Attachment 4i - Final Aggregate Report - example

Analyses of June 2006 M. tuberculosis and Nontuberculous Mycobacteria Drug Susceptibility Test Results
Reported by Participating Laboratories
This report analyzes the laboratory test results reported to the Centers for Disease Control and Prevention (CDC)
by participant laboratories for the four Mycobacterium tuberculosis complex and one M. simiae strain shipped in June 2006.
Participant laboratories received either four M. tuberculosis complex strains only or four M. tuberculosis complex strains and
one nontuberculous mycobacteria (NTM) strain. Testing results were received and analyzed from 135 of 144 (93.8%)
laboratories participating in this shipment. Of the laboratories submitting results, 92 (68.1%) reported via the online data entry
system, a 20% increase over the January 2006 shipment.
Descriptive Information on Participant Laboratories
Laboratory classifications reported by the 135 participants are:
•
•
•
•

79 (58.5%) health departments,
39 (28.9%) hospitals,
12 (8.9%) independent laboratories, and
5 (3.7%) other type of laboratories.

Figure 1 shows the distribution of the annual volume of M.tuberculosis susceptibility testing performed by participants. The
numbers on top of the bars indicate the number of laboratories at the upper limit of that group.
Figure 1: Distribution of the Annual Volume of M. tuberculosis Isolates Tested for Drug Susceptibility by Participating Laboratories
in Calendar Year 2005.
25

23
N=134

21
20

Number of Laboratories Responding

18

18

18

15

12
10
10

5
5

3

3

3

1281-2560

>2560

0
0-5

6-10

11-20

21-40

41-80

81-160

161-320

321-640

641-1280

Number of Isolates Tested per Year

According to the annual volume of testing reported, some laboratories perform less than one drug susceptibility test per month.
Laboratories performing these low testing volumes may want to consider referring drug susceptibility tests to other facilities.
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CDC TB DST Results – 2006-06

Biosafety Levels of Participant Laboratories
The biosafety levels (BSL) reported by participant laboratories for handling M. tuberculosis are:
•
•
•

BSL-3, 76 participants,
BSL-2 with facilities with level 3 containment equipment, 45 participants,
BSL-2, 14 participants.

All laboratories are strongly encouraged to consult the CDC/NIH manual, Biosafety in Microbiological and Biomedical
Laboratories (4th Edition), which can be accessed on the web at http://www.cdc.gov/od/ohs/biosfty/bmbl4/bmbl4toc.htm, for
recommendations and to determine their correct biosafety level.
Laboratory Test Procedures
Figure 2 shows the number of laboratories by the type of procedure used for drug susceptibility testing.
Figure 2: Procedures Used by the Participating Laboratories for M. tuberculosis Drug Susceptibility Testing
80

70
70
N=135*

Number of Laboratories Responding

60

57

50

38

40

30

20

10

7
4

0
Radiometric**

MGIT†

Agar proportion‡

Other§

L-J Proportion

Test Procedures

* Some participants reported more than one test method.
** Radiometric is BACTEC 460TB
† MGIT, Mycobacteria Growth Indicator Tube (BACTEC MGIT 960)
‡ Agar proportion using Middlebrook 7H10 or 7H11 medium.
§ Other methods listed were microtiter, BacT/ALERT, VersaTREK ESP and Colorimetric method for determining MICs with Alamar Blue, Pyrazinamidase test, and
resistance ratio method (RRM) on LJ genotype MTBDR HAIN Lifescience.

Some methods, such as the RRM and BacT/ALERT, reflect procedures used by international participants.

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CDC TB DST Results - 2006-06

M. tuberculosis Complex Strains Test Results:
To facilitate comparison among laboratories, the aggregate test results are provided in Tables 1.0 through 1.3 at the end of this
document, representing strains F, G, H and I. The tables for the M. tuberculosis complex strains F, G, H, and I include the results
for the radiometric (BACTEC), agar proportion (AP), Lowenstein-Jensen (L-J) proportion, MGIT and other methods at each
concentration of drug.
In the tables, the concentrations recommended by CDC and the Clinical and Laboratory Standards Institute (CLSI) for the
primary [isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB)] and secondary [streptomycin (SM),
ethionamide (THA), kanamycin (KM), capreomycin (CM), and p-amino-salicylic acid (PAS)] antituberculosis drugs are
highlighted for the conventional and radiometric methods.

3

CDC TB DST Results - 2006-06

Strain F and strain I are duplicate strains of Mycobacterium tuberculosis, resistant to ethambutol at 5.0 µg/ml by agar
proportion and MGIT methods, and at 2.5 µg/ml of ethambutol by BACTEC 460TB. See Tables1.0 and 1.3, respectively.
The table below shows the side-by-side comparison of the results reported to CDC by participant laboratories.
Table: Ethambutol Resistance reported by participant laboratories for Strains F and I.*
Method (drug concentration)
AP (5.0 µg/ml)
MGIT (5.0 µg/ml)
BACTEC 460TB (2.5 µg/ml)

Strain F % resistant
(#of laboratories)
66.7% (20/30)
54.7% (29/53)
98.2% (55/56)

Strain I % resistant
(# of laboratories)
69.0% (20/29)
55.8% (29/52)
98.2% (54/55)

* One laboratory reported both strains as sensitive to EMB at 5.0 µg/ml using ESPII.
Ethambutol is a first-line antituberculous drug used for treating all forms of tuberculosis. It is included in the initial treatment
regimens primarily to prevent emergence of RIF resistance when primary resistance to INH may be present. 1 Exposure of EMB
sensitive mycobacteria results in the accumulation of mycolic acid leading to cell death. 2
The presence of microcolonies may represent true resistance, partial resistance, or may be a result of drug degradation followed
by an overgrowth of susceptible organisms. It has been reported that most strains that had microcolonies with EMB in the agar
,
proportion method had EMB-susceptible results with BACTEC 460TB. 3 4
The significance of microcolonies is unknown. Since the frequency of microcolonies may vary from one laboratory to another,
each laboratory should determine how to best report results. 5
Strain G, M. tuberculosis- INH resistant at 0.2 µg/ml by the agar proportion method. See Table 1.1.
This strain is a recently isolated clinical culture which demonstrated mono-resistance to low concentrations
(0.1-0.2 µg/ml of INH).
Isoniazid has two recommended concentrations for the AP method (0.2 µg/ml and 1.0 µg/ml) and equivalent concentrations for
BACTEC 460TB and MGIT (0.1 µg/ml and 0.4 µg/ml, respectively).
For participants using agar proportion,
•
•

75.9% (22/29) reported resistance at 0.2 µg/ml,
100% (31/31) of the laboratories reported the isolate as susceptible at 1.0 µg/ml.

