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Lee, Kim, Hong, Huh, and Chae: Evaluation of the Phoenix Automated Microbiology System for Detecting Extended-Spectrum β-Lactamase in Escherichia coli, Klebsiella species and Proteus mirabilis
Original Article

Korean J Leg Med 2008;28(3):185-190.

Published online: 14 February 2008

DOI: https://doi.org/10.3343/kjlm.2008.28.3.185

Evaluation of the Phoenix Automated Microbiology System for Detecting Extended-Spectrum β-Lactamase in Escherichia coli, Klebsiella species and Proteus mirabilis

Kyo Kwan Lee, M.D.1, Sung Tae Kim, M.T.1, Ki Suk Hong, M.D.2, Hee Jin Huh, M.D.1, Seok-Lae Chae, M.D.1

1Department of Laboratory Medicine, Dongguk University International Hospital, Goyang, Korea

2Department of Laboratory Medicine, School of Medicine, Ewha Womans University, Seoul, Korea

Received 29 December 20074 March 2008       Accepted 24 March 2008

Copyright © 2008 by the Korean Society for Legal Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

The aim of this study was to compare the BD Phoenix (Beckton Dickinson Diagnostic Systems, USA) extended-spectrum β-lactamase (ESBL) test with the Clinical and Laboratory Standards Institute (CLSI) ESBL phenotypic confirmatory test by disk diffusion (CLSI ESBL test) in Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca and Proteus mirabilis.

Methods

We tested 224 clinical isolates of E. coli, K. pneumoniae, K. oxytoca and P. mirabilis during May 2006 to March 2007. These isolates were examined by the Phoenix and the CLSI ESBL tests simultaneously. For the isolates showing discordant results between the two tests, boronic acid disk test was performed to differentiate AmpC β-lactamase and ESBL.

Results

Among the 224 clinical isolates, 75 and 79 isolates were positive for ESBL by CLSI ESBL test and Phoenix test, respectively. Having detected 4 more isolates as ESBL-producers, Phoenix test showed a 98.2% agreement with a 100% sensitivity and 97.3% specificity compared with CLSI ESBL test. Among the four false positive isolates, three were AmpC-positive but ESBL-negative.

Conclusions

The BD Phoenix ESBL test was sensitive and specific, and can be used as a rapid and reliable method to detect ESBL production in E. coli, Klebsiella species, and P. mirabilis.

Keywords: Extended-spectrum β-lactamase, BD Phoenix ESBL test, CLSI ESBL phenotypic confirmatory test

REFERENCES

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Table 1.
Overall agreement of the Phoenix ESBL automated test and the CLSI ESBL phenotypic confirmatory test
CLSI ESBL test Phoenix ESBL test
N positive N negative
ESBL-positive∗ 75 0
ESBL-negative∗ 4 145

∗ , The result of CLSI phenotypic confirmatory test for ESBL by disk diffusion methods.

Abbreviations: ESBL, extended-spectrum β-lactamase; CLSI, Clinical and Laboratory Standards Institute.

Table 2.
Characteristics of 4 false positive isolates in Phoenix ESBL test compared to CLSI ESBL test
Strain No. Species Minimum inhibitory concentrations (μg/mL) Difference in zone diameter (mm)
Ceftazidime Cefotaxime FOX-BA vs FOX CTT-BA vs CTT CAZ-BA-CA vs CAZ-BA CTX-BA-CA vs CTX-BA
25 E. coli 1 ≤2 5 3 0 0
120 E. coli 1 ≤2 1 0 -1 0
124 E. coli 1 2 6 3 1 1
128 K. pneumoniae ≥16 4 3 5 -3 0

Abbreviations: FOX, cefoxitin; CTT, cefotetan; BA, boronic acid; CAZ, ceftazidime; CTX, cefotaxime; CA, clavulanic acid.

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