This test is for a selection of custom drug testing of any single agent considered a primary or secondary antimicrobial for M. tuberculosis Complex. Testing will be performed by an automated macro-broth method.

In order to perform susceptibility testing and interpret test results, the identification of the isolate is required.

This test is approved for New York patient testing.

 Antimicrobial Testing

Posaconazole is a newer triazole antifungal agent for treatment and prophylaxis of fungal infections and has broad spectrum activity against yeasts and moulds. Blood levels may be affected by other concurrent medications, patient conditions, fat intake at dosing, and other factors. Blood levels above the MIC over the time of dosing interval may be associated with antifungal efficacy. This therapeutic drug monitoring assay is precise and accurate for detection of posaconazole in serum within the clinical range of 0.01 mcg/mL to 4.0 mcg/mL.

Serum Level Ranges:
Single 200 mg dose, fasting: 0.05 – 0.27 mcg/mL
Single 200 mg dose high fat: 0.24 – 1.02 mcg/mL
Steady state, 200 mg TID: 0.02 – 3.65 mcg/mL

This test is approved for New York patient testing.

Small free-living amebae belonging to the genera Acanthamoeba and Naegleria have been identified as agents of human disease, causing infections of the central nervous system, cornea, lungs, and skin. These amebae are commonly found in soil, fresh water, sewage, and sludge. Acanthamoeba spp. are known to cause a chronic granulomatous amebic encephalitis as well as a painful vision-threatening keratitis. Naegleria fowleri is implicated in primary amebic meningoencephalitis, an acute fulminating disease that is often fatal. For detection of intestinal amebae, such as Entamoeba histolytica, please request Focus unit code 51730, Parasite Examination (Ova and Parasite).

This test is approved for New York patient testing.

The following antimicrobials are available for susceptibility testing. To inquire about additional drugs, contact Client Services.

Antibacterial Amikacin Amoxicillin Amoxicillin/   Clavulanate Ampicillin Ampicillin/   Sulbactam Azithromycin Aztreonam Bacitracin Carbenicillin Cefaclor Cefazolin Cefepime Cefixime Cefotaxime Ceftazidime Cefoxitin Cefpodoxime Cefprozil Ceftizoxime Ceftriaxone Cefuroxime Cephalexin Cephalothin Chloramphenicol Ciprofloxacin Clarithromycin Clindamycin Colistin

Daptomycin Dicloxacillin Doripenem Doxycycline Ertapenem Erythromycin Gemifloxacin Gentamicin Imipenem Kanamycin Levofloxacin Linezolid Lomefloxacin Meropenem Metronidazole Minocycline Moxifloxacin Mupirocin Nafcillin Nalidixic Acid Neomycin Nitrofurantoin Norfloxacin Ofloxacin Oxacillin Penicillin Pipercillin Pipercillin/   Tazobactam Polymyxin B Quinupristin/   Dalfopristin

Rifampin Streptomycin Sulfamethoxazole Sulfisoxazole Tetracycline Ticarcillin Ticarcillin/   Clavulanate Tigecycline Tobramycin Trimethoprim Trimethoprim/   Sulfamethoxazole Vancomycin Antifungal Amphotericin B Anidulafungin Butoconazole Caspofungin Clotrimazole Fluconazole 5-Fluorocytosine Griseofulvin Itraconazole Ketoconazole Micafungin Miconazole Natamycin Nystatin Terbinafine Terconazole Voriconazole

Antimycobacterial Amikacin Capreomycin Cefoxitin Ciprofloxacin Clarithromycin Cycloserine Doxycycline Ethambutol Ethionamide Imipenem Isoniazid Kanamycin Linezolid Minocycline Moxifloxacin p-Aminosalicylic acid Pyrazinamide Rifabutin Rifampicin Rifampin Streptomycin Tigecycline Tobramycin Trimethoprim/   Sulfamethoxazole Antiviral Acyclovir Foscarnet Ganciclovir

HPLC fluorescence detection and conventional biochemical methods are used for identification of Mycobacterium species.

This test is approved for New York patient testing.

Antimicrobial susceptibility testing of anaerobes has become increasingly more relevant to patient care due to increased resistance rates among anaerobic bacteria. This test provides MICs and interpretations for antimicrobials commonly used for therapy of anaerobic infections as recommended by the Clinical and Laboratory Standards Institute (CLSI).

Antimicrobials tested
Antimicrobial	BFRAG	BLACN	CPGP	CLOST
Ampicillin/sulbactam	X	X	X	X
Cefoxitin	-	-	-	X
Cefotetan	-	-	-	X
Clindamycin	X	X	X	X
Imipenem	X	X	X	X
Meropenem	X	-	-	X
Metronidazole	X	X	X	X
Penicillin	-	X	X	X
Piperacillin/tazobactam	X	X	X	X

BFRAG = B. fragilis group and other ß-lactamase positive gram-negatives
BLACN = ß-lactamase negative gram-negatives
CPGP = Clostridium perfringens and other non-clostridial gram-positives
CLOST = Clostridium species other than C. perfringens

This test is approved for New York patient testing.

Specimens collected just before or within 15 minutes of the next dose represent the TROUGH levels. Specimens obtained within 15-30 minutes after the end of I.V. infusion or 45-60 minutes after an IM injection or 90 minutes after oral intake represent the PEAK level.

