Evaluation of a diagnostic flow chart for detection and confirmation of extended spectrum β-lactamases (ESBL) in Enterobacteriaceae  S. Polsfuss, G.V.

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Evaluation of a diagnostic flow chart for detection and confirmation of extended spectrum β-lactamases (ESBL) in Enterobacteriaceae  S. Polsfuss, G.V. Bloemberg, J. Giger, V. Meyer, E.C. Böttger, M. Hombach  Clinical Microbiology and Infection  Volume 18, Issue 12, Pages 1194-1204 (December 2012) DOI: 10.1111/j.1469-0691.2011.03737.x Copyright © 2012 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 1 Diagnostic approach combining screening and confirmation of ESBL production in Enterobacteriaceae. Proposed diagnostic algorithm for detection and confirmation of ESBL. CPD, cefpodoxime; CRO, ceftriaxone; CAZ, ceftazidime; CTX, cefotaxime; FEP, cefepime; AMC, amoxicillin-clavulanic acid; CDT, combined disk test. (a) For isolates with positive AmpC screening or species with known chromosomal AmpC, the use of Mueller-Hinton agar with cloxacillin is recommended. (b) For Klebsiella oxytoca, Citrobacter koseri and Citrobacter amalonaticus use CAZ for CDT confirmation testing only. (c) Results for two isolates in this study were considered borderline or inconclusive, because only one of the three CDT tests was marginally positive. For both isolates ESBL genes were not detected by PCR methods. No general recommendations can be deduced because only two isolates were considered borderline. The borderline category was created to allow clinical microbiologists to subject indifferent or questionable results to further analyses. (d) Isolates that are ESBL screening positive regarding critical diameters of third-generation cephalosporins, but negative with the CDT, should be checked for the presence of AmpC enzymes and/or carbapenemases. Clinical Microbiology and Infection 2012 18, 1194-1204DOI: (10.1111/j.1469-0691.2011.03737.x) Copyright © 2012 European Society of Clinical Infectious Diseases Terms and Conditions

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