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CC BY-NC-ND 4.0 · J Lab Physicians 2023; 15(01): 117-125
DOI: 10.1055/s-0042-1760399
Original Article

Performance of Phenotypic Tests to Detect β-Lactamases in a Population of β-Lactamase Coproducing Enterobacteriaceae Isolates

Vindya Perera 
1   Faculty of Medicine, Department of Microbiology, University of Colombo, Sri Lanka
2   Faculty of Medicine, Department of Microbiology, Sabaragamuwa University of Sri Lanka, Ratnapura, Sri Lanka
,
Nelun de Silva 
2   Faculty of Medicine, Department of Microbiology, Sabaragamuwa University of Sri Lanka, Ratnapura, Sri Lanka
4   Neville Fernando Teaching Hospital, Malabe, Sri Lanka
,
Kushlani Jayatilleke 
3   Sri Jayewardenapura General Hospital, Nugegoda, Sri Lanka
,
Sara de Silva
3   Sri Jayewardenapura General Hospital, Nugegoda, Sri Lanka
,
Enoka Corea 
1   Faculty of Medicine, Department of Microbiology, University of Colombo, Sri Lanka
› Author Affiliations Funding This work was supported by the National Research Council of Sri Lanka Grant No 14–45 and University of Colombo Research Grant No AP/3/2/2018/SG/16.
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Abstract

Objectives This study aimed to evaluate the performance of routinely used phenotypic tests to detect β-lactamase production in isolates coproducing multiple β-lactamase types.

Methods Commonly used phenotypic tests for the detection of extended spectrum β-lactamases (ESBL), AmpC β-lactamase, and carbapenemases were compared with detection and sequencing of β-lactamase genes (as the reference test) in 176 uropathogenic Enterobacteriaceae coproducing multiple β-lactamases from two hospitals in the Western Province of Sri Lanka.

Results Majority of the isolates (147/176, 83.5%) carried β-lactamase genes with (90/147, 61%) harboring multiple genes. The Clinical and Laboratory Standards Institute screening method using cefotaxime (sensitivity [Se], 97; specificity [Sp], 93; accuracy [Ac], 94) and ceftriaxone (Se, 97; Sp, 91; Ac, 93) was the most effective to detect ESBLs. The modified double disc synergy test (Se, 98; Sp, 98; Ac, 97) and combined disc test (Se, 94; Sp, 98; Ac, 96) showed good specificity for confirmation of ESBLs. Cefoxitin resistance (Se, 97; Sp, 73; Ac, 85) and the AmpC disc test (Se, 96; Sp, 82; Ac, 86) were sensitive to detect AmpC β-lactamase producers coproducing other β-lactamases but showed low specificity, probably due to coproduction of carbapenemases. Meropenem was useful to screen for New Delhi metallo β-lactamases and OXA-48-like carbapenemases (Se, 97; Sp, 96; Ac, 96). The modified carbapenem inactivation method showed excellent performance (Se, 97; Sp, 98; Ac, 97) in identifying production of both types of carbapenemases and was able to distinguish this from carbapenem resistance due to potential mutations in the porin gene.

Conclusion Microbiology laboratories that are still depend on phenotypic tests should utilize tests that are compatible with the types of β-lactamase prevalent in the region and those that are least affected by coexisting resistance mechanisms.

Keywords

AmpC β-lactamases - β-lactamase coproducers - carbapenemases - Enterobacteriaceae - extended spectrum β-lactamases (ESBL) - phenotypic tests - Sri Lanka

Authors' Contributions

Both V.P. and E.C. contributed to performing the concepts design, definition of intellectual content, literature search, clinical studies, experimental studies, data analysis, statistical analysis, manuscript preparation, and manuscript editing. Both K.J. and N.d.S. contributed to concepts design, definition of intellectual content, and manuscript editing. S.d.S. contributed to data acquisition, data analysis, and manuscript preparation. All authors contributed to data acquisition and manuscript review.


Ethical Approval

Ethics approval for this study was obtained from the Ethics Review Committee, Faculty of Medicine, University of Colombo (EC-14–143).




Publication History

Article published online:
18 January 2023

© 2023. The Indian Association of Laboratory Physicians. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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