Can we rely on one laboratory test in detection of extended-spectrum beta-lactamases among Enterobacteriaceae? An evaluation of the Vitek 2 system and comparison with four other detection methods in Kuwait.
OBJECTIVE
Clinical hospitals need to correctly identify extended spectrum beta-lactamase (ESBL)-producing bacteria in infected patients to correctly treat the patient and avoid spreading antibiotic resistance. Kuwaiti hospitals use one laboratory test for detecting ESBL bacteria. This study evaluated whether that was sufficient to detect ESBL bacteria, and compared the Vitek system with other detection systems.


METHODS
(Klebsiella pneumoniae, Escherichia coli, K oxytoca and Enterobacter cloacae) were collected from five different Kuwaiti main hospitals, all of which were flagged as ESBL-positive by the Vitek 2 system. The isolates were retested by the Vitek 2 system, and were also tested by double disc diffusion (DDD), the disc approximation test, the E-test and the MicroScan system for the detection of ESBLs.


RESULTS
Retesting with the Vitek system revealed 100% compatibility with the results of the source hospitals. The MicroScan system, DDD, disc approximation test and E-test could detect ESBL in 199, 192, 178 and 205 isolates, respectively.


CONCLUSIONS
Technically, the MicroScan and Vitek 2 systems were the least demanding method to detect ESBL as it is an integral part of the routine susceptibility test card. E-test strips were reliable but the most expensive of all techniques used. The DDD test and disc approximation, while relatively inexpensive, were technically subjective. The Vitek system may be very suitable in clinical laboratories, but would be better if accompanied with another test for detection of ESBL bacteria.
Dashti
A A
AA
Department of Medical Laboratory Sciences, Health Science Centre, Kuwait University, PO Box 31470, Sulabikhat 90805, Kuwait. aad@hsc.edu.kw
Jadaon
M M
MM
Habeeb
F M
FM
D001431:Bacteriological Techniques / Q000379:methods; D052978:Disk Diffusion Antimicrobial Tests; D004755:Enterobacteriaceae / Q000187:drug effects / Q000201:enzymology* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000175:diagnosis*; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000379:methods; D011934:Reagent Strips; D015203:Reproducibility of Results; D001618:beta-Lactamases / Q000096:biosynthesis*
D011934:Reagent Strips; D001618:beta-Lactamases