Top

European Journal of Clinical Microbiology & Infectious Diseases

Published in:

01-03-2022 | Escherichia Coli | Original Article

Direct detection of extended-spectrum-β-lactamase-producers in Enterobacterales from blood cultures: a comparative analysis

Authors: Matteo Boattini, Gabriele Bianco, Sara Comini, Marco Iannaccone, Roberto Casale, Rossana Cavallo, Patrice Nordmann, Cristina Costa

Published in: European Journal of Clinical Microbiology & Infectious Diseases | Issue 3/2022

Abstract

Accurate detection of extended-spectrum-β-lactamase (ESBL)-producing Enterobacterales from bloodstream infection (BSI) is of paramount importance for both epidemiological and clinical purposes, especially for optimization of antibiotic stewardship interventions. Three phenotypic methods for the detection of ESBL phenotype in Klebsiella pneumoniae and Escherichia coli BSI were compared over a 4-month period (May–August 2021) in a main University Hospital from Northern Italy. The methods were the biochemical Rapid ESBL NP®, the immunological NG-Test CTX-M MULTI®, and the E-test technique based on ESBL E-test®. One hundred forty-two blood cultures (BCs) positive for K. pneumoniae or E. coli were included. ESBL and carbapenemase phenotype were detected in 26.1% (n = 37) and 16.9% (n = 24), respectively. The Rapid ESBL NP®, NG-Test CTX-M MULTI®, and direct ESBL E-test® positive and negative predictive values with 95% confidence intervals were 1 (0.87–1) and 0.97 (0.92–0.99), 1 (0.87–1) and 0.97 (0.92–0.99), and 1 (0.88–1) and 1 (0.96–1), respectively. The three phenotypic methods evaluated showed good performance in the detection of ESBL phenotype from K. pneumoniae– or E. coli–positive BCs. Rapid ESBL NP® and NG-test CTX-M® offer the important advantage of a turnaround time of 15 to 45 min, and the Rapid ESBL NP test in addition detects any type of ESBL producers.

Pitout JD, Nordmann P, Laupland KB, Poirel L (2005) Emergence of Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBLs) in the community. J Antimicrob Chemother 56:52–59. https://doi.org/10.1093/jac/dki166CrossRefPubMed

Lee JA, Kang CI, Joo EJ, Ha YE, Kang SJ, Park SY et al (2011) Epidemiology and clinical features of community-onset bacteremia caused by extended-spectrum β-lactamase-producing Klebsiella pneumoniae. Microb Drug Resist 17:267–273. https://doi.org/10.1089/mdr.2010.0134CrossRefPubMed

Rodríguez-Baño J, Pascual A (2008) Clinical significance of extended-spectrum beta-lactamases. Expert Rev Anti Infect Ther 6:671–683. https://doi.org/10.1586/14787210.6.5.671CrossRefPubMed

Bevan ER, Jones AM, Hawkey PM (2017) Global epidemiology of CTX-M β-lactamases: temporal and geographical shifts in genotype. J Antimicrob Chemother 72:2145–2155. https://doi.org/10.1093/jac/dkx146CrossRefPubMed

Kazmierczak KM, de Jonge BLM, Stone GG, Sahm DF (2020) Longitudinal analysis of ESBL and carbapenemase carriage among Enterobacterales and Pseudomonas aeruginosa isolates collected in Europe as part of the International Network for Optimal Resistance Monitoring (INFORM) global surveillance programme, 2013–17. J Antimicrob Chemother 75:1165–1173. https://doi.org/10.1093/jac/dkz571CrossRefPubMed

Bush K, Bradford PA (2020) Epidemiology of β-lactamase-producing pathogens. Clin Microbiol Rev 33:e00047-e119. https://doi.org/10.1128/CMR.00047-19CrossRefPubMedPubMedCentral

Decousser JW, Poirel L, Nordmann P (2017) Recent advances in biochemical and molecular diagnostics for the rapid detection of antibiotic-resistant Enterobacteriaceae: a focus on ß-lactam resistance. Expert Rev Mol Diagn 17:327–350. https://doi.org/10.1080/14737159.2017.1289087CrossRefPubMed

Noster J, Thelen P, Hamprecht A (2021) Detection of multidrug-resistant Enterobacterales—from ESBLs to carbapenemases. Antibiotics 10:1140. https://doi.org/10.3390/antibiotics10091140CrossRefPubMedPubMedCentral

Castanheira M, Simner PJ, Bradford PA (2021) Extended-spectrum β-lactamases: an update on their characteristics, epidemiology and detection. JAC Antimicrob Resist 3:dlab092. https://doi.org/10.1093/jacamr/dlab092CrossRefPubMedPubMedCentral

10.

