Detecting Metallo-Beta-Lactamases and Colistin Resistance in Gram Negative Bacilli (by CACMLE) (Online Course)

Paul Schreckenberger, PhD, D(ABMM)

Developed from a teleconference, the goal of this self-study course is to use a structured, yet self-paced format to provide a review of metallo-beta-lactamase and colistin resistance mechanisms, and the phenotypic methods used to identify these mechanisms in the Gram Negative bacilli.

Presented in an easy-to-use PowerPoint slide format with corresponding audio, it’s just like being at a live presentation!

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Continuing Education Credits


  • Recognize pitfalls of susceptibility testing for detection of antibiotic resistance
  • Identify best methods for detecting metallo-beta-lactamases and colistin resistance.
  • Add appropriate interpretative comments to susceptibility reports to aid in physician understanding

Course Outline

  • PowerPoint Slides
      • Detecting Metallo-Beta-Lactamase and Colistin Resistance in Gram Negative Bacilli
      • Course Goal
      • Course Overview
      • Author
      • Introduction
      • Learning Objectives
      • Case 1
      • Case 1-MicroScan Report
      • Case 1- MicroScan Panel, cont.
      • Case 1 - ID Consult
      • Case 1 - 12 Disk Test Result
      • Case 1 - Modified Hodge Test
      • MBL E Test, Colistin, Tigecycline Results
      • Case 1 - Sensititre Results: E. cloacae
      • The Answer is....
      • Carbapenemases in the U.S.
      • Metallo-beta-lactamases belong to which molecular class of carbapenemases:
      • MicroScan Panel
      • IMI/NMC-A Enzymes
      • You have isolated an Enterobacter cloacae from a positive blood culture. AST gives the following results: ampicillin is resistant, all cephalosporins ...
      • Case 2
      • Case 2, cont.
      • Case 2 - MicroScan Report
      • Case 2 - MicroScan Report, cont.
      • Case 2 - 12 Disk Test Results
      • Case 2- MBL ETest, Colistin, Tigecycline
      • Case 2 - Sensititre Results: K. pneumoniae
      • Polymyxin Antibiotics - Mechanism of Action
      • The target for polymyxin antibiotics is the cell membrane.
      • Polymyxin Antibiotics - Development of Resistance
      • Polymyxin Antibiotics - Pharmacokinetics
      • Polymyxin Antibiotics - Spectrum of Activity
      • Polymyxin Antibiotics - Susceptibility Testing
      • Assessment of Colistin and Polymyxin B AST Methods - Breakpoints
      • Acinetobacter spp: Colistin MIC vs. Disk
      • Acinetobacter spp: Polymyxin B MIC vs. Disk
      • Assessment of Colistin and Polymyxin B AST Methods - Acinetobacter spp.
      • • For Acinetobacter spp. - disk diffusion methods are able to reliably detect colistin and polymyxin resistance (MIC >4 mg/ml)
      • Ps. aeruginosa: Colistin MIC vs. Disk
      • Ps. aeruginosa: Polymyxin B MIC vs. Disk
      • Assessment of Colistin and Polyxin B AST Methods - Ps. aeruginosa
      • Assessment of Colistin and Polymyxin B AST Methods - Error Rates
      • Assessment of Colistin and Polymyxin B AST Methods - Conclusions
      • Colistin/Polymyxin B: Breakpoints for Ps. aeruginosa
      • Colistin/Polymyxin B: Breakpoints for Acinetobacter
      • Testing Caveats
      • Testing Caveats, cont.
      • When testing for colistin resistance, polymyxin should be the preferred choice as a representative of the polymyxin antibiotics.
      • Colistin Resistant KPC
      • A colistin and tigecycline resistant KPC may be treated with:
      • Colistin Resistant KPC, cont.
      • Colistin Resistant KPC, cont.
      • Conclusion

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