Therapeutic levels:

600 mg Oral, Peak 600 mg IV, Peak 300 mg IV,Peak

7 mcg/mL (4-32 mcg/mL) 17.4 + or - 5.1 mcg/mL 9.0 + or - 3.0 mcg/mL

Drugs which may interfere with this test include: Sulindac.

This test is approved for New York patient testing.

 Antimicrobial Testing

Specimens collected just before or within 15 minutes of the next dose represent the TROUGH levels. Specimens obtained within 15-30 minutes after the end of I.V. infusion or 45-60 minutes after an IM injection or 90 minutes after oral intake represent the PEAK level.

Therapeutic levels:

Peak serum

1.0-4.5 mcg/mL

Drugs which may interfere with this assay include: Iproniazid.

List all other antimicrobials being used to treat the patient.

This test is approved for New York patient testing.

 Antimicrobial Testing

Identification is performed using DNA probes directed against Mycobacterium tuberculosis complex and M. avium complex. Cultures submitted on slants should be no more than 4 weeks old. Cultures submitted in Bactec bottles should have a GI >=500. Cultures submitted in other liquid media should have a turbidity >=1.0 McFarland Standard. The intensity of growth and viability of the culture are essential for avoiding false-negative results. A negative result may be due to the fact that the organism submitted is not of the species to which the DNA probes are directed, or it may be due to insufficient growth of the organism in the liquid medium that is submitted. At your request, liquid media cultures that have tested negative with both probes will be sub-cultured to new liquid media in an effort to enhance growth and will be re-tested for an additional charge. For re-testing, please request HPLC and Conventional Methods (Focus Unit Code 51175) or DNA probes (Focus Unit Code 51166 and/or 51176).

This test is approved for New York patient testing.

Focus performs studies on most FDA approved drugs as well as investigational drugs. Susceptibility panels are customized per client request. Any number of drugs can be tested. Please inquire for additional information.

51330   1 Drug	51360   4 Drugs
51340   2 Drug	51365   5 Drugs
51350   3 Drug	51370   6 Drugs

In order to perform susceptibility testing to the drugs of choice and to interpret test results, the identification of the isolate is required. Focus will identify the organism for an additional charge if not supplied on the test requisition.

Please see the following technical sheet for more information:
 Antimicrobial Testing

The fluorescent stain calcofluor white is used for the rapid detection of Acanthamoeba and Naegleria cysts. For detection of intestinal amebae, such as Entamoeba histolytica, please request Focus unit code 51730, Parasite Examination (Ova and Parasite).

This test is approved for New York patient testing.

This unit code has been inactivated.

Please see unit code 50776.

Please see the following technical sheet for more information:
 Antimicrobial Testing

Susceptibility to TCH(thiophene-2-carboxylic acid hydrazide) is used to distinguish niacin-positive Mycobacterium bovis from M. tuberculosis and other nonchromogenic, slow growing mycobacteria. Most M. bovis isolates are susceptible to low concentrations of TCH, whereas M. tuberculosis and most other slowly growing mycobacteria are resistant.

This test is approved for New York patient testing.

This unit code has been inactivated.

Please see unit code 50777.

Please see the following technical sheet for more information:
 Antimicrobial Testing

Focus performs studies on most FDA approved drugs as well as investigational drugs. Susceptibility panels are customized per client request. Any number of drugs can be tested. Please inquire for additional information.

51335   1 Drug 51345   2 Drug 51355   3 Drug

51415   4 Drugs 51390   5 Drugs 51395   6 Drugs

In order to perform susceptibility testing to the drugs of choice and to interpret test results, the identification of the isolate is required. Focus will identify the organism for an additional charge if not supplied on the test requisition.

Please see the following technical sheet for more information:
 Antimicrobial Testing

Acetylcholine receptor (AChR) binding antibody is present in 87% of generalized myasthenia gravis (MG) patients, 71% of ocular MG patients and 81% of all MG patients in remission. The AChR binding antibody is the most common AChR antibody found in MG patients and its absence makes the diagnosis of MG unlikely.

†This test was developed and its performance characteristics determined by Focus Diagnostics. It has not been cleared or approved by the U.S. Food and Drug Administration. The FDA has determined that such clearance or approval is not necessary. Performance characteristics refer to the analytical performance of the test.

Test performed at Quest Diagnostics Nichols Institute.

Focus performs studies on most FDA approved drugs as well as new investigational drugs. Susceptibility panels are customized per client request. Any number of drugs can be tested . Please inquire for additional information.

51480   1 Drug	51500   3 Drugs
51490   2 Drugs

In order to perform susceptibility testing to the drugs of choice and to interpret test results, the identification of the isolate is required.

Please see the following technical sheet for more information:
 Antimicrobial Testing

Specimens collected just before or within 15 minutes of the next dose represent the TROUGH levels. Specimens obtained within 15-30 minutes after the end of I.V. infusion or 45-60 minutes after an IM injection or 90 minutes after oral intake represent the PEAK level.

Therapeutic levels:

	Peak serum	5-25 mcg/mL
	Trough serum	<=5 mcg/mL
	For Mycobacterium tuberculosis	25-50 mcg/mL

Drugs which may interfere with this assay include: Sulindac.

List all other antimicrobials being used to treat the patient.

This test is approved for New York patient testing.

