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Jaidane N, Vanparis O, Mansour W, Volland H, Oueslati S, Naas T. Evaluation of a novel lateral flow immunochromatographic assay for the rapid detection of KPC, NDM, IMP, VIM and OXA-48 carbapenemases in Gram-negatives. J Antimicrob Chemother 2024:dkae239. [PMID: 39001779 DOI: 10.1093/jac/dkae239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2024] Open
Affiliation(s)
- Nadia Jaidane
- Laboratoire de Biophysique métabolique et Pharmacologie Appliquée (LR12ES02), Faculté de Médecine Ibn Al Jazzar Sousse, Sousse, Tunisia
| | - Océane Vanparis
- Department of Bacteriology-Hygiene, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
- Team Resist, INSERM UMR 1184, Faculty of Medicine, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Wejdene Mansour
- Laboratoire de Biophysique métabolique et Pharmacologie Appliquée (LR12ES02), Faculté de Médecine Ibn Al Jazzar Sousse, Sousse, Tunisia
| | - Hervé Volland
- Service de Pharmacologie et Immunoanalyse, Médicaments et Technologies pour la Santé (MTS), CEA, INRA, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Saoussen Oueslati
- Department of Bacteriology-Hygiene, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
- Team Resist, INSERM UMR 1184, Faculty of Medicine, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Thierry Naas
- Department of Bacteriology-Hygiene, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
- Team Resist, INSERM UMR 1184, Faculty of Medicine, Paris-Saclay University, Le Kremlin-Bicêtre, France
- French National Reference Center for Carbapenem-resistant Enterobacterales, Le Kremlin-Bicêtre, France
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2
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Khoo BY, Hon PY, Leong J, Sai Rama Sridatta P, Thevasagayam NM, Loy SQD, Chua JJY, Ang BSP, Chow A, Marimuthu K, De PP, Ng OT, Vasoo S. Evaluation of NG-Test CARBA 5 version 2, Cepheid Xpert Carba-R, and carbapenem inactivation methods in comparison to whole-genome sequencing for the identification of carbapenemases in non-fermenting Gram-negative bacilli. J Clin Microbiol 2023; 61:e0031623. [PMID: 37671882 PMCID: PMC10512785 DOI: 10.1128/jcm.00316-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/11/2023] [Indexed: 09/07/2023] Open
Abstract
NG-Test CARBA 5 (NG-Biotech) is a rapid in vitro multiplex immunoassay for the phenotypic detection and differentiation of the "big five" carbapenemase families (KPC, OXA-48-like, VIM, IMP, and NDM). Version 2 of this assay was evaluated alongside the Xpert Carba-R assay (Cepheid, Inc.), the modified carbapenem inactivation method (mCIM), and the CIMTris assay, with a collection of carbapenem-resistant non-fermenting Gram-negative bacilli comprising 138 Pseudomonas aeruginosa and 97 Acinetobacter baumannii isolates. Whole-genome sequencing (WGS) was used as the reference standard. For P. aeruginosa, NG-Test CARBA 5 produced an overall percentage agreement (OPA) with WGS of 97.1%, compared with 92.8% forXpert Carba-R and 90.6% for mCIM. For A. baumannii, as OXA-type carbapenemases (non-OXA-48) are not included, both the NG-Test CARBA 5 and Xpert Carba-R only had an OPA of 6.2%, while the CIMTris performed well with an OPA of 99.0%. The majority of A. baumannii isolates (95.9%) tested falsely positive for IMP on NG-Test CARBA 5; no IMP genes were found on WGS. No clear cause was found for this phenomenon; a cross-reacting protein antigen unique to A. baumannii is a possible culprit. NG-Test CARBA 5 performed well for carbapenemase detection in P. aeruginosa. However, results from A. baumannii isolates should be interpreted with caution.
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Affiliation(s)
- Bo Yan Khoo
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, , Singapore
| | - Pei Yun Hon
- Infectious Diseases Research Laboratory, National Centre for Infectious Diseases, , Singapore
| | - Janice Leong
- Department of Laboratory Medicine, Tan Tock Seng Hospital, , Singapore
| | | | | | - Song Qi Dennis Loy
- Infectious Diseases Research Laboratory, National Centre for Infectious Diseases, , Singapore
| | - Jasmine J. Y. Chua
- Infectious Diseases Research Laboratory, National Centre for Infectious Diseases, , Singapore
| | - Brenda Sze Peng Ang
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, , Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, , Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, , Singapore
- Department of Infection Prevention and Control, Tan Tock Seng Hospital, , Singapore
| | - Angela Chow
- National Centre for Infectious Diseases, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, , Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, , Singapore
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge (OCEAN), Tan Tock Seng Hospital, , Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, , Singapore
| | - Kalisvar Marimuthu
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, , Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, , Singapore
| | - Partha Pratim De
- Department of Laboratory Medicine, Tan Tock Seng Hospital, , Singapore
| | - Oon Tek Ng
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, , Singapore
- Infectious Diseases Research Laboratory, National Centre for Infectious Diseases, , Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, , Singapore
| | - Shawn Vasoo
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, , Singapore
- Infectious Diseases Research Laboratory, National Centre for Infectious Diseases, , Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, , Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, , Singapore
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3
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Coșeriu RL, Mare AD, Toma F, Vintilă C, Ciurea CN, Togănel RO, Cighir A, Simion A, Man A. Uncovering the Resistance Mechanisms in Extended-Drug-Resistant Pseudomonas aeruginosa Clinical Isolates: Insights from Gene Expression and Phenotypic Tests. Microorganisms 2023; 11:2211. [PMID: 37764055 PMCID: PMC10535578 DOI: 10.3390/microorganisms11092211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: The purpose of the study was to describe the activity of mex efflux pumps in Multidrug-Resistant (MDR) clinical isolates of Pseudomonas aeruginosa and to compare the carbapenem-resistance identification tests with PCR; (2) Methods: Sixty MDR P. aeruginosa were analyzed for detection of carbapenemase by disk diffusion inhibitory method, carbapenem inactivation method and Modified Hodge Test. Endpoint PCR was used to detect 7 carbapenemase genes (blaKPC, blaOXA48-like, blaNDM, blaGES-2, blaSPM, blaIMP, blaVIM) and mcr-1 for colistin resistance. The expression of mexA, mexB, mexC, mexE and mexX genes corresponding to the four main efflux pumps was also evaluated; (3) Results: From the tested strains, 71.66% presented at least one carbapenemase gene, with blaGES-2 as the most occurring gene (63.3%). Compared with the PCR, the accuracy of phenotypic tests did not exceed 25% for P. aeruginosa. The efflux pump genes were present in all strains except one. In 85% of the isolates, an overactivity of mexA, mexB and mostly mexC was detected. Previous treatment with ceftriaxone increased the activity of mexC by more than 160 times; (4) Conclusions: In our MDR P. aeruginosa clinical isolates, the carbapenem resistance is not accurately detected by phenotypic tests, due to the overexpression of mex efflux pumps and in a lesser amount, due to carbapenemase production.
