July 2011 IN THIS ISSUE:

July 2011 IN THIS ISSUE: Mass Spectrometry Pg 2 VITEK 2 PC5.01 Pg 3 Henry Ford Hospital Pg 5 ProLab Pg 6 New VITEK 2 Cards Pg 8 Total AST Pg 11 Events Calendar Pg 12

Mass Spectrometry: Cutting Edge Microbial Identification Nedal Safwat, Ph.D. Senior US Clinical Marketing Manager biomérieux, Inc. Durham, NC The rapid identification of microorganisms has been a major obstacle to clinicians as they struggle to provide appropriate antimicrobial treatment while waiting sometimes days for a definitive identification of the pathogen. Now, a new method has emerged that can reduce identification to a few minutes. Mass Spectrometry (MS) is a technique used to screen simultaneously a multitude of molecules and determine their identity by analyzing their individual mass-to-charge ratio. These molecular signatures can be used for rapid bacterial and fungal identification (ID) from isolated colonies. The use of mass spectrometry for bacterial ID promises to be particularly suitable and cost-efficient for laboratories with high volumes of samples. But the big payoff for clinicians is the huge reduction in the time it takes to identify organisms. Specifically, mass spectrometry enables laboratories to rapidly identify organisms from colonies grown overnight. mass spectrometry for microbial ID, biomérieux is developing integrated workflow solutions with its VITEK 2 range to ensure optimal user convenience, full sample traceability and quality of results. All of biomérieux s systems will be managed with the new MYLA Web-based middleware solution, commercialized in early 2011. The fully integrated system will provide rich connectivity, enhanced information and workflow management. This technology may also assist clinical microbiologists in facing the ever-increasing number of potentially pathogenic species of bacteria and fungi. A modern identification system such as MS, coupled with a flexible database that can be easily updated and expanded, can meet this growing challenge. What does MALDI-TOF stand for? MALDI-TOF stands for Matrix Assisted Laser Desorption/ Ionization Time Of Flight. It describes the way a sample is converted into charged particles, or ionized, and what method has been used to separate the different mass particles after charging. A spectrum is produced by measuring and plotting the different mass particles. 2 Lab of the Future biomérieux is moving quickly to provide an integrated solution to this emerging technology through a partnership agreement with Shimadzu, a pioneer in the development of MALDI-TOF MS technology, and by acquiring a comprehensive microbial mass spectra database from AnagnosTec, a primary innovator in MALDI-TOF MS microbial identification. For microbiologists who choose * Research Use Only - Not for use in diagnostic procedures.

FIREWALL New VITEK 2 PC5.01 Software Release: A Major Leap Forward Nedal Safwat, Ph.D. Senior U.S. Clinical Marketing Manager biomérieux, Inc. Durham, NC Microbiology laboratories are struggling with challenges that impede their ability to complete their work in a timely manner. Loss of skilled labor, increasing pressure to deliver more rapid results and coping with increasing workloads create issues that take time to resolve. This highlights the need for increased productivity by eliminating inefficient steps in our day-to-day activities. biomérieux s new software release for the VITEK 2 PC has features designed to help you become more efficient by saving you steps and saving you time. but this person may not always be available to examine inconsistent results easily. Through remote access, multiple users can log into the VITEK 2 computer from anywhere on their laboratory network. Up to 10 users may access the computer remotely at the same time. This will help increase productivity of the testing process, eliminate the need to waste steps going back and forth to check results and allows the opportunity to accomplish tasks within normal working hours. Common tasks include: Remote Multiuser Access Satellite Lab Director Lab Simultaneous Multi-user Access View and approve patient isolates in the isolate view View VITEK 2 Advanced Expert System TM (AES) configuration Resolve AES conflicts Validate results which bioart has stopped for review If you are interested in capitalizing on the benefits of remote multi-user access, please contact your local biomérieux sales representative. Main Lab Remote Diagnostics & Services This new software release has an optional