For participants using BACTEC 460,
•
•

98.4% (61/62) reported resistance at 0.1 µg/ml,
100 % (17/17) of the laboratories reported the isolate as susceptible at 0.4 µg/ml.

For participants using MGIT,
•
•

96.3% (52/54) detected resistance at 0.1 µg/ml and
96.1% (25/26) detected susceptibility at 0.4 µg/ml.

4

CDC TB DST Results - 2006-06

Strain H, M. tuberculosis, was resistant to rifampin at 2.0 µg/ml by the BACTEC method and to ciprofloxacin (a
fluoroquinlone) at 2.0 µg/ml by the agar proportion and BACTEC 460TB methods. See Table 1.2.
One hundred thirty-five participants reported results for strain H:
•
•
•

58.6% (34/58) using BACTEC 460TB reported resistance to RIF at 2.0 µg/ml, and
69.7% (23/33) of the participant laboratories using the agar proportion method reported resistance to rifampin at the
equivalent concentration of 1.0 µg/ml, and
28.3% (15/53) using MGIT reported resistance at 1.0 µg/ml.

Nineteen laboratories tested ciprofloxacin. Of the 12 laboratories that tested ciprofloxacin at 2.0 µg/ml:
•
•

66.7% (6/9) using the agar proportion method detected resistance, and
75.0% (3/4) using BACTEC 460TB method detected resistance.

Ofloxacin, the class representative for the fluoroquinolones, was tested by 24 laboratories. Eighteen of those laboratories tested
ofloxacin at the recommended concentration of 2.0 µg/ml.
Of those 18 laboratories:
• 77.8% (7/9) using the agar proportion method detected resistance,
• 75.0% (6/8) using BACTEC 460TB detected resistance, and
• One laboratory using MGIT reported this isolate susceptible.
Several laboratories tested both ofloxacin and ciprofloxacin. There were no discrepant results reported by laboratories that
tested both drugs at 2.0 µg/ml.
Note: This strain proved problematic for many of the participating laboratories. One laboratory reported a mutation in the 81bp
core region of rpoB gene at codon His526. Several mutations in the rpoB gene have been shown to confer rifampin resistance. 6,7
Note: Our providing test results for all drugs that are reported to CDC by participant laboratories should not be construed as a
recommendation or endorsement for testing particular drug concentrations with patient isolates of the M. tuberculosis complex.
It is assumed that some of the drugs are being tested for research purposes or potential use in the few referral institutions that
may treat patients with M. tuberculosis isolates resistant to almost all standard drugs. Laboratories should not add drugs to their
testing regimen without consulting physicians having expertise in treating multi-drug resistant tuberculosis. Laboratories may
contact their local TB control program for referrals of physicians with experience and expertise in treating multi-drug resistant
tuberculosis.

5

CDC TB DST Results - 2006-06

Nontuberculous Mycobacteria-Strain J, M. simiae
Twenty-seven laboratories performed susceptibility testing on M. simiae. Figure 3 shows the procedures used.
Figure 3: Procedures Used by Participating Laboratories Testing Strain J, M. simiae

11

Agar Proportion

8

BACTEC 460

4

Testing Procedures

Microtiter

MGIT

2

Agar Disk elution

2

L J RRM**

1

L J Proportion

1

0

2

N=27*

4

6

8

10

12

Number of Laboratories Responding

*Some participants reported more than one test method. Therefore, the total is greater than the number of laboratories
reporting results.
** LJ RRM, resistance ratio method

M. simiae case history:
Patient: The patient was an 87 year old woman who had been in good health until 85 years of age when she noticed increasing
dyspnea. After an acute episode of shortness of breath and cough, her chest x-ray was found to be abnormal, and her sputum
was positive for acid fast bacilli (AFB). She was admitted to the hospital, where admission radiographs showed extensive
infiltrates in both left and right lower lobes with generalized fibrosis.
Laboratory Findings: Sputum cultures were positive for Mycobacterium simiae. Cultures remained positive for this organism
over a period of two years (13 isolates) despite treatment with isoniazid, streptomycin, ethambutol, and cycloserine; she was lost
to follow-up.
M. simiae is an uncommon cause of pulmonary and disseminated infection. For patients with proven disease, initial therapy may
be started with the regimen recommended for M. avium complex (clarithromycin, ethambutol, rifabutin and streptomycin).
According to the Clinical and Laboratory Standards Institute (CLSI), susceptibility testing should include the same primary and
secondary drugs used for M. kansasii, with the use of the same interpretive criteria. No specific susceptibility test method has
been recommended for M. simiae. Antimicrobial agents recommended for testing M. simiae are found on pages 20, 23-24, and
Table 6 on page 38 in the CLSI Guidelines.5 The drugs recommended for testing are rifampin (primary) and the secondary
drugs, rifabutin, ethambutol, isoniazid, streptomycin, clarithromycin, amakacin, ciprofloxacin, moxifloxacin, and trimethoprimsulfamethoxazole or sulfamethoxazole. 8 Treatment for M. simiae is difficult and optimal pharmacological management has not
been determined. However, a regimen of a macrolide (such as clarithromycin or azithromycin), TMP-SMX and moxifloxacin is
recommended by most experts.
6

CDC TB DST Results - 2006-06

Susceptibility results:
Of the 27 laboratories reporting susceptibility testing for M. simiae,
•
•
•

100% (15/15) reported resistance to RIF at 1.0 µg/ml and 2.0 µg/ml,
100% (12/12) reported resistance to EMB at 5.0 µg/ml, and
2 laboratories reported M. simiae as susceptible to clarithromycin at 16.0 µg/ml by AP and MGIT methods.

