Comparison of nine phenotypic methods for detection of extended-spectrum beta-lactamase production by Enterobacteriaceae.
The detection of extended-spectrum β-lactamase-producing (ESBL) bacteria is of importance for infection control and epidemiological surveillance. We aimed to compare phenotypic methods available in the routine laboratory and to evaluate two-step strategies using these methods for the detection of ESBL-positive Enterobacteriaceae. Two methods used for routine susceptibility testing (Vitek2 and disk diffusion methods) and seven methods designed for the detection of ESBL production (ESBL Etests, combination disks, double-disk synergy [DDS] methods on Mueller-Hinton [MH] agar and cloxacillin-containing MH agar, and the Cica-Beta test) were tested against 107 strains of Enterobacteriaceae not susceptible to extended-spectrum cephalosporins. All strains were screened for the presence of acquired ESBL-encoding genes by PCR, and the PCR result was considered the gold standard for evaluation of the other test methods. Among the 107 strains, 52 (49%) were ESBL positive. With Vitek2, sensitivities were the highest when using extended cards (73% to 79%), but 25% to 31% of the strains yielded indeterminate results. For the disk diffusion method, sensitivities were the highest (96%) when testing at least cefotaxime, cefepime, and a third compound (ceftazidime, cefpodoxime, or aztreonam). For the specific methods, specificities ranged from 62% (ceftazidime ESBL Etest) to 100% (DDS using a disk spacing of 20 mm). When a method designed for ESBL detection was used on strains considered ESBL negative or with an indeterminate result by a first routine susceptibility method, sensitivities reached 100% for a majority of combinations. In conclusion, two-step strategies using phenotypic methods available in most clinical laboratories may reach a sensitivity of 100% for ESBL detection among a large panel of species, including AmpC producers, providing a sensible choice of tests.
Laboratoire de Bactériologie-Hygiène, et UMR9, Faculté de Médecine Pierre et Marie Curie, Site Pitié-Salpêtrière, Paris, France.
Hélène
H
Garrec
Laurence
L
Drieux-Rouzet
Jean-Louis
JL
Golmard
Vincent
V
Jarlier
Jérôme
J
Robert
D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D004269:DNA, Bacterial / Q000235:genetics; D004755:Enterobacteriaceae / Q000201:enzymology* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000382:microbiology; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000379:methods; D016133:Polymerase Chain Reaction; D012680:Sensitivity and Specificity; D001618:beta-Lactamases / Q000096:biosynthesis* / Q000235:genetics; D047090:beta-Lactams / Q000494:pharmacology*
D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D047090:beta-Lactams; D001618:beta-Lactamases
J Antimicrob Chemother. 2003 Oct;52(4):591-7
12972449
J Antimicrob Chemother. 2005 Jul;56(1):52-9
15917288
Eur J Clin Microbiol Infect Dis. 2009 May;28(5):491-8
19002728
J Clin Microbiol. 2006 Sep;44(9):3257-62
16954257
Clin Microbiol Rev. 2005 Oct;18(4):657-86
16223952
J Clin Microbiol. 2000 Nov;38(11):4228-32
11060096
Stat Med. 2000 Mar 15;19(5):649-63
10700737
Clin Microbiol Infect. 2008 Feb;14(2):148-54
18076663
Clin Microbiol Infect. 2008 Jan;14 Suppl 1:33-41
18154526
J Clin Microbiol. 2003 Aug;41(8):3542-7
12904353
J Clin Microbiol. 2009 Feb;47(2):358-61
19109470
J Clin Microbiol. 2007 Apr;45(4):1167-74
17287329
J Clin Microbiol. 2005 Mar;43(3):1081-5
15750065
Antimicrob Agents Chemother. 1992 Sep;36(9):1877-82
1416878
Arch Intern Med. 2008 Sep 22;168(17):1897-902
18809817
J Clin Microbiol. 2000 Feb;38(2):542-6
10655342
Lancet Infect Dis. 2009 Apr;9(4):228-36
19324295
J Antimicrob Chemother. 2008 Nov;62(5):1015-7
18669518
Clin Microbiol Infect. 2008 Jan;14 Suppl 1:42-52
18154527
Antimicrob Agents Chemother. 2004 Jan;48(1):1-14
14693512
J Antimicrob Chemother. 2007 Nov;60(5):956-64
17804424
Clin Microbiol Infect. 2008 Jan;14 Suppl 1:90-103
18154532
J Antimicrob Chemother. 2008 Feb;61(2):273-81
18077311
J Antimicrob Chemother. 2002 Feb;49(2):289-300
11815570
J Clin Microbiol. 1996 Aug;34(8):1880-4
8818874
Clin Microbiol Infect. 2006 Oct;12(10):1013-20
16961639
J Antimicrob Chemother. 2007 Dec;60(6):1375-9
17913719
J Clin Microbiol. 2007 Aug;45(8):2380-4
17596369
J Antimicrob Chemother. 2004 Jul;54(1):134-8
15150168
J Antimicrob Chemother. 2000 Jun;45(6):881-5
10837444
Rev Infect Dis. 1988 Jul-Aug;10(4):867-78
3263690