Proteus mirabilis strains that produce extended-spectrum β-lactamase (ESBL), AmpC β-lactamase, and carbapenemase pose potential threats to patient care because most clinical diagnostic laboratories may not attempt to detect these three major groups of enzymes. Therefore, the objective of this study was to ascertain if P. mirabilis isolates collected from our heathcare facility possess various mechanisms of resistance to β-lactams (i.e., ESBL, AmpC, and carbapenemases) and to additionally arrive at conclusions regarding concurrent testing for these three mechanism of drug resistance in order to reduce cost and time in routine diagnostic testing. Between January 2011 and June 2011, 60 consecutive non-repeated strains of P. mirabilis were evaluated for production of ESBLs, AmpC β-lactamases, and carbapenemases. Of these, 36 isolates were found to be ESBL producers, and 7 (12%) were positive for production of AmpC β-lactamases and ESBLs. Therefore, 19.4% of ESBL-producing Proteus strains coproduced AmpC enzymes. The modified Hodge test confirmed carbapenemase production in only 1 isolate (1.7%), which was also ESBL- and AmpC-positive. The clinical impact of additional AmpC expression in ESBL-producing P. mirabilis results in a newly acquired resistance to β-lactamase inhibitors. In addition, to save time and costs, we recommend the use of cefepime/cefepime-clavulanate or boronic acid for the ESBL detection but in only those strains that were positive for ESBL by screening and negative by confirmatory tests.

译文

:产生超广谱β-内酰胺酶(ESBL),AmpCβ-内酰胺酶和碳青霉烯酶的奇异变形杆菌菌株对患者的护理构成潜在威胁,因为大多数临床诊断实验室可能不会尝试检测这三大类酶。因此,本研究的目的是确定从我们的医疗卫生设施中收集的奇异假单胞菌分离株是否具有多种对β-内酰胺类药物的抗药性(即ESBL,AmpC和碳青霉烯酶),并得出关于同时检测这些细菌的结论。三种耐药机制是为了减少常规诊断测试的成本和时间。在2011年1月至2011年6月之间,对60株连续的非重复性狂犬疟原虫菌株进行了ESBLs,AmpCβ-内酰胺酶和碳青霉烯酶生产的评估。在这些菌株中,发现有36株是ESBL的产生者,其中7株(占12%)的AmpCβ-内酰胺酶和ESBLs阳性。因此,产生ESBL的变形杆菌菌株中有19.4%共同产生AmpC酶。改良的Hodge测试确认只有1个分离株(1.7%)中碳青霉烯酶的产生,而ESBL和AmpC也是阳性的。在产生ESBL的奇异假单胞菌中额外的AmpC表达的临床影响导致新获得的对β-内酰胺酶抑制剂的耐药性。此外,为节省时间和成本,我们建议使用头孢吡肟/头孢吡肟-克拉维酸盐或硼酸进行ESBL检测,但仅适用于通过筛选而对ESBL呈阳性而经确认试验呈阴性的菌株。

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