See Tables 2 and 3 for complete susceptibility testing results reported for M. simiae.
The addition of NTM strains to this performance evaluation program should not be interpreted as a recommendation for
laboratories to adopt NTM drug susceptibility testing, especially if the laboratory has limited experience with these tests
and methods. We encourage laboratories that perform NTM drug susceptibility testing to consult recommendations,
references, and physicians with expertise in infectious diseases when selecting test methods, drugs, and test interpretations.

7

CDC TB DST Results - 2006-06

Tables
The test results are listed in the appropriate (susceptible or resistant) columns with a corresponding total number of tests (Sum)
column provided as a denominator for determining the level of consensus. This report contains all results reported by
participating laboratories, including many drug concentrations with only one result.
The CDC and CLSI recommendations reflect the critical concentrations of anti-tuberculosis drugs in 7H10 agar and those
concentrations for the BACTEC 460TB method that directly correlate with the critical concentrations in the conventional
method. 9, 10 , 11 , 12 These critical values are highlighted. When two concentrations are highlighted, such as for isoniazid and
ethambutol, the lower value is the critical concentration which should always be included for determining whether the M.
tuberculosis isolate is resistant.
Participants should note that the Clinical and Laboratory Standards Institute approved standard “Susceptibility Testing of
Mycobacteria, Nocardiae, and Other Aerobic Actinomycetes,” M24-A (ISBN 1-56238-500-3) CLSI, 940 West Valley Road,
Suite 1400, Wayne, Pennsylvania 19087-1898, USA, 2003 recommends testing streptomycin as a secondary drug and also adds
ofloxacin and rifabutin to the list of recommended secondary drugs.
Concentrations are listed in micrograms per milliliter, µg/ml.

Acknowledgments

Special thanks to the following persons for reviewing this report: Nancy G. Warren, Ph.D., Pennsylvania Department of Health;
Barbara Brown-Elliott, M.S., University of Texas at Tyler, TX; Beverly Metchock, Dr. PH; Pamela H. Robinson, CDC/Atlanta;
Wendy Gross, M.S., TB Reference Laboratory, West Haven, CT; G. David Cross, M.S., CDC/Atlanta; and Bereneice Madison,
Ph.D., CDC/Lusaka, Zambia.

8

CDC TB DST Results - 2006-06

Table 1.0: Participant Results for culture F, M. tuberculosis resistant to ethambutol at 5.0 µg/ml.
Test Method

DRUG
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Rifampin
Rifampin
Rifampin
Rifampin
Rifampin
Rifampin
Rifampin
Rifampin
Rifampin
Rifampin
Rifampin
Rifampin
Pyrazinamide
Pyrazinamide
Pyrazinamide
Pyrazinamide
Pyrazinamide
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Streptomycin

Conc
0.03
0.05
0.06
0.10
0.12
0.20
0.40
0.50
1.00
5.00
10.00
100.00
0.08
0.12
0.25
0.50
1.00
2.00
5.00
8.00
16.00
32.00
40.00
50.00
64.00
99.00
100.00
300.00
400.00
1.0
1.6
2.0
2.5
3.2
4.0
5.0
6.40
7.50
8.00
10.00
16.00
32.00
0.25
0.50
1.00
2.00
4.00
5.00
6.00
7.50
8.00
10.00
15.00
30.00

AP
Results
S
R Sum

BACTEC
Results
S
R Sum

60
1
29

1
29

31
5

31
5

33
1
4

33
1
4

1

LJ Prop
Results
S
R Sum

61

3
15

3
15

4

4

2
6
61

2
6
61

1

1

4
1
2

1
2

2
1

2
1

1

1

1

55

15

1

16

1

53
2

53
2

Other Tests
Results
S
R Sum
1
1
1
1
1
1
2
1
3
1
1
1
1

1
1
1

1
1
1
1
2
2

1
1
1
1
2
2

1
1
1

1
1
1

1

1

2

2

1

3
1
1
53
1

54
4

1

1
52
1

MGIT
Results
S
R Sum

3
1

1

1

1
1

45

1

46

1
1

1
1

2
1

55

56

30

3

2
4

2
7

1

11

3

14

2

4

1
2

2
1

10
1

20

1
1

1

24
4

29

53

1
1

4
1

10

30
1

22

1
1
1

1
1

1
1
1
1
1
2

10

30
1

1
52
2

1
52
2

11

11

22

1

1

3
1

3
1

39
2
6

1
1
1
1
1
1
1
1

1

9

39
2
6

1
1
1
1
1
1
1

1
1

1
1
1

1
1

1
1

1

CDC TB DST Results - 2006-06

Table 1.0: Participant Results for culture F, M. tuberculosis resistant to ethambutol at 5.0 µg/ml
Test Method

DRUG
Ethionamide
Ethionamide
Ethionamide
Ethionamide
Ethionamide
Ethionamide
Ethionamide
Ethionamide
Ethionamide
Kanamycin
Kanamycin
Kanamycin
Kanamycin
Kanamycin
Capreomycin
Capreomycin
Capreomycin
Capreomycin
Capreomycin
Capreomycin
Capreomycin
Capreomycin
Capreomycin
Capreomycin
Cycloserine
Cycloserine
Cycloserine
Cycloserine
Cycloserine
Cycloserine
Cycloserine
Cycloserine
Cycloserine
p-Aminosalicylic acid
p-Aminosalicylic acid
p-Aminosalicylic acid
p-Aminosalicylic acid
p-Aminosalicylic acid
p-Aminosalicylic acid
Amikacin
Amikacin
Amikacin
Amikacin
Amikacin
Amikacin
Amikacin
Amikacin
Amikacin
Amikacin
Amikacin
Amikacin

Conc
1.00
1.25
2.00
2.50
4.00
5.00
10.00
20.00
40.00
5.00
6.00
10.00
20.00
40.00
0.50
1.00
1.25
5.00
6.00
10.00
12.50
25.00
40.0
50.0
10.0
12.0
20.0
24.0
25.0
30.0
40.0
48.0
60.0
0.50
1.00
2.00
4.00
8.00
10.00
0.50
1.00
2.00
2.50
4.00
5.00
6.00
7.50
8.00
12.00
15.00
30.00

