ReviewTowards a phenotypic screening strategy for emerging β-lactamases in Gram-negative bacilli
Introduction
The increasing incidence of infection with Gram-negative bacilli (GNB) producing emerging β-lactamases, such as extended-spectrum β-lactamases (ESBL), AmpC β-lactamases and carbapenemases, has become a great concern. Infections caused by these multidrug-resistant GNB are associated with higher morbidity and mortality, prolonged hospital stay, rising healthcare costs and limited therapeutic options [1]. Moreover, these bacteria are a serious problem for infection control practitioners. Therefore, early detection and identification of these resistance enzymes will enable optimum antimicrobial therapy [2] and ensure timely introduction of infection control procedures to prevent further spread [3], [4].
Since routine susceptibility testing is not suitable for detecting and identifying these emerging β-lactamases in GNB, supplementary phenotypic screening and confirmation tests have been a major subject of research during the past two decades.
This review re-evaluates the approved guidelines on this topic, incorporates new literature and discusses controversies. Furthermore, it formulates recommendations to facilitate the development of an efficient screening strategy for emerging β-lactamases in GNB in routine clinical laboratories.
Section snippets
Methods
The literature search for this study was done via the MEDLINE database for citations from January 1980 to March 2011. Only papers published in the English language were considered. MeSH terms were ‘ESBL, AmpC, carbapenemase, KPC, metallo-β-lactamase, OXA- or beta-lactamase’ combined with ‘detection, screening, confirmation, identification, chromogenic agar, Vitek2, Phoenix, E-test, Enterobacteriaceae, Pseudomonas aeruginosa, Acinetobacter spp.’ and ‘β-lactamase-, AmpC-, carbapenemase-, and
Screening for extended-spectrum β-lactamases in surveillance samples
Recently, chromogenic media designed for the rapid detection and presumptive identification of ESBL-producing Enterobacteriaceae have become commercially available, namely chromID ESBL (bioMérieux, Marcy l’Étoile, France) and Brilliance ESBL agar (Oxoid Ltd., Basingstoke, UK). Only a few studies have evaluated the performance of these media in detecting ESBL-producing Enterobacteriaceae in surveillance samples (e.g. faecal samples, lower respiratory tract samples, urine) [9], [10], [11], [12].
Conclusion
Reliable detection of emerging β-lactamases in GNB is crucial in minimising their spread and optimising antimicrobial therapy. In the past two decades, different phenotypic screening and confirmation methods compatible for use in routine clinical microbiology laboratories have been developed and evaluated for the detection and identification of the emerging β-lactamases in GNB. In previous sections, we reviewed approved guidelines on this topic, incorporated newly available literature and
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