 Antimicrobial Testing

This test is a comprehensive susceptibility panel that includes both primary and secondary antimicrobial agents to the M. tuberculosis complex. The test is performed by the agar proportion method and includes antimicrobial agents:

Panel includes:

Amikacin, Capreomycin, Ciprofloxacin, Cycloserine, Ethambutol, Ethionamide, Isoniazid, p-Aminosalicylic Acid, Pyrazinamide, Rifampin and Streptomycin.

In order to perform susceptibility testing to the drugs of choice and to interpret test results, the identification of the isolate is required.

This test is available for New York patient testing.

 Antimicrobial Testing

Antifungal susceptibility tests are designed to provide information that will allow the physician to select the appropriate antifungal agent useful for treating a specific infection. Testing is performed using the broth microdilution method for pathogenic yeasts. No CLSI interpretive guidelines are established for these agents. The identification of the submitted isolate is required in order to perform and interpret this test.

Panel includes: Itraconazole, Griseofulvin, and Terbinafine

This test is available for New York patient testing.

Acetycholine receptor blocking antibodies are found in approximately 40% of myasthenia gravis patients and correlate with disease activity. Nearly all MG patients positive for acetylcholine blocking antibodies are also positive for acetylcholine receptor binding antibodies. Recent use of muscle relaxants may cause false positive results in this assay.

†This test was developed and its performance characteristics determined by Focus Diagnostics. It has not been cleared or approved by the U.S. Food and Drug Administration. The FDA has determined that such clearance or approval is not necessary. Performance characteristics refer to the analytical performance of the test.

Test performed at Quest Diagnostics Nichols Institute.

If the species of the organism is unknown, or not supplied on the test requisition, Focus will identify the organism to the level necessary to perform and interpret the requested test for an additional charge. Once the Focus Microbiology staff has identified the organism, the unit code will be changed to reflect the correct MIC panel and billed accordingly.

51339  Enterococcus
51455  Fastidious Gram-Negative Rods
51280  &Gram-Negative Rods
51284  &Gram-Positive Rods
51275  Haemophilus
51445  Neisseria gonorrhoeae
51450  Neisseria meningitidis
52293  Nocardia/Aerobic Actinomycetes MIC Panel
51310  Staphylococcus
51266  Stenotrophomonas maltophilia
51315  Streptococcus
51435  Streptococcus pneumoniae

Please see the following technical sheet for more information:
 Antimicrobial Testing

Identification is performed using DNA probes directed against Mycobacterium kansasii and Mycobacterium gordonae. Cultures submitted on slants should be no more than 4 weeks old. Cultures submitted in BACTEC bottles should have a GI>=500. Cultures submitted in other liquid media should have a turbidity >=1.0 McFarland Standard. The intensity of growth and viability of the culture are essential for avoiding false-negative results. A negative result may be due to the fact that the organism submitted is not of the species to which the DNA probes are directed, or it may be due to insufficient growth of the organism in the liquid medium that is submitted. At your request, liquid media cultures that have tested negative with both probes will be subcultured to new liquid media in an effort to enhance growth and will be retested for an additional charge. For retesting, please request DNA probes (Focus Unit Code 51166 or 51176) or HPLC and Conventional Methods (Focus Unit Code 51175).

This test is approved for New York patient testing.

Susceptibility panels are customized per client request. Any number of drugs can be tested by Focus. Please inquire for additional information.

53610   1 Drug	53630   3 Drugs	53650   5 Drugs
53620   2 Drug	53640   4 Drugs	53660   6 Drugs

In order to perform susceptibility testing to the drugs of choice and to interpret test results, the identification of the isolate is required.

Please see the following technical sheet for more information:
 Antimicrobial Testing

In order to perform susceptibility testing and to interpret test results, the identification of the isolate is required.

51200 - AFB Susceptibility, Custom Drug Panel (1) 51205 - AFB Susceptibility, Custom Drug Panel (2) 51210 - AFB Susceptibility, Custom Drug Panel (3)

Please see the following technical sheet for more information:
 Antimicrobial Testing

Acetycholine receptor (AChR) modulating antibodies are found together with AChR binding antibodies in 90% of myasthenia gravis (MG) patients. An additional 1-2% of MG patients exhibit only AChR modulating antibodies.

†This test was developed and its performance characteristics determined by Focus Diagnostics. It has not been cleared or approved by the U.S. Food and Drug Administration. The FDA has determined that such clearance or approval is not necessary. Performance characteristics refer to the analytical performance of the test.

Test performed at Quest Diagnostics Nichols Institute.

This unit code has been inactivated.

Please see unit code 50776.

Please see the following technical sheet for more information:
 Antimicrobial Testing

• Myasthenia Gravis Panel 2

Susceptibility testing for molds can be selected from a number of antifungal drugs, click on the Technical Information link below. Please specify the drug on the test requisition. This assay tests for both the minimum inhibitory concentration of the drug and the minimum fungicidal concentration. In order to perform susceptibility testing to the drugs of choice and to interpret test results, the identification of the isolate is required.

This test is approved for New York patient testing.

 Antimicrobial Susceptibility Testing

This unit code has been inactivated.

Please see unit code 51477.

Please see the following technical sheet for more information:
 Antimicrobial Testing

• Antimicrobial Susceptibility, AFB

This unit code has been inactivated.

Please see unit code 51887.