AP
Results
S
R Sum

21
4

11
12

21
4

11
12

BACTEC
Results
S
R Sum
1
1
2
2
1
1
3
3
1
1
1
1
2

4

1
2
1
16

LJ Prop
Results
S
R Sum

1
1

1
1

1
1
1

1
1
1

1
1
1

1
1
1

1
1

1
1

1
1

1
1

1

1

1

1

1

1

1

1

1
1

1
1

1

1

1
1

1
1

1
2

1
16

1

1
1

1
9

1
9

1

1

1
1

16

16

2
4

2
4

1
1

1
1

3

3

7

7

2

2

2
2
1
1
1

2
2
1
1
1

1

1

1

1
1

1
2

2

Other Tests
Results
S
R Sum

4

1
1

MGIT
Results
S
R Sum

1
2

2

10

CDC TB DST Results - 2006-06

Table 1.0: Participant Results for culture F, M. tuberculosis resistant to ethambutol at 5.0 µg/ml
Test Method

DRUG
Ofloxacin
Ofloxacin
Ofloxacin
Ofloxacin
Ofloxacin
Ofloxacin
Ofloxacin
Ofloxacin
Ciprofloxacin
Ciprofloxacin
Ciprofloxacin
Ciprofloxacin
Ciprofloxacin
Ciprofloxacin
Ciprofloxacin
Clarithromycin
Clarithromycin
Clarithromycin
Clofazimine
Clofazimine
Clofazimine
Clofazimine
Clofazimine
Clofazimine
Clofazimine
Clofazimine
Rifabutin
Rifabutin
Rifabutin
Levofloxacin
Levofloxacin
Levofloxacin
Moxifloxacin
Gatifloxacin

Conc
0.50
1.00
1.25
2.00
2.50
4.00
5.00
8.00
0.5
1.0
1.6
2.0
3.2
4.0
6.4
6.00
12.00
24.00
0.06
0.12
0.25
0.50
1.00
17.50
35.00
70.00
0.50
1.00
2.00
1.00
2.00
4.00
0.50
2.00

AP
Results
S R Sum

BACTEC
Results
S
R Sum

3

3

2

9

9

7

1

1

3

3

2

2

1

8

2

4

4

9

9

4

4

2

2

1

1

4
1
5

4
1
5

MGIT
Results
S
R Sum

1

1

2

2

1
2
1
1

LJ Prop
Results
S
R Sum

1

1

1
1

1

1

1

1
1
1

1
1
1

1

1

1
1
1
1

1
1
1
1

2
2
1
1

1

1

2
1

2
1

1
1
1
1
1
1
1
1

1
1

Other Tests
Results
S
R Sum
1
1
1
1
1
1

1
1
1
1
1
1
1

1

1
1

11

CDC TB DST Results - 2006-06

Table 1.1: Participant Results for Culture G, M. tuberculosis, resistant to isoniazid at 0.2 µg/ml
Test Method

DRUG
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Rifampin
Rifampin
Rifampin
Rifampin
Rifampin
Rifampin
Rifampin
Rifampin
Rifampin
Rifampin
Rifampin
Rifampin
Pyrazinamide
Pyrazinamide
Pyrazinamide
Pyrazinamide
Pyrazinamide
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Streptomycin

Conc
0.03
0.05
0.06
0.10
0.12
0.20
0.40
0.50
1.00
2.00
5.00
10.00
100.00
0.08
0.12
0.25
0.50
1.00
2.00
5.00
8.00
16.00
32.00
40.00
50.00
64.00
99.00
100.00
300.00
400.00
1.0
1.6
2.0
2.5
3.2
4.0
5.0
6.4
7.50
8.00
10.00
16.00
32.00
0.25
0.50
1.00
2.00
4.00
5.00
6.00
7.50
8.00
10.00
15.00

AP
Results
S
R Sum

7

1
22

1
29

31

31

4

4

BACTEC
Results
S
R Sum

1

61

62

1
17

2

3
17

4
1

4
1

LJ Prop
Results
S
R Sum

2

2

MGIT
Results
S
R Sum

2

52

54

25

1

26

4

1
2

1
2

2
1

2
1

Other Tests
Results
S
R Sum
1
1
1
1
1
1
3
3
1
1
1
1

1
1
1
1

1

32
1
5

32
1
5

2
6
61

2
6
61

1

1

1
1

1
53
1

54
2
6
12

30

30

2
6

1

1

12

53
2

1
1
1

1
1
1

1

1

3
1

1

1

1
1

1
1

4
54

53
2

1
1
1
1
2
2

1

3
1
1
53
1

1

1
1
1
2
2

41

3

44

2

1

1

2

1

1
1
1

1
1

4

1

1

2

53

53

3

3

1
1
1
1
1
2

11

11
1
1

1
1
1

1
1
1
1
1
1
1

1
1
1

1
1
1

1

1

1
1
28
1

23

1
1
1
1
1
2

1

29
1

1
51
2

1
51
2

11

11

23

1
3
1

1

12

1
3
1

37
2
6

2

39
2
6

1

CDC TB DST Results - 2006-06

Table 1.1: Participant Results for Culture G, M. tuberculosis, resistant to isoniazid at 0.2 µg/ml
Test Method

DRUG
Ethionamide
Ethionamide
Ethionamide
Ethionamide
Ethionamide
Ethionamide
Ethionamide
Ethionamide
Ethionamide
Kanamycin
Kanamycin
Kanamycin
Kanamycin
Kanamycin
Capreomycin
Capreomycin
Capreomycin
Capreomycin
Capreomycin
Capreomycin
Capreomycin
Capreomycin
Capreomycin
Capreomycin
Cycloserine
Cycloserine
Cycloserine
Cycloserine
Cycloserine
Cycloserine
Cycloserine
Cycloserine
Cycloserine
p-Aminosalicylic acid
p-Aminosalicylic acid
p-Aminosalicylic acid
p-Aminosalicylic acid
p-Aminosalicylic acid
p-Aminosalicylic acid
Amikacin
Amikacin
Amikacin
Amikacin
Amikacin
Amikacin
Amikacin
Amikacin
Amikacin
Amikacin
Amikacin
Amikacin

