title: Extended-Spectrum beta-lactamase (ESBL) producing Enterobacter aerogenes phenotypically misidentified as Klebsiella pneumoniae or K. terrigena.
abstract: BACKGROUND
  Enterobacter aerogenes and Klebsiella pneumoniae are common isolates in clinical microbiology and important as producers of extended spectrum beta-lactamases (ESBL). The discrimination between both species, which is routinely based on biochemical characteristics, is generally accepted to be straightforward. Here we report that genotypically unrelated strains of E. aerogenes can be misidentified as K. pneumoniae by routine laboratories using standard biochemical identification and using identification automates.
  
  
  RESULTS
  Ten clinical isolates, identified as K. pneumoniae or K. terrigena with the routinely used biochemical tests and with API-20E, were identified as E. aerogenes by tDNA-PCR - an identification that was confirmed by 16S rRNA gene sequencing for five of these isolates. Misidentification also occurred when using the automated identification systems Vitek 2 and Phoenix, and was due to delayed positivity for ornithine decarboxylase and motility. Subculture and prolonged incubation resulted in positive results for ornithine decarboxylase and for motility. It could be shown by RAPD-analysis that the E. aerogenes strains belonged to different genotypes.
  
  
  CONCLUSIONS
  Clinical E. aerogenes isolates can be easily misidentified as Klebsiella due to delayed positivity for ornithine decarboxylase and motility. The phenomenon may be widespread, since it was shown to occur among genotypically unrelated strains from different hospitals and different isolation dates. A useful clue for correct identification is the presence of an inducible beta-lactamase, which is highly unusual for K. pneumoniae. In several instances, the use of genotypic techniques like tDNA-PCR may circumvent problems of phenotypic identification.
authors.affiliation: Department of Microbiology, Ghent University Hospital, Ghent, Belgium. Geert.Claeys@UGent.be <Geert.Claeys@UGent.be>
authors.forename: Geert
authors.initials: G
authors.lastname: Claeys
authors.forename: Thierry
authors.initials: T
authors.lastname: De Baere
authors.forename: Georges
authors.initials: G
authors.lastname: Wauters
authors.forename: Patricia
authors.initials: P
authors.lastname: Vandecandelaere
authors.forename: Gerda
authors.initials: G
authors.lastname: Verschraegen
authors.forename: An
authors.initials: A
authors.lastname: Muylaert
authors.forename: Mario
authors.initials: M
authors.lastname: Vaneechoutte
mesh_terms: D015373:Bacterial Typing Techniques; D003951:Diagnostic Errors; D024881:Drug Resistance, Bacterial; D021902:Enterobacter aerogenes / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D007711:Klebsiella pneumoniae / Q000302:isolation & purification*; D008826:Microbial Sensitivity Tests; D010641:Phenotype; D012336:RNA, Ribosomal, 16S / Q000032:analysis / Q000235:genetics; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D012336:RNA, Ribosomal, 16S; D001618:beta-Lactamases