Please see the following technical sheet for more information:
 Antimicrobial Testing

• AFB Susceptibility, M. avium Complex, Drug Combinations, Agar Method
• AFB Susceptibility, M. tuberculosis Complex Panel, Agar Method (PZA Broth Method)
• AFB Susceptibility, M. tuberculosis Complex Primary Panel, Agar Method
• AFB Susceptibility, M. tuberculosis Complex, Primary Panel, Broth Method
• AFB Susceptibility, M. tuberculosis Complex, Secondary Panel, Agar Method
• AFB, Culture and Smear, Conventional Method and Broth Method
• AFB, Environmental Culture
• AFB, Identification, HPLC and Conventional Methods
• AFB, Identification, M. kansasii/gordonae, DNA Probe
• AFB, Identification, MTB/MAC, DNA Probe
• AFB, Identification, TCH Susceptibility, Broth Method
• AFB, Mycobacterium tuberculosis Complex DNA, PCR
• AFB, Smear, FM and LM
• AFB, Susceptibility, M. tuberculosis Complex, Secondary Panel, Broth Method
• Antimicrobial Susceptibility, AFB Rapid Grower, MIC
• Antimicrobial Susceptibility, AFB, Custom MIC-1 Drug, Rapid, Broth Method
• Antimicrobial Susceptibility, AFB, Pyrazinamide, Broth Method
• Mycobacterium avium Complex MIC Panel
• Mycobacterium Slow Grower MIC
• Mycobacterium tuberculosis Complex PCR with AFB Culture and Smear, Broth Method

Panel includes:
	Amikacin, Cefoxitin, Ciprofloxacin, Clarithromycin, Doxycycline, Imipenem, Linezolid, Moxifloxacin, Tigecycline, Tobramycin, Trimethoprim/Sulfamethoxazole In order to perform susceptibility testing and to interpret test results, the identification of the isolate is required.

*This test was performed using a kit that has not been cleared or approved by the FDA. The analytical performance characteristics of this test have been determined by Focus Diagnostics. This test should not be used for diagnosis without confirmation by other medically established means.

This test is approved for New York patient testing.

 Antimicrobial Testing

This test is performed by the agar proportion method and includes the primary antimicrobial agents used for testing isolates identified as M. tuberculosis complex. The panel includes (list drugs in the DOS descriptor)

Mtb Drug Panel includes:

Ethambutol, Isoniazid, Pyrazinamide, Rifampin and Streptomycin.

In order to perform susceptibility testing and interpret test results, the identification of the isolate is required.

This test is available for New York patient testing.

 Antimicrobial Testing

Antifungal susceptibility tests are designed to provide information that will allow the physician to select the appropriate antifungal agent useful for treating a specific invasive infection. Testing is performed using the broth microdilution method for filamentous fungi. The identification of the submitted isolate is required in order to perform and interpret this test.

Panel includes:

Amphotericin B, Fluconazole, 5-Fluorocytosine, Itraconazole, and Ketoconazole.

This test is approved for New York patient testing.

 Antimicrobial Testing

Decreased serum levels of alpha-1-acid glycoprotein may be found in association with malnutrition, severe liver damage, and in women using estrogen-related oral contraceptives. Increased serum levels have been reported in conditions of acute and chronic inflammation, including myocardial infarction, rheumatoid arthritis, systemic lupus erythematosus, and malignancy. Except for a difference in sialic acid content, alpha-1-acid glycoprotein is identical to immunosuppressive acidic protein (IAP).

This test is approved for New York patient testing.

Panel includes:

Ciprofloxacin, Gentamicin, Rifampin, Tetracycline, and Trimethoprim/Sulfamethoxazole.

In order to perform susceptibility testing and to interpret test results, the identification of the isolate is required. Perform all work in a Biological Safety Cabinet prior to transport.

This test is available for New York patient testing.

 Antimicrobial Testing

Susceptibility panels are customized per client request. Any number of drugs can be tested by Focus. Please inquire for additional information.

51610   1 Drug	51630   3 Drugs	51650   5 Drugs
51620   2 Drug	51640   4 Drugs	51660   6 Drugs

In order to perform susceptibility testing to the drugs of choice and to interpret test results, the identification of the isolate is required.

Please see the following technical sheet for more information:
 Antimicrobial Testing

This test uses antimicrobial agent combinations and is performed by the agar proportion method. The panel incudes (the rest is in the DOS descriptor)

Panel includes:

Ethambutol in combination with Clarithromycin, Erythromycin and Rifampin.

In order to perform susceptibility testing and interpret test results, the identification of the isolate is required.

This test is not approved for New York patient testing.

 Antimicrobial Testing

Antifungal susceptibility tests are designed to provide information that will allow the physician to select the appropriate antifungal agent useful for treating a specific infection. Testing is performed using the broth microdilution method for pathogenic yeasts. MIC interpretations are provided for those drugs for which guidelines have been published.
The identification of the submitted isolate is required in order to perform and interpret this test.

Panel includes:
Amphotericin B, Anidulafungin, Caspofungin, Fluconazole, 5-Fluorocytosine, Itraconazole, Micafungin, Posaconazole, and Voriconazole.

*This test was performed using a kit that has not been cleared or approved by the FDA. The analytical performance characteristics of this test have been determined by Focus Diagnostics. This test should not be used for diagnosis without confirmation by other medically established means.

This test is approved for New York patient testing.

• Entamoeba histolytica Antigen, EIA
• Entamoeba histolytica IgG, ELISA

Panel includes:

Ciprofloxacin, Clindamycin, Erythromycin, Gentamicin, and Tetracycline.

