{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:48:56Z","timestamp":1787759336925,"version":"build-2784847793"},"reference-count":36,"publisher":"American Society for Microbiology","issue":"2","license":[{"start":{"date-parts":[[2017,2,1]],"date-time":"2017-02-01T00:00:00Z","timestamp":1485907200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/100009633","name":"HHS | NIH | Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["T32HD055148"],"award-info":[{"award-number":["T32HD055148"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["J Clin Microbiol"],"published-print":{"date-parts":[[2017,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            Extended-spectrum beta-lactamase (ESBL)-producing\n            <jats:named-content content-type=\"genus-species\">Enterobacteriaceae<\/jats:named-content>\n            generally cannot be treated with penicillins and cephalosporins. However, some later-generation cephalosporins, including cefepime, are poorly hydrolyzed by specific ESBL enzymes, and certain strains demonstrate\n            <jats:italic>in vitro<\/jats:italic>\n            susceptibility to these agents, potentially affording additional treatment opportunities. Moreover, the ability to adjust both the dose and dosing interval of beta-lactam agents allows the treatment of strains with elevated MICs that were formerly classified in the intermediate range. The ability to treat strains with elevated cefepime MICs is codified in new susceptible dose-dependent (SDD) breakpoints promulgated by the Clinical and Laboratory Standards Institute. In the interest of validating and implementing new cefepime SDD criteria, we evaluated the performances of Vitek 2, disk diffusion, and a MicroScan panel compared to that of reference broth microdilution (BMD) during the testing of 64 strains enriched for presumptive ESBL phenotype (based on nonsusceptibility to ceftriaxone). Surprisingly, categorical agreement with BMD was only 47.6%, 57.1%, and 44.6% for the three methods, respectively. Given these findings, we tested the performance of the HP D300 inkjet-assisted broth microdilution digital dispensing method (DDM), which was previously described by our group as an at-will testing alternative. In contrast to commercial methods, DDM results correlated well with the reference method, with 86% categorical agreement, 91.1% evaluable essential agreement, and no major or very major errors. The reproducibility and accuracy of MIC determinations were statistically equivalent to BMD. Our results provide support for the use of the DDM as a BMD equivalent methodology that will enable hospital-based clinical laboratories to support cefepime MIC-based dosing strategies.\n          <\/jats:p>","DOI":"10.1128\/jcm.02128-16","type":"journal-article","created":{"date-parts":[[2016,12,1]],"date-time":"2016-12-01T03:30:21Z","timestamp":1480563021000},"page":"470-478","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":22,"title":["Improved Accuracy of Cefepime Susceptibility Testing for Extended-Spectrum-Beta-Lactamase-Producing Enterobacteriaceae with an On-Demand Digital Dispensing Method"],"prefix":"10.1128","volume":"55","author":[{"given":"Kenneth P.","family":"Smith","sequence":"first","affiliation":[{"name":"Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thea","family":"Brennan-Krohn","sequence":"additional","affiliation":[{"name":"Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA"},{"name":"Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Weir","sequence":"additional","affiliation":[{"name":"Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James E.","family":"Kirby","sequence":"additional","affiliation":[{"name":"Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkm318"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2015.239"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diagmicrobio.2016.04.022"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.3390\/ph6111335"},{"key":"e_1_3_2_6_2","volume-title":"State of the world's antibiotics, 2015","author":"Center for Disease Dynamics Economics and Policy","year":"2015","unstructured":"Center for Disease Dynamics Economics and Policy. 2015. State of the world's antibiotics, 2015. Center for Disease Dynamics Economics and Policy, Washington, DC."},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.2807\/ese.13.47.19044-en"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmm.2016.05.006"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13756-016-0117-4"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkw372"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.018085-0"},{"key":"e_1_3_2_12_2","first-page":"83","article-title":"Epidemiology of infections due to extended-spectrum beta-lactamase-producing bacteria in a pediatric intensive care unit","volume":"19","author":"Benner KW","year":"2014","unstructured":"Benner KW Prabhakaran P Lowros AS . 2014. Epidemiology of infections due to extended-spectrum beta-lactamase-producing bacteria in a pediatric intensive care unit. 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J Antimicrob Chemother68:2282\u20132285.","journal-title":"J Antimicrob Chemother"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.024075-0"},{"key":"e_1_3_2_33_2","volume-title":"Coordinating ed, Sharp SE","author":"Clark RB","year":"2009","unstructured":"Clark RB Lewinski MA Loeffelholz MJ Tibbetts RJ . 2009. Cumitech 31A, Verification and validation of procedures in the clinical microbiology laboratory. Coordinating ed, Sharp SE. American Society for Microbiology, Washington, DC."},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00036-08"},{"key":"e_1_3_2_35_2","volume-title":"Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically; approved standard\u201410th ed","author":"Clinical and Laboratory Standards Institute","year":"2015","unstructured":"Clinical and Laboratory Standards Institute. 2015. 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