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Journal of Clinical Microbiology
Article . 2002 . Peer-reviewed
License: ASM Journals Non-Commercial TDM
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Evaluation of a New Etest for Detecting Metallo-β-Lactamases in Routine Clinical Testing

Authors: Anne Bolmström; Ana Cristina Gales; Anette Qwärnström; Timothy R. Walsh;

Evaluation of a New Etest for Detecting Metallo-β-Lactamases in Routine Clinical Testing

Abstract

ABSTRACT Several Etest (AB BIODISK, Solna, Sweden) gradient formats were developed for detection of metallo-β-lactamases based on the reduction of imipenem (IP) or ceftazidime (TZ) MICs in the presence of EDTA or 2-mercaptopropionic acid (MPA). The Etest metallo-β-lactamase (Etest MBL) strips consisted of a double-sided seven-dilution range of IP or TZ (4 to 256 μg/ml) and IP or TZ (1 to 64 μg/ml) overlaid with a constant concentration of EDTA or MPA. The prototype strips were evaluated on several agar media (brain heart infusion agar, Isosensitest agar, nutrient agar, and Mueller-Hinton agar for aerobes and brucella blood agar for anaerobes) with 138 challenge strains: Acinetobacter spp. ( n = 9), Aeromonas spp. ( n = 8), Chryseobacterium spp. ( n = 28), Escherichia coli ( n = 1), Klebsiella pneumoniae ( n = 4), Pseudomonas aeruginosa ( n = 14), Proteus mirabilis ( n = 3), Serratia spp. ( n = 10), Stenotrophomonas maltophilia ( n = 43), Sphingobacterium spp. ( n = 3), and Bacteroides fragilis group ( n = 15). PCR analysis using specific primers for IMP-1, L1, CcrA, and bla B/C confirmed the presence of the metallo-β-lactamase genes. Enzyme assays were also performed with IP as an indicator substrate followed by EDTA inhibition profiles. EDTA was found to be a better inhibitor of metallo-β-lactamases, especially for anaerobes. IP was a better than TZ. Mueller-Hinton agar was the preferred medium, particularly when compared to Isosensitest agar, which frequently produced falsely low MICs for IP. Etest IP plus IP-EDTA with Mueller-Hinton agar had a sensitivity of 94% (79 of 84) and specificity of 95% (124 of 130). The Etest MBL strip appears to be an acceptable diagnostic reagent to detect metallo-β-lactamase phenotypes in the clinical microbiology laboratory.

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Keywords

Imipenem, Bacteria, Humans, Microbial Sensitivity Tests, Ceftazidime, Polymerase Chain Reaction, Sensitivity and Specificity, beta-Lactamases, Anti-Bacterial Agents, Culture Media, Reagent Strips

  • BIP!
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    citations
    This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    219
    popularity
    This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
    Top 10%
    influence
    This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    Top 1%
    impulse
    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
    Top 1%
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citations
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
219
Top 10%
Top 1%
Top 1%
bronze