Multi-centre evaluation of a phenotypic extended spectrum β-lactamase detection guideline in the routine setting  T.N. Platteel, J.W. Cohen Stuart, A.J.

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Multi-centre evaluation of a phenotypic extended spectrum β-lactamase detection guideline in the routine setting  T.N. Platteel, J.W. Cohen Stuart, A.J. de Neeling, G.M. Voets, J. Scharringa, N. van de Sande, A.C. Fluit, M.J.M. Bonten, M.A. Leverstein-van Hall  Clinical Microbiology and Infection  Volume 19, Issue 1, Pages 70-76 (January 2013) DOI: 10.1111/j.1469-0691.2011.03739.x Copyright © 2013 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 1 Extended spectrum β-lactamase (ESBL) detection algorithm for Enterobacteriaceae according to the Dutch guideline for phenotypic ESBL detection. (1) If cefoxitin resistant, perform cefepime confirmation test. (2) Inhibitor resistant ESBL not excluded. (3) Nd = non-determinable = out of range (MIC Etest strip or no inhibition zone). (4)The ESBL confirmation test may generate false-positive results in K1 β-lactamase hyperproducing Klebsiella oxytoca. Exceptions are K oxytoca isolates with high-grade resistance to ceftazidime and synergy between ceftazidime and clavulanic acid, which is indicative of ESBL production. Clinical Microbiology and Infection 2013 19, 70-76DOI: (10.1111/j.1469-0691.2011.03739.x) Copyright © 2013 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 2. Diagram of inclusion and test results of isolates. In five isolates no cefepime/cefepime plus clavulanic acid Etest was performed. Plasmid-borne AmpC. Clinical Microbiology and Infection 2013 19, 70-76DOI: (10.1111/j.1469-0691.2011.03739.x) Copyright © 2013 European Society of Clinical Infectious Diseases Terms and Conditions

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