The papers assembled in this collection comprise a majority of the oral presentations as well as several poster presentations given at the 22nd Annual Symposium arranged by the Bastern Pennsylvania Branch of the American Society for MicrobioloS)'. The symposium would not be possible without the generous support of the many sponsors (see sponsor list) or without the concerted effort of a11 the Committee members. This Symposium series has evolved into an annual Bastern Pennsylvania Branch ASM event that attracts participants from a wide geographie area. It should be noted that one of the hallmarks of these symposia involves interaction between the presenters and those in attendance. Several authors have altered their by the participants. Therefore, the manuscript that manuscripts based on comments fo11ows should be viewed as a group effort of both the participants and presenters. J ames Poupard Lori Walsh Bruee Kleger ix CONTENTS 1 Introduction 1: CURRENT METHODS The Evolution of Antimicrobial Susceptibility Testing Methods . . . . . . . . . . . . . . . 3 James A. Poupard, Stephen F. Rittenhouse, and Lori R. Walsh Antimicrobial Susceptibility Tests: Testing Methods and Interpretive Problems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Patrick R. Murray Clinician Utilization of Rapid Antibiotic Susceptibility Data: A Prospective Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Franklin P. Koontz SESSION 2: CONTEMPORARY ISSUES IN SUSCEPTIBILITY TESTING When We Should Be Testing, How Often and What to Report . . . . . . . . . . . . . . . 35 Raymond C. Bartlett Areas of Recent Emphasis of the National Committee for Clinical Laboratory Standards Subcommittee on Antimicrobial Susceptibility Testing . . . . . . . . . . . . . . . . .. . . . . . 61 James H. Jorgensen Non-Traditional Approaches for Quality Control of Antimicrobial Susceptibility Tests . . . . . . . . . . . . . . . . . . . . . . . . .

The papers published herein comprise the presentations given at the eighteenth of an annual series of clinical symposia arranged under the auspices of the Eastern Pennsylvania Branch of the American Society for Microbiology. This symposium allowed approximately 200 persons to gather and exchange ideas on the rapid laboratory diagnosis of infectious diseases. The institution of the Diagnosis Related Group (DRG) method for reimbursement by both government agencies and private insurance carriers has provided a financial aspect to the established clinical reasons for rapid laboratory diagnosis. Now the health of the institution, as well as the patient, is dependent on a timely diagnosis and, hopefully, cure. Accordingly, the goal of this symposium was to present the latest developments in "same-day microbiology". In the face of stable or diminishing resources, the laboratory director is presented with many choices. Do nucleic acid probes, non­ instrumental ELISA techniques, or time-resolved fluorometry have a place in his or her laboratory? Should the laboratory test for newly described human pathogens such as human immunodeficiency virus or human papilloma virus? Can rapid techniques supplant conventional methods? Or are they merely adjunctive? This symposium attempted to assist in the formulation of informed decisions. Bruce Kleger Donald Jungkind Eileen Rinks Linda A. Miller vii ACKNOWLEDGEMENTS We would like to thank the Eastern Pennsylvania Branch of t~e American Society for Microbiology for sponsoring this symposium and for making this publication possible. We especially thank the Symposium Committee for their diligent work in organizing an informative and successful symposium.

The papers published herein comprise the presentations given at the eighteenth of an annual series of clinical symposia arranged under the auspices of the Eastern Pennsylvania Branch of the American Society for Microbiology. This symposium allowed approximately 200 persons to gather and exchange ideas on the rapid laboratory diagnosis of infectious diseases. The institution of the Diagnosis Related Group (DRG) method for reimbursement by both government agencies and private insurance carriers has provided a financial aspect to the established clinical reasons for rapid laboratory diagnosis. Now the health of the institution, as well as the patient, is dependent on a timely diagnosis and, hopefully, cure. Accordingly, the goal of this symposium was to present the latest developments in "same-day microbiology". In the face of stable or diminishing resources, the laboratory director is presented with many choices. Do nucleic acid probes, non­ instrumental ELISA techniques, or time-resolved fluorometry have a place in his or her laboratory? Should the laboratory test for newly described human pathogens such as human immunodeficiency virus or human papilloma virus? Can rapid techniques supplant conventional methods? Or are they merely adjunctive? This symposium attempted to assist in the formulation of informed decisions. Bruce Kleger Donald Jungkind Eileen Rinks Linda A. Miller vii ACKNOWLEDGEMENTS We would like to thank the Eastern Pennsylvania Branch of t~e American Society for Microbiology for sponsoring this symposium and for making this publication possible. We especially thank the Symposium Committee for their diligent work in organizing an informative and successful symposium.

