Form 0920-0600 Att. 7-Results Worksheet

CDC Model Performance Evaluation Program (MPEP) for Mycobacterium tuberculosis

Drug Susceptibility Testing

Attachment 7

MPEP M. tuberculosis Results Worksheet

MPEP Mycobacterium tuberculosis Results Worksheet

Enter your drug susceptibility test results for each isolate by using the data worksheets below. There are two worksheets—one for growth-based drug susceptibility results and one for molecular test results. These worksheets are provided as a tool for recording results prior to online data entry.

Growth-based Drug Susceptibility Worksheet: Isolate            Method           

Drug	Resistant	Susceptible	Intermediate	Contaminated/ No Growth	No Interpretation	Not Done
Rifampin
Isoniazid—low
Isoniazid—high
Ethambutol
Pyrazinamide
Streptomycin
Ofloxacin
Ciprofloxacin
Moxifloxacin
Levofloxacin
Amikacin
Kanamycin
Capreomycin
Ethionamide
Rifabutin
Cycloserine
Para-aminosalicylic Acid
Rifapentine
Bedaquiline
Linezolid
Clofazimine
Delamanid
Pretomamid

Molecular Results Worksheet: Isolate            Method           

Drug	Mutation Detected	Mutation Not Detected	No Result	Not Done
Rifamycins (Rifampin, Rifabutin, Rifapentine)
Isoniazid
Ethambutol
Pyrazinamide
Streptomycin
Ofloxacin
Ciprofloxacin
Moxifloxacin
Levofloxacin
Amikacin
Kanamycin
Capreomycin
Ethionamide
Cycloserine
Para-aminosalicylic Acid
Bedaquiline
Linezolid
Clofazimine
Delamanid
Pretomanid