feature which allows users to access the VITEK 2 PC remotely to view and validate results. Avoid walking from one location to Another These wasted steps can be taken back through remote access to the VITEK 2 PC computer. Fast reporting Impaired workflow process allows users to recapture time previously spent walking results from one location to another and to verify results on their own time. Improved Review of Inconsistent Results Some laboratories have access to a microbiology expert, VILINK TM Gateway bioart intelligence simplifies workflow bioart is biomérieux s Advanced Reporting Tool which allows users to: Create antibiotic suppression rules Hold isolates for review Create customized comments or instructions for each organism situation bioart ensures quality reporting through predefined rules, such as product limitations or FDA Indications For Use, and allows creation of custom rules to ensure compliance with your institution s policies and procedures. These rules are created easily and may be constructed by using the MIC value, interpretation, card type, organism, patient location, patient physician, phenotype, specimen source, specimen type or test results. bioart was designed to be easy to use and to help you save time through efficient processing and validation of organisms tailored to the needs of your institution. biomérieux Connection July 2011 3

Multiple Instrument Control The new software also allows up to four computers to connect to the VITEK 2 PC. This may help your institution consolidate information onto one computer and reduce the footprint of the system. support to resolve issues remotely and download these software updates. If you are interested in learning more about the VILINK gateway, please contact your local bioméreiux sales representative. Streamlined QC option With the CLSI M50-A changes related to streamlined QC, the software contains the list of organisms for either comprehensive or streamlined QC for Identification cards. Streamlined QC tests a key biochemical reaction in the ID card to ensure that no card degradation has occurred during shipment. Preliminary AST results Preliminary results may be reported when they become available before the entire AST card finishes. Preliminary card results may also be expertised by the Advanced Expert System. By providing preliminary reports to physicians, appropriate clinical decisions may be made earlier, which can have a positive impact on patient care. 4 MIC suppression This feature allows users to suppress an MIC when the final category call does not match the tested MIC value, as in the case of therapeutic or biological corrections. This helps eliminate confusion by allowing microbiologists to suppress the MIC on the chart report in these instances. Rapid software updates through VILINK By implementing the VILINK computer into your laboratory network you can receive incremental software updates through the Internet. If CLSI makes a change to organism breakpoints, biomérieux can create new organism updates and provide them to you quickly through the VILINK. VILINK is biomérieux s secure solution for remote monitoring and troubleshooting of your VITEK 2 instrument. The VILINK gateway computer allows biomérieux customer New card options Streptococci AST card This software update will support our Streptococci card. The new AST-ST card will be validated for most major Streptococcal pathogens including S. pneumonia, S. agalactiae, S. pyogenes and a host of other clinically significant species. Download isolate information The VITEK 2 Systems software will now be able to receive a downloaded organism identification and beta-lactamase result from a Laboratory Information System (LIS) or OBSERVA. The downloaded organism identification will automatically link with the AST card when the accession number matches. If the organism identification is not an organism claimed by the AST card, then the organism field will not be populated. There is a new button in the View and Maintain Isolate Results screen that will allow access to the organism identification and beta-lactamase result downloaded from the LIS. Intelligent software programs have become essential tools that improve the analysis of test results and detection of resistant organisms. PC5.01 is such a tool: This new release is a major leap forward in software-controlled, automated identification and susceptibility instrumentation. A wide range of new features has been added to help you save steps and time.