When we were setting the theme of "infection control dilemmas and practical solutions" for this symposium, we asked ourselves a basic question: What are some of the most vexing problems and situations facing the hospital microbiologist­ epidemiologist team in today''s world of opportunistic and new infectious diseases unheard of as common pathogenic occurrences 10 years ago? One of the areas which we immediately focused upon was the tremendous amount of time, energy, and financial resources that are presently being expended to satisfy the requirements mandated by the recognition of the danger of spread of blood-borne pathogens in the hospital environment. With the advent of Universal Precautions, primarily in response to HIV infection and the AIDS crisis, but certainly augmented by the increased incidence of hepatitis in its various forms, a significant effort has been required to meet the standards rec­ ommended and/or required by OSHA and the CDC. With this in mind we brought together experts in the field of infectious diseases to address the problems engendered by the threat of nosocomial spread of selected pathogens. Further, we devoted several sessions to discussing the investi­ gation and resolution of institutional outbreaks of disease, particularly with reference to methicillin-resistant Staphylo­ coccus aureus (MRSA). Special problems of dental offices and clinical teaching as well as extended care facilities were also selected for attention, particularly with relation to blood­ borne pathogens.

When we were setting the theme of "infection control dilemmas and practical solutions" for this symposium, we asked ourselves a basic question: What are some of the most vexing problems and situations facing the hospital microbiologist­ epidemiologist team in today's world of opportunistic and new infectious diseases unheard of as common pathogenic occurrences 10 years ago? One of the areas which we immediately focused upon was the tremendous amount of time, energy, and financial resources that are presently being expended to satisfy the requirements mandated by the recognition of the danger of spread of blood-borne pathogens in the hospital environment. With the advent of Universal Precautions, primarily in response to HIV infection and the AIDS crisis, but certainly augmented by the increased incidence of hepatitis in its various forms, a significant effort has been required to meet the standards rec­ ommended and/or required by OSHA and the CDC. With this in mind we brought together experts in the field of infectious diseases to address the problems engendered by the threat of nosocomial spread of selected pathogens. Further, we devoted several sessions to discussing the investi­ gation and resolution of institutional outbreaks of disease, particularly with reference to methicillin-resistant Staphylo­ coccus aureus (MRSA). Special problems of dental offices and clinical teaching as well as extended care facilities were also selected for attention, particularly with relation to blood­ borne pathogens.

The papers assembled in this collection comprise a majority of the oral presentations as well as several poster presentations given at the 22nd Annual Symposium arranged by the Bastern Pennsylvania Branch of the American Society for MicrobioloS)''. The symposium would not be possible without the generous support of the many sponsors (see sponsor list) or without the concerted effort of a11 the Committee members. This Symposium series has evolved into an annual Bastern Pennsylvania Branch ASM event that attracts participants from a wide geographie area. It should be noted that one of the hallmarks of these symposia involves interaction between the presenters and those in attendance. Several authors have altered their by the participants. Therefore, the manuscript that manuscripts based on comments fo11ows should be viewed as a group effort of both the participants and presenters. J ames Poupard Lori Walsh Bruee Kleger ix CONTENTS 1 Introduction 1: CURRENT METHODS The Evolution of Antimicrobial Susceptibility Testing Methods . . . . . . . . . . . . . . . 3 James A. Poupard, Stephen F. Rittenhouse, and Lori R. Walsh Antimicrobial Susceptibility Tests: Testing Methods and Interpretive Problems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Patrick R. Murray Clinician Utilization of Rapid Antibiotic Susceptibility Data: A Prospective Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Franklin P. Koontz SESSION 2: CONTEMPORARY ISSUES IN SUSCEPTIBILITY TESTING When We Should Be Testing, How Often and What to Report . . . . . . . . . . . . . . . 35 Raymond C. Bartlett Areas of Recent Emphasis of the National Committee for Clinical Laboratory Standards Subcommittee on Antimicrobial Susceptibility Testing . . . . . . . . . . . . . . . . .. . . . . . 61 James H. Jorgensen Non-Traditional Approaches for Quality Control of Antimicrobial Susceptibility Tests . . . . . . . . . . . . . . . . . . . . . . . . .