In order to perform susceptibility testing and interpret test results, the identification of the isolate is required.

*This test was performed using a kit that has not been cleared or approved by the FDA. The analytical performance characteristics of this test have been determined by Focus Diagnostics. This test should not be used for diagnosis without confirmation by other medically established means.

This test is available for New York patient testing.

 Antimicrobial Testing

Antifungal susceptibility tests are designed to provide information that will allow the physician to select the appropriate antifungal agent useful for treating a specific infection. Testing is performed using the broth microdilution method for pathogenic yeasts. MIC interpretations are provided for those drugs for which guidelines have been established by the CLSI (formerlly NCCLS). The identification of the submitted isolate is required in order to perform and interpret this test.

Panel includes:

Amphotericin B, Fluconazole, 5-Fluorocytosine, Itraconazole, and Ketoconazole.

Drug	Susceptible	Susceptible Dose Dependent	Intermediate	Resistant
Amphotericin B	<=1 mcg/mL	---	---	>=2 mcg/mL
Fluconazole	<=8 mcg/mL	16-32 mcg/mL	---	>=64 mcg/mL
5-Fluorocytosine	<=4 mcg/mL	---	8-16 mcg/mL	>=32 mcg/mL
Itraconazole	<=0.12 mcg/mL	0.25-0.5 mcg/mL	---	>=1 mcg/mL
Voriconazole	<=	2.0	---	>=

*This test was performed using a kit that has not been cleared or approved by the FDA. The analytical performance characteristics of this test have been determined by Focus Diagnostics. This test should not be used for diagnosis without confirmation by other medically established means.

This test is available for New York patient testing.

 Antimicrobial Testing

This test is performed by an automated macro-broth method and includes the primary antimicrobial agents used for testing isolates identified as M. tuberculosis complex. The panel includes (list drugs in the DOS descriptor)

Mtb Drug Panel includes:

Ethambutol, Isoniazid, Pyrazinamide, Rifampin and Streptomycin. Note: Pyrazinamide will be performed only on M. tuberculosis (Focus Unit Code 51905) upon request and for an additional charge.

In order to perform susceptibility testing and to interpret test results, the identification of the isolate is required.

This test is approved for New York patient testing.

 Antimicrobial Testing

Susceptibility panels are customized per client request. Any number of drugs can be tested by Focus. Please inquire for additional information.

51615   1 Drug	51635   3 Drugs
51625   2 Drug

In order to perform susceptibility testing to the drugs of choice and to interpret test results, the identification of the isolate is required.

Please see the following technical sheet for more information:
 Antimicrobial Testing

Antibodies recognizing actin are the main component of smooth muscle antibodies associated with autoimmune liver disease. Actin antibodies are found in approximately 75% of patients with autoimmune hepatitis and approximately 30% of patients with primary biliary cirrhosis.

This test is approved for New York patient testing.

Panel includes:

Ampicillin, Daptomycin, Erythromycin, Levofloxacin, Linezolid, Penicillin, Quinupristin/Dalfopristin, Rifampin, Tetracycline, Vancomycin, Gentamicin 500, and Streptomycin 1000.

In order to perform susceptibility testing and interpret test results, the identification of the isolate is required.

This test is approved for New York patient testing.

• Antiviral Susceptibility, Acyclovir

This test is performed by the agar proportion method and includes the antimicrobial agents considered as secondary agents for M. tuberculosis Complex. The panel includes (see DOS)

Mtb Drug Panel includes:

Amikacin, Capreomycin, Ciprofloxacin, Cycloserine, Ethionamide and p-Aminosalicylic Acid.

In order to perform susceptibility testing and interpret test results, the identification of the isolate is required.

This test is available for New York patient testing.

 Antimicrobial Testing

Panel includes:

Amoxicillin/Clavulanate, Ampicillin, Ceftriaxone, Cefuroxime, Chloramphenicol, Clarithromycin, Imipenem, Levofloxacin, Meropenem, Penicillin, Tetracycline, and Trimethoprim/ Sulfamethoxazole.

In order to perform susceptibility testing and interpret test results, the identification of the isolate is required.

This test is approved for New York patient testing.

In order to perform susceptibility testing and to interpret test results, the identification of the isolate is required.

This test is approved for New York patient testing.

 Antimicrobial Testing

Standard reference procedures are used for culturing and staining of all mycobacteria. Specimens are set to both solid and liquid media. HPLC and conventional methods are used for identification. Identification by DNA probes is available upon request for an additional charge. Culture includes the identification of the predominant organism or pathogen. A charge will be added for each additional identification.

This test is approved for New York patient testing.

Human adenoviruses consist of 49 known serotypes. Adenoviruses may cause a variety of clinical illnesses in humans, including respiratory, ocular, and gastrointestinal infections. Enteric adenoviruses (Type 40-41) have been implicated as an important cause of sporadic outbreaks of diarrhea and are agents of gastroenteritis in children. This test utilizes a monoclonal antibody that is capable of detecting the presence of all 49 adenovirus serotypes.

This test is approved for New York patient testing.

This unit code has been inactivated.

Please see unit code 51881.

Please see the following technical sheet for more information:
 Antimicrobial Testing

• Anti-Neutrophil Cytoplasmic Antibody, IFA

Panel includes:

Amoxicillin/Clavulanate, Ampicillin, Ceftriaxone, Cefuroxime, Chloramphenicol, Clarithromycin, Imipenem, Levofloxacin, Meropenem, Penicillin, Tetracycline, and Trimethoprim/ Sulfamethoxazole.