VITEK PC 5.01 A Welcome Boost to the Microbiology Workhorse Robert G. Fowler, MT, (ASCP), CLS Henry Ford Hospital Detroit, MI Robert G. Fowler, senior lead technologist at the 800-bed Henry Ford Hospital in Detroit always considered the VITEK 2 the workhorse of the hospital s microbiology lab. It s hard to improve a device that already turns around pathogen antibiotic susceptibility results in less than eight hours, said Fowler. But the new v5.01 upgrade, installed late last year at Henry Ford, has made Fowler a believer that even the best instruments can improve. Someone in the lab compared the VITEK 2 with the v5.01 upgrade to jumping directly to a smart phone from a rotary dial phone, and I think that s a very appropriate description, Fowler said. The two VITEK 2 units at Henry Ford always have been central to the lab s antibiotic panels and infectious disease susceptibility testing including microbial identification with bacteria and yeast identification (ID), antibiotic susceptibility testing (AST) and resistance mechanism detection as well as epidemiologic trending and reporting. However, the old interface presented some challenges for a machine that performs up to 200 tests per day from samples taken at the main hospital and satellite hospitals. According to Fowler, the old roll and scroll interface could make it time-consuming to find specific results. Since there was just a single PC in the lab to interface with the two VITEK 2 units, there was often a line of lab scientists waiting to get to their results. Ease of Use and Flexibility With the GUI (Graphic User Interface), working with VITEK 2 has gotten a lot easier and more intuitive. The interface is less text heavy and more graphical, including windows, icons and various menus and buttons allowing the staff at the Henry Ford microbiology lab to find and categorize samples by patients or ID type. The automated software generates a list of unusual patterns for review. The Advanced Expert System (AES) findings, the ART (Antibiotic Resistance Transferability) comments, the analysis messages and the results are all on the same window so branching to other areas such as from the AES findings to the phenotypic graphical display is just a point and click, Fowler said. The Navigation tree is very flexible. The view screen has folders for cassettes, patients, bench and date tested. This fits our needs quite well as our lab has a high volume and is organized by bench. So a tech on respiratory service or urine service can sort by bench folder and review only their own specimens. I can view by date tested, i.e., 5 days ago, which really helps us find those 'stragglers or forgotten' specimens. The filter screens are sorted by the status of the isolate: preliminary, qualified, to be reviewed, etc. Isolates and patients can be searched by accession number or patient number only. All in all, this has been a huge leap forward over the `roll and scroll interface. Remote Viewer Perhaps Fowler s favorite new feature is the remote viewer. In February, the lab added a new remote viewer application to the VITEK 2 system, which allows as many as 10 PCs to interface, search and gather results simultaneously. This is probably the best feature with our staff, Fowler said. Before the Web-based interface, the different benches would batch and hold onto problem specimens until they could get in line and view the single VITEK 2 PC. That s no longer a problem. I definitely think these improvements will help us better treat patients and improve outcomes, Fowler added. The VITEK 2 is an incredibly fast and hands-free machine even without these features. In healthcare, every minute counts. When the lab can provide valuable information quickly, we increase our value in the hospital and among clinicians who depend on this data to treat. The Microbiology