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JAC Advance Access originally published online on October 7, 2004
Journal of Antimicrobial Chemotherapy 2004 54(5):870-875; doi:10.1093/jac/dkh449
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JAC vol.54 no.5 © The British Society for Antimicrobial Chemotherapy 2004; all rights reserved

Evaluation of the MicroScan ESBL plus confirmation panel for detection of extended-spectrum ß-lactamases in clinical isolates of oxyimino-cephalosporin-resistant Gram-negative bacteria

Enno Stürenburg1,*, Melanie Lang1, Matthias A. Horstkotte1, Rainer Laufs1 and Dietrich Mack1,2

1 Institut für Infektionsmedizin, Zentrum für Klinisch-Theoretische Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany; 2 Chair of Medical Microbiology and Infectious Diseases, Swansea Clinical School, University of Wales Swansea SA2 8PP, UK

* Corresponding author. Tel: +49-40-42803-3147; Fax: +49-40-42803-4881; Email: e.stuerenburg{at}uke.uni-hamburg.de

Objective: We aimed to assess the performance of the MicroScan ESBL plus confirmation panel using a series of 87 oxyimino-cephalosporin-resistant Gram-negative bacilli of various species.

Methods: Organisms tested included 57 extended-spectrum ß-lactamase (ESBL) strains comprising Enterobacter aerogenes (3), Enterobacter cloacae (10), Escherichia coli (11), Klebsiella pneumoniae (26), Klebsiella oxytoca (3) and Proteus mirabilis (4). Also included were 30 strains resistant to oxyimino cephalosporins but lacking ESBLs, which were characterized with other resistance mechanisms, such as inherent clavulanate susceptibility in Acinetobacter spp. (4), hyperproduction of AmpC enzyme in Citrobacter freundii (2), E. aerogenes (3), E. cloacae (3), E. coli (4), Hafnia alvei (1) and Morganella morganii (1), production of plasmid-mediated AmpC ß-lactamase in K. pneumoniae (3) and E. coli (3) or hyperproduction of K1 enzyme in K. oxytoca (6).

Results: The MicroScan MIC-based clavulanate synergy correctly classified 50 of 57 ESBL strains as ESBL-positive and 23 of 30 non-ESBL strains as ESBL-negative (yielding a sensitivity of 88% and a specificity of 76.7%, respectively). False negatives among ESBL producers were highest with Enterobacter spp. due to masking interactions between ESBL and AmpC ß-lactamases. False-positive classifications occurred in two Acinetobacter spp., one E. coli producing plasmid-mediated AmpC ß-lactamase and two K. oxytoca hyperproducing their chromosomal K1 ß-lactamase.

Conclusion: The MicroScan clavulanate synergy test proved to be a valuable tool for ESBL confirmation. However, this test has limitations in detecting ESBLs in Enterobacter spp. and in discriminating ESBL-related resistance from the K1 enzyme and from inherent clavulanate susceptibility in Acinetobacter spp.

Keywords: ESBLs , ESBL detection , ESBL discrimination , MIC-based clavulanate synergy test


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