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You cannot always trust the ESBL confirmatory test on the Vitek 1 (Vitek legacy). We are Vitek 1 users and have had a number of false ESBL results both false positive and false negative. The rule we apply is as follows: if ESBL confirmatory test is positive and phenotype is consistent with ESBL (i.e. one of the 3rd generation cephalosporins is I or R and the others are S) then we accept the result that organism is ESBL positive without further confirmation and change all the cephalosporins to resistant. If ESBL confirmatory result doen not match the phenotype (i.e. all the cephalosporins are sensitive and ESBL is positive or all 3rd generation cephalosporins are resistant but cefepime is sensitive and ESBL is negative) then we perform the Disk Confirmatory test. In these cases we accept the results of the ESBL disk confirmatory test and act accordingly.
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