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Affiliation(s)
- Răzvan Lucian Coșeriu
- Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology Târgu Mureș, 540142 Târgu Mures, Romania; (R.L.C.); (F.T.); (C.V.); (C.N.C.); (R.O.T.); (A.C.); (A.S.); (A.M.)
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology Târgu Mureș, 540142 Târgu Mures, Romania
| | - Anca Delia Mare
- Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology Târgu Mureș, 540142 Târgu Mures, Romania; (R.L.C.); (F.T.); (C.V.); (C.N.C.); (R.O.T.); (A.C.); (A.S.); (A.M.)
| | - Felicia Toma
- Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology Târgu Mureș, 540142 Târgu Mures, Romania; (R.L.C.); (F.T.); (C.V.); (C.N.C.); (R.O.T.); (A.C.); (A.S.); (A.M.)
| | - Camelia Vintilă
- Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology Târgu Mureș, 540142 Târgu Mures, Romania; (R.L.C.); (F.T.); (C.V.); (C.N.C.); (R.O.T.); (A.C.); (A.S.); (A.M.)
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology Târgu Mureș, 540142 Târgu Mures, Romania
| | - Cristina Nicoleta Ciurea
- Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology Târgu Mureș, 540142 Târgu Mures, Romania; (R.L.C.); (F.T.); (C.V.); (C.N.C.); (R.O.T.); (A.C.); (A.S.); (A.M.)
| | - Radu Ovidiu Togănel
- Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology Târgu Mureș, 540142 Târgu Mures, Romania; (R.L.C.); (F.T.); (C.V.); (C.N.C.); (R.O.T.); (A.C.); (A.S.); (A.M.)
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology Târgu Mureș, 540142 Târgu Mures, Romania
| | - Anca Cighir
- Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology Târgu Mureș, 540142 Târgu Mures, Romania; (R.L.C.); (F.T.); (C.V.); (C.N.C.); (R.O.T.); (A.C.); (A.S.); (A.M.)
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology Târgu Mureș, 540142 Târgu Mures, Romania
| | - Anastasia Simion
- Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology Târgu Mureș, 540142 Târgu Mures, Romania; (R.L.C.); (F.T.); (C.V.); (C.N.C.); (R.O.T.); (A.C.); (A.S.); (A.M.)
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology Târgu Mureș, 540142 Târgu Mures, Romania
| | - Adrian Man
- Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology Târgu Mureș, 540142 Târgu Mures, Romania; (R.L.C.); (F.T.); (C.V.); (C.N.C.); (R.O.T.); (A.C.); (A.S.); (A.M.)
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Mendez-Sotelo BJ, López-Jácome LE, Colín-Castro CA, Hernández-Durán M, Martínez-Zavaleta MG, Rivera-Buendía F, Velázquez-Acosta C, Rodríguez-Zulueta AP, Morfín-Otero MDR, Franco-Cendejas R. Comparison of Lateral Flow Immunochromatography and Phenotypic Assays to PCR for the Detection of Carbapenemase-Producing Gram-Negative Bacteria, a Multicenter Experience in Mexico. Antibiotics (Basel) 2023; 12:antibiotics12010096. [PMID: 36671297 PMCID: PMC9855030 DOI: 10.3390/antibiotics12010096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 01/07/2023] Open
Abstract
The identification of carbapenemase-producing Enterobacterales and Pseudomonas aeruginosa is important for treating and controlling hospital infections. The recommended methods for their identification require a long waiting time, technical training, and expertise. Lateral flow immunoassays such as NG-Test CARBA 5® overcome these needs. We analyzed 84 clinical isolates of carbapenem-resistant Enterobacterales and P. aeruginosa from four different hospitals in a two-year period. Antimicrobial resistance patterns were confirmed with the broth dilution method. Evaluation of KPC, VIM, NDM, IMP, and OXA-48-like enzymes was performed and compared to NG-Test CARBA 5 and phenotypic assays. Enterobacterales represented 69% of isolates and P. aeruginosa represented 31%. Carbapenemase-producing strains were 51 (88%) of Enterobacterales and 23 (88.4%) of P. aeruginosa; 20 (34%) and 23 (88%) were Class B ß-lactamases, respectively. The NG-Test CARBA 5® assay for Enterobacterales showed high sensitivity (98%), specificity (100%), and PPV (100%); however, it did not for P. aeruginosa. The Kappa concordance coefficient was 0.92 for Enterobacterales and 0.52 for P. aeruginosa. NG-Test CARBA 5® is a fast and easy-to-use assay. In Enterobacterales, we found excellent agreement in our comparison with molecular tests. Despite the low agreement in P. aeruginosa, we suggest that this test could be used as a complementary tool.
