The Caspase Inhibitor VI nmr specificities of the four screening agars have been documented in previous studies focusing on the ability to detect ESBL-producing Cytoskeletal Signaling inhibitor bacteria within the Enterobacteriaceae family. These studies included none or just a few Salmonella isolates, and the specificity varied greatly. ChromID ESBL agar was included in most of the studies, and the specificity ranged

from 72.9% – 94.9% [33-36]. The specificity of the Brilliance agar ranged from 57.9%– 95.1% [33,34,36], and for BLSE agar the specificity ranged from 60.8-85.0% [34,35]. CHROMagar ESBL has been evaluated by Grohs et al. only, with a reported specificity of 72.3% [33]. However, some of the previous studies seem to have included ESBL-producing non-Enterobacteriaceae isolates as test positives, while other studies only included ESBL-producing isolates within the Enterobacteriaceae family. This difference may explain the apparent great variations in specificities reported. The frequency of human infection with Salmonella and Shigella in Norway is relatively low. Consequently, to gain proper statistical power in a real-life study evaluating screening plates for ESBL-positive strains of these two genera would be time consuming. We therefore chose

to use a suspension of a normal fecal sample spiked Vemurafenib with the ESBL- positive isolates. The quantity of ESBL-positive bacteria in the fecal samples is known to be a factor of the sensitivity of the screening agars [37]. In genuine fecal samples the quantity of bacteria varies, but Racecadotril in this study we spiked the same quantity of bacteria in all samples. Salmonella are normally lactose negative and produce neither β-galactosidase nor β-glucuronidase. Consequently, colonies of Salmonella appeared colourless on agarplates that use these enzymes in the chromogenic reactions. Shigella sonnei is both β-glucuronidase and β-galactosidase-positive and appeared much like E. coli on these screening agars. Therefore direct differentiation of Shigella sonnei and E. coli is difficult. However, none

of the manufacturers mention this similarity in their product information. On the other hand, Shigella flexneri does not express these enzymes, and will not appear like E. coli on the screening agars. This was confirmed in our testing. Obviously, testing only two Shigella flexneri isolates is insufficient to give a statistically reliable result. Three Salmonella isolates of different serovars had pink colonies on both ChromID and Brilliance agars, whereas the rest of the Salmonella isolates had colorless colonies. It is necessary for the pink color formation that the bacteria express β-glucuronidase, which is described that some Salmonella bacteria actually do [38]. The color-based identification was non-specific and comparable to expected results from using a non-chromogenic agar with the same antibacterial supplements.