BD PHOENIX AUTOMATED MICROBIOLOGY SYSTEM - CEFOTETAN (GN) 2-64 UG/ML

K043458 · Becton, Dickinson & CO · LON · Mar 15, 2005 · Microbiology

Device Facts

Record IDK043458
Device NameBD PHOENIX AUTOMATED MICROBIOLOGY SYSTEM - CEFOTETAN (GN) 2-64 UG/ML
ApplicantBecton, Dickinson & CO
Product CodeLON · Microbiology
Decision DateMar 15, 2005
DecisionSESE
Submission TypeTraditional
Regulation21 CFR 866.1645
Device ClassClass 2

Indications for Use

The BD Phoenix™ Automated Microbiology System is intended for in vitro quantitative determination of antimicrobial susceptibility by minimal inhibitory concentration (MIC) of gram-negative aerobic and facultative anaerobic bacteria belonging to the family Enterobacteriaceae and non – Enterobacteriaceae and most gram-positive bacteria isolates from pure culture belonging to the genera Staphylococcus and Enterococcus. The BD Phoenix™ Automated Microbiology System is intended for the in vitro rapid identification (ID) and quantitative determination of antimicrobial susceptibility by minimal inhibitory concentration (MIC) of gram-negative aerobic and facultative anaerobic bacteria belonging to the family Enterobacteriaceae and non-Enterobacteriaceae.

Device Story

BD Phoenix System performs automated identification and antimicrobial susceptibility testing (AST) of bacterial isolates. Input: pure culture bacterial isolates inoculated into Phoenix ID/AST broth. Process: molded polystyrene panels containing biochemicals and antimicrobial agents (cefotetan 2-64 µg/mL) incubated at 35°C; system monitors redox indicator changes and bacterial turbidity every 20 minutes. Output: MIC values and categorical interpretations (S, I, R). Used in clinical microbiology laboratories; operated by laboratory technicians. Results assist clinicians in selecting appropriate antimicrobial therapy for patients with bacterial infections.

Clinical Evidence

Bench testing only. Performance evaluated against NCCLS reference broth microdilution method. Reproducibility study conducted at three sites using gram-negative isolates tested in triplicate over three days. Results showed intra-site reproducibility >90% and inter-site reproducibility >95%.

Technological Characteristics

System includes instrumentation, software, and 136-well polystyrene trays. Uses redox indicator (colorimetric oxidation-reduction) for growth detection. Cation-adjusted Mueller-Hinton broth with 0.01% Tween 80. Continuous incubation at 35°C. Automated barcode scanning. Software-based 'EXPERT' system for rule-based interpretation per CLSI standards.

Indications for Use

Indicated for testing Enterobacteriaceae using cefotetan at concentrations of 2–64 µg/mL. Contraindicated for Enterobacter species; alternate methods required.

Regulatory Classification

Identification

A fully automated short-term incubation cycle antimicrobial susceptibility system is a device that incorporates concentrations of antimicrobial agents into a system for the purpose of determining in vitro susceptibility of bacterial pathogens isolated from clinical specimens. Test results obtained from short-term (less than 16 hours) incubation are used to determine the antimicrobial agent of choice to treat bacterial diseases.

Special Controls

*Classification.* Class II (special controls). The special control for this device is FDA's guidance document entitled “Class II Special Controls Guidance Document: Antimicrobial Susceptibility Test (AST) Systems; Guidance for Industry and FDA.”

Predicate Devices

Submission Summary (Full Text)