Lab at Henry Ford installed the VITEK 2 upgrade in preparation for introducing MYLA to the microbiology lab. The intelligent microbiology middleware solution is designed by microbiologists for microbiologists and can provide an actionable, comprehensive picture of lab workflow to rapidly impact patient management across the full spectrum of microbiology lab equipment. PC5.01 has been a huge improvement to the lab: the remote viewer feature is greatly appreciated as it suppresses bottlenecks in the lab. Its ease of use and intuitive interface allow for the reduction of multiple steps and is a significant time savings. Finally, the flexibility of the software fits the lab s needs perfectly. biomérieux Connection July 20115

PREVI Isola Provides Positive Impact to Laboratory Efficiency and Speeds Valuable Clinical Information to Physicians An Inverview with: Allan Foulks, MS, MT (ASCP) Microbiology Laboratory Manager Professional Clinical Laboratories, Inc. (ProLab) Fort Worth, TX When Allen Foulks, the microbiology lab manager at Professional Clinical Laboratories, Inc., (ProLab) in Fort Worth, Texas, installed the first PREVI Isola in the ProLab network, he expected to see faster turnaround results and improved workflow. He didn t expect the device to do the work of a full-time equivalent (FTE), save his lab as much as $300 per week on plates, prevent unnecessary hospitalizations and assist nursing homes and long-term care facilities in selecting the best antimicrobial treatments for their patients. Unintended consequences are often bad, but they have only been good for us since installing PREVI Isola in 2010, Foulks said. Rapid and accurate turnaround time is vital for these infections in the elderly. Nursing homes depend on us to get them quick results to save lives and save costs. If the infection is serious, we provide the data that helps them make the best treatment decisions. If the infection is not too serious, we help avert an unnecessary hospitalization for an infection that can be treated within the facility. It s all about quality care that is cost-effective. We pride ourselves on this service, and the PREVI Isola has dramatically helped us to achieve this goal. Since making the switch, our workload is heavier on the initial reading due to the better colony isolation, said Foulks. But the payoff comes on the second day because greater than 90% of the urine cultures with pathogenic growth are finalized in under 48 hours! Urine turnaround times are important in Foulks lab. In 2010, the Fort Worth lab ran 107,000 cultures, 88,000 of which were urine cultures. This ratio of urine cultures to total number of cultures is typical for a geriatric patient population. Routine patient testing is done monthly on nursing home patients, including a CBC and urine analysis as mandated by the Joint Commission Patient Safety Guidelines for long-term care facilities. Based on microscopic examination as part of the urine analysis, the lab will perform a culture if indicated. Geriatric patients often suffer from renal disease and kidney malfunctions, so urine cultures typically contain multiple bacterial isolates in this population. The lab s protocol for polymicrobial testing is to utilize three plates for all urine samples. The objective is to get a sufficient number of isolated colonies to perform identification and susceptibility testing (ID/AST). 6 ProLab is a reference laboratory that caters to nursing homes and acute care hospitals. ProLab has facilities inside acute care hospitals and other locations. The Fort Worth facility that Foulks manages is a centralized microbiology lab that receives all the cultures from remote ProLab facilities throughout the Dallas/Fort Worth area. ProLab has testing facilities in Texas, Oklahoma and Alabama, and currently provides service in Mississippi, Louisiana, Kansas, Georgia and Tennessee. Prior to the implementation of PREVI Isola, we were able to get a general idea of the number of different organisms by performing gram staining, but we still needed to perform subcultures to obtain pure isolates in order to proceed with the ID/ASTs, said Foulks. PREVI Isola trims 24-48 hours from our old process, which ultimately allows physicians to begin appropriate treatment 24-48 hours earlier. According to Foulks, only 5% of cultures now require