Conc
1.00
1.25
2.00
2.50
4.00
5.00
10.00
20.00
40.00
5.00
6.00
10.00
20.00
40.00
0.50
1.00
1.25
5.00
6.00
10.00
12.50
25.00
40.0
50.0
10.0
12.0
20.0
24.0
25.0
30.0
40.0
48.0
60.0
0.50
1.00
2.00
4.00
8.00
10.00
0.50
1.00
2.00
2.50
4.00
5.00
6.00
7.50
8.00
12.00
15.00
30.00

S

15
2

AP
Results
R
Sum

7
1

22
3

BACTEC
Results
S R
Sum
1
1
1
1
1
1
1 2
3
1
1
2
2

S

LJ Prop
Results
R
Sum

10
12

3

1
2
1
15

1

1
1

1
1
1

1
1
1

1

1
1
1

1
1

1
1

1
1

1
1

1

1

1

1

1

1

1

1

1
2

1
2

1

1

1
1

1
1

1
2

1
15

1

1
1

1
9

1
9

1

1

17

17

2
4

2
4

1
1
1
3

1
1
1
3

6

6

1

1
1

1

2

1

3

1
1

Other Tests
Results
S R
Sum

1
1

10
12

S

MGIT
Results
R
Sum

2

2

2
2
1
1
1

2
2
1
1
1

1

1

1
1

1
1

1
2

2

13

CDC TB DST Results - 2006-06

Table 1.1: Participant Results for Culture G, M. tuberculosis, resistant to isoniazid at 0.2 µg/ml
Test Method
AP
Results
DRUG
Ofloxacin
Ofloxacin
Ofloxacin
Ofloxacin
Ofloxacin
Ofloxacin
Ofloxacin
Ofloxacin
Ciprofloxacin
Ciprofloxacin
Ciprofloxacin
Ciprofloxacin
Ciprofloxacin
Ciprofloxacin
Ciprofloxacin
Clarithromycin
Clarithromycin
Clarithromycin
Clofazimine
Clofazimine
Clofazimine
Clofazimine
Clofazimine
Clofazimine
Clofazimine
Clofazimine
Clofazimine
Rifabutin
Rifabutin
Rifabutin
Levofloxacin
Levofloxacin
Levofloxacin
Levofloxacin
Moxifloxacin
Moxifloxacin
Gatifloxacin

Conc
1.00
1.20
1.25
2.00
2.50
4.00
5.00
8.00
0.5
1.0
1.6
2.0
3.2
4.0
6.4
6.00
12.00
24.00
0.06
0.12
0.25
0.50
1.00
2.00
17.50
35.00
70.00
0.50
1.00
2.00
1.00
1.20
2.00
4.00
0.50
1.00
2.00

S
4
1

R

Sum

BACTEC
Results
S

4
1

R
2

LJ Prop
Results

Sum

S

R

Sum

MGIT
Results
S

R

Sum

Other Tests
Results
S

R

1
8
1

8
1

6

1

7

3

3

2

2

1

1

1

1

1
1
1
1
1

3

3

4

4

7

7

4

4

2

2
2
1
1
1

4
1
4

1

1

1

1

1
1
1
1

1
1
1
1

2

2
2
1
1
1

1

1
1
1

1
1
1

1
1
1
1
1
1

2
1

1
1
1
1
1

1
1

1

4
1
4

Sum

2

1
1
1
1
1
1
1

1

2
1

1
1
1

14

CDC TB DST Results - 2006-06

Table 1.2: Participant Results for Culture H, M. tuberculosis, resistant to rifampin and ciprofloxacin at 2.0µg/ml
Test Method

DRUG
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Rifampin
Rifampin
Rifampin
Rifampin
Rifampin
Rifampin
Rifampin
Rifampin
Rifampin
Rifampin
Rifampin
Rifampin
Pyrazinamide
Pyrazinamide
Pyrazinamide
Pyrazinamide
Pyrazinamide
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Streptomycin

Conc
0.03
0.05
0.06
0.10
0.12
0.20
0.40
0.50
1.00
5.00
10.00
100.00
0.08
0.12
0.25
0.50
1.00
2.00
5.00
8.00
16.00
32.00
40.00
50.00
64.00
99.00
100.00
300.00
400.00
1.00
1.60
2.00
2.50
3.20
4.00
5.00
6.40
7.50
8.00
10.00
16.00
32.00
0.25
0.50
1.00
2.00
4.00
5.00
6.00
7.50
8.00
10.00
15.00
30.00

S

AP
Results
R
Sum

1
30

1
30

32
5

10
1
5

32
5

23

33
1
5

BACTEC
Results
S
R Sum

60

60

3
15

3
15

4

4

3
24

2
3
34
1

1

LJ Prop
Results
S
R
Sum

4

1
2

2
1

2
1

1

1

1

1

3
1
1
52
1

31
1
10

31
1

23

2

1

1
53
1

54

54

33

2
5

2
6

1

11

1

52

3

55

15

1

16

4

1
2

2
6
58
1
1

S

MGIT
Results
R
Sum

38
2

15

1
1
1
1

1
1
1
1

1
1
1

1
1
1
1
2
2

1
1
1

1
1
1

1
2
2

3
1

1

1

1
1

1
1

4

4

46

46

1

11

1

1

2

2

1
1

1
1
1

1

2

1
1
1
1
1
2

1
1
1
1
1
1
1

1
1
1
1
1
1
1

1
2

1

53
2

Other Tests
Results
S
R Sum
1
1
1
1
1
1
2
1
3

52
3

2

1

53

1
1
1

3

1

10

31
1

1
52
2

1
52
2

11

11

23

1

1

3
1

3
1

39
2
6

1

1

15

39
2
6

1
1

1
1
1

1
1

1
1

1

CDC TB DST Results - 2006-06

Table 1.2: Participant Results for Culture H, M. tuberculosis, resistant to rifampin and ciprofloxacin at 2.0µg/ml
Test Method

