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In vitro susceptibility of piperacillin-resistant and piperacillin/tazobactam-susceptible Pseudomonas aeruginosa

In vitro susceptibility of piperacillin-resistant and piperacillin/tazobactam-susceptible Pseudomonas aeruginosa

Abstracts of the Interscience Conference on Antimicrobial Agents and Chemotherapy 43: 174

Background: Pseudomonas aeruginosa is known to produce various beta-lactamases, although resistance is not largely attributed to these enzymes. At our institution in 2001, greater than 15% of P. aeruginosa isolates were reported as resistant to piperacillin and susceptible to piperacillin/tazobactam (P-R, PT-S) by Vitek(R). This discrepancy is greater than rates reported elsewhere. We evaluated isolates that exhibited this discrepancy using broth microdilution to confirm these findings, to determine if this effect is evident with ticarcillin and ticarcillin/clavulanic acid and if beta-lactamase inhibitors alone have an effect. Methods: P. aeruginosa isolates were collected between September 2002 and January 2003. Additional isolates were removed from stock that had previously been stored. Isolates P-R, PT-S by Vitek(R) were collected and stocked along with 10 control isolates that were susceptible to piperacillin and piperacillin/tazobactam (P-S, PT-S) and 10 that were resistant to both (P-R, PT-R). Isolates were tested against piperacillin, ticarcillin, clavulanic acid, tazobactam, sulbactam, and combinations of each beta-lactam with each inhibitor. Trays were supplied by Trek Diagnostics, Inc., Westlake, Ohio, USA. Results: A total of 65 isolates of P. aeruginosa were collected and tested. These include 10 P-S, PT-S controls, 10 P-R, PT-R controls, and 45 P-R, PT-S study isolates. Of the 45 discordant study isolates, only 9 were read as P-R, PT-S by tray; 21 were read as P-R, PT-R and 15 as P-S, PT-S. Isolates resistant to ticarcillin were also resistant to ticarcillin/clavulanic acid. No inhibitory effect was observed with beta-lactamase inhibitors alone. Conclusions: Using trays, fewer isolates were P-R, PT-S compared to Vitek(R), suggesting that Vitek(R) might be overcalling piperacillin/tazobactam susceptibilities. Institutions using Vitek(R) should be aware of the potential for false susceptibilities to piperacillin/tazobactam for P. aeruginosa.

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