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Affiliation(s)
- Braulio Josue Mendez-Sotelo
- División de Infectología, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City 14389, Mexico
| | - Luis Esaú López-Jácome
- División de Infectología, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City 14389, Mexico
- Correspondence: (L.E.L.-J.); (R.F.-C.)
| | - Claudia A. Colín-Castro
- División de Infectología, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City 14389, Mexico
| | - Melissa Hernández-Durán
- División de Infectología, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City 14389, Mexico
| | | | - Frida Rivera-Buendía
- Oficina de Apoyo Sistemático para la Investigación Superior, Subdirección de Investigación Clínica, Instituto Nacional de Cardiología, Mexico City 14080, Mexico
| | | | | | - Maria del Rayo Morfín-Otero
- Infectología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Universidad de Guadalajara, Guadalajara 44280, Mexico
| | - Rafael Franco-Cendejas
- Biomedical Research Subdirection, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México 14389, Mexico
- Correspondence: (L.E.L.-J.); (R.F.-C.)
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5
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Bernabeu S, Bonnin RA, Dortet L. Comment on: Comparison of three lateral flow immunochromatographic assays for the rapid detection of KPC, NDM, IMP, VIM and OXA-48 carbapenemases in Enterobacterales. J Antimicrob Chemother 2022; 78:314-317. [PMID: 36376016 DOI: 10.1093/jac/dkac381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sandrine Bernabeu
- Department of Bacteriology-Hygiene, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France.,INSERM UMR 1184, RESIST Unit, Paris-Saclay University, Faculty of Medicine, Le Kremlin-Bicêtre, France.,French National Reference Center for Antimicrobial Resistance, France
| | - Rémy A Bonnin
- INSERM UMR 1184, RESIST Unit, Paris-Saclay University, Faculty of Medicine, Le Kremlin-Bicêtre, France.,French National Reference Center for Antimicrobial Resistance, France
| | - Laurent Dortet
- Department of Bacteriology-Hygiene, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France.,INSERM UMR 1184, RESIST Unit, Paris-Saclay University, Faculty of Medicine, Le Kremlin-Bicêtre, France.,French National Reference Center for Antimicrobial Resistance, France
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6
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Bernabeu S, Bonnin RA, Dortet L. Comparison of three lateral flow immunochromatographic assays for the rapid detection of KPC, NDM, IMP, VIM and OXA-48 carbapenemases in Enterobacterales. J Antimicrob Chemother 2022; 77:3198-3205. [PMID: 36101500 DOI: 10.1093/jac/dkac303] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Sandrine Bernabeu
- Department of Bacteriology-Hygiene, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Le Kremlin-Bicêtre, France.,INSERM UMR 1184, RESIST Unit, Paris-Saclay University, Faculty of Medicine, Le Kremlin-Bicêtre, France.,French National Reference Center for Antimicrobial Resistance, Le Kremlin-Bicêtre, France
| | - Rémy A Bonnin
- INSERM UMR 1184, RESIST Unit, Paris-Saclay University, Faculty of Medicine, Le Kremlin-Bicêtre, France.,French National Reference Center for Antimicrobial Resistance, Le Kremlin-Bicêtre, France
| | - Laurent Dortet
- Department of Bacteriology-Hygiene, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Le Kremlin-Bicêtre, France.,INSERM UMR 1184, RESIST Unit, Paris-Saclay University, Faculty of Medicine, Le Kremlin-Bicêtre, France.,French National Reference Center for Antimicrobial Resistance, Le Kremlin-Bicêtre, France
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7
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López-Hernández I, López-Cerero L, Fernández-Cuenca F, Pascual Á. The role of the microbiology laboratory in the diagnosis of multidrug-resistant Gram-negative bacilli infections. The importance of the determination of resistance mechanisms. Med Intensiva 2022; 46:455-464. [PMID: 35643635 DOI: 10.1016/j.medine.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/06/2022] [Accepted: 01/12/2022] [Indexed: 06/15/2023]
Abstract
Early diagnosis and treatment has an important impact on the morbidity and mortality of infections caused by multidrug-resistant bacteria. Multidrug-resistant gram-negative bacilli (MR-GNB) constitute the main current threat in hospitals and especially in intensive care units (ICU). The role of the microbiology laboratory is essential in providing a rapid and effective response. This review updates the microbiology laboratory procedures for the rapid detection of BGN-MR and its resistance determinants. The role of the laboratory in the surveillance and control of outbreaks caused by these bacteria, including typing techniques, is also studied. The importance of providing standardized resistance maps that allow knowing the epidemiological situation of the different units is emphasized. Finally, the importance of effective communication systems for the transmission of results and decision making in the management of patients infected by BGN-MR is reviewed.
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Affiliation(s)
- I López-Hernández
- Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain; Red Española de Investigación en Patología Infecciosa (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
| | - L López-Cerero
- Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain; Red Española de Investigación en Patología Infecciosa (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
| | - F Fernández-Cuenca
- Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain; Red Española de Investigación en Patología Infecciosa (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain.
| | - Á Pascual
- Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain; Red Española de Investigación en Patología Infecciosa (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
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Boutal H, Moguet C, Pommiès L, Simon S, Naas T, Volland H. The Revolution of Lateral Flow Assay in the Field of AMR Detection. Diagnostics (Basel) 2022; 12:1744. [PMID: 35885647 PMCID: PMC9317642 DOI: 10.3390/diagnostics12071744] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022] Open
Abstract
The global spread of antimicrobial resistant (AMR) bacteria represents a considerable public health concern, yet their detection and identification of their resistance mechanisms remain challenging. Optimal diagnostic tests should provide rapid results at low cost to enable implementation in any microbiology laboratory. Lateral flow assays (LFA) meet these requirements and have become essential tools to combat AMR. This review presents the versatility of LFA developed for the AMR detection field, with particular attention to those directly triggering β-lactamases, their performances, and specific limitations. It considers how LFA can be modified by detecting not only the enzyme, but also its β-lactamase activity for a broader clinical sensitivity. Moreover, although LFA allow a short time-to-result, they are generally only implemented after fastidious and time-consuming techniques. We present a sample processing device that shortens and simplifies the handling of clinical samples before the use of LFA. Finally, the capacity of LFA to detect amplified genetic determinants of AMR by isothermal PCR will be discussed. LFA are inexpensive, rapid, and efficient tools that are easy to implement in the routine workflow of laboratories as new first-line tests against AMR with bacterial colonies, and in the near future directly with biological media.