subculturing since they ve implemented the PREVI Isola. Prior to implementation, the subculturing rate was about 30% when the initial culture was set up using manual plate streaking. This improvement has dramatically reduced turn-around time. Since one-third of ProLab s urine cultures are polymicrobial, it previously took an extra 1-2 days to get results for 30% of the lab s urine cultures. Now, 25% of the final culture results are reported in less than 48 hours, so the prime culprits in nursing homes Escherichia coli, Proteus mirabilis, Staphylococcus aureus can be found and treated much more quickly. ProLab s goal has always been to get results to a longterm care facility prior to the patient being transferred to the hospital. It s preferable if these patients can be treated within the facility to avoid the stress of a transfer, the risk of exposure to new pathogens and the cost to transfer a patient. As part of the PREVI Isola evaluation, the lab performed cultures struck manually on 20 samples, all which resulted in no growth. These same samples resulted in the isolation of 35 pathogens when inoculated and plated by the PREVI Isola. instead of the typical 72 hours for manual streaking. The results were impressive, Foulks said. This improved efficiency had an unexpected result. Foulks calculated a cost savings of $335/week in unused Columbia CNA and MacConkey plates. The additional plates were no longer necessary due to the reduction in the subculturing required when the PREVI Isola was used to inoculate and plate the original cultures. If the lab can achieve this savings every week, it could achieve a plate cost savings of approximately $17,500 in a single year. Looking forward, Foulks intends to add positive blood cultures to the lab s PREVI Isola workload. The benefits for urine cultures have been undeniable: Reduction of overtime, reallocation of FTE duties for more value-added functions, better colony isolation and improved turnaround time for results. If we can achieve this improvement across all samples in the lab, we ll be a much more efficient and valuable partner to our clinicians. The added level of confidence provided by the PREVI Isola is a great relief, said Foulks. No-growth plates are always a source of second-guessing in the microbiology lab. We often end up manually reculturing no-growth samples, which means an enormous delay in actionable clinical information when they become positive. The clinical improvements of the PREVI Isola are the most significant benefits of the device, said Foulks, but there have been many non-clinical improvements, as well. Foulks has been able to reallocate 4 hours daily of an FTE onto other more value-added tasks now that manual streaking has been so dramatically reduced. According to Foulks, having staff use this new time on ID/AST testing has been a tremendous improvement. According to Foulk s calculations, the PREVI Isola can streak an extra six urine cultures (or 18 plates) every 30 minutes compared to manual streaking. In a small evaluation of the PREVI Isola vs. manual streaking, Foulks lab performed 500 urine culture comparisons using both methods. We saved three hours of an FTE s time and had better colonization isolation, which resulted in more than 250 organisms effectively worked up with a turnaround time of 24 hours International Association for Food Protection 2011 IAFP Annual Meeting July 31-August 3 Milwaukee, WI biomérieux Connection July 2011 7