DRUG
Ofloxacin
Ofloxacin
Ofloxacin
Ofloxacin
Ofloxacin
Ofloxacin
Ofloxacin
Ofloxacin
Ofloxacin
Ciprofloxacin
Ciprofloxacin
Ciprofloxacin
Ciprofloxacin
Ciprofloxacin
Ciprofloxacin
Ciprofloxacin
Clarithromycin
Clarithromycin
Clarithromycin
Clofazimine
Clofazimine
Clofazimine
Clofazimine
Clofazimine
Clofazimine
Clofazimine
Clofazimine
Rifabutin
Rifabutin
Rifabutin
Rifabutin
Rifabutin
Levofloxacin
Levofloxacin
Levofloxacin
Moxifloxacin
Gatifloxacin

Conc
1.00
1.25
2.00
2.50
4.00
5.00
8.00
16.00
32.00
1.00
1.60
2.00
3.20
4.00
6.40
8.00
6.00
12.00
24.00
0.06
0.12
0.25
0.50
1.00
17.50
35.00
70.00
0.50
1.00
2.00
8.00
16.00
1.00
2.00
4.00
0.50
2.00

AP
Results
S
R
Sum
4
4

BACTEC
Results
S
R
Sum
2
2

LJ Prop
Results
S
R
Sum

MGIT
Results
S
R
Sum

2

2

1

1

7

9

1

1

6

8

3

3

2

2

1

Other Tests
Results
S
R
Sum
1

1

1

1

1

1

1

1
1

1

1

1
1

1
1

1

1

3

3

3

1

3

4

6

9

1

3

4

2

2
1

1
1
1
2
2
1
1
1

2
2
1
1

1
1

1

1
1
1
3
1
5

1

4
1
5

1

1
1
2

1
1

1

2
1

1
1

1
1
1
1
1

1

1

1

1
1
1
1

1
1

16

CDC TB DST Results - 2006-06

Table 1.3: Participant Results for Culture I, M. tuberculosis, resistant to ethambutol at 5.0 µg/ml

Test Method

DRUG
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Rifampin
Rifampin
Rifampin
Rifampin
Rifampin
Rifampin
Rifampin
Rifampin
Rifampin
Rifampin
Rifampin
Pyrazinamide
Pyrazinamide
Pyrazinamide
Pyrazinamide
Pyrazinamide
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Streptomycin

Conc
0.03
0.05
0.06
0.10
0.12
0.20
0.40
0.50
1.00
5.00
10.00
100.00
0.12
0.25
0.50
1.00
2.00
5.00
8.00
16.00
32.00
40.00
50.00
64.00
99.00
100.00
300.00
400.00
1.00
1.60
2.00
2.50
3.20
4.00
5.00
6.40
7.50
8.00
10.00
16.00
32.00
0.25
0.50
1.00
2.00
4.00
5.00
6.00
7.50
8.00
10.00
15.00
30.00

AP
Results
S
R
Sum

BACTEC
Results
S
R
Sum

59
1
28

1
28

30
4

30
4

32
1
4

32
1
4

1

LJ Prop
Results
S
R
Sum

60

2
14

2
14

4

4

2
6
60

2
6
60

1

1

54
4

16
1
2

1
2

2
1

2
1

1

1

2
54

55

29

1
2

1
5

2
7

1

10

3

13

1

16

53
2

53
2

1
1
1
1

1
1
1
1

1
1
1
2
2

1
1
1
2
2

1
1
1

1
1
1

1

1

2

2

3
1

1

1

1

55

Other Tests
Results
S
R
Sum
1
1
1
1
1
1
2
1
3

1

3
1
1
52
1

1

4

1

1
52
1

MGIT
Results
S
R
Sum

1

1
1

2

4

45

1

46

1
1
1
1

1

2
1

9
1

20

1
1

1

23
3

29

52

1
1

3
1

10

29
1

21

1
1
1

1
1

1
1
1
1
1
2

10

29
1

1
51
2

1
51
2

10

10

21

1

1

3
1

3
1

1

17

39
2
6

39
2
6

1
1
1
1
1
1
1

1
1
1
1
1
1
1

1
1
1

1
1
1

1
1

1
1

1

CDC TB DST Results - 2006-06

Table 1.3: Participant Results for Culture I, M. tuberculosis, resistant to ethambutol at 5.0 µg/ml

Test Method

DRUG
Ethionamide
Ethionamide
Ethionamide
Ethionamide
Ethionamide
Ethionamide
Ethionamide
Ethionamide
Ethionamide
Kanamycin
Kanamycin
Kanamycin
Kanamycin
Kanamycin
Capreomycin
Capreomycin
Capreomycin
Capreomycin
Capreomycin
Capreomycin
Capreomycin
Capreomycin
Capreomycin
Capreomycin
Cycloserine
Cycloserine
Cycloserine
Cycloserine
Cycloserine
Cycloserine
Cycloserine
Cycloserine
Cycloserine
p-Aminosalicylic acid
p-Aminosalicylic acid
p-Aminosalicylic acid
p-Aminosalicylic acid
p-Aminosalicylic acid
p-Aminosalicylic acid
Amikacin
Amikacin
Amikacin
Amikacin
Amikacin
Amikacin
Amikacin
Amikacin
Amikacin
Amikacin
Amikacin
Amikacin

Conc
1.00
1.25
2.00
2.50
4.00
5.00
10.00
20.00
40.00
5.00
6.00
10.00
20.00
40.00
0.50
1.00
1.25
5.00
6.00
10.00
12.50
25.00
40.00
50.00
10.00
12.00
20.00
24.00
25.00
30.00
40.00
48.00
60.00
0.50
1.00
2.00
4.00
8.00
10.00
0.50
1.00
2.00
2.50
4.00
5.00
6.00
7.50
8.00
12.00
15.00
30.00

