The chromogenic Lacta test developed for the rapid detection of -lactamase-hydrolyzing extended-spectrum cephalosporins in Enterobacteriaceae revealed good performance with extended-spectrum -lactamase (ESBL) producers (97.5% true-positive results). However, false-negative results occurred with chromosomal AmpC hyperproducers and plasmid AmpC producers, whereas uninterpretable results were mostly due to VIM-1 carbapenemase producers and possibly low levels of expressed ESBLs.
Detection of Enterobacteriaceae resistant to broad-spectrum cephalosporins, mostly due to production of extended-spectrum -lactamases (ESBL), plasmid AmpC -lactamases, and/or carbapenemases, has become a challenge in clinical microbiology laboratories because of important clinical consequences for infection control purposes and guidance of antimicrobial therapy (1-3). Methods routinely used to detect these organisms are primarily based on susceptibility testing results, either MICs or disk diffusion inhibition zones, as well as on ancillary testing using disk synergy tests with different -lactamase inhibitors or MIC-gradient strips combining -lactams and -lactamase inhibitors (4). Molecular methods based on PCR or microarray hybridization techniques have been also developed (5, 6). In addition, mass spectrometry-based protocols using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and in-house colorimetric tests have been developed to detect the production of ESBLs in less than 4 h (7,8). Increased interest in rapid colorimetric assays has been observed, because of their easy implementation in the routine workflow of clinical laboratories (8).The Lacta test (Bio-Rad, Marnes la Coquette, France) is a new chromogenic method based on the use of a yellow substrate (HMRZ-86) that turns to red when hydrolyzed by ESBLs, AmpC -lactamases, and most carbapenemases (9-11). According to the manufacturer, reading of the results can be performed visually in less than 15 min. In the present study, we assessed the performance of the Lacta test for rapid detection of -lactamasehydrolyzing extended-spectrum cephalosporins in two groups of Enterobacteriaceae clinical isolates. The first group (Table 1) consisted of 338 contemporary clinical isolates collected prospectively (in January to March 2012), and the second group (Table 2) included 106 clinical isolates with -lactamase-mediated resistance mechanisms that were characterized at the molecular level and affected broad-spectrum cephalosporins (12-15). All isolates were recovered at the Ramón y Cajal University Hospital and were identified using both a MicroScan system (Siemens, West Sacramento, CA) and MALDI-TOF MS (Bruker Daltonics, Germany). In addition, the Escherichia coli ATCC 35218 strain (TEM-1 producer) was used as a negative control, whereas the Klebsiella pneumoniae ATCC 700603 strain (SHV-18 producer) was used as a positive control. Susceptibility testing of -lactam antibiotics, including broad-spectrum cephalosporins (cefotaxime, ceftazi...