Detection of extended-spectrum β-lactamases

Detection of extended-spectrum beta-lactamases in clinical isolates of Pseudomonas aeruginosa

With the occurrence of extended-spectrum beta-lactamases (ESBLs) in Pseudomonas aeruginosa being increasingly reported worldwide, there is a need for a reliable test to detect ESBLs in clinical isolates of P. aeruginosa. In our study, a total of 75 clinical isolates of P. aeruginosa were studied. Nitrocefin tests were performed to detect the beta-lactamase enzyme; isoelectric focusing electrophoresis, PCR, and PCR product sequencing were designed to further characterize the contained ESBLs. Various ESBL-screening methods were designed to compare the reliabilities of detecting ESBLs in clinical isolates of P. aeruginosa whose beta-lactamases were well characterized. Thirty-four of 36 multidrug-resistant P. aeruginosa clinical isolates were positive for ESBLs. bla(VEB-3) was the most prevalent ESBL gene in P. aeruginosa in our study. Among the total of 34 isolates that were considered ESBL producers, 20 strains were positive using conventional combined disk tests and 10 strains were positive using a conventional double-disk synergy test (DDST) with amoxicillin-clavulanate, expanded-spectrum cephalosporins, aztreonam, and cefepime. Modifications of the combined disk test and DDST, which consisted of shorter distances between disks (20 mm instead of 30 mm) and the use of three different plates that contained cloxacillin (200 microg/ml) alone, Phe-Arg beta-naphthylamide dihydrochloride (MC-207,110; 20 microg/ml) alone, and both cloxacillin (200 microg/ml) and MC-207,110 (20 microg/ml) increased the sensitivity of the tests to 78.8%, 91.18%, 85.29%, and 97.06%.

Antimicrobial resistance in the chronically critically ill patient

Infection caused by organisms resistant to conventional antimicrobial therapy is an emerging problem of global proportions. This article describes the epidemiology of infections caused by resistant organisms in chronically critically ill patients and explores factors and mechanisms that lead to the development of resistance. Specific organisms and strategies for the treatment and control of these resistance organisms are discussed.

beta-Lactam susceptibility patterns and investigation of cephalosporin hydrolysing beta-lactamases of Gram-negative extraintestinal clinical isolates

Of more than 3500 isolates of enterobacteriaceae, 48-69% were resistant to aminopenicillins and 11-45% to amoxycillin+clavulanic acid. Resistance to second and third generation cephalosporins was present in 11-17 and 3-8% of Escherichia coli, 47-56 and 15-52% of Klebsiella-Enterobacter, 36-57 and 16-27% of Proteus, Providencia and Morganella isolates. Pseudomonas aeruginosa strains varied in their resistance to antipseudomonal beta-lactams. Isoelectric points, inhibitor profiles and substrate profiles of beta-lactamases extracted from representatives of the resistant strains indicated that the resistance was mainly due to the hyperproduction of chromosomally encoded AmpC beta-lactamases. This was confirmed by plasmid profile and PCR investigations. Extended-spectrum beta-lactamase and metallo-penicillinase producing strains were not found. One Pseudomonas maltophilia strain produced an oxacillinase.

Comparison of screening methods for detection of extended-spectrum beta-lactamases and their prevalence among Escherichia coli and Klebsiella species in Hong Kong

Three tests, the disk diffusion test, the double-disc synergy test and the inhibitor-potentiated disc diffusion test, were compared for their abilities to detect production of extended-spectrum beta-lactamases (ESBL) in 702 Escherichia coli and 472 Klebsiella spp. strains from four hospitals. Eleven percent E. coli and 13% Klebsiella spp. were found to produce ESBL. As an indicator of ESBL activity, the sensitivities of the five extended-spectrum beta-lactams were as follows: cefotaxime (100%), cefpodoxime (99.3%), ceftriaxone (98.6%), aztreonam (93%) and ceftazidime (57.7%) when interpreted using the National Committee for Clinical Laboratory Standards criteria. Their positive predictive values ranged from 67.8-83.8%. Both the inhibitor-potentiated disc diffusion test and the double-disc synergy test (at three inter-disc widths of 20, 25 and 30 mm) were capable of identifying all the ESBL-producers. However, at a single inter-disc width of 30 mm, the double-disc synergy test has limited sensitivity (83.8%). As a second test for confirming ESBL activity in strains with reduced susceptibility to beta-lactams, the inhibitor-potentiated disc diffusion test is therefore a simple and reliable option.

Molecular epidemiology of a cluster of cases due to Klebsiella pneumoniae producing SHV-5 extended-spectrum beta-lactamase in the premature intensive care unit of a Hungarian hospital

Fifteen nosocomial cases of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae occurred among 132 neonates in a premature intensive care unit in Hungary in June through November 1998. Fourteen strains were indistinguishable by molecular biological typing and harbored the same single conjugative extended-spectrum beta-lactamase-encoding plasmid that was spontaneously found in a Serratia marcescens strain in the same patient.