Bernabeu S, Ratnam KC, Boutal H, Gonzalez C, Vogel A, Devilliers K et al (2020) A lateral flow immunoassay for the rapid identification of CTX-M-producing Enterobacterales from culture plates and positive blood cultures. Diagnostics (Basel) 10:764. https://doi.org/10.3390/diagnostics10100764CrossRef

11.

Bianco G, Boattini M, Iannaccone M, Cavallo R, Costa C (2020) Evaluation of the NG-Test CTX-M MULTI immunochromatographic assay for the rapid detection of CTX-M extended-spectrum-β-lactamase producers from positive blood cultures. J Hosp Infect 105:341–343. https://doi.org/10.1016/j.jhin.2020.02.009CrossRefPubMed

12.

Boattini M, Bianco G, Iannaccone M, Ghibaudo D, Almeida A, Cavallo R et al (2021) Fast-track identification of CTX-M-extended-spectrum-β-lactamase- and carbapenemase-producing Enterobacterales in bloodstream infections: implications on the likelihood of deduction of antibiotic susceptibility in emergency and internal medicine departments. Eur J Clin Microbiol Infect Dis 40:1495–1501. https://doi.org/10.1007/s10096-021-04192-8CrossRefPubMedPubMedCentral

13.

Hasso M, Porter V, Simor AE (2017) Evaluation of the β-Lacta test for detection of extended-spectrum-β-lactamase (ESBL)-producing organisms directly from positive blood cultures by use of smudge plates. J Clin Microbiol 55:3560–3562. https://doi.org/10.1128/JCM.01354-17CrossRefPubMedPubMedCentral

14.

Prod’hom G, Durussel C, Blanc D, Croxatto A, Greub G (2015) Early detection of extended-spectrum β-lactamase from blood culture positive for an Enterobacteriaceae using βLACTA test. New Microbes New Infect 8:1–3. https://doi.org/10.1016/j.nmni.2015.05.007CrossRefPubMedPubMedCentral

15.

Poirel L, Fernández J, Nordmann P (2016) Comparison of three biochemical tests for rapid detection of extended-spectrum-β-lactamase-producing Enterobacteriaceae. J Clin Microbiol 54:423–427. https://doi.org/10.1128/JCM.01840-15CrossRefPubMedPubMedCentral

16.

Nordmann P, Dortet L, Poirel L (2012) Rapid detection of extended-spectrum-β-lactamase-producing Enterobacteriaceae. J Clin Microbiol 50:3016–3022. https://doi.org/10.1128/JCM.00859-12CrossRefPubMedPubMedCentral

17.

Dortet L, Poirel L, Nordmann P (2015) Rapid detection of ESBL-producing Enterobacteriaceae in blood cultures. Emerg Infect Dis 21:504–507. https://doi.org/10.3201/eid2103.141277CrossRefPubMedPubMedCentral

18.

Bianco G, Boattini M, Iannaccone M, Fossati L, Cavallo R, Costa C (2019) Direct β-lactam inactivation method: a new low-cost assay for rapid detection of carbapenemase- or extended-spectrum-β-lactamase-producing Enterobacterales directly from positive blood culture bottles. J Clin Microbiol 58:e01178-e1219. https://doi.org/10.1128/JCM.01178-19CrossRefPubMedPubMedCentral

19.

Bianco G, Boattini M, Iannaccone M, Zanotto E, Cavallo R, Costa C (2020) Direct Ethylenediaminetetraaceticacid-modified β-lactam inactivation method: an improved method to identify serine-carbapenemase-, metallo-β-lactamase-, and extended-spectrum-β-lactamase-producing Enterobacterales directly from positive blood culture. Microb Drug Resist. https://doi.org/10.1089/mdr.2020.0343CrossRefPubMed

20.

Oviaño M, Fernández B, Fernández A, Barba MJ, Mouriño C, Bou G (2014) Rapid detection of Enterobacteriaceae producing extended-spectrum-β-lactamases directly from positive blood cultures by matrix-assisted laser desorption ionization-time of flight mass spectrometry. Clin Microbiol Infect 20:1146–1157. https://doi.org/10.1111/1469-0691.12729CrossRefPubMed

21.

Jung JS, Popp C, Sparbier K, Lange C, Kostrzewa M, Schubert S (2014) Evaluation of matrix-assisted laser desorption ionization-time of flight mass spectrometry for rapid detection of β-lactam resistance in Enterobacteriaceae derived from blood cultures. J Clin Microbiol 52:924–930. https://doi.org/10.1128/JCM.02691-13CrossRefPubMedPubMedCentral

22.

