Systematic Review of Plasmid AmpC Type Resistances in Escherichia coli and Klebsiella pneumoniae and Preliminary Proposal of a Simplified Screening Method for ampC
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Rodríguez Guerrero, Enrique; Callejas Rodelas, Juan Carlos; Navarro Marí, José María; Gutiérrez Fernández, JoséEditorial
MDPI
Materia
Plasmidic AmpCbetalactamase Enterobacteriaceae Multi-resistant bacteria diagnosis Screening
Date
2022-03-14Referencia bibliográfica
Rodríguez-Guerrero, E... [et al.]. Systematic Review of Plasmid AmpC Type Resistances in Escherichia coli and Klebsiella pneumoniae and Preliminary Proposal of a Simplified Screening Method for ampC. Microorganisms 2022, 10, 611. [https://doi.org/10.3390/microorganisms10030611]
Abstract
Beta-lactamase (BL) production is a major public health problem. Although not the most
frequent AmpC type, AmpC-BL is increasingly isolated, especially plasmid AmpC-BL (pAmpCBL).
The objective of this study was to review information published to date on pAmpC-BL in
Escherichia coli and Klebsiella pneumoniae, and on the epidemiology and detection methods used by
clinical microbiology laboratories, by performing a systematic review using the MEDLINE PubMed
database. The predictive capacity of a screening method to detect AmpC-BL using disks with
cloxacillin (CLX) was also evaluated by studying 102 Enterobacteriaceae clinical isolates grown in
CHROMID ESBL medium with the addition of cefepime (FEP), cefoxitin (FOX), ertapenem (ETP),
CLX, and oxacillin with CLX. The review, which included 149 publications, suggests that certain
risk factors (prolonged hospitalization and previous use of cephalosporins) are associated with
infections by pAmpC-BL-producing microorganisms. The worldwide prevalence has increased over
the past 10 years, with a positivity rate ranging between 0.1 and 40%, although AmpC was only
detected when sought in a targeted manner. CMY-2 type has been the most prevalent pAmpC-BLproducing
microorganism. The most frequently used phenotypic method has been the double-disk
synergy test (using CLX disks or phenyl-boronic acid and cefotaxime [CTX] and ceftazidime) and
the disk method combined with these inhibitors. In regard to screening methods, a 1- g oxacillin
disk with CLX showed 88.9% sensitivity, 100% specificity, 100% positive predictive value (PPV),
98.9% negative predictive value (NPV), and 98.9% validity index (VI). This predictive capacity
is reduced with the addition of extended-spectrum beta-lactamases, showing 62.5% sensitivity,
100% specificity, 100% PPV, 93.5% NPV, and 94.1% VI. In conclusion, there has been a worldwide
increase in the number of isolates with pAmpC-BL, especially in Asia, with CMY-2 being the most
frequently detected pAmpC-BL-producing type of microorganism. Reduction in its spread requires
routine screening with a combination of phenotypic methods (with AmpC inhibitors) and genotypic
methods (multiplex PCR). In conclusion, the proposed screening technique is an easy-to-apply and
inexpensive test for the detection of AmpC-producing isolates in the routine screening of multidrugresistant
microorganisms.