Clinical Any Process as 35-37 Aerobic 18-24hr ESBL ≥18hr samples: sample requested in Enterobacteriaceae accordance with Any the relevant condition SOPS. + Include the indicator detection of antimicrobials: 30µg producing cefotaxime and 30µg ceftazidime (or 10µg cefpodoxime only) Screening: Screening MacConkey 35-37 Aerobic 18-24hr ESBL ≥18hr specimens agar 65or CLED Enterobacteriaceae Screening agar + 30µg most especially – test for Rectal or cefotaxime and Klebsiella species Peri-rectal 30µg producing Escherichia coli swabs ceftazidime (or 10µg cefpodoxime only) Chromogenic agar using 30µg cefotaxime and ceftazidime 30µg (or 10µg cefpodoxime only)66 as necessary Other organisms for consideration ESBLs are harder to detect in species of Enterobacteriaceae with inducible, – chromosomal AmpC enzymes (eg Enterobacter, Citrobacter freundii, Morganella morganii, Providencia and Serratia) but some confirmatory tests (cefpirome/clavulanate or cefepime/clavulanate) can be used for identification of these. Refer to the Introduction. 4.6 Identification Refer to individual SMIs for organism identification. 4.6.1 Minimum level of identification in the laboratory species species species species level maltophilia Note: The methods described herein are not suitable for detecting ESBLs in Acinetobacter species, which are often susceptible to clavulanic acid and so may yield a false ESBL-positive result. Ceftazidime-clavulanate synergy may be used to indicate ESBL production (usually VEB or PER enzymes) in isolates of
Clinical samples: Any condition + detection of Any sample Process as requested in accordance with the relevant SOPS. Include the indicator antimicrobials: 30µg cefotaxime and 30µg ceftazidime (or 10µg cefpodoxime only) 35-37 Aerobic 18-24hr ≥18hr ESBL producing Enterobacteriaceae Screening: Screening test for Screening specimens – Rectal or Peri-rectal swabs MacConkey agar 65or CLED agar + 30µg cefotaxime and 30µg ceftazidime (or 10µg cefpodoxime only) Chromogenic agar using 30µg cefotaxime and ceftazidime 30µg (or 10µg cefpodoxime only)66 as necessary 35-37 Aerobic 18-24hr ≥18hr ESBL producing Enterobacteriaceae most especially Klebsiella species Escherichia coli Other organisms for consideration – ESBLs are harder to detect in species of Enterobacteriaceae with inducible, chromosomal AmpC enzymes (eg Enterobacter, Citrobacter freundii, Morganella morganii, Providencia and Serratia) but some confirmatory tests (cefpirome/clavulanate or cefepime/clavulanate) can be used for identification of these. Refer to the Introduction. 4.6 Identification Refer to individual SMIs for organism identification. 4.6.1 Minimum level of identification in the laboratory species species species maltophilia species level Note: The methods described herein are not suitable for detecting ESBLs in Acinetobacter species, which are often susceptible to clavulanic acid and so may yield a false ESBL-positive result. Ceftazidime-clavulanate synergy may be used to indicate ESBL production (usually VEB or PER enzymes) in isolates of