Relationship between the distribution of cefepime minimum inhibitory concentrations and detection of extended-spectrum β-lactamase production among clinically important Enterobacteriaceae isolates obtained from patients in intensive care units in Taiwan

Results from the Surveillance of Multicenter Antimicrobial Resistance in Taiwan (SMART) in 2007

ShioShin Jean, Wen-Sen Lee, Kuan-Jen Bai, Carlos Lam, Chin-Wung Hsu, Kwok Woon Yu, Chun Hsing Liao, Feng Yi Chang, Wen Chien Ko, Jiunn Jong Wu, Yen Hsu Chen, Yao Shen Chen, Jien Wei Liu, Min Chi Lu, Cheng Yi Liu, Ray-Jade Chen, Po Ren Hsueh

Research output: Contribution to journalArticle

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Abstract

Background: The data on susceptibility of important cephalosporins against four Enterobacteriaceae members producing potential extended-spectrum β-lactamase (ESBL) collected from Taiwanese intensive care units are lacking. Methods: Minimum inhibitory concentrations (MICs) of cefotaxime, ceftazidime, and cefepime were determined using agar dilution method, against Escherichia coli (n=344), Klebsiella pneumoniae (n=359), Enterobacter cloacae (n=103), and Proteus mirabilis (n=78). Susceptibilities of these isolates to three cephalosporins were assessed according to MIC breakpoints recommended by the Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) in 2013. The double-disk synergy test using disks containing cefepime (30μg) with or without clavulanate (10μg) was applied to confirm production of ESBL for isolates with cephalosporin MIC≥2μg/mL. Results: A total of 175 isolates were verified as ESBL producers. The rates of cefepime susceptibility among the ESBL-producing isolates, according to CLSI (EUCAST) criteria, were 56.7% (22.4%) for E. coli, 61.3% (12.0%) for K. pneumoniae, 57.9% (31.6%) for E. cloacae, and 71.4% (7.1%) for P. mirabilis. Using different cefepime MIC breakpoints (MICs≥16μg/mL recommended by CLSI criteria and ≥2μg/mL by EUCAST criteria) to define nonsusceptibility, we found that both criteria were poorer at predicting ESBL producers among K. pneumoniae and E. cloacae than among the other two species. In addition, we also found that the cefepime MIC level of 1.0μg/mL best distinguished non-ESBL- from ESBL-producing K. pneumoniae and E. cloacae. Conclusion: To detect ESBLs, CLSI should revise the cefepime MIC breakpoint against Enterobacteriaceae.

Original languageEnglish
Pages (from-to)85-91
Number of pages7
JournalJournal of Microbiology, Immunology and Infection
Volume48
Issue number1
DOIs
Publication statusPublished - Feb 1 2015

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Microbial Sensitivity Tests
Enterobacteriaceae
Taiwan
Intensive Care Units
Enterobacter cloacae
Klebsiella pneumoniae
Cephalosporins
Proteus mirabilis
Escherichia coli
Clavulanic Acid
Ceftazidime
Cefotaxime
Agar
cefepime

Keywords

  • Cefepime
  • Clinical and Laboratory Standards Institute
  • Enterobacteriaceae
  • Extended-spectrum β-lactamase
  • Surveillance for Monitoring Antimicrobial Resistance in Taiwan

ASJC Scopus subject areas

  • Microbiology (medical)
  • Immunology and Allergy
  • Immunology and Microbiology(all)
  • Infectious Diseases
  • Medicine(all)

