Extended Spectrum Beta Lactamase (ESBL) Confirmation Test using E-Test

Abstract

Extended-Spectrum Beta-Lactamase (ESBL) is a β-Lactamase enzyme produced mainly by gram-negative bacteria Enterobacteriaceae, mostly found in Klebsiella pneumonia and Escherichia coli. Gram-negative bacteria produce ESBL enzymes that can hydrolyze β-lactam antibiotics and become resistant to almost all antibiotics, causing limited infection therapy options. This has an impact on difficult therapy, increased length of stay in the hospital, higher hospital costs incurred, and higher mortality rates. β-lactam antibiotics have a β-lactam ring structure that plays a role in inhibiting bacterial cell wall synthesis. The β-lactam ring bound to penicillin-binding proteins (PBPs) will stop the process of bacterial cell wall synthesis, causing bacterial cell death. Bacterial resistance to β-lactam antibiotics has 3 pathways, namely: the destruction of β-lactamase enzymes in antibiotics, changes in targets for antibiotics, and decreased intracellular uptake of antibiotics. β-lactamase-producing bacteria that destroy β-lactams are the main cause of resistance. Beta-lactamases cause antibiotic resistance by breaking down the structure of antibiotics. Beta-lactamases will open the β-lactam ring and change the structure of the drug and block the binding of penicillin-binding proteins (PBPs). Until now, no method has become the gold standard for detecting ESBL-producing Enterobacteriaceae. The Clinical and Laboratory Standards Institute recommends screening tests and confirmatory ESBL tests. E-Test (Epsilometer Test) is one of the confirmatory tests of ESBL, as an exponential gradient method to determine antimicrobial resistance, and also as a quantitative method to provide a quantity of antimicrobial sensitivity to microorganisms.