Test ID: MMLNS
Antimicrobial Susceptibility, Nocardia species
NY State Approved 
Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
Determining the resistance of species of Nocardia and other aerobic actinomycetes to antimicrobial agents
Additional Tests Lists test(s) that are always performed, at an additional charge, with the initial test(s)
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| SSNS | Susceptibility Nocardia species | No, (Bill Only) | Yes |
Testing Algorithm Delineates situation(s) when tests are added to the initial order. This includes reflex and additional tests.
When this test is ordered, Susceptibility Nocardia species will be performed and charged.
Special Instructions and Forms Describes specimen collection and preparation information, test algorithms, and other information pertinent to test. Also includes pertinent information and consent forms to be used when requesting a particular test
Method Name A short description of the method used to perform the test
Minimum Inhibitory Concentration (MIC)
Antimicrobials for Nocardia species are: ceftriaxone, tobramycin, ciproflazacin, minocycline, imipenem, amikacin, clarithromycin, trimethoprim/sulfamethoxazole, linezolid, augmentin, and moxifloxacin.
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Aliases Lists additional common names for a test, as an aid in searching
Amikacin Sulfate (Amikin)
Amikin (Amikacin Sulfate)
Amoxicillin and Clavulanate Potassium (Augmentin)
Augmentin (Amoxicillin and Clavulanate Potassium)
Ciprofloxacin
Clarithromycin
Imipenim
Linezolid (Zyvox)
MIC (Minimum Inhibitory Concentration)
Minimum Inhibitory Concentration (MIC)
Minocycline
Moxifloxacin
Nocardia Susceptibilities
Sulfamethoxazole
Susceptibility Testing
Tobramycin
Zyvox (Linezolid)
Cefepime
Ceftriaxone
Trimethoprim/sulfamethoxazole
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Specimen Type: Organism
Container/Tube:
Preferred: Middlebrook 7H10 agar slant without antimicrobials
Acceptable: Sabouraud's dextrose agar slant or similar media without antimicrobials (eg, 7H11 agar slant, LJ, MGIT [7H9] broth media)
Specimen Volume: Isolate
Collection Instructions:
1. Organism must be in pure culture, actively growing.
2. Place specimen in a large infectious container (Supply T146) and label as an etiologic agent.
Additional Information:
1. Specimen source is required.
2. See Antimicrobial Susceptibility Tests and Infectious Specimen Shipping Guidelines in Special Instructions.
Forms: If not ordering electronically, submit a Microbiology Request Form (Supply T244) with the specimen.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | NA |
| Lipemia | NA |
| Icterus | NA |
| Other | Agar plate |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| Varies | Ambient (preferred) | |
| Refrigerated | ||
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Nocardia asteroides, the most commonly recognized aerobic actinomycete, causes significant disease in immunocompromised patients. Clinical presentations can include pneumonia, skin abscess, bacteremia, brain abscess, eye infection, and joint infection. Other species associated with human disease include Nocardia brasiliensis, Nocardia otitidiscaviarum, Nocardia farcinica, Nocardia nova, and Nocardia transvalensis.
Treatment usually consists of trimethoprim-sulfamethoxazole, sometimes in combination with other antimicrobials, such as amikacin. However, some patients develop drug allergy, others develop resistant isolates due to noncompliance, and some antimicrobials penetrate the central nervous system better than others. Therefore, the selection of appropriate agents becomes extremely important to patient outcome.
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.
The following are interpretive values for susceptibility testing of Nocardia species using a broth microdilution method.
| Antimicrobial Agent | Concentration Range mcg/mL | Interpretations | ||
| S | I | R | ||
| Trimethoprim/ Sulfamethoxazole(3) | 0.25/4.75-8/152 | < or =2/38 | - | > or =4/76 |
| Linezolid(2) | 1-32 | < or =8 | - | - |
| Ciprofloxacin | 0.12-4 | < or =1 | 2 | > or =4 |
| Imipenem | 2-64 | < or =4 | 8 | > or =16 |
| Moxifloxacin(1,3) | 0.25-8 | - | - | - |
| Cefepime(3) | 1-32 | < or =8 | 16 | > or =32 |
| Augmentin(3) | 2/1-64/32 | < or =8/4 | 16/8 | > or =32/16 |
| Amikacin | 1-64 | < or =8 | - | > or =16 |
| Ceftriaxone(3) | 4-64 | < or =8 | 16-32 | > or =64 |
| Doxycycline | 0.12-16 | < or =1 | 2-4 | > or =8 |
| Minocycline(3) | 1-8 | < or =1 | 2-4 | > or =8 |
| Tobramycin | 1-16 | < or =4 | 8 | > or =16 |
| Clarithromycin | 0.06-16 | < or =2 | 4 | > or =8 |
Interpretation Provides information to assist in interpretation of the test results
Interpretive values for susceptibility testing of Nocardia species using a broth microdilution method. (Values expressed in mcg/mL):
| Antimicrobial Agent | Interpretations | ||
| S | I | R | |
| Trimethoprim/ Sulfamethoxazole(3) | < or = 2/38 | - | > or =4/76 |
| Linezolid(2) | < or =8 | - | - |
| Ciprofloxacin | < or =1 | 2 | > or =4 |
| Imipenem | < or =4 | 8 | > or =16 |
| Moxifloxacin(1,3) | - | - | - |
| Cefepime(3) | < or =8 | 16 | > or =32 |
| Augmentin(3) | < or =8/4 | 16/8 | > or =32/16 |
| Amikacin | < or =8 | - | > or =16 |
| Ceftriaxone(3) | < or =8 | 16-32 | > or =64 |
| Doxycycline | < or =1 | 2-4 | > or =8 |
| Minocycline(3) | < or =1 | 2-4 | > or =8 |
| Tobramycin | < or =4 | 8 | > or =16 |
| Clarithromycin | < or =2 | 4 | > or =8 |
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
No significant cautionary statements
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Corti ME, Villafane-Fioti MF: Nocardiosis: a review. Int J Infect Dis 2003;7:243-250
2. Saubolle MA, Sussland D: Nocardiosis: review of clinical and laboratory experience. J Clin Microbiol 2003;41:4497-4501
3. Brown-Elliott BA, Brown JM, Conville PS, Wallace RJ Jr: Clinical and laboratory features of the Nocardia species based on current molecular taxonomy. Clin Microbiol Rev 2006;19:259-282
Method Description Describes how the test is performed and provides a method-specific reference
A standardized inoculum made from a pure culture of aerobic actinomycete is prepared and inoculated into wells of a microtiter plate containing different concentrations of 13 antimicrobial agents. These include trimethoprim/ sulfamethoxazole, linezolid, ciprofloxacin, imipenem, moxifloxacin, cefepime, augmentin, amikacin, ceftriaxone, doxycycline, minocycline, tobramycin, and clarithromycin.
Growth at specified breakpoints is indicative of resistance.(Wallace RJ Jr, Steele LC: Susceptibility testing of Nocardia species for the clinical laboratory. Diagn Microbiol Infect Dis 1988;9:155-66; Clinical Laboratory Standards Institute: Susceptibility Testing of Mycobacteria, Nocardiae, and Other Aerobic Actinomycetes. CLSI document M24-A, CLSI, Wayne, PA, 2003)
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
One or two times per week; NA
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Performing Laboratory Location The location of the laboratory that performs the test
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's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.
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 Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
87186
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| MMLNS | Susceptibility, Nocardia species | In Process |
External
link
PDF
document
Excel
document
Word
document