title: An evaluation of susceptibility testing methods for ampicillin-sulbactam using a panel of beta-lactamase-producing bacteria.
abstract: Bacteria possessing TEM-1-like beta-lactamases are generally regarded as susceptible to ampicillin-sulbactam (SAM), while those harboring OXA-1 enzymes are considered resistant. The current study was undertaken to compare susceptibility testing using various combinations of ampicillin and sulbactam to improve clinical correlation. Members of the Enterobacteriaceae family harboring TEM-1, SHV-1 or OXA-1-like beta-lactamases were tested using the agar dilution method. A substantial proportion of strains harboring OXA-1-like beta-lactamases showed false susceptibility to SAM at the 1:1 ratio or fixed sulbactam concentration of 8 microg/ml. At a fixed sulbactam concentration of 4 microg/ml, the activity of ampicillin-sulbactam appeared to be reduced, with large numbers of TEM-1 producers becoming frankly resistant. Results obtained with the 2:1 ratio exhibited the closest correlation with that obtained by the currently recommended disk diffusion test. However, very major errors were still found between the disk diffusion test and agar dilution test, suggesting the necessity for consideration of a change in criteria for interpretation of disk diffusion test results. In conclusion, SAM susceptibility testing by agar dilution using other than a 2:1 ratio is not recommended and results should be interpreted with caution.
authors.affiliation: Department of Microbiology, University of Hong Kong, Hong Kong.
authors.forename: L K
authors.initials: LK
authors.lastname: Siu
authors.forename: J Y
authors.initials: JY
authors.lastname: Lo
authors.forename: W L
authors.initials: WL
authors.lastname: Cheng
authors.forename: P L
authors.initials: PL
authors.lastname: Ho
authors.forename: W S
authors.initials: WS
authors.lastname: Ng
authors.forename: P Y
authors.initials: PY
authors.lastname: Chau
mesh_terms: D000362:Agar; D000667:Ampicillin / Q000494:pharmacology*; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D003470:Culture Media; D004341:Drug Evaluation; D004926:Escherichia coli / Q000187:drug effects*; D006801:Humans; D007709:Klebsiella / Q000187:drug effects*; D008826:Microbial Sensitivity Tests; D012760:Shigella / Q000187:drug effects*; D013407:Sulbactam / Q000494:pharmacology*; D001618:beta-Lactamases
chemical_list: D000900:Anti-Bacterial Agents; D003470:Culture Media; D000667:Ampicillin; D000362:Agar; D001618:beta-Lactamases; D013407:Sulbactam