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Affiliation(s)
- Hervé Boutal
- Département Médicaments et Technologies Pour la Santé (DMTS), Université Paris Saclay, CEA, INRAE, SPI, 91191 Gif-sur-Yvette, France; (H.B.); (C.M.); (L.P.); (S.S.)
| | - Christian Moguet
- Département Médicaments et Technologies Pour la Santé (DMTS), Université Paris Saclay, CEA, INRAE, SPI, 91191 Gif-sur-Yvette, France; (H.B.); (C.M.); (L.P.); (S.S.)
| | - Lilas Pommiès
- Département Médicaments et Technologies Pour la Santé (DMTS), Université Paris Saclay, CEA, INRAE, SPI, 91191 Gif-sur-Yvette, France; (H.B.); (C.M.); (L.P.); (S.S.)
| | - Stéphanie Simon
- Département Médicaments et Technologies Pour la Santé (DMTS), Université Paris Saclay, CEA, INRAE, SPI, 91191 Gif-sur-Yvette, France; (H.B.); (C.M.); (L.P.); (S.S.)
| | - Thierry Naas
- Bacteriology-Hygiene Unit, APHP, Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France;
- Team Resist, UMR1184, Université Paris-Saclay—INSERM—CEA, LabEx Lermit, 91190 Gif-sur-Yvette, France
- Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriaceae, 94270 Le Kremlin-Bicêtre, France
| | - Hervé Volland
- Département Médicaments et Technologies Pour la Santé (DMTS), Université Paris Saclay, CEA, INRAE, SPI, 91191 Gif-sur-Yvette, France; (H.B.); (C.M.); (L.P.); (S.S.)
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9
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El papel del laboratorio de microbiología en el diagnóstico de infecciones por bacilos gramnegativos multirresistentes. Importancia de la determinación de mecanismos de resistencias. Med Intensiva 2022. [DOI: 10.1016/j.medin.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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10
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Comparison of sCIM and Other Phenotypic Detection Methods for Carbapenemase-Producing Enterobacterales. Microbiol Spectr 2021; 9:e0160821. [PMID: 34787440 PMCID: PMC8597650 DOI: 10.1128/spectrum.01608-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Rapid detection and reporting of carbapenemase-producing Enterobacterales (CPE) is one of the top priorities of clinical microbiology laboratories. The Clinical and Laboratory Standards Institute recommends the modified carbapenem inactivation method (mCIM) as the preferred method for this purpose, but it requires a broth incubation process which can be cumbersome. Here, we compared the performance of mCIM with three alternative rapid CPE detection methods against a collection of genetically defined CPE, with most carrying blaIMP, and non-CPE clinical isolates. The sensitivities of mCIM, simplified carbapenem inactivation method (sCIM), Rapidec Carba NP, and NG-Test Carba 5 were 98.0%, 54.9%, 90.2%, and 72.5%, whereas the specificities were 89.5%, 84.2%, 89.5%, and 100%, respectively. Modification of the interpretive criteria of sCIM increased its sensitivity to 88.2% and specificity to 89.5%. The results suggest that mCIM is currently the optimal method for CPE detection in an epidemiological setting where CPE-producing IMP group carbapenemase is predominant. While sCIM is easier to perform, it requires further validation before it can be widely adopted as an alternative to mCIM in the clinical laboratory. IMPORTANCE Simple identification methods for carbapenemase-producing Enterobacterales are required for the clinical laboratory. The simplified carbapenem inactivation method (sCIM) is a carbapenemase detection method that can be performed with less hands-on time than mCIM, but its sensitivity and specificity were suboptimal compared with other phenotypic detection methods when tested against a collection of IMP-producing CPE. Insufficient inactivation of imipenem from inadequate inoculation was suspected as the cause. While sCIM is easier to perform, it requires optimization before it can be widely adopted as an alternative to mCIM in the clinical laboratory.
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11
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Diagnosis of Multidrug-Resistant Pathogens of Pneumonia. Diagnostics (Basel) 2021; 11:diagnostics11122287. [PMID: 34943524 PMCID: PMC8700525 DOI: 10.3390/diagnostics11122287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/09/2021] [Accepted: 11/26/2021] [Indexed: 12/15/2022] Open
Abstract
Hospital-acquired pneumonia and ventilator-associated pneumonia that are caused by multidrug resistant (MDR) pathogens represent a common and severe problem with increased mortality. Accurate diagnosis is essential to initiate appropriate antimicrobial therapy promptly while simultaneously avoiding antibiotic overuse and subsequent antibiotic resistance. Here, we discuss the main conventional phenotypic diagnostic tests and the advanced molecular tests that are currently available to diagnose the primary MDR pathogens and the resistance genes causing pneumonia.
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12
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Jacobs MR, Colson JD, Rhoads DD. Recent advances in rapid antimicrobial susceptibility testing systems. Expert Rev Mol Diagn 2021; 21:563-578. [PMID: 33926351 DOI: 10.1080/14737159.2021.1924679] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Until recently antimicrobial susceptibility testing (AST) methods based on the demonstration of phenotypic susceptibility in 16-24 h remained largely unchanged. AREAS COVERED Advances in rapid phenotypic and molecular-based AST systems. EXPERT OPINION AST has changed over the past decade, with many rapid phenotypic and molecular methods developed to demonstrate phenotypic or genotypic resistance, or biochemical markers of resistance such as β-lactamases associated with carbapenem resistance. Most methods still require isolation of bacteria from specimens before both legacy and newer methods can be used. Bacterial identification by MALDI-TOF mass spectroscopy is now widely used and is often key to the interpretation of rapid AST results. Several PCR arrays are available to detect the most frequent pathogens associated with bloodstream infections and their major antimicrobial resistance genes. Many advances in whole-genome sequencing of bacteria and fungi isolated by culture as well as directly from clinical specimens have been made but are not yet widely available. High cost and limited throughput are the major obstacles to uptake of rapid methods, but targeted use, continued development and decreasing costs are expected to result in more extensive use of these increasingly useful methods.
