Introduction. Increased carbapenem resistance is often caused by carbapenemase production. Aim. The objective of our study was to assess which antibiotic susceptibility patterns, as tested by automated systems, are highly associated with the absence of carbapenemase production in Enterobacteriaceae isolates, and could therefore be used as a screening tool. Methodology. Routine antibiotic susceptibility testing data from 42 medical microbiology laboratories in the Netherlands in the period between January 2011 and June 2017 were obtained from the national antimicrobial resistance surveillance programme. Data on Enterobacteriaceae isolates that had an elevated minimum inhibitory concentration (MIC) for carbapenems (meropenem >0.25 mg l−1 or imipenem >1.0 mg l−1) were selected and subjected to phenotypic or genotypic carbapenemase production testing. Routinely available amoxicillin/clavulanic acid, piperacillin/tazobactam, cefuroxime and ceftriaxone/cefotaxime susceptibilities were studied in relation to carbapenemase production by calculating the negative predictive value. Results. No evidence for carbapenemase-producing Enterobacteriaceae (CPE) was found in 767 of 1007 (76 %) isolates. The negative predictive value was highest for amoxicillin/clavulanic acid (99.6 %) and piperacillin/tazobactam (98.8 %). Conclusion. Enterobacteriaceae isolates with elevated carbapenem MICs that are susceptible to amoxicillin/clavulanic acid or piperacillin/tazobactam are unlikely to be carbapenemase producers. Preselection based on this susceptibility pattern may lead to increased laboratory efficiency and reduction of costs. Whether this is also true for countries with a different distribution of CPE species and types or a higher prevalence of CPE needs to be studied.

中文翻译：

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常规可获得的抗菌药敏感性信息可用于提高产生碳青霉烯酶的肠杆菌科细菌的筛选效率。

介绍。碳青霉烯酶的耐药性增加通常是由于碳青霉烯酶的产生。目的。我们研究的目的是评估通过自动化系统测试的哪种抗生素敏感性模式与肠杆菌科细菌分离物中不存在碳青霉烯酶的产生高度相关，因此可以用作筛选工具。方法。2011年1月至2017年6月期间，荷兰42个医学微生物学实验室的常规抗生素敏感性测试数据来自国家抗菌素耐药性监测计划。肠杆菌科数据 选择对碳青霉烯具有最低抑菌浓度（MIC）升高的分离株（美洛培南> 0.25 mg l -1或亚胺培南> 1.0 mg l -1），并对其进行表型或基因型碳青霉烯酶生产测试。通过计算阴性预测值，研究了常规可得的阿莫西林/克拉维酸，哌拉西林/他唑巴坦，头孢呋辛和头孢曲松/头孢噻肟敏感性与碳青霉烯酶生产的关系。结果。在1007株分离物中的767株（占76％）中未发现产生碳青霉烯酶的肠杆菌科（CPE）的证据。阿莫西林/克拉维酸（99.6％）和哌拉西林/他唑巴坦（98.8％）的阴性预测值最高。结论。 碳青霉烯MIC升高且对阿莫西林/克拉维酸或哌拉西林/他唑巴坦敏感的肠杆菌科细菌不太可能是碳青霉烯酶的生产者。基于这种敏感性模式的预选可以提高实验室效率并降低成本。对于CPE种类和类型不同或CPE患病率较高的国家，这是否也适用。