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Recognition and clinical significance of mechanisms of bacterial resistance to beta-lactams

  • Pathogenicity And Medical Microbiology
  • Published:
Antonie van Leeuwenhoek Aims and scope Submit manuscript

Abstract

Resistance to beta-lactams may be difficult to recognize. This is due to the difficulty in detecting these resistances, when the routine tests performed in diagnostic laboratories are interpreted in the usual manner. Since failure to recognize this type of resistance may have serious consequences for the patient, it is essential that it be detected when present. For the detection of methicillin resistance ofStaphylococcus aureus a standardized method using either a medium containing 5% NaCl or a low incubation temperature is advocated. Methicillin resistance ofS. epidermidis can only be recognized reliably by means of a quantitative test and incubation for 42–48 h.

Resistance ofHaemophilus influenzae to ampicillin may be intrinsic or it may be caused by a TEM beta-lactamase; a beta-lactamase test should be used to detect the latter type of resistance. Inducible cephalosporinase may be responsible for the rapid development of resistance of some bacterial species to cefamandole, even during therapy. If a stable beta-lactamase production is attained by mutation, resistance to other beta-lactams will usually be present as well. Routine induction tests should be performed for all isolates of species ofEnterobacter, Serratia, Citrobacter andProteus, indole-positive. The same type of ‘hidden’ resistance may be present inPseudomonas aeruginosa, with regard to cefotaxime and other third-generation cephalosporins.

Beta-lactamase-positiveNeisseria gonorrhoeae can easily be recognized by a beta-lactamase test. In addition, the results of diffusion tests allow one to distinguish between beta-lactamase-positive and beta-lactamase-negative strains. Recognition of those strains ofN. gonorrhoeae having a decreased susceptibility to penicillin is only possible when well-standardized quantitative tests are used.

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  1. Department of Medical Microbiology, University Hospital, P.O. Box 320, 2300 AH, Leiden, The Netherlands

    R. P. Mouton

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Mouton, R.P. Recognition and clinical significance of mechanisms of bacterial resistance to beta-lactams. Antonie van Leeuwenhoek 50, 711–727 (1984). https://doi.org/10.1007/BF02386236

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