The papers assembled in this collection comprise a majority of the oral presentations as well as several poster presentations given at the 22nd Annual Symposium arranged by the Bastern Pennsylvania Branch of the American Society for MicrobioloS)'. The symposium would not be possible without the generous support of the many sponsors (see sponsor list) or without the concerted effort of a11 the Committee members. This Symposium series has evolved into an annual Bastern Pennsylvania Branch ASM event that attracts participants from a wide geographie area. It should be noted that one of the hallmarks of these symposia involves interaction between the presenters and those in attendance. Several authors have altered their by the participants. Therefore, the manuscript that manuscripts based on comments fo11ows should be viewed as a group effort of both the participants and presenters. J ames Poupard Lori Walsh Bruee Kleger ix CONTENTS 1 Introduction 1: CURRENT METHODS The Evolution of Antimicrobial Susceptibility Testing Methods . . . . . . . . . . . . . . . 3 James A. Poupard, Stephen F. Rittenhouse, and Lori R. Walsh Antimicrobial Susceptibility Tests: Testing Methods and Interpretive Problems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Patrick R. Murray Clinician Utilization of Rapid Antibiotic Susceptibility Data: A Prospective Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Franklin P. Koontz SESSION 2: CONTEMPORARY ISSUES IN SUSCEPTIBILITY TESTING When We Should Be Testing, How Often and What to Report . . . . . . . . . . . . . . . 35 Raymond C. Bartlett Areas of Recent Emphasis of the National Committee for Clinical Laboratory Standards Subcommittee on Antimicrobial Susceptibility Testing . . . . . . . . . . . . . . . . .. . . . . . 61 James H. Jorgensen Non-Traditional Approaches for Quality Control of Antimicrobial Susceptibility Tests . . . . . . . . . . . . . . . . . . . . . . . . .

The papers published herein comprise the presentations given at the eighteenth of an annual series of clinical symposia arranged under the auspices of the Eastern Pennsylvania Branch of the American Society for Microbiology. This symposium allowed approximately 200 persons to gather and exchange ideas on the rapid laboratory diagnosis of infectious diseases. The institution of the Diagnosis Related Group (DRG) method for reimbursement by both government agencies and private insurance carriers has provided a financial aspect to the established clinical reasons for rapid laboratory diagnosis. Now the health of the institution, as well as the patient, is dependent on a timely diagnosis and, hopefully, cure. Accordingly, the goal of this symposium was to present the latest developments in "same-day microbiology". In the face of stable or diminishing resources, the laboratory director is presented with many choices. Do nucleic acid probes, non­ instrumental ELISA techniques, or time-resolved fluorometry have a place in his or her laboratory? Should the laboratory test for newly described human pathogens such as human immunodeficiency virus or human papilloma virus? Can rapid techniques supplant conventional methods? Or are they merely adjunctive? This symposium attempted to assist in the formulation of informed decisions. Bruce Kleger Donald Jungkind Eileen Rinks Linda A. Miller vii ACKNOWLEDGEMENTS We would like to thank the Eastern Pennsylvania Branch of t~e American Society for Microbiology for sponsoring this symposium and for making this publication possible. We especially thank the Symposium Committee for their diligent work in organizing an informative and successful symposium.

The papers published herein comprise the presentations given at the eighteenth of an annual series of clinical symposia arranged under the auspices of the Eastern Pennsylvania Branch of the American Society for Microbiology. This symposium allowed approximately 200 persons to gather and exchange ideas on the rapid laboratory diagnosis of infectious diseases. The institution of the Diagnosis Related Group (DRG) method for reimbursement by both government agencies and private insurance carriers has provided a financial aspect to the established clinical reasons for rapid laboratory diagnosis. Now the health of the institution, as well as the patient, is dependent on a timely diagnosis and, hopefully, cure. Accordingly, the goal of this symposium was to present the latest developments in "same-day microbiology". In the face of stable or diminishing resources, the laboratory director is presented with many choices. Do nucleic acid probes, non­ instrumental ELISA techniques, or time-resolved fluorometry have a place in his or her laboratory? Should the laboratory test for newly described human pathogens such as human immunodeficiency virus or human papilloma virus? Can rapid techniques supplant conventional methods? Or are they merely adjunctive? This symposium attempted to assist in the formulation of informed decisions. Bruce Kleger Donald Jungkind Eileen Rinks Linda A. Miller vii ACKNOWLEDGEMENTS We would like to thank the Eastern Pennsylvania Branch of t~e American Society for Microbiology for sponsoring this symposium and for making this publication possible. We especially thank the Symposium Committee for their diligent work in organizing an informative and successful symposium.

