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JAC Advance Access published online on May 18, 2004
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh274
© 2004 by The British Society for Antimicrobial Chemotherapy
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Received February 20, 2004
Revised April 13, 2004
Accepted April 14, 2004

Original article

Evaluation of a new cefepime-clavulanate ESBL Etest to detect extended-spectrum {beta}-lactamases in an Enterobacteriaceae strain collection

Enno Stürenburg 1*, Ingo Sobottka 1, Djahesh Noor 1, Rainer Laufs 1, Dietrich Mack 1

1 Institut für Infektionsmedizin, Zentrum für Klinisch-Theoretische Medizin I, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany

* To whom correspondence should be addressed. E-mail: e.stuerenburg{at}uke.uni-hamburg.de.


  Abstract

Objectives: In this study, we evaluated the performance of a new ESBL Etest configuration based on clavulanate synergy with cefepime compared with cefotaxime-clavulanate and ceftazidime-clavulanate ESBL Etest strips for the detection of extended-spectrum {beta}-lactamases (ESBL) in an Enterobacteriaceae strain collection, with special focus on Enterobacter spp.

Methods: Overall, a total of 54 clinical isolates of ESBL-producing Enterobacteriaceae species were evaluated: Enterobacter aerogenes (n=3), Enterobacter cloacae (n=10), Escherichia coli (n=10), Klebsiella oxytoca (n=3), Klebsiella pneumoniae (n=25) and Proteus mirabilis (n=3). To check Etest behaviour with resistance phenotypes similar to ESBL, our panel was expanded by six clinical isolates of K. oxytoca that were identified as putative producers of their chromosomal K1 {beta}-lactamase.

Results: With this panel, ESBL Etest was 98% sensitive with cefepime-clavulanate, 83% with cefotaxime-clavulanate, and 74% with ceftazidime-clavulanate strips. Concentrating on Enterobacter spp., reliable ESBL detection could only be achieved by the new cefepime-clavulanate strip since it confirmed ESBL production in all strains (100% sensitivity) whereas only 4/13 (31%) of Enterobacter strains were positive using cefotaxime-clavulanate or ceftazidime-clavulanate strips. A limitation of using the new cefepime strip was less than optimal specificity with K1 phenotypes of K. oxytoca: among six strains, four isolates were scored false-positive by Etest strips containing cefepime-clavulanate.

Conclusion: The new Etest ESBL strip containing cefepime-clavulanate is a valuable supplement to current methods for detection of ESBLs. In our study collection, the cefepime-clavulanate strip was the best configuration for detection of ESBLs, particularly in Enterobacter spp.

Key Words: Keywords: ESBL detection, Etest methodology


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