AP
Results
S
R
Sum

21
3

11
12

21
3

11
12

S
1
2
1
3
1
2

BACTEC
Results
R
Sum
1
2
1
3
1
2

4

1
1

1
1

1
1
1

1
1
1

1
1
1

1
1
1

1
1

1
1

1
1

1
1

1

1

1

1

1

1

1

1

1
1

1
1

1

1

1
1

1
1

1
16

1

1
1

1
9

1
9

1

1

1
1

15

15

2
4

2
4

1
1

1
1

3

3

6

6

2

2

2
2
1
1
1

2
2
1
1
1

1

1

1

1
1

1
2

2

Other Tests
Results
S
R
Sum

1
2

1
1

MGIT
Results
S
R
Sum

4

1
2
1
16

LJ Prop
Results
S
R
Sum

1
2

2

18

CDC TB DST Results - 2006-06

Table 1.3: Participant Results for Culture I, M. tuberculosis, resistant to ethambutol at 5.0 µg/ml

Test Method

DRUG
Ofloxacin
Ofloxacin
Ofloxacin
Ofloxacin
Ofloxacin
Ofloxacin
Ofloxacin
Ofloxacin
Ciprofloxacin
Ciprofloxacin
Ciprofloxacin
Ciprofloxacin
Ciprofloxacin
Ciprofloxacin
Clarithromycin
Clarithromycin
Clarithromycin
Clofazimine
Clofazimine
Clofazimine
Clofazimine
Clofazimine
Clofazimine
Clofazimine
Clofazimine
Clofazimine
Rifabutin
Rifabutin
Rifabutin
Levofloxacin
Levofloxacin
Levofloxacin
Moxifloxacin
Moxifloxacin
Gatifloxacin

Conc
0.50
1.00
1.25
2.00
2.50
4.00
5.00
8.00
0.50
1.00
1.60
2.00
4.00
6.40
6.00
12.00
24.00
0.06
0.12
0.25
0.50
1.00
2.00
17.50
35.00
70.00
0.50
1.00
2.00
1.00
2.00
4.00
0.50
1.00
2.00

AP
Results
S
R
Sum

BACTEC
Results
S
R
Sum

3

3

2

2

9

9

8

8

1

1

3

3

2

2

2

2

4

4

8

8

4
2

4
2

2
2
1
1
1

LJ Prop
Results
S
R
Sum

MGIT
Results
S
R
Sum

1

1

1

Other Tests
Results
S
R
Sum
1
1
1
1
1
1

1
1

1

1

1

1
1
1

1
1
1

1
1
1
1

1
1
1
1

2
2
1
1

1

1
1
1

4
1
5

4
1
5

1

1

2
1

2
1

1
1
1
1
1

1
1
1

1
1
1
1
1
1
1

1

1
1
1

19

CDC TB DST Results - 2006-06

Table 2: Participant Results for Culture J, M. simiae

Test Method

DRUG
Amikacin
Amikacin
Amikacin
Amikacin
Amikacin
Amikacin
Clofazimine
Clarithromycin
Clarithromycin
Clarithromycin
Clarithromycin
Clarithromycin
Clarithromycin
Clarithromycin
Clarithromycin
Clarithromycin
Clarithromycin
Capreomycin
Capreomycin
Capreomycin
Capreomycin
Ciprofloxacin
Ciprofloxacin
Ciprofloxacin
Ciprofloxacin
Ciprofloxacin
Cycloserine
Cycloserine
Cycloserine
Cycloserine
Cycloserine
Doxycycline
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid
Isoniazid

Conc
1.00
4.00
6.00
10.00
32.00
50.00
1.00
3.00
4.00
6.00
10.00
12.00
15.00
16.00
24.00
32.00
64.00
10.00
12.50
25.00
50.00
1.60
2.00
3.20
4.00
6.40
12.00
24.00
30.00
40.00
48.00
5.00
1.60
2.50
3.20
5.00
6.40
7.50
10.00
50.00
0.05
0.10
0.20
1.00
5.00
10.00

AP
Results
S
R Sum
1
1
1
1

BACTEC
Results
S
R Sum
1
1

1

1
1

1

1

1

1

1

1
1

1

1

1

1

1

1
1
1
1

1
1
1
1

1

1

1
1

1
1
1

1

1
1
1

3

2

1
1

2

Other Tests
Results
S
R Sum

1
1
1

1

MGIT
Results
S
R Sum

1
1
1
1
1

1

LJ Prop
Results
S
R Sum

1

1
1

2

4
1
1

2

2
1

1
1

1

9

3

1

5
8
2

1

1

9

3

3

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1
1
1

1
1
1

1

3

5
8
3

20

3

3

1
1
1

1
1
1

1

1

1

1

CDC TB DST Results - 2006-06

Table 2: Participant Results for Culture J, M. simiae

Test Method

DRUG
Conc
Kanamycin
5.00
Kanamycin
6.00
Kanamycin
20.00
Levofloxacin
2.00
Levofloxacin
5.00
Moxifloxacin
0.50
Ofloxacin
1.00
Ofloxacin
1.25
Ofloxacin
2.00
Ofloxacin
2.50
Ofloxacin
5.00
Ofloxacin
20.00
p-Aminosalicylic acid
1.00
p-Aminosalicylic acid
2.00
Pyrazinamide
400.00
Rifabutin
0.10
Rifabutin
0.50
Rifabutin
1.00
Rifabutin
2.00
Rifampin
1.00
Rifampin
2.00
Rifampin
5.00
Rifampin
8.00
Rifampin
10.00
Rifampin
16.00
Rifampin
32.00
Rifampin
50.00
Streptomycin
1.00
Streptomycin
2.00
Streptomycin
7.50
Streptomycin
10.00
Streptomycin
15.00
Streptomycin
30.00
Streptomycin
50.00
StreptomycinX
32.00
StreptomycinX
38.00
Ethionamide
5.00
Ethionamide
10.00
Ethionamide
20.00
Ethionamide
40.00
Trimethoprim-Sulfamethoxazole
2.50
Trimethoprim-Sulfamethoxazole 30.00

