title: ESBL Detection: Comparison of a Commercially Available Chromogenic Test for Third Generation Cephalosporine Resistance and Automated Susceptibility Testing in Enterobactericeae.
abstract: Rapid detection and reporting of third generation cephalosporine resistance (3GC-R) and of extended spectrum betalactamases in Enterobacteriaceae (ESBL-E) is a diagnostic and therapeutic priority to avoid inefficacy of the initial antibiotic regimen. In this study we evaluated a commercially available chromogenic screen for 3GC-R as a predictive and/or confirmatory test for ESBL and AmpC activity in clinical and veterinary Enterobacteriaceae isolates. The test was highly reliable in the prediction of cefotaxime and cefpodoxime resistance, but there was no correlation with ceftazidime and piperacillin/tazobactam minimal inhibitory concentrations. All human and porcine ESBL-E tested were detected with exception of one genetically positive but phenotypically negative isolate. By contrast, AmpC detection rates lay below 30%. Notably, exclusion of piperacillin/tazobactam resistant, 3GC susceptible K1+ Klebsiella isolates increased the sensitivity and specificity of the test for ESBL detection. Our data further imply that in regions with low prevalence of AmpC and K1 positive E. coli strains chromogenic testing for 3GC-R can substitute for more time consuming ESBL confirmative testing in E. coli isolates tested positive by Phoenix or VITEK2 ESBL screen. We, therefore, suggest a diagnostic algorithm that distinguishes 3GC-R screening from primary culture and species-dependent confirmatory ESBL testing by βLACTATM and discuss the implications of MIC distribution results on the choice of antibiotic regimen.
authors: Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Sigmund-Freud-Str. 25, D-53105, Bonn, Germany.
authors: Mohamed Ramadan
authors: MR
authors: El-Jade
authors: Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Sigmund-Freud-Str. 25, D-53105, Bonn, Germany.
authors: Marijo
authors: M
authors: Parcina
authors: Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Sigmund-Freud-Str. 25, D-53105, Bonn, Germany.|Institute of Animal Science, Preventive Health Management Group, University of Bonn, Katzenburgweg 7-9, D-53115, Bonn, Germany.
authors: Ricarda Maria
authors: RM
authors: Schmithausen
authors: Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Sigmund-Freud-Str. 25, D-53105, Bonn, Germany.|Division of Microbiology, Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, D-63225, Langen, Germany.
authors: Christoph
authors: C
authors: Stein
authors: Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Sigmund-Freud-Str. 25, D-53105, Bonn, Germany.
authors: Alina
authors: A
authors: Meilaender
authors: Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Sigmund-Freud-Str. 25, D-53105, Bonn, Germany.
authors: Achim
authors: A
authors: Hoerauf
authors: Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Sigmund-Freud-Str. 25, D-53105, Bonn, Germany.
authors: Ernst
authors: E
authors: Molitor
authors: Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Sigmund-Freud-Str. 25, D-53105, Bonn, Germany.|Division of Microbiology, Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, D-63225, Langen, Germany.
authors: Isabelle
authors: http://orcid.org/0000-0001-6646-5888
authors: I
authors: Bekeredjian-Ding
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002439:Cefotaxime / Q000494:pharmacology; D015296:Ceftizoxime / Q000031:analogs & derivatives / Q000494:pharmacology; D002511:Cephalosporins / Q000494:pharmacology*; D024881:Drug Resistance, Bacterial / Q000187:drug effects*; D004755:Enterobacteriaceae / Q000187:drug effects / Q000302:isolation & purification / Q000378:metabolism*; D004926:Escherichia coli / Q000187:drug effects / Q000378:metabolism; D006801:Humans; D007709:Klebsiella / Q000187:drug effects / Q000378:metabolism; D008826:Microbial Sensitivity Tests / Q000379:methods; D008967:Molecular Biology / Q000379:methods*; D013045:Species Specificity; D013552:Swine; D001618:beta-Lactamases / Q000378:metabolism*; D000097623:Cefpodoxime
chemical_list: D000900:Anti-Bacterial Agents; D002439:Cefotaxime; D015296:Ceftizoxime; D002511:Cephalosporins; D001618:beta-Lactamases; D000097623:Cefpodoxime