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Clin Infect Dis. 2014 May;58(9):1287-96. doi: 10.1093/cid/ciu043. Epub 2014 Jan 22.

Rationale for eliminating Staphylococcus breakpoints for β-lactam agents other than penicillin, oxacillin or cefoxitin, and ceftaroline.

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Department of Pathology and Laboratory Medicine, Keck School of Medicine, University of Southern California and Children's Hospital Los Angeles.


Due to the ongoing concern about the reliability of Staphylococcus breakpoints (interpretive criteria) for other β-lactam agents, the Clinical and Laboratory Standards Institute recently approved the elimination of all breakpoints for antistaphylococcal β-lactams except for penicillin, oxacillin or cefoxitin, and ceftaroline. Routine testing of penicillin and oxacillin or cefoxitin should be used to infer susceptibility for all β-lactams with approved clinical indications for staphylococcal infections. It is critical for laboratories to reject requests for susceptibility testing of other β-lactams against staphylococci and to indicate that susceptibility to these agents can be predicted from the penicillin and oxacillin or cefoxitin results. This article reviews β-lactam resistance mechanisms in staphylococci, current antimicrobial susceptibility testing and reporting recommendations for β-lactams and staphylococci, and microbiologic data and clinical data supporting the elimination of staphylococcal breakpoints for other β-lactam agents.


CLSI breakpoints; Staphylococcus susceptibility; β-lactams and Staphylococcus

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