AP
Results
S
R Sum
1
1
3
3

BACTEC
Results
S
R Sum

LJ Prop
Results
S
R Sum

1
1
1
1
1

1
1
1

2

2

1

1

1

1
1

1
1

1

1

1
1

1
1

1

1

1
1

1
1

1
1

1
1
1

1
1

1

1

1

3

1
1
4
9

1
1
4
9

2

2

1

1

1

1

1
4

1
4

1

1

1

1

9

Other Tests
Results
S
R Sum

1

1
3

MGIT
Results
S
R Sum

7

7

1

1

10

1

1
2

1
1
1
3
2

1
1
3
2

1
1

1
1

1

1
3
1

1

1

1

1

1

1

1

21

1

1

CDC TB DST Results - 2006-06

Table 3: Minimum Inhibitory Concentrations for Culture J, M. simiae
DRUG
Amikacin*
Amikacin
Amikacin
Amikacin
Amikacin
Amikacin
Azithromycin
Clofazimine
Clarithromycin
Clarithromycin
Clarithromycin
Clarithromycin
Clarithromycin
Clarithromycin
Clarithromycin
Clarithromycin
Ciprofloxacin
Ciprofloxacin*
Ciprofloxacin
Ciprofloxacin
Ciprofloxacin
Ciprofloxacin
Ciprofloxacin
Cycloserine
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Ethambutol
Linezolid
Moxifloxacin
Ofloxacin
Ofloxacin
Rifabutin
Rifabutin
Rifabutin
Rifabutin
Rifabutin
Rifabutin
Rifampin
Rifampin
Rifampin
Rifampin
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Streptomycin
Ethionamide
Trimethoprim-Sulfamethoxazole

Test Method
BACTEC 460
Microtiter
Microtiter
Microtiter
Microtiter
MGIT
Microtiter
BACTEC 460
BACTEC 460
BACTEC 460
BACTEC 460
Microtiter
Microtiter
Microtiter
Microtiter
MGIT
BACTEC 460
BACTEC 460
Microtiter
Microtiter
Microtiter
Microtiter
MGIT
BACTEC 460
BACTEC 460
BACTEC 460
Microtiter
Microtiter
Microtiter
BACTEC 460
BACTEC 460
Microtiter
Microtiter
BACTEC 460
BACTEC 460
Microtiter
Microtiter
Microtiter
MGIT
BACTEC 460
BACTEC 460
Microtiter
Microtiter
BACTEC 460
BACTEC 460
Microtiter
Microtiter
Microtiter
BACTEC 460
Microtiter

MIC Susceptible Resistant Intermediate Sum
>8.00
1
1
2
<0.50
1
1
>1.00
1
1
4.00
2
2
16.00
1
1
>1.00
1
1
>32.00
1
1
0.12
1
1
<8.00
1
1
16.00
1
1
>32.00
1
1
<0.50
2
2
2.00
1
1
<4.00
1
1
>8.00
1
1
<16.00
1
1
<1.00
1
1
<2.00
1
1
>0.50
1
1
1.00
1
1
2.00
1
1
4.00
1
1
<1.00
1
1
>16.00
1
1
4.00
1
1
>8.00
1
1
2
4.00
1
1
8.00
1
1
>32.00
1
1
>16.00
1
1
1.00
1
1
<4.00
1
1
>8.00
1
1
>0.5
1
1
>1.0
1
1
1.00
1
1
8.00
1
1
>32.0
1
1
1.00
1
1
4.00
1
1
>8.00
1
1
>8.00
2
2
>16.00
1
1
4.00
1
1
4.00
1
1
2.00
2
2
8.00
1
1
>32.00
2
2
>4.00
1
1
8.00
1
1

22

CDC TB DST Results - 2006-06

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1

Centers for Disease Control and Prevention. Treatment of Tuberculosis. MMWR. 2003;52(RR-11):24.

2

Lee, A.S.G., Othman, S.N.K., Ho, Y.M., Wong, S.Y. 2004. Novel mutations within the emb B gene in Ethambutol-susceptible clinical
isolates of Mycobacterium tuberculosis. Antimicrob Agents Chemother. 48(11):4447-4449.

3

Ridderhof J, George I, Gross W, et al. “Problems with Ethambutol Susceptibility Testing for Mycobacterium Tuberculosis.” Abstract 865.
San Francisco, CA: Interscience Conference on Antimicrobial Agents and Chemotherapy. 1999;204.

4

Madison, B. , B. Robinson,-Dunn, I. George, W. Gross, H. Lipman, B. Metchock, A. Sloutsky, G. Washabaugh, G. Mazurek, and J.
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radiometric methods. J. Clin. Micorbiol. 40(11):3976-3979.

5

CLSI. 2003. Susceptibility Testing of Mycobacteria, Nocardia, and Other Aerobic Actinomycetes; Approved Standard. M24-A; Vol. 23,
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6

Deneke, H. Miriam, Yohannes Mengistu, Sven E. Hoffner, and Dan I. Andersson. 2004. Effort of rpoB mutations conferring Rifampin
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7

Cooksey, Robert C., Glenn P. Morlock, Suzanne Glickman, and Jack T. Crawford. 1997. Evaluation of a line probe assay kit for
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8

Wallace, R.J. Jr. et al. 1997. Diagnosis and treatment of disease caused by non-tuberculous mycobacteria. American Thoracic Society
Statement. Am. J. Resp. Crit. Care Med. 156:S1-S25.

9

Inderlied, C.B. and G. E. Pfyffer. 2003. “Susceptibility Test Methods: Mycobacteria.” p. 1149-1177. In Murray, P.R., E.J.Baron, J.H.
Jorgensen, M.A. Pfaller and R.H. Yolken (ed.) Manual of Clinical Microbiology, 8th ed. American Society of Microbiology,
Washington, D. C.

10

Kent, P.T and G.P. Kubica. 1985. Public Health Mycobacteriology: A Guide for the Level III Laboratory. Centers for Disease Control,
Atlanta, GA.

11

Siddiqi, S.H., J.E. Hawkins, and A. Laszlo. 1985. Interlaboratory drug susceptibility testing of Mycobacterium tuberculosis by a
radiometric procedure and two conventional methods. J. Clin. Microbiol. 22:919-923.

12

Pfyffer, G.E., Brown-Elliott, B. A., Wallace, Richard J. Jr. 2003. Mycobacterium: General Characteristics, Isolation and Staining
Procedures, p. 532-559. In Murray, P.R., E.J. Baron, J.H. Jorgensen, M.A. Pfaller and R.H. Yolken (ed.) Manual of Clinical
Microbiology, 8th ed. American Society for Microbiology, Washington, D.C.

23

CDC TB DST Results - 2006-06