New VITEK 2 Cards The expanded VITEK 2 menu now includes 20 Gram Negative (GN) cards with an array of new antibiotic combinations, the XN04 extension card that mates to the GN45 card, and the new Yeast susceptibility card. Select GN cards feature a new and improved formulation of Meropenem, which allows for better detection of Carbapenemase producers. In addition, the new Meropenem formulation is cleared for testing Acinetobacter species, which was a limitation on the previous Meropenem formulation. The XN04 extension card mates with the GN45 card and provides 18 additional antibiotics, including Doripenem and the new formulation of Meropenem. Finally, the new FDA-cleared Yeast susceptibility YS05 card provides rapid and automated antifungal susceptibility (AFST) results for Fluconazole, Voriconazole and Caspofungin; this is an upgrade from the current YS02 card that provides an AFST result only for Fluconazole. With the addition of the YS05 VITEK 2 card, biomérieux now can offer its customers the flexibility to personalize a complete AFST solution that best fits their clinical needs: use the YS05 card as an automated, 3-drug primary AFST panel and use any of the extensive Etest options as a secondary AFST panel or upon clinical request. The complete new menu of VITEK 2 cards, including drugs and item numbers, is now available as of July 5, 2011. Visit www.biomerieux-usa.com for more information. TOTAL AST The AST Configurator is a user-friendly, interactive tool designed to give microbiologists and clinicians real-time feedback to their AST needs. The AST Configurator allows users to enter their drug(s) of choice (searchable by application or class) into a queue and, with the click of a button, have immediate access to their different VITEK 2 and Etest solutions. Customers also will have the option to download a printable PDF-version of the report. Whether you are a new VITEK 2/Etest user curious what the menu has to offer or an experienced VITEK 2/Etest user looking to add or switch cards with a specific formulary in mind, the AST Configurator will provide the most efficient VITEK 2 and Etest solutions. In addition, pharmacists can use this tool to gain visibility of what testing options are available for the respective drugs on their formulary, adding immediate value to any clinical antibiotic stewardship program, and at zero cost. As a world leader in in vitro diagnostics, biomerieux continues to invest in its total AST solution, in an on-going effort to live up to its mission of advancing diagnostics to improve public health. The power and intelligence of the AST Configurator, combined with VITEK 2 and Etest technologies, offer our customers the most comprehensive and innovative AST solution available. Visit www.totalast.com for more information. 8

VITEK 2 Test Cards VITEK 2 GRAM NEGATIVE SUSCEPTIBILITY TEST CARDS AST - GN45* (411920) AST- XN04 (410401) Amikacin Amoxicillin/Clavulanic Acid Ampicillin Aztreonam Ampicillin/Sulbactam Cefalotin Cefazolin Cefotaxime Cefepime Cefotetan Cefoxitin Cefpodoxime Ceftazidime Ceftizoxime Ceftriaxone Cefuroxime Doripenem Ertapenem Meropenem (new formula) ESBL Confirmation Test Moxifloxacin Gentamicin Nalidixic Acid Imipenem Norfloxacin Levofloxacin Piperacillin Nitrofurantoin Tetracycline Tobramycin Ticarcillin Ticarcillin/Clavulanic Acid Tigecycline AST - GN46 (411924) AST - GN47 (411923) Amikacin Amikacin Ampicillin Ampicillin Ampicillin/Sulbactam Ampicillin/Sulbactam Cefazolin Aztreonam Cefepime Cefazolin Cefoxitin Cefepime Ceftazidime Ceftriaxone Ceftriaxone Ertapenem Doripenem ESBL Confirmation Test Ertapenem Gentamicin ESBL Confirmation Test Imipenem Gentamicin Meropenem (new formula) Imipenem Moxifloxacin