In order to perform susceptibility testing and interpret test results, the identification of the isolate is required.

This test is approved for New York patient testing.

 Antimicrobial Testing

Smears are stained with a fluorescent monoclonal antibody that will detect the presence of adenovirus in specimens.

This test is approved for New York patient testing.

This test is performed by and automated macro-broth method and includes the antimicrobial agents considered as secondary agents for M. tuberculosis Complex. The panel includes (see DOS)

Mtb Drug Panel includes:

Amikacin, Capreomycin, Ciprofloxacin, Ethionamide and p-Aminosalicylic Acid.

In order to perform susceptibility testing and interpret test results, the identification of the isolate is required.

This test is available for New York patient testing.

 Antimicrobial Testing

This unit code has been inactivated.

Please see unit code 51315.

Please see the following technical sheet for more information:
 Antimicrobial Testing

This unit code has been inactivated.

Please see unit code 51238.

Please see the following technical sheet for more information:
 Antimicrobial Testing

The real-time PCR assay is a highly sensitive and specific method to detect Anaplasma phagocytophilum, the agent responsible for Human Granulocytic Anaplasmosis (HGA) in whole blood or ticks.

This test is not approved for New York patient testing.

Adenovirus serotyping is based on neutralization using type-specific antisera. Adenovirus serotypes 1-11 and 19-24 can be identified.

This test is available for New York patient testing.

Anaplasma phagocytophilum is the tick-borne agent causing Human Granulocytic Anaplasmosis (HGA). HGA is distinct and separate from Human Monocytic Ehrlichiosis (HME), caused by Ehrlichia chaffeensis. Single IgG titers of 1:64 or greater indicate exposure to A. phagocytophilum; a four-fold rise in IgG titer between acute and convalescent samples suggests recent or current infection.

†This test was developed and its performance characteristics determined by Focus Diagnostics. It has not been cleared or approved by the U.S. Food and Drug Administration. The FDA has determined that such clearance or approval is not necessary. Performance characteristics refer to the analytical performance of the test.

This test is approved for New York patient testing.

Panel includes:

Chloramphenicol, Ciprofloxacin, Erythromycin, Gentamicin, Rifampin, and Tetracycline.

In order to perform susceptibility testing and interpret test results, the identification of the isolate is required.

This test is available for New York patient testing.

 Antimicrobial Testing

Panel Includes:

Amikacin, Ampicillin, Ampicillin/Sulbactam, Aztreonam, Cefazolin, Cefepime, Cefoxitin, Ceftazidime, Ceftriaxone, Cefuroxime, Ciprofloxacin, Gentamicin, Imipenem, Meropenem, Piperacillin, Piperacillin/Tazobactam, Ticarcillin/Clavulanate, Tobramycin, and Trimethoprim/Sulfamethoxazole.

In order to perform susceptibility testing and interpret test results, the identification of the isolate is required.

This test is approved for New York patient testing.

This includes antifungal, antiretroviral, and antiviral drugs.

Specimens collected just before or within 15 minutes of the next dose represent the TROUGH levels. Specimens obtained within 15-30 minutes after the end of I.V. infusion or 45-60 minutes after an IM injection or 90 minutes after oral intake represent the PEAK level.

Focus performs studies on most FDA approved drugs as well as new investigational drugs. Please inquire for additional information. Several drugs noted also have additional information under the individual assay listing in this catalog.

For Amikacin levels, inquire about testing from Client Services.

Unit Code	Antimicrobial Agent	Specimen	Method
51966	Acyclovir	2 mL serum	HPLC
51760	Amoxicillin	1 mL serum	BA
51971	Amprenavir	2 mL serum	HPLC
51426	Amphotericin B	2 mL serum; Protect from light.	HPLC
51765	Ampicillin	1 mL serum	BA
52135	Azithromycin	1 mL serum	BA
52105	Aztreonam	1 mL serum	BA
51959	Capreomycin	2 mL serum	HPLC
51795	Cefazolin	1 mL serum	BA
51810	Cefotaxime	1 mL serum	BA
51815	Ceftazidime	1 mL serum	BA
51830	Ceftriaxone	1 mL serum	BA
51835	Cefuroxime	1 mL serum	BA
51840	Cephalexin	1 mL serum	BA
52120	Ciprofloxacin	1 mL serum	BA
52310	Clarithromycin	1 mL serum	BA
51865	Clindamycin	1 mL serum	BA
51430	Cycloserine	2 mL serum	HPLC
51999	Delaverdine	2 mL serum; Protect from light.	HPLC
51885	Dicloxacillin	1 mL serum	BA
51890	Doxycycline	1 mL serum	BA
51895	Erythromycin	1 mL serum	BA
51969	Fluconazole	2 mL serum	HPLC
51590	5-Fluorocytosine	1 mL serum	BA
51967	Ganciclovir	2 mL serum	HPLC
51972	Indinavir	2 mL serum	HPLC
51963	Isoniazid	2 mL serum	HPLC
51523	Itraconazole	2 mL serum	HPLC
51910	Kanamycin	1 mL serum	BA
51987	Kaletra®	2 mL serum	HPLC
51685	Ketoconazole	1 mL serum	BA
56175	Levofloxacin	1 mL serum	BA
51920	Metronidazole	1 mL serum	BA
51930	Minocycline	1 mL serum	BA
51940	Nafcillin	1 mL serum	BA
51973	Nelfinavir	2 mL serum.	HPLC
52140	Neomycin	1 mL serum	BA
51976	Nevirapine	2 mL serum; Protect from light.	HPLC
51955	Oxacillin	1 mL serum	BA
51960	Penicillin	1 mL serum	BA
51965	Piperacillin	1 mL serum	BA
51939	Posaconazole	2 mL serum	HPLC
51964	Rifampin	2 mL serum; Protect from light.	HPLC
51974	Saquinavir	2 mL serum	HPLC
51962	Streptomycin	2 mL serum	HPLC
51990	Tetracycline	1 mL serum	BA
51995	Ticarcillin	1 mL serum	BA
52160	Ticarcillin/ Clavulanate	1 mL serum	BA
52060	Trimethoprim/ Sulfamethoxazole	1 mL serum	BA
51929	Voriconazole	2 mL serum or Heparin or EDTA; CSF	HPLC

