1887

Abstract

Phenotypic identification of AmpC, KPC and extended-spectrum -lactamases (ESBLs) among members of the remains challenging. This study compared the Phoenix Automated Microbiology System (BD Diagnostics) with the Clinical and Laboratory Standards Institute confirmatory method to identify ESBL production among 200 and clinical isolates. The Phoenix system misclassified nearly half of the isolates as ESBL-positive, requiring manual testing for confirmation. Inclusion of aztreonam±clavulanic acid (CA) and cefpodoxime±CA in the testing algorithm increased the ESBL detection rate by 6 %. Boronic acid-based screening identified 24 isolates as AmpC, but in a subset of genotypically characterized isolates, appeared to have a high false-positivity rate. PCR screening revealed eight KPC isolates, all of which tested as ESBL or ESBL AmpC by phenotypic methods, but half were reported as carbapenem-susceptible by the Phoenix system. Overall, these results indicate that laboratories should use the Phoenix ESBL results only as an initial screen followed by confirmation with an alternative method.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.006171-0
2009-06-01
2019-10-18
Loading full text...

Full text loading...

/deliver/fulltext/jmm/58/6/774.html?itemId=/content/journal/jmm/10.1099/jmm.0.006171-0&mimeType=html&fmt=ahah

References

  1. Anderson, K. F., Lonsway, D. R., Rasheed, J. K., Biddle, J., Jensen, B., McDougal, L. K., Carey, R. B., Thompson, A., Stocker, S. & other authors ( 2007; ). Evaluation of methods to identify the Klebsiella pneumoniae carbapenemase in Enterobacteriaceae. J Clin Microbiol 45, 2723–2725.[CrossRef]
    [Google Scholar]
  2. CLSI ( 2008; ). Performance Standards for Antimicrobial Susceptibility Testing; 18th Informational Supplement. CLSI standard M100-S18. Wayne, PA: Clinical and Laboratory Standards Institute.
  3. Coudron, P. E. ( 2005; ). Inhibitor-based methods for detection of plasmid-mediated AmpC β-lactamases in Klebsiella spp., Escherichia coli, and Proteus mirabilis. J Clin Microbiol 43, 4163–4167.[CrossRef]
    [Google Scholar]
  4. Jacoby, G. A. & Munoz-Price, L. S. ( 2005; ). The new β-lactamases. N Engl J Med 352, 380–391.[CrossRef]
    [Google Scholar]
  5. Jacoby, G. A., Walsh, K. E. & Walker, V. J. ( 2006; ). Identification of extended-spectrum, AmpC, and carbapenem-hydrolyzing β-lactamases in Escherichia coli and Klebsiella pneumoniae by disk tests. J Clin Microbiol 44, 1971–1976.[CrossRef]
    [Google Scholar]
  6. Livermore, D. M., Warner, M. & Mushtaq, S. ( 2007; ). Evaluation of the chromogenic Cica-β-Test for detecting extended-spectrum, AmpC and metallo-β-lactamases. J Antimicrob Chemother 60, 1375–1379.[CrossRef]
    [Google Scholar]
  7. Pasteran, F. G., Otaegui, L., Guerriero, L., Radice, G., Maggiora, R., Rapoport, M., Faccone, D., Di Martino, A. & Galas, M. ( 2008; ). Klebsiella pneumoniae carbapenemase-2, Buenos Aires, Argentina. Emerg Infect Dis 14, 1178–1180.[CrossRef]
    [Google Scholar]
  8. Paterson, D. L., Rice, L. B. & Bonomo, R. A. ( 2001; ). Rapid method of extraction and analysis of extended-spectrum β-lactamases from clinical strains of Klebsiella pneumoniae. Clin Microbiol Infect 7, 709–711.[CrossRef]
    [Google Scholar]
  9. Paterson, D. L., Hujer, K. M., Hujer, A. M., Yeiser, B., Bonomo, M. D., Rice, L. B. & Bonomo, R. A. ( 2003; ). Extended-spectrum β-lactamases in Klebsiella pneumoniae bloodstream isolates from seven countries: dominance and widespread prevalence of SHV- and CTX-M-type β-lactamases. Antimicrob Agents Chemother 47, 3554–3560.[CrossRef]
    [Google Scholar]
  10. Pérez-Pérez, F. J. & Hanson, N. D. ( 2002; ). Detection of plasmid-mediated AmpC β-lactamase genes in clinical isolates by using multiplex PCR. J Clin Microbiol 40, 2153–2162.[CrossRef]
    [Google Scholar]
  11. Smith Moland, E., Hanson, N. D., Herrera, V. L., Black, J. A., Lockhart, T. J., Hossain, A., Johnson, J. A., Goering, R. V. & Thomson, K. S. ( 2003; ). Plasmid-mediated, carbapenem-hydrolysing β-lactamase, KPC-2, in Klebsiella pneumoniae isolates. J Antimicrob Chemother 51, 711–714.[CrossRef]
    [Google Scholar]
  12. Steward, C. D., Rasheed, J. K., Hubert, S. K., Biddle, J. W., Raney, P. M., Anderson, G. J., Williams, P. P., Brittain, K. L., Oliver, A. & other authors ( 2001; ). Characterization of clinical isolates of Klebsiella pneumoniae from 19 laboratories using the National Committee for Clinical Laboratory Standards extended-spectrum β-lactamase detection methods. J Clin Microbiol 39, 2864–2872.[CrossRef]
    [Google Scholar]
  13. Tenover, F. C., Raney, P. M., Williams, P. P., Rasheed, J. K., Biddle, J. W., Oliver, A., Fridkin, S. K., Jevitt, L. & McGowan, J. E., Jr ( 2003; ). Evaluation of the NCCLS extended-spectrum β-lactamase confirmation methods for Escherichia coli with isolates collected during Project ICARE. J Clin Microbiol 41, 3142–3146.[CrossRef]
    [Google Scholar]
  14. Tenover, F. C., Kalsi, R. K., Williams, P. P., Carey, R. B., Stocker, S., Lonsway, D., Rasheed, J. K., Biddle, J. W., McGowan, J. E., Jr & Hanna, B. ( 2006; ). Carbapenem resistance in Klebsiella pneumoniae not detected by automated susceptibility testing. Emerg Infect Dis 12, 1209–1213.[CrossRef]
    [Google Scholar]
  15. Thomson, K. S., Cornish, N. E., Hong, S. G., Hemrick, K., Herdt, C. & Moland, E. S. ( 2007; ). Comparison of Phoenix and VITEK 2 extended-spectrum-β-lactamase detection tests for analysis of Escherichia coli and Klebsiella isolates with well-characterized β-lactamases. J Clin Microbiol 45, 2380–2384.[CrossRef]
    [Google Scholar]
  16. Wiegand, I., Geiss, H. K., Mack, D., Sturenburg, E. & Seifert, H. ( 2007; ). Detection of extended-spectrum β-lactamases among Enterobacteriaceae by use of semiautomated microbiology systems and manual detection procedures. J Clin Microbiol 45, 1167–1174.[CrossRef]
    [Google Scholar]
  17. Yagi, T., Wachino, J., Kurokawa, H., Suzuki, S., Yamane, K., Doi, Y., Shibata, N., Kato, H., Shibayama, K. & Arakawa, Y. ( 2005; ). Practical methods using boronic acid compounds for identification of class C β-lactamase-producing Klebsiella pneumoniae and Escherichia coli. J Clin Microbiol 43, 2551–2558.[CrossRef]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.006171-0
Loading
/content/journal/jmm/10.1099/jmm.0.006171-0
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error