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1 TECHNICAL SPECIFICATION ISO/TS First edition Clinical laboratory testing Criteria for acceptable lots of dehydrated Mueller-Hinton agar and broth for antimicrobial susceptibility testing Détermination de la sensibilité aux antibiotiques Critères d acceptabilité pour les lots d agar déshydraté et de bouillon Mueller- Hinton pour déterminer la sensibilité aux antibiotiques Reference number ISO/TS 16782:2016(E) ISO 2016
2 ISO/TS 16782:2016(E) COPYRIGHT PROTECTED DOCUMENT ISO 2016, Published in Switzerland All rights reserved. Unless otherwise specified, no part of this publication may be reproduced or utilized otherwise in any form or by any means, electronic or mechanical, including photocopying, or posting on the internet or an intranet, without prior written permission. Permission can be requested from either ISO at the address below or ISO s member body in the country of the requester. ISO copyright office Ch. de Blandonnet 8 CP 401 CH-1214 Vernier, Geneva, Switzerland Tel Fax ii ISO 2016 All rights reserved
3 ISO/TS 16782:2016(E) Contents Page Foreword...iv Introduction...v 1 Scope Normative reference Terms and definitions Requirements for Mueller-Hinton broth Components of Mueller-Hinton broth Physical and chemical characteristics Dehydrated powder or granules Prepared broth medium Cation supplementation and content for MHB Other medium components Specific adjustments required by the manufacturer Manufacturers protocol for testing production lots of dehydrated Mueller-Hinton broth Interpreting the results Evaluating the results Requirements for Muller-Hinton agar Components of Mueller-Hinton agar Physical and chemical characteristics Dehydrated powder or granules Prepared agar medium Cation supplementation and content for MHA Other medium components Specific adjustments required by the manufacturer Manufacturer s protocol for testing production lots of dehydrated Mueller-Hinton agar Interpreting the results Evaluating the results Testing new antimicrobial agents with production lots of dehydrated Mueller- Hinton broth or agar...11 Annex A (informative) Mueller-Hinton medium...12 Annex B (informative) Preparing control cultures...14 Annex C (informative) Suggested data sheet for testing of production lots...16 Annex D (informative) Label statement...19 Bibliography...20 ISO 2016 All rights reserved iii
4 ISO/TS 16782:2016(E) Foreword ISO (the International Organization for Standardization) is a worldwide federation of national standards bodies (ISO member bodies). The work of preparing Technical Specifications is normally carried out through ISO technical committees. Each member body interested in a subject for which a technical committee has been established has the right to be represented on that committee. International organizations, governmental and non-governmental, in liaison with ISO, also take part in the work. ISO collaborates closely with the International Electrotechnical Commission (IEC) on all matters of electrotechnical standardization. The procedures used to develop this document and those intended for its further maintenance are described in the ISO/IEC Directives, Part 1. In particular the different approval criteria needed for the different types of ISO documents should be noted. This document was drafted in accordance with the editorial rules of the ISO/IEC Directives, Part 2 (see Attention is drawn to the possibility that some of the elements of this document may be the subject of patent rights. ISO shall not be held responsible for identifying any or all such patent rights. Details of any patent rights identified during the development of the document will be in the Introduction and/or on the ISO list of patent declarations received (see Any trade name used in this document is information given for the convenience of users and does not constitute an endorsement. For an explanation on the meaning of ISO specific terms and expressions related to conformity assessment, as well as information about ISO s adherence to the WTO principles in the Technical Barriers to Trade (TBT) see the following URL: Foreword - Supplementary information The committee responsible for this document is ISO/TC 212, Clinical laboratory testing and in vitro diagnostic test systems. iv ISO 2016 All rights reserved
5 ISO/TS 16782:2016(E) Introduction Historically, although various media have been recommended for susceptibility testing, Mueller- Hinton broth (MHB) has been selected as the medium for the reference broth microdilution minimum inhibitory concentration (MIC) method (ISO ) and Mueller-Hinton agar (MHA) is most widely used for disc diffusion testing of rapidly growing bacteria. Mueller-Hinton medium provides satisfactory growth of most non-fastidious pathogens, acceptable batch-to-batch reproducibility, low sulfonamide, trimethoprim, and tetracycline inhibitors and a large amount of data has been collected from antimicrobial susceptibility tests with this medium over several decades. This International Standard is the result of an effort to establish a standard description and protocol by which manufacturers of dehydrated Mueller-Hinton agar (dmha) and broth (dmhb) may determine its acceptable performance characteristics. The results of testing conform to defined quality control limit ranges for each combination of antimicrobial agent and quality control strains. Each production lot is tested at least against these combinations of antimicrobial agents and quality control strains. This Technical Specification has been developed in part based upon two Clinical and Laboratory Standards Institute (CLSI) documents, CLSI M6-A2 [1] (protocols for evaluating dehydrated Mueller- Hinton agar) and CLSI M32-P[2] (evaluation of lots of dehydrated Mueller-Hinton broth for antimicrobial susceptibility testing) with permission. Upon publication of ISO 16782, CLSI documents M6-A2[1] and M32-P[2] will no longer be available. Manufacturers can follow ISO to assess the performance characteristics of their production lots of dmha and dmhb. ISO 2016 All rights reserved v
7 TECHNICAL SPECIFICATION ISO/TS 16782:2016(E) Clinical laboratory testing Criteria for acceptable lots of dehydrated Mueller-Hinton agar and broth for antimicrobial susceptibility testing 1 Scope This Technical Specification provides a standard description of the physical properties of dehydrated Mueller-Hinton broth (dmhb) and Mueller-Hinton agar (dmha) and performance criteria by which manufacturers can assess the performance characteristics of their production lots of dmha and dmhb. Production lots of broth or agar can then be utilized by all users, including in vitro susceptibility testing device manufacturers, as the test medium for performance of antimicrobial susceptibility testing. This Technical Specification does not address supplements (e.g. blood or blood products) that are added to the medium to support growth of fastidious bacteria[3][4][5][6]. Those additives are provided after the dehydrated medium is prepared in its liquid state as a final product and fall outside of the scope of this Technical Specification. Although dmha can be used for determination of MICs using the agar dilution method [4][6] or the gradient diffusion method, this Technical Specification only includes performance testing of dmha using disc diffusion methodology as described by the Clinical and Laboratory Standards Institute (CLSI)[5] and European Committee on Antimicrobial Susceptibility Testing (EUCAST)[3]. 2 Normative reference The following documents, in whole or in part, are normatively referenced in this document and are indispensable for its application. For dated references, only the edition cited applies. For undated references, the latest edition of the referenced document (including any amendments) applies. ISO :2006, Clinical laboratory testing and in vitro diagnostic test systems Susceptibility testing of infectious agents and evaluation of performance of antimicrobial susceptibility test devices Part 1: Reference method for testing the in vitro activity of antimicrobial agents against rapidly growing aerobic bacteria involved in infectious diseases CLSI M100, Performance Standards for Antimicrobial Susceptibility Testing; Informational Supplement 3 Terms and definitions For the purposes of this document, the following terms and definitions apply. 3.1 antimicrobial agent substance of biological, semi-synthetic or synthetic origin that inhibits the growth of or kills bacteria and is thus of potential use in the treatment of infections Note 1 to entry: Disinfectants, antiseptics and preservatives are not included in this definition. [SOURCE: ISO :2006, 2.1] 3.2 antimicrobial disc small paper disc containing known amounts of antimicrobial agents used for in vitro susceptibility testing ISO 2016 All rights reserved 1
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