Yeon-Joon Park; Wonkeun Song

doi:10.5145/ACM.2013.16.3.111

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Park and Song: Strategies for Interpretive Standards of β-Lactams Susceptibility Testing and Identification of Extended-Spectrum β-Lactamases and Carbapenemases in Enterobacteriaceae

Original Article

Ann Clin Microbiol 2013;16(3):111-119.

Published online: 5 December 2013

DOI: https://doi.org/10.5145/ACM.2013.16.3.111

Strategies for Interpretive Standards of β-Lactams Susceptibility Testing and Identification of Extended-Spectrum β-Lactamases and Carbapenemases in Enterobacteriaceae

Yeon-Joon Park¹, Wonkeun Song²

Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul

Hallym University College of Medicine, Chuncheon, Korea

Correspondence: Wonkeun Song, Department of Laboratory Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 948-1, Daerim 1-dong, Youngdeungpo-gu, Seoul 150-950, Korea. (Tel) 82-2-829-5259, (Fax) 82-2-847-2403, (E-mail) swonkeun@hallym.or.kr

Received 11 June 20133 July 2013 Accepted 3 July 2013

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.

초록

The Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) have recently revised the susceptibility interpretive criteria of oxyimino-β -lactams and carbapenems for Enterobacteriaceae. According to the new criteria, susceptibility testing results are sufficient to detect extended-spectrum β -lactamases (ESBLs) and carbapenemases; it is not necessary to perform ESBL or carbapenemase detection tests for therapeutic purposes. Thus, it has been recomme-nded that these related tests be performed only for infection control. These changes in the susceptibility guidelines are supported by some clinical cases and the results of pharmacodynamic and animal studies. However, differences still exist between the breakpoints established by the CLSI and EUCAST with re-gard to some oxyimino-β -lactam and carbapenem an-tibiotics, in particular, the breakpoints for ceftazidime and cefepime established by the CLSI are higher than those established by the EUCAST. Also, similar num-bers of successful and unsuccessful cases have been reported regarding the use of cephalosporins or carbapenems in treating infections caused by low-mini-mal inhibitory concentration (MIC) ESBL-producers or low-MIC carbapenemase-producers. Finally, routine susceptibility test methods are not as accurate as re-search-purpose test methods, showing differences in MICs ranging approximately from 1 to 8 μ g/mL. In conclusion, it is strategically prudent to continue to perform ESBL and carbapenemase detection tests and to avoid the use of the corresponding antimicrobial agents for the treatment of ESBL or carbapene-mase-producing bacterial infections.

Keywords: β-Lactams, Carbapenemase, Enterobacteriaceae, Extended-spectrum β-lactama-ses, Microbial sensitivity tests

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Fig. 1.

Distribution of MICs by new CLSI interpretation criteria for E. coli and K. pneumoniae isolates producing ESBLs in Korea.

Table 1.

Interpretation of carbapenemase phenotypic tests

Test	Carbapenemase			AmpC with porin loss	ESBL with porin loss
Test	Class A	Class B	Class D	AmpC with porin loss	ESBL with porin loss
Modified hodge	+	+	+	+/-	+/-
Carba NP	+	+	+	-	-
Carba NP II
Imipenem+tazobactam	-	+	+	-	-
Imipenem+EDTA	+	-	+	-	-
Carbapenemase inhibition
Meropenem±PBA	+	-	-	+/-	-
Meropenem±CLX	-	-	-	+/-	-
Meropenem±DPA	-	+	-	-	-

Abbreviations: EDTA, ethylene diamine tetra-acetic acid; PBA, phenylboronic acid; CLX, cloxacillin; DPA, dipicolinic acid.

Table 2.

Old and new interpretative standards for Enterobacteriaceae

Organization		Breaakpoint (μ g/mL)
		Old					New
		CTX CRO	CAZ ATM	FEP	IPM MPM	EPM	CTX CRO	CAZ ATM	FEP	IPM MPM	EPM	DPM
CLSI	S≤	8	8	8	4	2	1	4	8	1	0.5	1
CLSI	R≥	64	32	32	16	8	4	16	32	4	1	4
EUCAST	S≤	1	1	1	2	0.5	1	1	1	2	0.5	1
EUCAST	R≥	4	16	16	16	2	4	8	8	16	2	8

Abbreviations: CTX, cefotaxime; CRO, ceftriaxone; CAZ, ceftazidime; ATM, aztreonam; IPM, imipenem; MPM, meropenem; EPM, ertapenem; DPM, doripenem; S, susceptible; R, resistant.

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