When we were setting the theme of "infection control dilemmas and practical solutions" for this symposium, we asked ourselves a basic question: What are some of the most vexing problems and situations facing the hospital microbiologist­ epidemiologist team in today''s world of opportunistic and new infectious diseases unheard of as common pathogenic occurrences 10 years ago? One of the areas which we immediately focused upon was the tremendous amount of time, energy, and financial resources that are presently being expended to satisfy the requirements mandated by the recognition of the danger of spread of blood-borne pathogens in the hospital environment. With the advent of Universal Precautions, primarily in response to HIV infection and the AIDS crisis, but certainly augmented by the increased incidence of hepatitis in its various forms, a significant effort has been required to meet the standards rec­ ommended and/or required by OSHA and the CDC. With this in mind we brought together experts in the field of infectious diseases to address the problems engendered by the threat of nosocomial spread of selected pathogens. Further, we devoted several sessions to discussing the investi­ gation and resolution of institutional outbreaks of disease, particularly with reference to methicillin-resistant Staphylo­ coccus aureus (MRSA). Special problems of dental offices and clinical teaching as well as extended care facilities were also selected for attention, particularly with relation to blood­ borne pathogens.

When we were setting the theme of "infection control dilemmas and practical solutions" for this symposium, we asked ourselves a basic question: What are some of the most vexing problems and situations facing the hospital microbiologist­ epidemiologist team in today's world of opportunistic and new infectious diseases unheard of as common pathogenic occurrences 10 years ago? One of the areas which we immediately focused upon was the tremendous amount of time, energy, and financial resources that are presently being expended to satisfy the requirements mandated by the recognition of the danger of spread of blood-borne pathogens in the hospital environment. With the advent of Universal Precautions, primarily in response to HIV infection and the AIDS crisis, but certainly augmented by the increased incidence of hepatitis in its various forms, a significant effort has been required to meet the standards rec­ ommended and/or required by OSHA and the CDC. With this in mind we brought together experts in the field of infectious diseases to address the problems engendered by the threat of nosocomial spread of selected pathogens. Further, we devoted several sessions to discussing the investi­ gation and resolution of institutional outbreaks of disease, particularly with reference to methicillin-resistant Staphylo­ coccus aureus (MRSA). Special problems of dental offices and clinical teaching as well as extended care facilities were also selected for attention, particularly with relation to blood­ borne pathogens.

The papers assembled in this collection comprise a majority of the oral presentations as well as several poster presentations given at the 22nd Annual Symposium arranged by the Bastern Pennsylvania Branch of the American Society for MicrobioloS)''. The symposium would not be possible without the generous support of the many sponsors (see sponsor list) or without the concerted effort of a11 the Committee members. This Symposium series has evolved into an annual Bastern Pennsylvania Branch ASM event that attracts participants from a wide geographie area. It should be noted that one of the hallmarks of these symposia involves interaction between the presenters and those in attendance. Several authors have altered their by the participants. Therefore, the manuscript that manuscripts based on comments fo11ows should be viewed as a group effort of both the participants and presenters. J ames Poupard Lori Walsh Bruee Kleger ix CONTENTS 1 Introduction 1: CURRENT METHODS The Evolution of Antimicrobial Susceptibility Testing Methods . . . . . . . . . . . . . . . 3 James A. Poupard, Stephen F. Rittenhouse, and Lori R. Walsh Antimicrobial Susceptibility Tests: Testing Methods and Interpretive Problems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Patrick R. Murray Clinician Utilization of Rapid Antibiotic Susceptibility Data: A Prospective Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Franklin P. Koontz SESSION 2: CONTEMPORARY ISSUES IN SUSCEPTIBILITY TESTING When We Should Be Testing, How Often and What to Report . . . . . . . . . . . . . . . 35 Raymond C. Bartlett Areas of Recent Emphasis of the National Committee for Clinical Laboratory Standards Subcommittee on Antimicrobial Susceptibility Testing . . . . . . . . . . . . . . . . .. . . . . . 61 James H. Jorgensen Non-Traditional Approaches for Quality Control of Antimicrobial Susceptibility Tests . . . . . . . . . . . . . . . . . . . . . . . . .