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Affiliation(s)
- Michael R Jacobs
- Emeritus Professor of Pathology and Emeritus Medical Director, Clinical Microbiology, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jordan D Colson
- Microbiology Fellow, Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel D Rhoads
- Section Head of Microbiology, Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
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13
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Baer D, Azrad M, Saleh N, Peretz A. Detection of Carbapenem-Resistant Enterobacterales in Simulated Blood Culture in 15 Minutes. Life (Basel) 2021; 11:life11020145. [PMID: 33672877 PMCID: PMC7917675 DOI: 10.3390/life11020145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 12/15/2022] Open
Abstract
Bacteremia leading to sepsis and organ dysfunction is a life-threatening situation, leading to death of up to one fourth of the infected individuals around the world. One major challenge in the treatment of sepsis is the rising prevalence of antibiotic resistant bacteria, such as carbapenem-resistant Enterobacterales (CRE). In recent years, several molecular assays have been developed for the detection of CRE mechanisms, enabling rapid results reporting. We evaluated the performance of the NG-Test CARBA 5 (NG Biotech) kit in detection of CRE in simulated blood cultures. Carbapenemase-producing (CP) CRE isolates (n = 38) and non-carbapenemase CRE (Non-CP) isolates (n = 10), previously identified using the routine methods practiced at the clinical microbiology laboratory of the Baruch Padeh Medical Center, Israel, were used in this analysis. Variable concentrations of the bacterial isolates were added to a suspension composed of human blood and saline, simulating the composition of a blood culture. Samples were then transferred to an anaerobic blood culture bottle and later tested with the NG-Test CARBA 5 (NG Biotech) kit, that identifies the CRE mechanism within 15 min. The NG-Test CARBA 5 kit correctly identified 43 samples (89.5%). The sensitivity and specificity of the kits were 86.8% and 100%, respectively. In conclusion, the NG-Test CARBA 5 kit is a reliable and accessible tool for the rapid diagnosis of CRE bloodstream infections.
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Affiliation(s)
- Daria Baer
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel;
| | - Maya Azrad
- Clinical Microbiology Laboratory, The Baruch Padeh Medical Center, Poriya, Tiberias 1528001, Israel; (M.A.); (N.S.)
| | - Nora Saleh
- Clinical Microbiology Laboratory, The Baruch Padeh Medical Center, Poriya, Tiberias 1528001, Israel; (M.A.); (N.S.)
| | - Avi Peretz
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel;
- Clinical Microbiology Laboratory, The Baruch Padeh Medical Center, Poriya, Tiberias 1528001, Israel; (M.A.); (N.S.)
- Correspondence: ; Tel.: +972-4-665-2322
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14
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Bonnin RA, Girlich D, Jousset AB, Emeraud C, Creton E, Gauthier L, Jové T, Dortet L, Naas T. Genomic analysis of VIM-2-producing Enterobacter hormaechei subsp. steigerwaltii. Int J Antimicrob Agents 2021; 57:106285. [PMID: 33493673 DOI: 10.1016/j.ijantimicag.2021.106285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 12/24/2020] [Accepted: 01/03/2021] [Indexed: 11/15/2022]
Abstract
Carbapenemase-producing Enterobacterales (CPE) is a major public-health concern. Here we describe the occurrence of blaVIM-2 in three isolates of Enterobacter hormaechei subsp. steigerwaltii. The blaVIM-2 gene was part of a class II transposon Tn1332 and was embedded in a remnant of a class 1 integron. Tn1332 was carried by a large, conjugative, non-typeable plasmid. The three isolates belonged to sequence type 90 (ST90). Two isolates (90H2 and 90H3) were highly related [<10 single nucleotide polymorphisms (SNPs)], whereas isolate 104D2 exhibited more than 50 SNPs and Tn1332 was inserted in a different place in the plasmid. Another IncHI-type plasmid carrying the extended-spectrum β-lactamase (ESBL) gene blaCTX-M-15 was identified in 90H2 and 90H3. Among the three isolates, isolate 104D2 was negative for detection of carbapenemase activity using the biochemical Carba NP test, despite the presence of Tn1332 on the same plasmid. Mutants of 104D2 with higher minimum inhibitory concentrations (MICs) for carbapenems were obtained and one mutant (m104D2) was analysed. In contrast to 104D2, mutant m104D2 gave a positive Carba NP test. The mutant possessed two copies of Tn1332 per cell and a nonsense mutation in WecA, an enzyme involved in enterobacterial common antigen and peptidoglycan intermediate biosynthesis. This study describes the first occurrence of Tn1332 in Enterobacterales and the phenotypic diversity of VIM-2-producing E. hormaechei.
