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Comparison of five methods for detection of carbapenemases in Enterobacterales with proposal of a new algorithm.

Authors
  • Baeza, L Lucena1
  • Pfennigwerth, N2
  • Greissl, C1
  • Göttig, S3
  • Saleh, A1
  • Stelzer, Y1
  • Gatermann, S G2
  • Hamprecht, A4
  • 1 Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Cologne, Germany. , (Germany)
  • 2 Department of Medical Microbiology, Ruhr University Bochum, Bochum, Germany. , (Germany)
  • 3 Institute of Medical Microbiology and Infection Control, Hospital of Johann Wolfgang Goethe-University, Frankfurt am Main, Germany. , (Germany)
  • 4 Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Cologne, Germany; DZIF (German Centre for Infection Research), Partner Site Bonn-Cologne, Germany. Electronic address: [email protected] , (Germany)
Type
Published Article
Journal
Clinical Microbiology and Infection
Publisher
Elsevier
Publication Date
Oct 01, 2019
Volume
25
Issue
10
Identifiers
DOI: 10.1016/j.cmi.2019.03.003
PMID: 30898725
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The aim of this study was to evaluate the performance of five different carbapenemase tests and to develop an algorithm which will permit the detection of most common and rare carbapenemases in routine microbiology laboratories. The immunochromatographic tests CARBA-5 (NG), RESIST-4 O.K.N.V. (Coris), the colorimetric β-CARBA (BioRad), a newly developed carbapenem-inactivation method (CIM) supplemented with zinc (zCIM), and the Xpert Carba-R (Cepheid) were challenged with a collection of 189 molecularly characterized Enterobacterales isolates, including 146 carbapenemase producers (CPE): VIM (n = 48), OXA-48-like (n = 40), NDM (n = 29), KPC (n = 13), IMI (n = 9), IMP (n = 9), OXA-58 (n = 2), and GES (n = 2). The overall sensitivity/specificity values for the five carbapenemase detection tests were 84.2% (CI 77.6-89.2%)/100% (CI 91.8-100%) for RESIST-4, 88.2% (CI 82.1-92.4%)/100% (CI 91.8-100%) for CARBA-5, 88.2% (CI 82.1-92.4%)/100% (CI 91.8-100%) for Xpert Carba-R, 73.7% (CI 66.2-80.0%)/100% (CI 93.4-99.0%) for β-CARBA, and 97.4% (CI 87.9-99.6%)/97.7% (CI 87.9-99.6%) for zCIM. The four common carbapenemases (KPC, OXA-48-like, NDM, and VIM) were detected with ≥97.6% sensitivity by all tests except for β-CARBA (76.6% (CI 68.4-83.2%)). IMI and GES were only detected by zCIM (sensitivity 90.9% (CI 62.3-98.4%)). Based on these results a new algorithm was developed, consisting of an immunochromatographic assay as the first test followed by zCIM, which allows detection of 99.3% of all carbapenemases assessed. Except for β-CARBA, all methods showed excellent sensitivity/specificity for the detection of the four most frequent carbapenemases. With the new algorithm, rare variants can also be detected. It is rapid, simple, and inexpensive and can be performed in any microbiology laboratory, as no PCR equipment is required. Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.

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