{0} 510(k) SUBSTANTIAL EQUIVALENCE DETERMINATION DECISION SUMMARY ASSAY ONLY TEMPLATE A. 510(k) Number: k043458 B. Purpose for Submission: Addition of cefotetan to the BD Phoenix™ Automated Microbiology System C. Measurand: Cefotetan 2 - 64 µg/ml D. Type of Test: Antimicrobial Susceptibility Test (AST) (Quantitative and Qualitative) colorimetric oxidation-reduction, growth-based E. Applicant: Becton, Dickinson &amp; Company F. Proprietary and Established Names: BD Phoenix™ Automated Microbiology System – Cefotetan Gram Negative Panel G. Regulatory Information: 1. Regulation section: 21 CFR 866.1645 Fully Automated Short-Term Incubation Cycle Antimicrobial Susceptibility System 2. Classification: II 3. Product code: LON System, Test, Automated, Antimicrobial Susceptibility, Short Incubation 4. Panel: 83 Microbiology H. Intended Use: 1. Intended use(s): The BD Phoenix™ Automated Microbiology System is intended for in vitro quantitative determination of antimicrobial susceptibility by minimal inhibitory concentration (MIC) of gram-negative aerobic and facultative anaerobic bacteria belonging to the family Enterobacteriaceae and non – Enterobacteriaceae and most gram-positive bacteria isolates from pure culture belonging to the genera Staphylococcus and Enterococcus. {1} The BD Phoenix™ Automated Microbiology System is intended for the in vitro rapid identification (ID) and quantitative determination of antimicrobial susceptibility by minimal inhibitory concentration (MIC) of gram-negative aerobic and facultative anaerobic bacteria belonging to the family Enterobacteriaceae and non-Enterobacteriaceae. 2. Indication(s) for use: This submission is for the addition of the antibiotic cefotetan at concentrations of 2 – 64 µg/mL to the gram negative susceptibility panel for testing Enterobacteriaceae. 3. Special conditions for use statement(s): For prescription use only Results for Enterobacter species have been excluded in the BD Phoenix™ therefore no results will be reported. An alternate method should be performed when this combination is identified. 4. Special instrument requirements: Not Applicable I. Device Description: The BD Phoenix™ Automated Microbiology System includes instrumentation and software, sealed and self-inoculating molded polystyrene trays with 136 micro-wells containing dried reagents, and specific inoculum broth formulations for ID and AST Indicator. The organism to be tested must be a pure culture and be preliminarily identified as gram positive or gram negative. Colonies are then suspended in broth, and equated to a 0.5 McFarland with the recommendation to use the BD CrystalSpec™ Nephelometer. A further dilution is made into an AST broth, which contains an AST indicator, prior to inoculating the panel. The AST broth is a cation-adjusted formulation of Mueller-Hinton broth containing 0.01% Tween 80. After adding the indicator solution to the AST inoculum the color is blue and after inoculation and incubation goes to pink to colorless as reduction in the panel well proceeds. Inoculated panels are barcode scanned and loaded into the BD Phoenix™ Automated Microbiology System instrument where the panels are continuously incubated at 35°C. The AST has a final inoculum of 5 × 10⁵ CFU/ml. The instrument incubates, reads and records the results of the biochemical substrates and antimicrobial agents and interprets the reactions to give an ID of the isolate and MIC value and category interpretation of the antimicrobial agents. Organisms growing in the presence of a given antimicrobic agent reduce the indicator, signaling organism growth and resistance to the antimicrobic agent. Organisms killed or inhibited by a given antimicrobic do not cause reduction of the indicator and therefore do not produce a color change. Additional interpretation is done using software driven "EXPERT" System using rules derived from the Clinical and Laboratory Standards Institute (CLSI) standards. {2} Readings are taken every 20 minutes with an ID result available between 2-12 hours and an AST result available between 4-16 hours. This is only an autoread result; there are no manual readings possible. ## J. Substantial Equivalence Information: 1. Predicate device name(s): VITEK® System 2. Predicate 510(k) number(s): N50510 3. Comparison with predicate: | Similarities | | | | --- | --- | --- | | Item | Device | Predicate | | 1. | Isolated colonies from culture used | Isolated colonies from culture used | | 2. | Report results as minimum inhibitory concentration (MIC) and categorical interpretation (SIR) | Report results as minimum inhibitory concentration (MIC) and categorical interpretation (SIR) | | 3. | <16 hours | <16 hours | | Differences | | | | --- | --- | --- | | Item | Device | Predicate | | 1. | Results are determined from serial twofold dilutions of antimicrobial agents | Results are determined from extrapolation of doubling dilutions | | 2. | Inoculum density equated to 0.5 McFarland standard | Inoculum density equated to 1.0 McFarland standard | | 3. | Automated growth based enhanced by