Please see the following technical sheet for more information:
 Antimicrobial Testing

Anaplasma phagocytophilum is the tick-borne agent causing Human Granulocytic Anaplasmosis (HGA). HGA is distinct and separate from Human Monocytic Ehrlichiosis (HME), caused by Ehrlichia chaffeensis. Single IgG titers of 1:64 or greater indicate exposure to A. phagocytophilum; a four-fold rise in IgG titer between acute and convalescent samples and/or the presence of IgM to A. phagocytophilum suggest recent or current infection.

†This test was developed and its performance characteristics determined by Focus Diagnostics. It has not been cleared or approved by the U.S. Food and Drug Administration. The FDA has determined that such clearance or approval is not necessary. Performance characteristics refer to the analytical performance of the test.

This test is approved for New York patient testing.

Adenovirus is increasingly recognized as a cause of severe or fatal infections in immunocompromised patients, particularly transplant recipients. The detection of adenovirus DNA is based upon the real-tme amplification and detection of conserved adenovirus genomic DNA sequences.

This test is not approved for New York patient testing.

See individual assay for description.

Panel includes:

• Anaplasma phagocytophilum Antibodies (IgG, IgM), IFA
• Ehrlichia chaffeensis Antibodies (IgG, IgM), IFA

This antimicrobial combination panel tests antimicrobials that are intended to assist with treatment options for multi-drug resistant Pseudomonas aeruginosa isolated from cystic fibrosis patients. This antimicrobial combination assay measures the activity (MIC) of ten individual antimicrobials and then twelve combinations of those antimicrobials to determine if synergy is detected. A Fractional Inhibitory Concentration (FIC) index is obtained based on the activity of each drug in the presence of the other drug and interpretations are based on the FIC and reported as Synergy, Additive, Indifference, or Antagonism.

Combinations tested:

Tobramycin + Piperacillin	Tobramycin + Meropenem
Tobramycin + Ceftazidime	Ticarcillin/Clavulanate + Tobramycin
Tobramycin + Imipenem	Aztreonam + Tobramycin
Meropenem + Amikacin	Imipenem + Ciprofloxacin
Ceftazidime + Amikacin	Meropenem + Ciprofloxacin
Piperacillin + Ciprofloxacin	Cefepime + Tobramycin

For antimicrobial combinations other than those listed or for non-Pseudomonas aeruginosa isolates, please order Antimicrobial Combination Testing, Synergy (2 drugs), or Antimicrobial Combination Testing, Synergy( 3 drugs).

This test is approved for New York patient testing.

See individual assay for description.

Panel includes:

• ANCA Screen with Reflex to ANCA Titer
• PR3 Antibody
• MPO Antibody

Adenovirus is increasingly recognized as a cause of severe or fatal infections in immunocompromised patients, particularly transplant recipients. This PCR assay provides sensitive detection for viral DNA, measuring viral loads ranging from 500 to 2,000,000 DNA copies/mL.

This test is not approved for New York patient testing.

The cytoplasmic pattern of ANCA is associated with antibodies to Proteinase 3 (PR3), and is a specific marker for Wegener’s granulomatosis. The perinuclear pattern of ANCA is typically associated with antibodies to Myeloperoxidase (MPO), and is usually indicative of organ-limited vasculitic diseases. The atypical perinuclear pattern of ANCA may be found in patients with ulcerative colitis, Crohn’s disease, and autoimmune liver disease. If the ANCA screen is positive, the titer is determined at an additional charge.

This test is approved for New York patient testing.

Antimicrobial combination therapy may help to expand the spectrum of coverage, minimize drug toxicity, minimize development of resistance, and may lead to antimicrobial combination synergy. This antimicrobial combination assay measures the activity of three antibacterial agents alone (A, B, and C) and in combination with each other (A+B, A+C, and B+C) to determine if synergy is present. A Fractional Inhibitory Concentration (FIC) index is obtained based on the activity of each drug in the presence of the other drug and interpretations of Synergy, Additive, Indifference, or Antagonism are reported. Antibacterial agents listed in the chart are available for combination testing.

The identification of the isolate and the three drugs to be tested are required. Missing information may cause testing delays.

This test is approved for New York patient testing.

