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Journal of Clinical Microbiology, April 2007, p. 1180-1184, Vol. 45, No. 4
0095-1137/07/$08.00+0     doi:10.1128/JCM.02322-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Detection of Extended-Spectrum ß-Lactamases by Using Boronic Acid as an AmpC ß-Lactamase Inhibitor in Clinical Isolates of Klebsiella spp. and Escherichia coli{triangledown}

Wonkeun Song,1 Il Kwon Bae,2 You-Nae Lee,2 Chae-Hoon Lee,3 Sang Hee Lee,4 and Seok Hoon Jeong2*

Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, Korea,1 Department of Laboratory Medicine and Research Institute for Antimicrobial Resistance, Kosin University College of Medicine, Busan, Korea,2 Department of Laboratory Medicine, Yeungnam University College of Medicine, Daegu, Korea,3 Department of Biological Sciences, School of Biotechnology and Environmental Engineering, Myongji University, Yongin, Korea4

Received 15 November 2006/ Returned for modification 22 January 2007/ Accepted 5 February 2007

We evaluated highly sensitive methods using boronic acid (BA) to detect extended-spectrum ß-lactamase (ESBL) production. A total of 182 clinical isolates of Klebsiella spp. (n = 118) and Escherichia coli (n = 64) were analyzed: 62 harbored only ESBLs, 80 harbored both ESBLs and plasmid-mediated AmpC ß-lactamases (pAmpCs), and 40 harbored only pAmpCs. The CLSI confirmatory test detected all isolates that produce only ESBLs but detected 85% of isolates that produce both enzymes. When a ≥5-mm increase in the zone diameter of either the cefotaxime (CTX) or the ceftazidime (CAZ) disk in the presence of both clavulanic acid (CA) and BA was considered to be a positive result, the test detected all isolates that harbor ESBLs (± pAmpCs) but showed frequent false-positive results (50%) for isolates that produce only pAmpCs. Meanwhile, when a ≥3-mm increase in the zone diameter of either the CTX/BA or the CAZ/BA disk in the presence of CA was considered to be a positive result, the test also detected all isolates that harbor ESBLs (± pAmpCs) and showed less frequent false-positive results (5%) in isolates that produce only pAmpCs. The latter new interpretive guideline has enhanced detection of ESBLs in clinical isolates of Klebsiella spp. and Escherichia coli and allowed detection of an ESBL even when potentially masked by a pAmpC.

* Corresponding author. Mailing address: Department of Laboratory Medicine, Kosin University College of Medicine, 34 Amnam-Dong, Suh-Gu, Busan, Republic of Korea 602-030. Phone: 82-51-990-6373. Fax: 82-51-990-3034. E-mail: kscpjsh{at}ns.kosinmed.or.kr

{triangledown} Published ahead of print on 14 February 2007.

Journal of Clinical Microbiology, April 2007, p. 1180-1184, Vol. 45, No. 4
0095-1137/07/$08.00+0     doi:10.1128/JCM.02322-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.



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