Levofloxacin Nitrofurantoin Nitrofurantoin Tigecycline Tobramycin Tobramycin AST - GN48 (412090) AST - GN49 (412091) Amikacin Amoxicillin/Clav.acid Ampicillin/Sulbactam Ampicillin Cefepime Cefalotin Cefotaxime Cefazolin Ceftazidime Cefepime Ceftriaxone Ceftriaxone Cefuroxime Gentamicin Imipenem Ertapenem Levofloxacin ESBL Confirm Meropenem Gentamicin Piperacillin Imipenem Tetracycline Levofloxacin Ticarcillin Nitrofurantoin Ticarcillin/Clav. Acid Piperacillin Tigecycline Tetracycline Tobramycin Tobramycin Trimethoprim/Sulfa Trimethoprim/Sulfa AST - GN50 (412100) AST - GN51 (412101) AST - GN52 (412105) Amoxicillin/Clavulanic Acid Amikacin Amikacin Ampicillin Ampicillin Ampicillin Aztreonam Ampicillin/Sulbactam Ampicillin/Sulbactam Cefalotin Cefazolin Cefazolin Cefazolin Cefepime Cefepime Cefepime Cefoxitin Cefoxitin Cefoxitin Ceftazidime Ceftazidime Cefpodoxime Ceftriaxone Ceftriaxone Ceftazidime Ceftriaxone ESBL Confirmation Test Ertapenem Cefuroxime Gentamicin ESBL Confirmation Test Imipenem Gentamicin Gentamicin Levofloxacin Imipenem Levofloxacin Meropenem (new formula) Levofloxacin Nitrofurantoin Nitrofurantoin Nitrofurantoin Norfloxacin Piperacillin Piperacillin Tetracycline Tobramycin Tigecycline Tobramycin AST - GN53 (412102) AST - GN54 (412099) AST - GN55 (411948) Amikacin Amikacin Amikacin Ampicillin Amoxicillin/Clavulanic Acid Ampicillin Ampicillin/Sulbactam Ampicillin Ampicillin/Sulbactam Cefazolin Ampicillin/Sulbactam Cefazolin Cefepime Aztreonam Cefepime Cefoxitin Cefazolin Cefoxitin Ceftazidime Cefepime Ceftazidime Ceftriaxone Cefoxitin Ceftriaxone Ceftriaxone Ertapenem Ertapenem ESBL Confirmation Test Ertapenem ESBL Confirmation Test Gentamicin ESBL Confirmation Test Gentamicin Imipenem Gentamicin Imipenem Levofloxacin Imipenem Moxifloxacin Meropenem (new formula) Levofloxacin Nitrofurantoin Nitrofurantoin Nitrofurantoin Ticaracillin/Clavulanic Acid Tigecycline Tigecycline Tigecycline Tobramycin Tobramycin AST - GN56 (412027) AST - GN57 (412103) AST - GN58 (412104) Amikacin Amikacin Amikacin Ampicillin Amoxicillin/Clavulanic Acid Ampicillin Cefazolin Ampicillin Ampicillin/Sulbactam Cefepime Cefalotin Cefazolin Cefotaxime Cefazolin Cefepime Cefoxitin Cefepime Cefoxitin Ceftazidime Ceftazidime Ceftazidime Ceftriaxone Ceftriaxone Ertapenem Ertapenem ESBL Confirmation Test Gentamicin Ertapenem Gentamicin Levofloxacin ESBL Confirmation Test Imipenem Meropenem (new formula) Gentamicin Levofloxacin Nitrofurantoin Imipenem Nitrofurantoin Norfloxacin Levofloxacin Piperacillin Piperacillin Meropenem (new formula) Tigecycline Tetracycline Nitrofurantoin Tobramycin Tigecycline Tobramycin Tobramycin AST - GN59 (412028) AST GN60 (412029) AST - GN61 (411943) Amikacin Amikacin Amikacin Ampicillin Amoxicillin/Clavulanic Acid Amoxicillin/Clavulanic Acid Ampicillin/Sulbactam Ampicillin Ampicillin Aztreonam Aztreonam Aztreonam Cefazolin Cefazolin Cefazolin Cefepime Cefepime Cefepime Cefotetan Ceftriaxone Cefoxitin Ceftazidime Ceftazidime Ceftriaxone Ertapenem Ceftriaxone Ertapenem ESBL Confirmation Test ESBL Confirmation Test Gentamicin Ertapenem Gentamicin Imipenem Gentamicin Levofloxacin Levofloxacin Levofloxacin Meropenem (new formula) Meropenem (new formula) Meropenem (new formula) Nitrofurantoin Nitrofurantoin Nitrofurantoin Tigecycline Tetracycline Piperacillin Tobramycin Tobramycin Tobramycin Tetracycline biomérieux Connection July 2011 9