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Affiliation(s)
- Rémy A Bonnin
- Team Resist, UMR-1184 (INSERM - Université Paris-Saclay - CEA), LabEx Lermit, Faculty of Medicine, Le Kremlin-Bicêtre, France; EERA 'Evolution and Ecology of Resistance to Antibiotics' Unit, (Institut Pasteur - APHP - Université Paris Saclay), Le Kremlin-Bicêtre, France; Associated French National Reference Center for Antibiotic Resistance 'Carbapenemase-producing Enterobacteriaceae', Bacteriology-Hygiene Unit, APHP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Delphine Girlich
- Team Resist, UMR-1184 (INSERM - Université Paris-Saclay - CEA), LabEx Lermit, Faculty of Medicine, Le Kremlin-Bicêtre, France; EERA 'Evolution and Ecology of Resistance to Antibiotics' Unit, (Institut Pasteur - APHP - Université Paris Saclay), Le Kremlin-Bicêtre, France; Associated French National Reference Center for Antibiotic Resistance 'Carbapenemase-producing Enterobacteriaceae', Bacteriology-Hygiene Unit, APHP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Agnès B Jousset
- Team Resist, UMR-1184 (INSERM - Université Paris-Saclay - CEA), LabEx Lermit, Faculty of Medicine, Le Kremlin-Bicêtre, France; EERA 'Evolution and Ecology of Resistance to Antibiotics' Unit, (Institut Pasteur - APHP - Université Paris Saclay), Le Kremlin-Bicêtre, France; Associated French National Reference Center for Antibiotic Resistance 'Carbapenemase-producing Enterobacteriaceae', Bacteriology-Hygiene Unit, APHP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Cecile Emeraud
- Team Resist, UMR-1184 (INSERM - Université Paris-Saclay - CEA), LabEx Lermit, Faculty of Medicine, Le Kremlin-Bicêtre, France; EERA 'Evolution and Ecology of Resistance to Antibiotics' Unit, (Institut Pasteur - APHP - Université Paris Saclay), Le Kremlin-Bicêtre, France; Associated French National Reference Center for Antibiotic Resistance 'Carbapenemase-producing Enterobacteriaceae', Bacteriology-Hygiene Unit, APHP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Elodie Creton
- Team Resist, UMR-1184 (INSERM - Université Paris-Saclay - CEA), LabEx Lermit, Faculty of Medicine, Le Kremlin-Bicêtre, France; Associated French National Reference Center for Antibiotic Resistance 'Carbapenemase-producing Enterobacteriaceae', Bacteriology-Hygiene Unit, APHP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Lauraine Gauthier
- Team Resist, UMR-1184 (INSERM - Université Paris-Saclay - CEA), LabEx Lermit, Faculty of Medicine, Le Kremlin-Bicêtre, France; EERA 'Evolution and Ecology of Resistance to Antibiotics' Unit, (Institut Pasteur - APHP - Université Paris Saclay), Le Kremlin-Bicêtre, France; Associated French National Reference Center for Antibiotic Resistance 'Carbapenemase-producing Enterobacteriaceae', Bacteriology-Hygiene Unit, APHP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Thomas Jové
- INSERM, CHU Limoges, RESINFIT, University of Limoges, Limoges, France
| | - Laurent Dortet
- Team Resist, UMR-1184 (INSERM - Université Paris-Saclay - CEA), LabEx Lermit, Faculty of Medicine, Le Kremlin-Bicêtre, France; EERA 'Evolution and Ecology of Resistance to Antibiotics' Unit, (Institut Pasteur - APHP - Université Paris Saclay), Le Kremlin-Bicêtre, France; Associated French National Reference Center for Antibiotic Resistance 'Carbapenemase-producing Enterobacteriaceae', Bacteriology-Hygiene Unit, APHP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Thierry Naas
- Team Resist, UMR-1184 (INSERM - Université Paris-Saclay - CEA), LabEx Lermit, Faculty of Medicine, Le Kremlin-Bicêtre, France; EERA 'Evolution and Ecology of Resistance to Antibiotics' Unit, (Institut Pasteur - APHP - Université Paris Saclay), Le Kremlin-Bicêtre, France; Associated French National Reference Center for Antibiotic Resistance 'Carbapenemase-producing Enterobacteriaceae', Bacteriology-Hygiene Unit, APHP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.
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15
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Bonnin RA, Jousset AB, Emeraud C, Oueslati S, Dortet L, Naas T. Genetic Diversity, Biochemical Properties, and Detection Methods of Minor Carbapenemases in Enterobacterales. Front Med (Lausanne) 2021; 7:616490. [PMID: 33553210 PMCID: PMC7855592 DOI: 10.3389/fmed.2020.616490] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/09/2020] [Indexed: 01/05/2023] Open
Abstract
Gram-negative bacteria, especially Enterobacterales, have emerged as major players in antimicrobial resistance worldwide. Resistance may affect all major classes of anti-gram-negative agents, becoming multidrug resistant or even pan-drug resistant. Currently, β-lactamase-mediated resistance does not spare even the most powerful β-lactams (carbapenems), whose activity is challenged by carbapenemases. The dissemination of carbapenemases-encoding genes among Enterobacterales is a matter of concern, given the importance of carbapenems to treat nosocomial infections. Based on their amino acid sequences, carbapenemases are grouped into three major classes. Classes A and D use an active-site serine to catalyze hydrolysis, while class B (MBLs) require one or two zinc ions for their activity. The most important and clinically relevant carbapenemases are KPC, IMP/VIM/NDM, and OXA-48. However, several carbapenemases belonging to the different classes are less frequently detected. They correspond to class A (SME-, Nmc-A/IMI-, SFC-, GES-, BIC-like…), to class B (GIM, TMB, LMB…), class C (CMY-10 and ACT-28), and to class D (OXA-372). This review will address the genetic diversity, biochemical properties, and detection methods of minor acquired carbapenemases in Enterobacterales.
