1887

Abstract

A subset of , , and isolates collected for the Study for Monitoring Antimicrobial Resistance Trends that were positive for the Clinical and Laboratory Standards Institute (CLSI) extended-spectrum β-lactamase (ESBL) phenotypic confirmatory test ( = 3245) or had an ertapenem MIC of ≥0.5 µg ml ( = 293), or both ( = 467), were analysed for ESBL genes. Most ESBL phenotype or possessed an ESBL gene (95.8 and 88.4 %, respectively), and this was 93.1 % if carbapenem-non-susceptible were removed. This rate was lower for (73.4 %) and (62.5 %). Virtually all ESBL-positive isolates (99.5 %) were cefotaxime non-susceptible [CLSI or European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints)]. Fewer isolates (82 %) were ceftazidime non-susceptible (CLSI breakpoints). In addition, 21.1 % of , 25 % of and 78.7 % of isolates were ceftazidime susceptible but ESBL positive. This suggests that CLSI breakpoints for ceftazidime are too high to detect ESBLs. The lower EUCAST breakpoints detected ESBLs in and better, but 59.6 % of ESBL-positive isolates of were ceftazidime susceptible. For isolates with ertapenem MICs ≥0.5 µg ml, more accurate ESBL phenotype analysis was observed for and (sensitivity >95 % for both, specificity 94.4 and 54.1 %, respectively). If carbapenemase-positive were excluded, the specificity increased to 78 %. The positive predictive values for the ESBL phenotypic test with and were 97.6 and 81.8 %, respectively, and negative predictive values were 75.9 and 95.2 %, respectively. We therefore suggest that it would be prudent to confirm phenotypic ESBL-positive , and with molecular analysis.

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2014-04-01
2019-10-23
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