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首页> 外文期刊>Journal of Clinical and Diagnostic Research >Comparision of three Laboratory Testsfor Detection of Ampc ? Lactamases inKlebsiella Species and E. Coli
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Comparision of three Laboratory Testsfor Detection of Ampc ? Lactamases inKlebsiella Species and E. Coli

机译：三种检测Ampc的实验室测试的比较克雷伯菌属和大肠杆菌中的内酰胺酶

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Background and objective: AmpC ? lactamases are one of the important causes of drug resistance in gram negative bacteria. Failure to detect these enzymes in the laboratory has contributed to therapeutic failures but there are till date no standard guideline available. This study was therefore undertaken to evaluate three phenotypic laboratory tests and the inhibitors used in two of the tests to detect AmpC ? lactamases produced by E. coli and Klebsiella species as they are most commonly isolated organisms.Methods: E. coli and Klebsiella isolates from different clinical samples were tested for ESBLs production as per CLSI guidelines and excluded from the study. The non-ESBLs isolates were then screened for AmpC ? lactamases production, by cefoxitin and then confirmed by three different methods i.e.; Disc Potentiation Test (DPT) , Double Disc Synergy Test (DDST) and Modified Three Dimensional Test (M3DT) which in the absence of molecular methods, was taken as the gold standard. Boronic acid and cloxacillin were used as inhibitory agents in the Disc Potentiation and Double Disc synergy Tests.Results: A total of 2933 isolates were tested out of which 165 isolates were detected as non ESBLs producers,135 (81.82%) when screened for AmpC ? lactamases based on resistance to cefoxitin were labelled as positive. 30 (18.18%) cefoxitin sensitive isolates were labelled as probably non AmpC producers . M3DT, in addition to detecting all the 135 (100%) cefoxitin resistant isolates, also detected 5 (16.67%) cefoxitin sensitive isolates as AmpC producers. Other phenotypic tests, DPT and DDST with different inhibitors like boronic acid and cloxacillin in different potencies were all found to be less sensitive. The best results among these two methods were obtained with DDST using cloxacillin 500μg.Conclusion: In the absence of recommended guidelines for AmpC detection, the study reports, among the tests performed, M3DT as the best phenotypic method for AmpC confirmation, as it is not only the most sensitive but also specific test for AmpC as it rules out the resistance due to other mechanisms like the porin channel.
机译：背景和目标：AmpC？内酰胺酶是革兰氏阴性细菌耐药性的重要原因之一。在实验室中未能检测到这些酶已导致治疗失败，但迄今为止尚无标准指南。因此，本研究旨在评估三种表型实验室测试以及其中两种测试中使用的抑制剂来检测AmpC？方法：根据CLSI指南测试来自不同临床样品的大肠杆菌和克雷伯菌分离物的ESBLs产生，并将其排除在研究之外。然后筛选非ESBLs分离株的AmpC？通过头孢西丁生产内酰胺酶，然后通过三种不同的方法证实：在没有分子方法的情况下，碟片增强测试（DPT），双碟片协同测试（DDST）和改进的三维测试（M3DT）被视为金标准。结果：总共检测了2933株菌株，其中165株为非ESBLs产生者，其中135株（81.82％）被筛选出AmpC？基于对头孢西丁抗性的内酰胺酶被标记为阳性。 30（18.18％）头孢西丁敏感菌被标记为可能不是AmpC产生者。 M3DT除了检测出所有135种（100％）耐头孢西丁的分离株外，还检测出5种（16.67％）头孢西丁敏感的分离株作为AmpC生产者。发现其他表型测试，DPT和DDST在不同效力下使用不同抑制剂（如硼酸和氯西林）的敏感性较低。在这两种方法中，DDST使用500μg氯沙西林可获得最佳结果。结论：在没有推荐的AmpC检测指导原则的情况下，该研究报告在进行的测试中，M3DT是确认AmpC的最佳表型方法，但并非如此。只有针对AmpC的最敏感但也是最具体的测试，因为它排除了由于诸如孔蛋白通道之类的其他机制而产生的阻力。

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