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Affiliation(s)
- Rémy A Bonnin
- Team "Resist" UMR1184 "Immunology of Viral, Auto-Immune, Hematological and Bacterial diseases (IMVA-HB)," INSERM, Université Paris-Saclay, CEA, LabEx LERMIT, Faculty of Medicine, Le Kremlin-Bicêtre, France.,Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriaceae, Le Kremlin-Bicêtre, France.,Evolution and Ecology of Resistance to Antibiotics Unit, Institut Pasteur-APHP-Université Paris-Sud, Paris, France
| | - Agnès B Jousset
- Team "Resist" UMR1184 "Immunology of Viral, Auto-Immune, Hematological and Bacterial diseases (IMVA-HB)," INSERM, Université Paris-Saclay, CEA, LabEx LERMIT, Faculty of Medicine, Le Kremlin-Bicêtre, France.,Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriaceae, Le Kremlin-Bicêtre, France.,Evolution and Ecology of Resistance to Antibiotics Unit, Institut Pasteur-APHP-Université Paris-Sud, Paris, France.,Bacteriology-Hygiene Unit, Assistance Publique-Hôpitaux de Paris, AP-HP Paris Saclay, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Cécile Emeraud
- Team "Resist" UMR1184 "Immunology of Viral, Auto-Immune, Hematological and Bacterial diseases (IMVA-HB)," INSERM, Université Paris-Saclay, CEA, LabEx LERMIT, Faculty of Medicine, Le Kremlin-Bicêtre, France.,Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriaceae, Le Kremlin-Bicêtre, France.,Evolution and Ecology of Resistance to Antibiotics Unit, Institut Pasteur-APHP-Université Paris-Sud, Paris, France.,Bacteriology-Hygiene Unit, Assistance Publique-Hôpitaux de Paris, AP-HP Paris Saclay, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Saoussen Oueslati
- Team "Resist" UMR1184 "Immunology of Viral, Auto-Immune, Hematological and Bacterial diseases (IMVA-HB)," INSERM, Université Paris-Saclay, CEA, LabEx LERMIT, Faculty of Medicine, Le Kremlin-Bicêtre, France.,Evolution and Ecology of Resistance to Antibiotics Unit, Institut Pasteur-APHP-Université Paris-Sud, Paris, France
| | - Laurent Dortet
- Team "Resist" UMR1184 "Immunology of Viral, Auto-Immune, Hematological and Bacterial diseases (IMVA-HB)," INSERM, Université Paris-Saclay, CEA, LabEx LERMIT, Faculty of Medicine, Le Kremlin-Bicêtre, France.,Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriaceae, Le Kremlin-Bicêtre, France.,Evolution and Ecology of Resistance to Antibiotics Unit, Institut Pasteur-APHP-Université Paris-Sud, Paris, France.,Bacteriology-Hygiene Unit, Assistance Publique-Hôpitaux de Paris, AP-HP Paris Saclay, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Thierry Naas
- Team "Resist" UMR1184 "Immunology of Viral, Auto-Immune, Hematological and Bacterial diseases (IMVA-HB)," INSERM, Université Paris-Saclay, CEA, LabEx LERMIT, Faculty of Medicine, Le Kremlin-Bicêtre, France.,Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriaceae, Le Kremlin-Bicêtre, France.,Evolution and Ecology of Resistance to Antibiotics Unit, Institut Pasteur-APHP-Université Paris-Sud, Paris, France.,Bacteriology-Hygiene Unit, Assistance Publique-Hôpitaux de Paris, AP-HP Paris Saclay, Bicêtre Hospital, Le Kremlin-Bicêtre, France
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16
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KPC-53, a KPC-3 Variant of Clinical Origin Associated with Reduced Susceptibility to Ceftazidime-Avibactam. Antimicrob Agents Chemother 2020; 65:AAC.01429-20. [PMID: 33106265 DOI: 10.1128/aac.01429-20] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/20/2020] [Indexed: 12/19/2022] Open
Abstract
This study reports on the characterization of a Klebsiella pneumoniae clinical isolate showing high-level resistance to ceftazidime-avibactam associated with the production of KPC-53, a KPC-3 variant exhibiting a Leu167Glu168 duplication in the Ω-loop and a loss of carbapenemase activity. Whole-genome sequencing (WGS) revealed the presence of two copies of bla KPC-53, located on a pKpQIL-like plasmid and on a plasmid prophage of the Siphoviridae family, respectively. The present findings provide new insights into the mechanisms of resistance to ceftazidime-avibactam.
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17
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Gelmez GA, Can B, Hasdemir U, Soyletir G. Evaluation of two commercial methods for rapid detection of the carbapenemase-producing Klebsiella pneumoniae. J Microbiol Methods 2020; 178:106084. [PMID: 33049329 DOI: 10.1016/j.mimet.2020.106084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/24/2020] [Accepted: 10/06/2020] [Indexed: 11/21/2022]
Abstract
In this study, we evaluated the performance of the two commercial methods (Rapidec Carba NP and NG-Test Carba-5) for the rapid detection of carbapenemase-producing Klebsiella pneumoniae. A total of 224 Klebsiella pneumoniae strains previously characterized for carbapenemase genes by polymerase chain reaction were included in the study. The strain collection included 30 non-carbapenemase producers, 85 OXA-48-like, 59 NDM, 14 IMP, 7 KPC, 7 VIM, 19 OXA-48-like plus NDM, and 3 KPC plus NDM producers. Rapidec Carba NP and NG-Test Carba 5 was performed according to the manufacturer's instructions. NG-Test Carba 5 correctly detected all carbapenemase-producing K. pneumoniae, however, Rapidec Carba NP failed to detect 41% of OXA-48-like producers even with extended incubation time. The overall sensitivity and specificity were 81,9% and 100% for Rapidec Carba NP, 100% and 100% for NG-Test Carba 5, respectively. Both tests seem to be fast and reliable for the detection of carbapenemase-producing K. pneumoniae especially for microbiology laboratories where molecular tests cannot be performed. However, Rapidec Carba NP with weak hydrolysis activity for OXA-48 like might be used in regions where OXA-48 is not prevalent. The additional advantage of NG-Test Carba 5 is that it specifically detects carbapenemases giving way to threat-related infections with an effective drug such as ceftazidime-avibactam or meropenem- vaborbactam.