use of a redox indicator (colorimetric oxidation-reduction) to detect organism growth. | Automated growth based with detection using an attenuation of light measured by an optical scanner. | ## K. Standard/Guidance Document Referenced (if applicable): "Class II Special Controls Guidance Document: Antimicrobial Susceptibility Test Systems; Guidance for Industry and FDA"; CLSI M7 (M100-S15) "Methods for {3} Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically; Approved Standard." ## L. Test Principle: The system employs conventional, colorimetric, fluorogenic and chromogenic substrates to identify the genus and species of the isolate. The AST portion of the BD Phoenix™ Automated Microbiology System is a broth based microdilution method that utilizes a redox indicator (colorimetric oxidation-reduction) to enhance detection of organism growth. The MIC is determined by comparing growth in wells containing serial two-fold dilutions of an antibiotic to the growth in "growth control wells" which contains no antibiotic. ## M. Performance Characteristics (if/when applicable): ### 1. Analytical performance: #### a. Precision/Reproducibility: Ten gram-negative on-scale organisms were evaluated for site to site and inter site reproducibility demonstrating &gt;95% reproducibility. The ten isolate study described in the guidance document was used (10 organisms tested 3 times on 3 days at 3 sites). #### b. Linearity/assay reportable range: Not applicable #### c. Traceability, Stability, Expected values (controls, calibrators, or methods): The recommended QC isolate was tested on every test occasion with the reference method and the BD Phoenix™. The reference method QC results were in range for every day tested. The Phoenix™ was tested a sufficient number of times to demonstrate that the system can produce QC results in the FDA/CLSI recommended ranges most of the time. Quality Control Table | ORGANISM | conc. | Reference | | Phoenix | | | | --- | --- | --- | --- | --- | --- | --- | | | | | | | | | | | | | | | | | | E. coli ATCC 25922 Expected Range : 0.06 - 25 μg/mL | ≤2 | | 196 | | 204 | | | | 4 | | 3 | | | | | | 8 | | | | 1 | | | | 16 | | 1 | | | | | | 32 | | | | | | | | 64 | | | | 1 | | | | | | | | | | Inoculum density control: The organism suspension density of the ID broth was equivalent to a 0.5 McFarland standard using the BBL™ CrystalSpec™ Nephelometer which was verified each day of testing. {4} Internal data was used to demonstrate that the use of the BBL™ CrystalSpec™ Nephelometer would produce reproducible results. Five different instruments were used. d. Detection limit: Not Applicable e. Analytical specificity: Not Applicable f. Assay cut-off: Not Applicable ## 2. Comparison studies: a. Method comparison with predicate device: The CLSI recommended broth dilution reference panel was prepared according to the CLSI recommendation. Clinical testing was performed at four sites. The testing included both fresh clinical isolates and stock isolates along with a challenge set with known results. The test device had a growth rate of &gt;90%. A comparison was provided to the reference method with the following agreement. Summary Table for Enterobacteriaceae spp. | | EA Tot | EA N | EA % | Eval EA Tot | Eval EA N | Eval EA % | CA N | CA % | #R | min | maj | vmj | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | | Clinical | 1086 | 1047 | 96.4 | 111 | 93 | 83.8 | 1049 | 96.6 | 53 | 33 | 2 | 2 | | Challenge | 89 | 88 | 98.9 | 9 | 9 | 100.0 | 88 | 98.9 | 8 | 1 | 0 | 0 | | Combined | 1175 | 1135 | 96.6 | 120 | 102 | 85 | 1137 | 96.8 | 61 | 34 | 2 | 2 | EA-Essential Agreement CA-Category Agreement R-resistant isolates maj-major discrepancies vmj-very major discrepancies min- minor discrepancies Essential agreement (EA) is when the BD Phoenix™ panels agree with the reference test panel results exactly or within one doubling dilution of the reference method. Category agreement (CA) is when the BD Phoenix™ panel result interpretation agrees exactly with the reference panel result interpretation. There were 2 vmj errors for the entire study however 1 of the vmj errors was tested at a reference laboratory independent of the clinical trial with a result that was in agreement with the test method. b. Matrix comparison: Not Applicable ## 3. Clinical studies: {5} a. Clinical Sensitivity: Not Applicable b. Clinical specificity: Not Applicable c. Other clinical supportive data (when a. and b. are not applicable): Not Applicable 4. Clinical cut-off: Not Applicable 5. Expected values/Reference range: Enterobacteriaceae ≤ 16 (S), 32 (I), ≥64 (R) The Interpretative criteria, QC isolates and the expected ranges are the same as recommended by the FDA and CLSI. All values will be included in the package insert. N. Proposed Labeling: The labeling is sufficient and it satisfies the requirements of 21 CFR Part 809.10. O. Conclusion: The submitted information in this premarket notification is complete and supports a substantial equivalence decision.
Innolitics

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