How should I screen for Extended-Spectrum Beta-Lactamases (ESBLs) and other mechanisms of resistance?
A. CLSI has revised their position on the detection of ESBLs: previous recommendations were to perform ESBL screen and confirmatory tests for E. coli, Klebsiella spp., and Proteus mirabilis. However, new data suggests that ESBL phenotypic tests are not optimal due to the presence of multiple resistance mechanisms that may mask ESBLs in confirmatory tests; ESBLs are now known to exist in species of Enterobacteriaceae other than E. coli, Klebsiella spp., and P. mirabilis where confirmatory tests are more problematic; and some MICs correlate better with patient outcomes rather than the knowledge of the resistance mechanism.
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