Form 0920-0600 Att C M tuberculosis Results Worksheet

CDC Model Performance Evaluation Program (MPEP) for Mycobacterium tuberculosis and Nontuberculous Mycobacteria Drug Susceptibility Testing

Att C M tuberculosis Results Worksheet

MPEP Mycobacterium Tuberculosis Results

OMB: 0920-0600

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CDC Model Performance Evaluation Program (MPEP) for Mycobacterium tuberculosis Drug Susceptibility Testing

Attachment C


M. tuberculosis Results Worksheet








































MPEP Mycobacterium tuberculosis Results Worksheet

Public reporting burden of this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-0600)



Enter your drug susceptibility test results for each culture by using the data entry forms below.  There are separate forms for conventional vs molecular drug results. You can either enter your results directly on the forms or print them out to enter results manually.

Conventional Drug Susceptibility Worksheet for Culture:      

Drug

Resistant

Susceptible

Borderline

Contaminated

No Growth

Not Done

Rifampin

Isoniazid low

Isoniazid high

Pyrazinamide

Ethambutol

Streptomycin

Ethionamide

Rifabutin

Amikacin

Kanamycin

Capreomycin

Ciprofloxacin

Levofloxacin

Ofloxacin

Moxifloxacin

Cycloserine

Para-Amino Salicyclic Acid













Molecular Results Worksheet for Culture:      

Drug

Mutation Detected

Mutation Not Detected

No Result

Not Done

Rifampin

Isoniazid

Pyrazinamide

Ethambutol

Streptomycin

Ethionamide

Rifabutin

Amikacin

Kanamycin

Capreomycin

Ciprofloxacin

Levofloxacin

Ofloxacin

Moxifloxacin

Cycloserine

Para-Amino Salicyclic Acid





File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorYakrus, Mitchell (CDC/OID/NCHHSTP)
File Modified0000-00-00
File Created2021-01-25

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