Overview
Automated AST systems are instrument platforms that incubate standardized inocula in multi-well cards or panels, estimate MICs from growth endpoints, and assign interpretive categories using laboratory-loaded breakpoint tables.
Classification
| Element | Purpose | Hold if |
|---|---|---|
| Inoculum prep | Standardize density | Out of range / wrong saline |
| Card/panel | Organism-appropriate drug set | Wrong card or expired lot |
| Expert system | Flag rare/implausible patterns | Unresolved alert |
| Breakpoint file | Category assignment source | Wrong standard/edition |
Morphologic Features
Automated AST does not replace morphologic purity checks. Mixed colony types invalidate MIC strings that look numerically complete.
Laboratory Characteristics
- Card/panel lot and inventory control
- Instrument maintenance and temperature logs
- Software and breakpoint-version documentation
- Manual backup methods when required by SOP
Reference Intervals
QC ranges, card acceptance limits, and verification algorithms are manufacturer- and institution-specific. Breakpoint values are not universal dogma, verify whether the laboratory adopts CLSI, EUCAST, or another authorized source, and which edition is loaded.
Clinical and Laboratory Significance
Released automated categories support clinical stewardship conversations only when ID, purity, QC, and breakpoint congruence are intact. The laboratory reports phenotypic data, not antimicrobial selection or doses.
Differential Considerations
Differentiate true unusual resistance phenotypes from inoculum error, mixed culture, wrong card, stale breakpoint files, and identification mismatch before accepting flagged results.
Comparison Tables
Automated AST review cues
| Situation | Correct lab action | Incorrect action |
|---|---|---|
| Expert flag | Review / verify per SOP | Blind Accept |
| Mixed culture suspected | Re-isolate; repeat AST | Release blended MICs |
| Unknown breakpoint source | Confirm adopted standard/edition | Assume CLSI = EUCAST |
Classification Frameworks
Not applicable.
Laboratory Notes
- Hedge manufacturer menus and local verification rules
- Never present instrument categories as universal breakpoints
- No treatment or dosing language in review notes
References
Authoritative textbooks, guidelines, and reviews supporting this reference entry. Verify reference intervals, critical limits, and reflex criteria against institutional protocols and current guideline editions.
Textbooks
- Forbes BA, Sahm DF, Weissfeld AS. Bailey & Scott's Diagnostic Microbiology. 15th ed. Elsevier; 2020.
- Mahon CR, Lehman DC, Manuselis G. Textbook of Diagnostic Microbiology. 6th ed. Elsevier; 2018.
- Carroll KC, Hobden JA, Miller S, et al. Jawetz, Melnick, & Adelberg's Medical Microbiology. 28th ed. McGraw-Hill; 2019.
- Murray PR, Rosenthal KS, Pfaller MA. Medical Microbiology. 9th ed. Elsevier; 2021.
CLSI and Professional Guidelines
- Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing. CLSI document M100 (verify current edition and institutional adoption).
- Centers for Disease Control and Prevention / NIH. Biosafety in Microbiological and Biomedical Laboratories (BMBL). Current edition (verify institutional adoption).
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