs © 2012Liofilchem ® and the Liofilchem company logo are registered trademarks of LIOFILCHEM s.r.l.20

DIAGNOSTICILIOFILCHEM®Microbiology productsMTSHow to Read Trim/Sulpha?- Explain the 80% inhibition end-point.- Read the first point of significant change of growth asjudged visually.- Use Interpretation Table and Technical Sheets.- Relevant for all bacteriostatic agents.- E-mail photos to Liofilchem if unresolved.Liofilchem ® - MIC Test Strip FAQs © 2012Liofilchem ® and the Liofilchem company logo are registered trademarks of LIOFILCHEM s.r.l.21

DIAGNOSTICILIOFILCHEM®Microbiology productsMTS M.I.C.s Higher forPneumococci & Macrolides ?MTS- Macrolide activity is affected by pH decrease in CO 2incubation.- Affects ALL methods incubated in CO 2 .- MTS uses CO 2incubation so capnophilic organisms growbetter.- QC and interpretive criteria may need adjustment for CO 2vs ambient results.Liofilchem ® - MIC Test Strip FAQs © 2012Liofilchem ® and the Liofilchem company logo are registered trademarks of LIOFILCHEM s.r.l.22

DIAGNOSTICILIOFILCHEM®Microbiology productsMTSHow to Store MTS Strips?- Refer to MTS package insert.- Read insert carefully yourself.- Pay attention to the labels on the packs.- Provide practical tips and give samples of storagecontainer.- Make sure storage details are clearly understood.- Stress that strips must be kept dry.Liofilchem ® - MIC Test Strip FAQs © 2012Liofilchem ® and the Liofilchem company logo are registered trademarks of LIOFILCHEM s.r.l.23

DIAGNOSTICILIOFILCHEM®Microbiology productsMTSMTS is Not Approved by CLSI- CLSI does not approve nor endorse any commercialproducts.- ”Agar gradient method” mentioned in CLSI documentpreface refers to MTS.Liofilchem ® - MIC Test Strip FAQs © 2012Liofilchem ® and the Liofilchem company logo are registered trademarks of LIOFILCHEM s.r.l.24

DIAGNOSTICILIOFILCHEM®Microbiology productsMTSHow Do We Start with MTS?- Review the Technical Sheets to identify testing needs.- Review AST Schemes for ideas.- Provide ”Synergy package” - MTS, media, QC strains etc.- Do a demonstration set up and in-service.- Invite customers to HEAR!Liofilchem ® - MIC Test Strip FAQs © 2012Liofilchem ® and the Liofilchem company logo are registered trademarks of LIOFILCHEM s.r.l.25

DIAGNOSTICILIOFILCHEM®Microbiology productsMTSIs HEAR a Commercial Event?- Review the HEAR programmes and faculty.- Give examples of complete programmes to review.- Refer to local participants who have enjoyed and learnt andknow HEAR.- Stress HEAR is not only about MTS.- Wide range of scientific & clinical issues for therapyguidance addressed.Liofilchem ® - MIC Test Strip FAQs © 2012Liofilchem ® and the Liofilchem company logo are registered trademarks of LIOFILCHEM s.r.l.26