Literature DB >> 25579154

Detection of AmpC β-lactamases production in Acinetobacter species by inhibitor (disk) based & modified three dimensional (enzyme extraction) methods.

E Kumar, K Usha, A Chaudhury, B V Ramana1, D V R Sai Gopal.   

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Year:  2014        PMID: 25579154      PMCID: PMC4311326     

Source DB:  PubMed          Journal:  Indian J Med Res        ISSN: 0971-5916            Impact factor:   2.375


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Sir, Among the nosocomial infections caused by Gram- negative bacteria, the Acinetobacter spp. is one of the established1 and predictable opportunistic pathogens in immunocompromised patients23. AmpC β-lactamases are class C or group I cephalosporinases and non susceptible to alpha methoxy β-lactams such as cefoxitin or cefotetan. The detection of these β-lactamases is clinically significant because these confer resistance to narrow, extended and broad spectrum cephalosporins as well as β-lactam/β-lactamase inhibitor combinations4. This study was undertaken to detect the presence of AmpC β-lactamase in clinical isolates of Acinetobacter species by two phenotypic methods. A total number of 136 non repetitive cefoxitin resistant clinical isolates of Acinetobacter spp. were obtained during January to December 2012 in the microbiology laboratory, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India. The isolates were identified only to the Genus level and speciation was not done. The zone size <18 mm around the cefoxitin disc was used as a screening test for the presence of AmpC β-lactamase production5. All cefoxitin resistant isolates were studied for the presence of AmpC enzyme by the modified three dimensional method5. In this method three kinds of results were recorded. Isolates that showed clear distortion of zone of inhibition of cefoxitin were considered as strong AmpC producers. Isolates with no distortion were considered AmpC non producers and isolates with little distortion were considered as weak or intermediate AmpC producer. The inhibitor (disc) based disc method6 was performed to confirm the AmpC producers. The test culture was swabbed on Mueller-Hinton agar (Hi-media, Mumbai) plates and cefoxitin (30 μg) and cefoxitin/boronic acid (30/400 μg) discs were placed at a distance of 20 mm from centre to centre. An increase of >0.5 mm around cefoxitin/boronic acid compared to cefoxitin alone was considered positive for the presence of AmpC production6. Among the 136 isolates screened, 82 (60.29%) were positive for the AmpC β-lactamase production by the inhibitor (disc) method. Of the total 136 isolates, 84 (61.76%) were strong AmpC producers, 16 (11.76%) intermediate or weak AmpC producers, and 36 (26.47%) were negative for the AmpC producers by the modified three dimensional (enzyme extract) method. The isolates harbouring AmpC β-lactamases are shown to be largely restricted to the hospitalized patients only578. The CLSI (Clinical and Laboratory Standards Institute) guidelines9 do not indicate the screening and confirmatory tests for detecting AmpC β-lactamases in Acinetobacter species. The modified three dimensional5 test is a confirmatory test for detecting both inducible and non inducible AmpC β-lactamases but is technically demanding. In case of inhibitor method using boronic acid with cefoxitin is simple, and this test is sensitive to detect the plasmid mediated AmpC β-lactamases1011 as well as similar to the ESBL confirmatory test5. Among the cefoxitin resistant Gram-negative isolates, Sasirekha12 reported 20.4 per cent positive for AmpC production whereas Manoharan et al13 reported 36.5 per cent positivity. In a study form Kolkata, 32.77 per cent of isolates were reported positive for ampC by Amp disk test14. Several other studies have also reported AmpC β-lactamase positive Acinetobacter spp.14151617. In this study, 84 (61.76%) and 82 (60.29%) isolates were determined as AmpC producers by modified three dimensional and boronic acid inhibitor methods, respectively. When the two phenotypic methods were compared, the inhibitor method failed to detect the presence of AmpC in only two isolates; 38.23 per cent of cefoxitin resistant isolates were negative for AmpC production by both methods. The resistance to cefoxitin can also be mediated by certain class A beta lactamses, carbapenemases and decreased production of outer membrane porins18. In a study from Turkey, more positives (89.76%) were observed by three dimensional method than by boronic acid disk test (85.03%)19. However, Bakthavatchalu et al20 reported higher percentage of positives (93%) of AmpC producers by boronic acid inhibitor test than by the three dimensional method (91%). Lee et al21 compared modified Hodge test with boronic acid test and EDTA disk test to evaluate the presence of AmpC beta lactamase and reported the combination-disk test with boronic acid as a sensitive and efficient test for detecting AmpC producers. In conclusion, our findings suggest that the inhibitor based disc method can be used in routine clinical microbiology laboratories to confirm the presence of AmpC in Acinetobacter species.
  17 in total

1.  AmpC beta-lactamase producing bacterial isolates from Kolkata hospital.

Authors:  Suranjana Arora; Manjusri Bal
Journal:  Indian J Med Res       Date:  2005-09       Impact factor: 2.375

Review 2.  Detection of plasmid-mediated class C beta-lactamases.

Authors:  Yohei Doi; David L Paterson
Journal:  Int J Infect Dis       Date:  2007-03-06       Impact factor: 3.623

3.  Use of boronic acid disk methods to detect the combined expression of plasmid-mediated AmpC beta-lactamases and extended-spectrum beta-lactamases in clinical isolates of Klebsiella spp., Salmonella spp., and Proteus mirabilis.

Authors:  Wonkeun Song; Seok Hoon Jeong; Jae-Seok Kim; Han-Sung Kim; Dong Hun Shin; Kyoung Ho Roh; Kyu Man Lee
Journal:  Diagn Microbiol Infect Dis       Date:  2006-12-15       Impact factor: 2.803

Review 4.  Acinetobacter spp. as nosocomial pathogens: microbiological, clinical, and epidemiological features.

Authors:  E Bergogne-Bérézin; K J Towner
Journal:  Clin Microbiol Rev       Date:  1996-04       Impact factor: 26.132

Review 5.  A functional classification scheme for beta-lactamases and its correlation with molecular structure.

Authors:  K Bush; G A Jacoby; A A Medeiros
Journal:  Antimicrob Agents Chemother       Date:  1995-06       Impact factor: 5.191

Review 6.  Acinetobacter baumannii: emergence of a successful pathogen.

Authors:  Anton Y Peleg; Harald Seifert; David L Paterson
Journal:  Clin Microbiol Rev       Date:  2008-07       Impact factor: 26.132

7.  Comparison of 3 phenotypic-detection methods for identifying plasmid-mediated AmpC beta-lactamase-producing Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis strains.

Authors:  Wookeun Lee; Bochan Jung; Seong Geun Hong; Wonkeun Song; Seok Hoon Jeong; Kyungwon Lee; Hyo Sun Kwak
Journal:  Korean J Lab Med       Date:  2009-10

Review 8.  AmpC beta-lactamases.

Authors:  George A Jacoby
Journal:  Clin Microbiol Rev       Date:  2009-01       Impact factor: 26.132

9.  Detection of plasmid-mediated AmpC β-lactamase in Escherichia coli and Klebsiella pneumoniae.

Authors:  N O Yilmaz; N Agus; E Bozcal; O Oner; A Uzel
Journal:  Indian J Med Microbiol       Date:  2013 Jan-Mar       Impact factor: 0.985

10.  Molecular description of plasmid-mediated AmpC β-lactamases among nosocomial isolates of Escherichia coli & Klebsiella pneumoniae from six different hospitals in India.

Authors:  Parveen R Mohamudha; B N Harish; S C Parija
Journal:  Indian J Med Res       Date:  2012       Impact factor: 2.375

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