We examined the effect of applying the updated 2010 Clinical and Laboratory Standards Institute (CLSI) susceptibility breakpoints for extended-spectrum cephalosporins (ESCs) to detect extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. In total, 202 ESBL-producing, plasmidic AmpC- and carbapenemase-negative isolates derived from separate patients were collected from three Greek hospitals during 2007-2011, including 150 Escherichia coli, 43 Klebsiella pneumoniae and 9 Enterobacter cloacae clinical isolates. ESBLs were detected using the ESBL CLSI confirmatory test and PCR assays. Sequencing analysis showed that 91 (45.0%) of the ESBL-producers carried the bla(CTX-M-3) gene, 66 (32.7%) carried the bla(CTX-M-15) gene and the remaining 45 (22.3%) carried the bla(SHV-5) gene. Minimum inhibitory concentrations for cefotaxime, ceftazidime and cefepime were determined by the agar dilution method. Based on the new CLSI breakpoints, 13 (6.4%) of the ESBL-producers were susceptible to cefotaxime, 90 (44.6%) to ceftazidime and 112 (55.4%) to cefepime; as many as 145 (71.8%) were susceptible to at least one ESC. Among the 150 E. coli, 12 (8.0%), 87 (58.0%) and 79 (52.7%) were susceptible to cefotaxime, ceftazidime and cefepime, respectively, whilst among the 43 K. pneumoniae, 1 (2.3%), 3 (7.0%) and 25 (58.1%) were susceptible to the above ESCs, respectively. None of the nine E. cloacae were susceptible to cefotaxime and ceftazidime, but all except one were susceptible to cefepime. By implementation of the new 2010 CLSI breakpoints, a considerable proportion of ESBL-possessing Enterobacteriaceae would be reported as susceptible, mostly to ceftazidime and cefepime, leading to possible infection control and therapeutic implications.

译文

:我们研究了应用更新的2010年临床和实验室标准协会(CLSI)敏感性点对超广谱头孢菌素(ESC)检测产生超广谱β-内酰胺酶(ESBL)的肠杆菌科的效果。在2007年至2011年期间,总共从三名希腊医院收集了202份来自不同患者的产ESBL的,质粒化的AmpC和碳青霉烯酶阴性的分离株,包括150株大肠杆菌,43株肺炎克雷伯菌和9株泄殖腔肠杆菌临床分离株。使用ESBL CLSI确证测试和PCR测定法检测ESBL。测序分析表明,有91个(45.0%)的ESBL生产者带有bla(CTX-M-3)基因,有66个(32.7%)带有bla(CTX-M-15)基因,其余45个(22.3%)携带bla(SHV-5)基因。用琼脂稀释法测定头孢噻肟,头孢他啶和头孢吡肟的最低抑菌浓度。根据新的CLSI断点,有13名(6.4%)的ESBL生产者易受头孢噻肟的影响,90名(44.6%)对头孢他啶易感,112名(55.4%)对头孢吡肟易感;多达145个(71.8%)易受至少一种ESC的影响。在150例大肠杆菌中,分别有12例(8.0%),87例(58.0%)和79例(52.7%)易受头孢噻肟,头孢他啶和头孢吡肟的影响,而43例肺炎克雷伯菌中有1例(2.3%),3例。 (7.0%)和25(58.1%)易受上述ESC影响。九种阴沟肠杆菌均不易受头孢噻肟和头孢他啶的影响,但除一个外,其余均易受头孢吡肟的影响。通过实施新的2010年CLSI断点,据报道,相当一部分拥有ESBL的肠杆菌科细菌很容易感染,其中大部分容易感染头孢他啶和头孢吡肟,从而可能导致感染控制和治疗意义。

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