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. 1997 Aug;35(8):2061–2067. doi: 10.1128/jcm.35.8.2061-2067.1997

Detection and clinical significance of extended-spectrum beta-lactamases in a tertiary-care medical center.

C L Emery 1, L A Weymouth 1
PMCID: PMC229903  PMID: 9230382

Abstract

The prevalence of extended-spectrum beta-lactamase (ESBL)-mediated resistance remains unknown for most hospitals, and national guidelines for testing and reporting ESBL-mediated resistance have not yet been developed. We undertook a study to determine the prevalence of ESBLs and the clinical need for testing in our tertiary-care medical center. Members of the family Enterobacteriaceae isolated over a 6-month period for which ceftazidime or ceftriaxone MICs were greater than 1 microg/ml were tested for production of ESBLs by the double-disk synergy method. Approximately 1.5% of isolates of the family Enterobacteriaceae (50 of 3,273), which were isolated from 1.2% of patients (23 of 1,844), were found to express ESBLs. ESBL-producing strains included eight different species and were isolated from patients located throughout the hospital, including outpatient clinics. By using the interpretive guidelines of the National Committee for Clinical Laboratory Standards, 26 to 39% of the isolates would have been reported to be susceptible to ceftazidime, depending upon the routine susceptibility method used. However, tests with cefpodoxime found all of the ESBL-producing strains to be resistant or intermediate. Nine patients infected with ESBL-producing isolates were treated with therapy which included an expanded-spectrum cephalosporin. Seven were cured. The deaths of the other two patients were not attributed to bacterial resistance missed by routine susceptibility testing. These observations suggest that in our tertiary-care medical center, it may not be clinically necessary or cost-effective at this time to institute additional testing on a routine basis to detect ESBL production in all clinical isolates of the family Enterobacteriaceae.