VITEK 2 Test Cards VITEK 2 GRAM NEGATIVE SUSCEPTIBILITY TEST CARDS VITEK 2 GRAM POSITIVE SUSCEPTIBILITY TEST CARDS AST - GN62 (411947) AST - GN63 (412150) AST - GN64 (411949) Amikacin Amikacin Amikacin Ampicillin/Sulbactam Ampicillin/Sulbactam Amoxicillin/Clavulanic Acid Aztreonam Aztreonam Ampicillin Cefazolin Cefepime Cefazolin Cefepime Cefotaxime Cefepime Cefoxitin Ceftazidime Cefotaxime Ceftazidime Ceftriaxone Cefoxitin Ceftriaxone Ceftazidime Ertapenem Ertapenem Gentamicin ESBL Confirmation Test Gentamicin Imipenem Gentamicin Imipenem Levofloxacin Imipenem Levofloxacin Meropenem (new formula) Meropenem (new formula) Meropenem (new formula) Piperacillin Nitrofurantoin Nitrofurantoin Ticarcillin/Clavulanic Acid Norfloxacin Piperacillin Tigecycline Piperacillin Tigecycline Tobramycin Tetracycline Tobramycin AST-GP67 (22226) AST-GP68 (22231) AST-GP70 (22340) Ampicillin Amoxicillin Ampicillin Benzylpenicillin Benzylpenicillin Cefoxitin Screen Cefoxitin Screen Cefotaxime Ceftriaxone Clindamycin Clindamycin Chloramphenicol Daptomycin Erythromycin Ertapenem Erythromycin Gentamicin Erythromycin Gentamicin Gentamicin High Level Synergy Levofloxacin Gentamicin High Level Synergy Inducible Clindamycin Resistance Linezolid Inducible Clindamycin Resistance Levofloxacin Meropenem Levofloxacin Linezolid Moxifloxacin Linezolid Moxifloxacin Ofloxacin Moxifloxacin Nitrofurantoin Telithromycin Nitrofurantoin Oxacillin Tetracycline Oxacillin Quinupristin/Dalfopristin Rifampicin Rifampicin Vancomycin Streptomycin High Level Synergy Streptomycin High Level Synergy Tetracycline Tetracycline Tigeycline Tigecycline Vancomycin Vancomycin VITEK 2 GRAM POSITIVE SUSCEPTIBILITY TEST CARDS VITEK 2 ANTIFUNGAL SUSCEPTIBILITY TEST CARDS AST-GP71 (410750) AST-GP72 (410770) Benzylpenicillin Ampicillin Cefoxitin Screen Ampicillin/Sulbactam Benzylpenicillin Clindamycin Chloramphenicol Daptomycin Erythromycin Daptomycin Gentamicin Erythromycin Inducible Clindamycin Resistance Gentamicin High Level Synergy Levofloxacin Levofloxacin Linezolid Linezolid Minocycline Minocycline Moxifloxacin Nitrofurantoin Nitrofurantoin Norfloxacin Oxacillin Quinupristin/Dalfopristin Quinupristin/Dalfopristin Streptomycin, High level Synergy Rifampicin Tigecycline Tetracycline Vancomycin Tigecycline Vancomycin AST-YS02 (22157) AST-YS05 (411945) Fluconazole Caspofungin Fluconazole Voriconazole 10

TOTAL AST Find The Best VITEK 2 and Etest Combination to Meet Your Needs. Handling more testing, more resistance with a need for more effeciency? Challenge: How can you optimize your algorithm to address these challenges? Provide clinicians with guidance on treatment options Promote the responsible use of antibiotics Provide clinicians and pharmacists with quantitative information to optimize dosage and regimens Solution: Visit the online AST Configurator Tool and find the best VITEK 2 and Etest solution that meets your AST optimization needs. www.totalast.com

100 Rodolphe Street, Durham, North Carolina 27712 www.biomerieux.com ADDRESS SERVICE REQUESTED 2011 BIOMÉRIEUX, INC. The blue logo, bioart, PREVI ISOLA, VITEK 2, AND vitek ms ARE REGISTERED TRADEMARKS OF BIOMÉRIEUX. PRINTED IN USA. biom21935-11. EVENTS CALENDAR AUGUST JULY SEPTEMBER Date Event & Location National 15-21 KSU Food Workshop 31-Aug 3 International Association of Food Protection (IAFP) Milwaukee, WI 2 HPG Vendor Fair and Conference, Nashville, TN 10-11 Cardinal Health National Sales Meeting, Las Vegas, NV 15-17 Lab Plus 7-10 Southwest Association of Clinical Microbiology (SWACM), Oklahoma City, OK 7-10 Intermountain State Seminar (IMSS), Snow King Resort, Jackson Hole, WY 19-22 PDA/FDA, Renaissance Hotel, Washington, DC 22-23 18th Annual Beaumont Symposium, Troy, MI 25 ICAHN 4th Annual Vendor Fair, Springfield, IL 30 WVA SCACM Regional biomérieux Connection is published by biomérieux, Inc., 100 Rodolphe Street, Durham, NC 27712. Please send address corrections and mailing list additions to biomerieux.connection@na.biomerieux.com. For customer service, call toll free 800-682-2666. Please visit our web site at www.biomerieux-usa.com. Please share your comments and suggestions with us through your local account manager or by emailing us at the address above. As always, we thank you for being a biomérieux customer.