Cite this

@article{04b2978fe97443bfafe184faa74e4e84,
title = "Relationship between the distribution of cefepime minimum inhibitory concentrations and detection of extended-spectrum β-lactamase production among clinically important Enterobacteriaceae isolates obtained from patients in intensive care units in Taiwan: Results from the Surveillance of Multicenter Antimicrobial Resistance in Taiwan (SMART) in 2007",
abstract = "Background: The data on susceptibility of important cephalosporins against four Enterobacteriaceae members producing potential extended-spectrum β-lactamase (ESBL) collected from Taiwanese intensive care units are lacking. Methods: Minimum inhibitory concentrations (MICs) of cefotaxime, ceftazidime, and cefepime were determined using agar dilution method, against Escherichia coli (n=344), Klebsiella pneumoniae (n=359), Enterobacter cloacae (n=103), and Proteus mirabilis (n=78). Susceptibilities of these isolates to three cephalosporins were assessed according to MIC breakpoints recommended by the Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) in 2013. The double-disk synergy test using disks containing cefepime (30μg) with or without clavulanate (10μg) was applied to confirm production of ESBL for isolates with cephalosporin MIC≥2μg/mL. Results: A total of 175 isolates were verified as ESBL producers. The rates of cefepime susceptibility among the ESBL-producing isolates, according to CLSI (EUCAST) criteria, were 56.7{\%} (22.4{\%}) for E. coli, 61.3{\%} (12.0{\%}) for K. pneumoniae, 57.9{\%} (31.6{\%}) for E. cloacae, and 71.4{\%} (7.1{\%}) for P. mirabilis. Using different cefepime MIC breakpoints (MICs≥16μg/mL recommended by CLSI criteria and ≥2μg/mL by EUCAST criteria) to define nonsusceptibility, we found that both criteria were poorer at predicting ESBL producers among K. pneumoniae and E. cloacae than among the other two species. In addition, we also found that the cefepime MIC level of 1.0μg/mL best distinguished non-ESBL- from ESBL-producing K. pneumoniae and E. cloacae. Conclusion: To detect ESBLs, CLSI should revise the cefepime MIC breakpoint against Enterobacteriaceae.",
keywords = "Cefepime, Clinical and Laboratory Standards Institute, Enterobacteriaceae, Extended-spectrum β-lactamase, Surveillance for Monitoring Antimicrobial Resistance in Taiwan",
author = "ShioShin Jean and Wen-Sen Lee and Kuan-Jen Bai and Carlos Lam and Chin-Wung Hsu and Yu, {Kwok Woon} and Liao, {Chun Hsing} and Chang, {Feng Yi} and Ko, {Wen Chien} and Wu, {Jiunn Jong} and Chen, {Yen Hsu} and Chen, {Yao Shen} and Liu, {Jien Wei} and Lu, {Min Chi} and Liu, {Cheng Yi} and Ray-Jade Chen and Hsueh, {Po Ren}",
year = "2015",
month = "2",
day = "1",
doi = "10.1016/j.jmii.2013.07.002",
language = "English",
volume = "48",
pages = "85--91",
journal = "Journal of Microbiology, Immunology and Infection",
issn = "0253-2662",
publisher = "Elsevier Taiwan LLC",
number = "1",

}

TY - JOUR

T1 - Relationship between the distribution of cefepime minimum inhibitory concentrations and detection of extended-spectrum β-lactamase production among clinically important Enterobacteriaceae isolates obtained from patients in intensive care units in Taiwan

T2 - Results from the Surveillance of Multicenter Antimicrobial Resistance in Taiwan (SMART) in 2007