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Selected References

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  1. Bauernfeind A., Chong Y., Schweighart S. Extended broad spectrum beta-lactamase in Klebsiella pneumoniae including resistance to cephamycins. Infection. 1989 Sep-Oct;17(5):316–321. doi: 10.1007/BF01650718. [DOI] [PubMed] [Google Scholar]
  2. Bingen E. H., Desjardins P., Arlet G., Bourgeois F., Mariani-Kurkdjian P., Lambert-Zechovsky N. Y., Denamur E., Philippon A., Elion J. Molecular epidemiology of plasmid spread among extended broad-spectrum beta-lactamase-producing Klebsiella pneumoniae isolates in a pediatric hospital. J Clin Microbiol. 1993 Feb;31(2):179–184. doi: 10.1128/jcm.31.2.179-184.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Brun-Buisson C., Legrand P., Philippon A., Montravers F., Ansquer M., Duval J. Transferable enzymatic resistance to third-generation cephalosporins during nosocomial outbreak of multiresistant Klebsiella pneumoniae. Lancet. 1987 Aug 8;2(8554):302–306. doi: 10.1016/s0140-6736(87)90891-9. [DOI] [PubMed] [Google Scholar]
  4. Bush K., Jacoby G. A., Medeiros A. A. A functional classification scheme for beta-lactamases and its correlation with molecular structure. Antimicrob Agents Chemother. 1995 Jun;39(6):1211–1233. doi: 10.1128/aac.39.6.1211. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Caron F., Gutmann L., Bure A., Pangon B., Vallois J. M., Pechinot A., Carbon C. Ceftriaxone-sulbactam combination in rabbit endocarditis caused by a strain of Klebsiella pneumoniae producing extended-broad-spectrum TEM-3 beta-lactamase. Antimicrob Agents Chemother. 1990 Nov;34(11):2070–2074. doi: 10.1128/aac.34.11.2070. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Casellas J. M., Goldberg M. Incidence of strains producing extended spectrum beta-lactamases in Argentina. Infection. 1989 Nov-Dec;17(6):434–436. doi: 10.1007/BF01645567. [DOI] [PubMed] [Google Scholar]
  7. Cormican M. G., Marshall S. A., Jones R. N. Detection of extended-spectrum beta-lactamase (ESBL)-producing strains by the Etest ESBL screen. J Clin Microbiol. 1996 Aug;34(8):1880–1884. doi: 10.1128/jcm.34.8.1880-1884.1996. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Dudley M. Bacterial resistance mechanisms to beta-lactam antibiotics: assessment of management strategies. Pharmacotherapy. 1995 Jan-Feb;15(1 Pt 2):9S–14S. [PubMed] [Google Scholar]
  9. Fantin B., Pangon B., Potel G., Caron F., Vallée E., Vallois J. M., Mohler J., Buré A., Philippon A., Carbon C. Activity of sulbactam in combination with ceftriaxone in vitro and in experimental endocarditis caused by Escherichia coli producing SHV-2-like beta-lactamase. Antimicrob Agents Chemother. 1990 Apr;34(4):581–586. doi: 10.1128/aac.34.4.581. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Jacoby G. A., Archer G. L. New mechanisms of bacterial resistance to antimicrobial agents. N Engl J Med. 1991 Feb 28;324(9):601–612. doi: 10.1056/NEJM199102283240906. [DOI] [PubMed] [Google Scholar]
  11. Jacoby G. A., Han P. Detection of extended-spectrum beta-lactamases in clinical isolates of Klebsiella pneumoniae and Escherichia coli. J Clin Microbiol. 1996 Apr;34(4):908–911. doi: 10.1128/jcm.34.4.908-911.1996. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Jacoby G. A., Medeiros A. A. More extended-spectrum beta-lactamases. Antimicrob Agents Chemother. 1991 Sep;35(9):1697–1704. doi: 10.1128/aac.35.9.1697. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Jarlier V., Nicolas M. H., Fournier G., Philippon A. Extended broad-spectrum beta-lactamases conferring transferable resistance to newer beta-lactam agents in Enterobacteriaceae: hospital prevalence and susceptibility patterns. Rev Infect Dis. 1988 Jul-Aug;10(4):867–878. doi: 10.1093/clinids/10.4.867. [DOI] [PubMed] [Google Scholar]
  14. Katsanis G. P., Spargo J., Ferraro M. J., Sutton L., Jacoby G. A. Detection of Klebsiella pneumoniae and Escherichia coli strains producing extended-spectrum beta-lactamases. J Clin Microbiol. 1994 Mar;32(3):691–696. doi: 10.1128/jcm.32.3.691-696.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Meyer K. S., Urban C., Eagan J. A., Berger B. J., Rahal J. J. Nosocomial outbreak of Klebsiella infection resistant to late-generation cephalosporins. Ann Intern Med. 1993 Sep 1;119(5):353–358. doi: 10.7326/0003-4819-119-5-199309010-00001. [DOI] [PubMed] [Google Scholar]
  16. Naumovski L., Quinn J. P., Miyashiro D., Patel M., Bush K., Singer S. B., Graves D., Palzkill T., Arvin A. M. Outbreak of ceftazidime resistance due to a novel extended-spectrum beta-lactamase in isolates from cancer patients. Antimicrob Agents Chemother. 1992 Sep;36(9):1991–1996. doi: 10.1128/aac.36.9.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Philippon A., Ben Redjeb S., Fournier G., Ben Hassen A. Epidemiology of extended spectrum beta-lactamases. Infection. 1989 Sep-Oct;17(5):347–354. doi: 10.1007/BF01650727. [DOI] [PubMed] [Google Scholar]
  18. Philippon A., Labia R., Jacoby G. Extended-spectrum beta-lactamases. Antimicrob Agents Chemother. 1989 Aug;33(8):1131–1136. doi: 10.1128/aac.33.8.1131. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Quinn J. P., Miyashiro D., Sahm D., Flamm R., Bush K. Novel plasmid-mediated beta-lactamase (TEM-10) conferring selective resistance to ceftazidime and aztreonam in clinical isolates of Klebsiella pneumoniae. Antimicrob Agents Chemother. 1989 Sep;33(9):1451–1456. doi: 10.1128/aac.33.9.1451. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Rice L. B., Willey S. H., Papanicolaou G. A., Medeiros A. A., Eliopoulos G. M., Moellering R. C., Jr, Jacoby G. A. Outbreak of ceftazidime resistance caused by extended-spectrum beta-lactamases at a Massachusetts chronic-care facility. Antimicrob Agents Chemother. 1990 Nov;34(11):2193–2199. doi: 10.1128/aac.34.11.2193. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Rice L. B., Yao J. D., Klimm K., Eliopoulos G. M., Moellering R. C., Jr Efficacy of different beta-lactams against an extended-spectrum beta-lactamase-producing Klebsiella pneumoniae strain in the rat intra-abdominal abscess model. Antimicrob Agents Chemother. 1991 Jun;35(6):1243–1244. doi: 10.1128/aac.35.6.1243. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Sanders C. C., Sanders W. E., Jr beta-Lactam resistance in gram-negative bacteria: global trends and clinical impact. Clin Infect Dis. 1992 Nov;15(5):824–839. doi: 10.1093/clind/15.5.824. [DOI] [PubMed] [Google Scholar]
  23. Sirot D. L., Goldstein F. W., Soussy C. J., Courtieu A. L., Husson M. O., Lemozy J., Meyran M., Morel C., Perez R., Quentin-Noury C. Resistance to cefotaxime and seven other beta-lactams in members of the family Enterobacteriaceae: a 3-year survey in France. Antimicrob Agents Chemother. 1992 Aug;36(8):1677–1681. doi: 10.1128/aac.36.8.1677. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Smith C. E., Tillman B. S., Howell A. W., Longfield R. N., Jorgensen J. H. Failure of ceftazidime-amikacin therapy for bacteremia and meningitis due to Klebsiella pneumoniae producing an extended-spectrum beta-lactamase. Antimicrob Agents Chemother. 1990 Jun;34(6):1290–1293. doi: 10.1128/aac.34.6.1290. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Spencer R. C., Wheat P. F., Winstanley T. G., Cox D. M., Plested S. J. Novel beta-lactamase in a clinical isolate of Klebsiella pneumoniae conferring unusual resistance to beta-lactam antibiotics. J Antimicrob Chemother. 1987 Dec;20(6):919–921. doi: 10.1093/jac/20.6.919. [DOI] [PubMed] [Google Scholar]
  26. Thomson K. S., Sanders C. C. Detection of extended-spectrum beta-lactamases in members of the family Enterobacteriaceae: comparison of the double-disk and three-dimensional tests. Antimicrob Agents Chemother. 1992 Sep;36(9):1877–1882. doi: 10.1128/aac.36.9.1877. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Thornsberry C. Trends in antimicrobial resistance among today's bacterial pathogens. Pharmacotherapy. 1995 Jan-Feb;15(1 Pt 2):3S–8S. [PubMed] [Google Scholar]

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