Panel includes:

Ciprofloxacin, Clindamycin, Daptomycin, Erythromycin, Gentamicin, Linezolid, Penicillin, Quinupristin/Dalfopristin, Rifampin, Tetracycline, Trimethoprim/Sulfamethoxazole, and Vancomycin

In order to perform susceptibility testing and interpret test results, the identification of the isolate is required.

This test is approved for New York patient testing.

This unit code has been inactivated.

Please see unit code 10683.

Antimicrobial combination therapy may help to expand the spectrum of coverage, minimize drug toxicity, minimize development of resistance, and may lead to antimicrobial combination synergy. This antimicrobial combination assay measures the activity of two antibacterial agents alone and then in combination to determine if synergy is present. A Fractional Inhibitory Concentration (FIC) index is obtained based on the activity of each drug in the presence of the other drug and interpretations of Synergy, Additive, Indifference, or Antagonism are reported. Antibacterial agents listed in the chart are available for combination testing.

The identification of the isolate and the two drugs to be tested are required. Missing information may cause testing delays.

This test is approved for New York patient testing.

Panel includes:

Ampicillin, Ampicillin/Sulbactam, Ceftriaxone, Cefuroxime, Chloramphenicol, Clarithromycin, Imipenem, Levofloxacin, Meropenem, Tetracycline, and Trimethoprim/Sulfamethoxazole.

In order to perform susceptibility testing and interpret test results, the identification of the isolate is required.

This test is approved for New York patient testing.

Serum levels of angiotensin converting enzyme (ACE) are often increased in patients with untreated active sarcoidosis. Spontaneous or therapy-induced remission of sarcoidosis is usually accompanied by decreasing serum levels of ACE. Although rarely increased in association with tuberculosis or other lung infections, serum ACE levels may be increased in histocytic medullary reticulosis and non-Hodgkin lymphoma.

Test performed at Quest Diagnostics Nichols Institute.

If Adenovirus DNA is detected in the qualitative assay, the specimen will reflex to Adenovirus DNA, Quantitative Real-Time PCR (Focus Unit Code 46995) for an additional charge. The quantitative range if reflexed is from 250 (2.4 log10) to 100,000,000 (8.0 log10) DNA copies/mL.

For samples with a Detected result, the Adenovirus DNA Quantitative Real-Time PCR assay (unit code 46995) is performed for an additional fee.

This test is not approved for New York patient testing.

Panel includes:

Amoxicillin, Clarithromycin, Metronidazole, Tetracycline.

In order to perform susceptibility testing and interpret test results, the identification of the isolate is required.

This test is available for New York patient testing.

 Antimicrobial Testing

CSF levels of angiotensin converting enzyme (ACE) are increased in approximately 50% of patients with neurosarcoidosis, but in less than 10% of systemic sarcoidosis patients without neurologic manifestations.

This test is not approved for New York patient testing.

Single titers >=1:64 are indicative of recent or current infection. Titers of 1:8 - 1:32 may be indicative of either past or recent infection, since CF antibody levels persist for only a few months. A four-fold or greater increase in titer between acute and convalescent specimens confirms the diagnosis.

This test is approved for New York patient testing.

• Cardiolipin Antibody (IgA)
• Cardiolipin Antibody (IgG)
• Cardiolipin Antibody (IgM)
• Cardiolipin Antibody Screen with Reflex to IgG and IgM
• Cardiolipin Antibody Screen with Reflex to IgG, IgA and IgM

This unit code has been inactivated.

Please see unit code 51991.

• Antimicrobial Drug Level

• Antimicrobial Susceptibility Testing

Detection of intrathecally-produced organism-specific antibodies in CSF indicates central nervous system infection. However, serum levels of organism-specific antibodies, blood-brain barrier integrity, and possible CSF contamination by blood should be considered when assessing CSF results.

This test is approved for New York patient testing.

Cycloserine is an antibiotic effective against Mycobacterium tuberculosis. Peak levels of Cycloserine occur in the bloodstream between 4 to 8 hours after administration and are maintained at 25 to 30 mcg/mL. The relationship between dosage and levels, however, is not always consistent. Intake of food at time of dosing may negatively affect intestinal absorption.

This test is approved for New York patient testing.

The presence of ANA is indicative of numerous disease states including Systemic Lupus Erythematosus (SLE), Mixed Connective Tissue Disease (MCTD), Rheumatoid Arthritis, Sjögren's Syndrome and other rheumatoid diseases. Low titer ANA (<=1:160) may also be seen in the elderly, transiently during viral infection and in otherwise healthy individuals; these ANA titers are of unknown significance. The absence of ANA is strong evidence against untreated SLE. The ANA screen includes screening for centromere antibody. If ANA screen is positive a titer and pattern will be performed at an additional charge.

This test is approved for New York patient testing.

 Autoantibodies Associated with Autoimmune Hepatitis

Ethambutol is the active component of the oral tablet Myambutol, for which each tablet may contain either 100 mg or 400 mg of the dihydrochloride salt of ethambutol. Myambutol is only recommended for patients over the age of 13 and is administered once every 24 hours in conjunction with another antimycobacterial medication. The bloodstream level of Ethambutol should be monitored to ensure that adequate levels of the drug are administered, absorbed and subsequently excreted from the body to prevent drug build-up that might lead to toxic side effects. The peak level of ethambutol is 2 - 5 mcg/mL and is attained within 2 - 4 hours of administration of the dichloride salt at 25 mg/kg (drug to patient body mass).

This test is approved for New York patient testing.