0920-0600 Att. 9-MIC Results Form

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

Att. 9-MIC Results Form

OMB: 0920-0600

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CDC Model Performance Evaluation Program (MPEP) for Mycobacterium tuberculosis

Drug Susceptibility Testing


Attachment 9


MPEP Mycobacterium tuberculosis Minimum Inhibitory Concentration (MIC)

Results Worksheet



MPEP Mycobacterium tuberculosis Minimum Inhibitory Concentration (MIC)

Results Worksheet

Enter your categorical drug susceptibility test result interpretation and minimum inhibitory concentration (MIC) for each isolate tested by Sensititre by using the data worksheet below. For laboratories who customize Sensititre plates, please use ‘Other’ for any additional antituberculosis drugs tested.

This worksheet is provided as a tool for recording results prior to online data entry.



MPEP Number                      Isolate           

Drug

Resistant

Susceptible

Intermediate

Contaminated/ No Growth

No Interpretation

Not Done

MIC (µg/ml)

Rifampin


Isoniazid


Ethambutol


Streptomycin


Ofloxacin


Ciprofloxacin


Moxifloxacin


Levofloxacin


Amikacin


Kanamycin


Capreomycin


Ethionamide


Rifabutin


Cycloserine


Para-aminosalicylic Acid


Rifapentine


Bedaquiline


Linezolid


Clofazamine


Delamanid


Pretomanid


Other: __________


Other: __________



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorYakrus, Mitchell (CDC/OID/NCHHSTP)
File Modified0000-00-00
File Created2023-09-02

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