AU - Jean, ShioShin

AU - Lee, Wen-Sen

AU - Bai, Kuan-Jen

AU - Lam, Carlos

AU - Hsu, Chin-Wung

AU - Yu, Kwok Woon

AU - Liao, Chun Hsing

AU - Chang, Feng Yi

AU - Ko, Wen Chien

AU - Wu, Jiunn Jong

AU - Chen, Yen Hsu

AU - Chen, Yao Shen

AU - Liu, Jien Wei

AU - Lu, Min Chi

AU - Liu, Cheng Yi

AU - Chen, Ray-Jade

AU - Hsueh, Po Ren

PY - 2015/2/1

Y1 - 2015/2/1

N2 - Background: The data on susceptibility of important cephalosporins against four Enterobacteriaceae members producing potential extended-spectrum β-lactamase (ESBL) collected from Taiwanese intensive care units are lacking. Methods: Minimum inhibitory concentrations (MICs) of cefotaxime, ceftazidime, and cefepime were determined using agar dilution method, against Escherichia coli (n=344), Klebsiella pneumoniae (n=359), Enterobacter cloacae (n=103), and Proteus mirabilis (n=78). Susceptibilities of these isolates to three cephalosporins were assessed according to MIC breakpoints recommended by the Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) in 2013. The double-disk synergy test using disks containing cefepime (30μg) with or without clavulanate (10μg) was applied to confirm production of ESBL for isolates with cephalosporin MIC≥2μg/mL. Results: A total of 175 isolates were verified as ESBL producers. The rates of cefepime susceptibility among the ESBL-producing isolates, according to CLSI (EUCAST) criteria, were 56.7% (22.4%) for E. coli, 61.3% (12.0%) for K. pneumoniae, 57.9% (31.6%) for E. cloacae, and 71.4% (7.1%) for P. mirabilis. Using different cefepime MIC breakpoints (MICs≥16μg/mL recommended by CLSI criteria and ≥2μg/mL by EUCAST criteria) to define nonsusceptibility, we found that both criteria were poorer at predicting ESBL producers among K. pneumoniae and E. cloacae than among the other two species. In addition, we also found that the cefepime MIC level of 1.0μg/mL best distinguished non-ESBL- from ESBL-producing K. pneumoniae and E. cloacae. Conclusion: To detect ESBLs, CLSI should revise the cefepime MIC breakpoint against Enterobacteriaceae.

AB - Background: The data on susceptibility of important cephalosporins against four Enterobacteriaceae members producing potential extended-spectrum β-lactamase (ESBL) collected from Taiwanese intensive care units are lacking. Methods: Minimum inhibitory concentrations (MICs) of cefotaxime, ceftazidime, and cefepime were determined using agar dilution method, against Escherichia coli (n=344), Klebsiella pneumoniae (n=359), Enterobacter cloacae (n=103), and Proteus mirabilis (n=78). Susceptibilities of these isolates to three cephalosporins were assessed according to MIC breakpoints recommended by the Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) in 2013. The double-disk synergy test using disks containing cefepime (30μg) with or without clavulanate (10μg) was applied to confirm production of ESBL for isolates with cephalosporin MIC≥2μg/mL. Results: A total of 175 isolates were verified as ESBL producers. The rates of cefepime susceptibility among the ESBL-producing isolates, according to CLSI (EUCAST) criteria, were 56.7% (22.4%) for E. coli, 61.3% (12.0%) for K. pneumoniae, 57.9% (31.6%) for E. cloacae, and 71.4% (7.1%) for P. mirabilis. Using different cefepime MIC breakpoints (MICs≥16μg/mL recommended by CLSI criteria and ≥2μg/mL by EUCAST criteria) to define nonsusceptibility, we found that both criteria were poorer at predicting ESBL producers among K. pneumoniae and E. cloacae than among the other two species. In addition, we also found that the cefepime MIC level of 1.0μg/mL best distinguished non-ESBL- from ESBL-producing K. pneumoniae and E. cloacae. Conclusion: To detect ESBLs, CLSI should revise the cefepime MIC breakpoint against Enterobacteriaceae.

KW - Cefepime

KW - Clinical and Laboratory Standards Institute

KW - Enterobacteriaceae

KW - Extended-spectrum β-lactamase

KW - Surveillance for Monitoring Antimicrobial Resistance in Taiwan

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U2 - 10.1016/j.jmii.2013.07.002

DO - 10.1016/j.jmii.2013.07.002

M3 - Article

VL - 48

SP - 85

EP - 91

JO - Journal of Microbiology, Immunology and Infection

JF - Journal of Microbiology, Immunology and Infection

SN - 0253-2662

IS - 1

ER -