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Affiliation(s)
| | - Barıs Can
- Marmara University Pendik Training and Research Hospital, Medical Microbiology Laboratory, Istanbul, Turkey
| | - Ufuk Hasdemir
- Marmara University School of Medicine, Department of Medical Microbiology, Istanbul, Turkey
| | - Guner Soyletir
- Marmara University School of Medicine, Department of Medical Microbiology, Istanbul, Turkey
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18
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Stokes W, Pitout J, Campbell L, Church D, Gregson D. Rapid detection of carbapenemase-producing organisms directly from blood cultures positive for Gram-negative bacilli. Eur J Clin Microbiol Infect Dis 2020; 40:381-384. [PMID: 32780248 DOI: 10.1007/s10096-020-04005-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/31/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The rapid detection of carbapenemase-producing organisms (CPOs) directly from blood cultures (BCs) positive for Gram-negative bacilli (GNB) may accelerate the appropriate treatment of at-risk patients. OBJECTIVE To evaluate the performance of two commercial assays in the rapid detection of CPOs directly from BC positive for GNB. METHODS BC positive for GNB were tested for the presence of CPOs with β CARBA® and NG-Test® CARBA 5. A subset of sterile BC samples was seeded with multidrug-resistant (MDR) GNB. Positive BCs from clinical and seeded samples were tested directly with β CARBA and CARBA 5 from BC pellets. RESULTS Sixty-five samples were tested (30 clinical, 35 seeded). β CARBA had a sensitivity, specificity, NPV, and PPV of 100%, 65.7%, 100%, and 71.4%, respectively. CARBA 5 had a sensitivity, specificity, NPV, and PPV of 90.0%, 100%, 92.1%, and 100%. False negatives for CARBA 5 occurred with 1 GES, 1 VIM-1, and 1 IMP-14. CONCLUSIONS This study demonstrates that the detection of CPOs directly from positive BC can be accurately achieved. β CARBA had excellent sensitivity but suffered from poor specificity. CARBA 5 had good sensitivity and specificity but is unable to detect certain CPOs.
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Affiliation(s)
- William Stokes
- University of Calgary, Calgary, AB, Canada. .,Alberta Precision Laboratories, Diagnostic & Scientific Centre, 9, 3535 Research Rd NW, Calgary, AB, T2L 2K8, Canada.
| | - Johann Pitout
- University of Calgary, Calgary, AB, Canada.,Alberta Precision Laboratories, Diagnostic & Scientific Centre, 9, 3535 Research Rd NW, Calgary, AB, T2L 2K8, Canada
| | - Lorraine Campbell
- Alberta Precision Laboratories, Diagnostic & Scientific Centre, 9, 3535 Research Rd NW, Calgary, AB, T2L 2K8, Canada
| | - Deirdre Church
- University of Calgary, Calgary, AB, Canada.,Alberta Precision Laboratories, Diagnostic & Scientific Centre, 9, 3535 Research Rd NW, Calgary, AB, T2L 2K8, Canada
| | - Daniel Gregson
- University of Calgary, Calgary, AB, Canada.,Alberta Precision Laboratories, Diagnostic & Scientific Centre, 9, 3535 Research Rd NW, Calgary, AB, T2L 2K8, Canada
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19
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Emergence of ceftazidime-avibactam resistance through distinct genomic adaptations in KPC-2-producing Klebsiella pneumoniae of sequence type 39 during treatment. Eur J Clin Microbiol Infect Dis 2020; 40:219-224. [PMID: 32729059 DOI: 10.1007/s10096-020-04000-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/27/2020] [Indexed: 12/22/2022]
Abstract
Three ceftazidime-avibactam-resistant KPC-2-producing Klebsiella pneumoniae strains of ST39 were isolated in Greece, from rectal swabs of three patients after 10-15 days of treatment. The patients were treated with ceftazidime-avibactam as monotherapy or in combination with colistin. Two of these strains harbored a D179Y or a D179V substitution in the Ω loop of KPC-2, corresponding to KPC-33, or to the novel KPC-57, respectively. The third strain had a 15 amino acid insertion after position 259 in the KPC-2, corresponding to KPC-44.
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20
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Chan WW, Campbell L, Doyle D, Pitout JD. Rapid detection of Enterobacterales that produce carbapenemases. Diagn Microbiol Infect Dis 2020; 98:115120. [PMID: 32688297 DOI: 10.1016/j.diagmicrobio.2020.115120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/08/2020] [Accepted: 06/20/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE The rapid detection of carbapenemases among Enterobacterales in clinical laboratories is critical for management of patients, and infection prevention and control efforts. METHODS A study was designed to evaluate the performances of the RAPIDEC CARBA NP®, β-CARBA®, NG-Test CARBA 5®, modified carbapenem-inactivation method, and EDTA version (eCIM) assays against a global collection of Enterobacterales (n = 216) with diverse carbapenemases. RESULTS The RAPIDEC CARBA NP® assay had a sensitivity of 98.6% and specificity of 19.6% and β-CARBA® a sensitivity of 94% and specificity of 97.8%, but showed low sensitivity with Klebsiella Pneumoniae Carbapenemase (KPC)-containing isolates. The NG-Test CARBA 5® had an overall sensitivity of 96.3% and specificity of 100% and failed to detect isolates with blaIMP-13, blaIMP-14. The eCIM gave false- positive results with Oxacillinase (OXA)-48-like enzymes. CONCLUSION The NG-Test CARBA 5® assay was technically simple and provided rapid accurate results on the types of carbapenemases. Such information has potential treatment benefits for patients.
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Affiliation(s)
- Wilson W Chan
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada; Clinical section of Microbiology, Calgary Laboratory Services, Calgary, Alberta, Canada
| | - Lorraine Campbell
- Clinical section of Microbiology, Calgary Laboratory Services, Calgary, Alberta, Canada
| | - Diana Doyle
- Clinical section of Microbiology, Calgary Laboratory Services, Calgary, Alberta, Canada
| | - Johann Dd Pitout
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada; Clinical section of Microbiology, Calgary Laboratory Services, Calgary, Alberta, Canada; Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa.
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