Torres I, Albert E, Giménez E, Olea B, Valdivia A, Pascual T et al (2021) Performance of a MALDI-TOF mass spectrometry-based method for rapid detection of third-generation oxymino-cephalosporin-resistant Escherichia coli and Klebsiella spp. from blood cultures. Eur J Clin Microbiol Infect Dis 40:1925–32. https://doi.org/10.1007/s10096-021-04251-0CrossRefPubMed

23.

Roncarati G, Foschi C, Ambretti S, Re MC (2021) Rapid identification and detection of β-lactamase-producing Enterobacteriaceae from positive blood cultures by MALDI-TOF/MS. J Glob Antimicrob Resist 24:270–274. https://doi.org/10.1016/j.jgar.2020.12.015CrossRefPubMed

24.

Available at https://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Breakpoint_tables/v_11.0_Breakpoint_Tables.pdf. Accessed 15 Sep 2021

25.

Demord A, Poirel L, D’Emidio F, Pomponio S, Nordmann P (2020) Rapid ESBL NP test for rapid detection of expanded-spectrum β-lactamase producers in Enterobacterales. Microb Drug Resist. https://doi.org/10.1089/mdr.2020.0391CrossRefPubMed

26.

Blanc DS, Poncet F, Grandbastien B, Greub G, Senn L, Nordmann P (2021) Evaluation of the performance of rapid tests for screening carriers of acquired ESBL-producing Enterobacterales and their impact on turnaround time. J Hosp Infect 108:19–24. https://doi.org/10.1016/j.jhin.2020.10.013CrossRefPubMed

27.

Bianco G, Boattini M, van Asten SAV, Iannaccone M, Zanotto E, Zaccaria T et al (2020) RESIST-5 O.O.K.N.V. and NG-Test Carba 5 assays for the rapid detection of carbapenemase-producing Enterobacterales from positive blood cultures: a comparative study. J Hosp Infect 105:162–6. https://doi.org/10.1016/j.jhin.2020.03.022CrossRefPubMed

28.

Girlich D, Bernabeu S, Fortineau N, Dortet L, Naas T (2018) Evaluation of the CRE and ESBL ELITe MGB® kits for the accurate detection of carbapenemase- or CTX-M-producing bacteria. Diagn Microbiol Infect Dis 92:1–7. https://doi.org/10.1016/j.diagmicrobio.2018.02.001CrossRefPubMed

29.

Rossolini GM, Bochenska M, Fumagalli L, Dowzicky M (2021) Trends of major antimicrobial resistance phenotypes in Enterobacterales and gram-negative non-fermenters from ATLAS and EARS-net surveillance systems: Italian vs. European and global data, 2008–2018. Diagn Microbiol Infect Dis 101:115512. https://doi.org/10.1016/j.diagmicrobio.2021.115512CrossRefPubMed

30.

Ortiz de la Rosa JM, Demord A, Poirel L, Greub G, Blanc D, Nordmann P (2021) False immunological detection of CTX-M enzymes in Klebsiella oxytoca. J Clin Microbiol 59:e00609-21. https://doi.org/10.1128/JCM.00609-21CrossRefPubMedPubMedCentral

Title: Direct detection of extended-spectrum-β-lactamase-producers in Enterobacterales from blood cultures: a comparative analysis
Authors: Matteo Boattini
Gabriele Bianco
Sara Comini
Marco Iannaccone
Roberto Casale
Rossana Cavallo
Patrice Nordmann
Cristina Costa
Publication date: 01-03-2022
Publisher: Springer Berlin Heidelberg
Keywords: Escherichia Coli
Cephalosporin Antibiotic
Published in: European Journal of Clinical Microbiology & Infectious Diseases / Issue 3/2022
Print ISSN: 0934-9723
Electronic ISSN: 1435-4373
DOI: https://doi.org/10.1007/s10096-021-04385-1

ACC 2024 Congress Coverage

Heart Failure Video

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Direct detection of extended-spectrum-β-lactamase-producers in Enterobacterales from blood cultures: a comparative analysis

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2022

Universal screening for hepatitis C — in for a penny, in for a pound

Increasing usage of chlorhexidine in health care settings: blessing or curse? A narrative review of the risk of chlorhexidine resistance and the implications for infection prevention and control

Correction to: Simplified therapeutic guidelines: the main tool of antimicrobial stewardship programs associated with optimal antibiotic therapy

Correction to: Rapid molecular detection of pathogenic microorganisms and antimicrobial resistance markers in blood cultures: evaluation and utility of the next-generation FilmArray Blood Culture Identification 2 panel

Increasing rates of extended-spectrum B-lactamase-producing Escherichia coli and Klebsiella pneumoniae in uncomplicated and complicated acute pyelonephritis and evaluation of empirical treatments based on culture results

Control of a nosocomial measles outbreak among previously vaccinated adults in a population with high vaccine coverage: Korea, 2019

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page