{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T19:30:37Z","timestamp":1777923037099,"version":"3.51.4"},"reference-count":29,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2021,4,1]],"date-time":"2021-04-01T00:00:00Z","timestamp":1617235200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Microbial Drug Resistance"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:p>\n                    Extended-spectrum \u03b2-lactamase (ESBL)-producing Gram-negative bacteria (GNB) are increasingly identified as the cause of both community and healthcare-associated urinary tract infections (UTIs), with CTX-Ms being the most common ESBLs identified. CTX-M-producing GNB are resistant to most \u03b2-lactam antibiotics and are frequently multidrug\u2013resistant, which limits treatment options. Rapid diagnostic tests that can detect ESBL-producing GNB, particularly CTX-M producers, in the urine of patients with UTIs are needed. Results from such a test could direct the selection of appropriate antimicrobial therapy at the point-of-care (POC). In this study, we show that a chromogenic, dual enzyme-mediated amplification system (termed DETECT [dual-enzyme trigger-enabled cascade technology]) can identify CTX-M-producing GNB from unprocessed urine samples in 30 minutes. We first tested DETECT against a diverse set of recombinant \u03b2-lactamases and \u03b2-lactamase-producing clinical isolates to elucidate its selectivity. We then tested DETECT with 472 prospectively collected clinical urine samples submitted for urine culture to a hospital clinical microbiology laboratory. Of these, 118 (25%) were consistent with UTI, 13 (11%) of which contained ESBL-producing GNB. We compared DETECT results in urine against a standard phenotypic method to detect ESBLs, and polymerase chain reaction and sequencing for CTX-M genes. DETECT demonstrated 90.9% sensitivity and 97.6% specificity (AUC, 0.937; 95% confidence interval, 0.822\u20131.000), correctly identifying 10 of 11 urine samples containing a clinically significant concentration of CTX-M-producing GNB (including\n                    <jats:italic toggle=\"yes\">Escherichia coli<\/jats:italic>\n                    ,\n                    <jats:italic toggle=\"yes\">Klebsiella pneumoniae<\/jats:italic>\n                    , and\n                    <jats:italic toggle=\"yes\">Proteus mirabilis<\/jats:italic>\n                    ). Our results demonstrate the clinical potential of DETECT to deliver diagnostic information at the POC, which could improve initial antibiotic selection.\n                  <\/jats:p>","DOI":"10.1089\/mdr.2020.0128","type":"journal-article","created":{"date-parts":[[2020,8,24]],"date-time":"2020-08-24T11:50:33Z","timestamp":1598269833000},"page":"450-461","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":8,"title":["A Dual Enzyme-Based Biochemical Test Rapidly Detects Third-Generation Cephalosporin-Resistant CTX-M-Producing Uropathogens in Clinical Urine Samples"],"prefix":"10.1177","volume":"27","author":[{"given":"Nicole J.","family":"Tarlton","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danka-Florence","family":"Petrovic","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, Highland Hospital, Alameda Health System, Oakland, California, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bradley W.","family":"Frazee","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Highland Hospital, Alameda Health System, Oakland, California, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clarissa A.","family":"Borges","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily M.","family":"Pham","sequence":"additional","affiliation":[{"name":"Department of Bioengineering, University of California, Berkeley, Berkeley, California, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aubrianne K.","family":"Milton","sequence":"additional","affiliation":[{"name":"Department of Bioengineering, University of California, Berkeley, Berkeley, California, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Jackson","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tara R.","family":"deBoer","sequence":"additional","affiliation":[{"name":"Department of Bioengineering, University of California, Berkeley, Berkeley, California, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niren","family":"Murthy","sequence":"additional","affiliation":[{"name":"Department of Bioengineering, University of California, Berkeley, Berkeley, California, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lee W.","family":"Riley","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2021,4,15]]},"reference":[{"key":"e_1_3_5_2_2","unstructured":"CDC. 2019. 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