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Gandra S, Takahashi S, Mitrani-Gold FS, Mulgirigama A, Ferrinho DA. A systematic scoping review of faropenem and other oral penems: treatment of Enterobacterales infections, development of resistance and cross-resistance to carbapenems. JAC Antimicrob Resist 2022; 4:dlac125. [PMID: 36570688 PMCID: PMC9777757 DOI: 10.1093/jacamr/dlac125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/16/2022] [Indexed: 12/24/2022] Open
Abstract
Background Antimicrobial resistance is an urgent global healthcare concern. Beyond carbapenems as broad-spectrum, often 'last resort' antibiotics, oral penem antibiotics currently are approved only in Japan and India, used for the treatment of indications including urinary tract infections (UTIs). Exploring oral penem use to better understand the impact of antibiotic resistance on public health would help inform the management of infectious diseases, including UTIs. Scoping Review Methodology This scoping review investigated the impact of faropenem and other oral penems on Enterobacterales infection treatment and evaluated evidence for faropenem resistance and cross-resistance to carbapenems. PubMed, Embase, J-STAGE and CiNii were searched for relevant English- or Japanese-language articles published between 1 January 1996 and 6 August 2021. Key Findings From 705 unique publications, 29 eligible articles were included (16 in vitro studies; 10 clinical trials; 2 in vitro and in vivo studies; and 1 retrospective medical chart review). Limited evidence described faropenem to treat infectious disease; only four randomized clinical trials were identified. Faropenem dosing regimens varied broadly within and between indications. One study indicated potential dependence of penem efficacy on underlying antibiotic resistance mechanisms, while several studies reported UTI persistence or recurrence after faropenem treatment. In vitro MIC data suggested some potential bacterial resistance to faropenem, while limited clinical data showed resistance emergence after faropenem treatment. Preliminary in vitro evidence suggested faropenem resistance might foster cross-resistance to carbapenems. Overall, very limited clinical evidence describes faropenem for treating infectious diseases. Preclinical and clinical research investment and dedicated community surveillance monitoring is crucial for understanding faropenem treatment patterns, resistance and potential cross-resistance to carbapenems.
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Affiliation(s)
- Sumanth Gandra
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Satoshi Takahashi
- Division of Laboratory Medicine, Sapporo Medical University Hospital, Sapporo, Japan,Department of Infection Control and Laboratory Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
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Detection of Multidrug-Resistant Enterobacterales-From ESBLs to Carbapenemases. Antibiotics (Basel) 2021; 10:antibiotics10091140. [PMID: 34572722 PMCID: PMC8465816 DOI: 10.3390/antibiotics10091140] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 12/16/2022] Open
Abstract
Multidrug-resistant Enterobacterales (MDRE) are an emerging threat to global health, leading to rising health care costs, morbidity and mortality. Multidrug-resistance is commonly caused by different β-lactamases (e.g., ESBLs and carbapenemases), sometimes in combination with other resistance mechanisms (e.g., porin loss, efflux). The continuous spread of MDRE among patients in hospital settings and the healthy population require adjustments in healthcare management and routine diagnostics. Rapid and reliable detection of MDRE infections as well as gastrointestinal colonization is key to guide therapy and infection control measures. However, proper implementation of these strategies requires diagnostic methods with short time-to-result, high sensitivity and specificity. Therefore, research on new techniques and improvement of already established protocols is inevitable. In this review, current methods for detection of MDRE are summarized with focus on culture based and molecular techniques, which are useful for the clinical microbiology laboratory.
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Systematic Comparison of Three Commercially Available Combination Disc Tests and the Zinc-Supplemented Carbapenem Inactivation Method (zCIM) for Carbapenemase Detection in Enterobacterales Isolates. J Clin Microbiol 2021; 59:e0314020. [PMID: 34133894 PMCID: PMC8373033 DOI: 10.1128/jcm.03140-20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Detection of carbapenemases in Enterobacterales is crucial for patient treatment and infection control. Among others, combination disc tests (CDTs) with different inhibitors (e.g., EDTA) and variations of the carbapenem inactivation method (CIM) are recommended by EUCAST or the CLSI and are used by many laboratories as they are relatively inexpensive. In this study, we compare three commercially available CDTs, faropenem disc testing (FAR), and the zinc-supplemented CIM (zCIM) test for the detection of carbapenemase-producing Enterobacterales (CPE). The Rosco KPC/MBL and OXA-48 Confirm kit (ROS-CDT), the Liofilchem KPC&MBL&OXA-48 disc kit (LIO-CDT), Mastdiscs Combi Carba plus (MAST-CDT), FAR, and zCIM were challenged with 106 molecularly characterized CPE and 47 non-CPE isolates. The sensitivities/specificities were 86% (confidence interval [CI], 78 to 92%)/98% (CI, 89 to 100%) for MAST-CDT and ROS-CDT, 96% (CI, 91 to 99%)/87% (CI, 74 to 95%) for LIO-CDT, and 99% (CI, 95 to 100%)/81% (CI, 67 to 91%) for FAR compared to 98% (CI, 93 to 100%)/100% (CI, 92 to 100%) for zCIM. The CDTs showed great performance differences depending on the carbapenemase class, with MAST-CDT and LIO-CDT best detecting class B, ROS-CDT best detecting class A, and LIO-CDT best detecting class D carbapenemases. The overall performance of commercially available CDTs was good but varied greatly for different carbapenemases and between manufacturers, compared with FAR and zCIM, which performed well for all carbapenemase types. For reliable carbapenemase detection, CDTs should preferably not be used as the sole test but can be part of a diagnostic strategy when combined with other assays (e.g., CIM-based, immunochromatographic, or molecular tests).
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Cordovana M, Abdalla M, Ambretti S. Evaluation of the MBT STAR-Carba Assay for the Detection of Carbapenemase Production in Enterobacteriaceae and Hafniaceae with a Large Collection of Routine Isolates from Plate Cultures and Patient-Derived Positive Blood Cultures. Microb Drug Resist 2020; 26:1298-1306. [PMID: 32412820 DOI: 10.1089/mdr.2019.0466] [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] [Indexed: 12/30/2022] Open
Abstract
The spread of carbapenemase-producing Enterobacterales is a major public health concern worldwide, and methods for their prompt and reliable detection are highly demanded for therapeutic and hygiene control purposes. In this study, we evaluate the MBT STAR®-Carba assay (Bruker Daltonik) to detect the carbapenemase production in clinical and surveillance isolates from plate cultures and directly from patient-derived positive blood cultures bottles. Overall, n = 1,307 samples were analyzed (n = 900 plate cultures, and n = 407 positive blood cultures, using the bacterial pellet obtained with the Sepsityper® Kit; Bruker Daltonik), including n = 793 carbapenemase producers (n = 579 Klebsiella pneumoniae carbapenemase, n = 161 metallo-beta-lactamases, n = 45 OXA-48, and eight isolates harboring two different enzymes), n = 239 carbapenem-resistant noncarbapenemase producers, and n = 275 carbapenem-susceptible strains. The STAR-Carba assay detected 657/661 (99.4%) carbapenemase producers from plate cultures, and 132/132 (100%) from positive blood cultures. Specificity resulted in 100% for carbapenem-susceptible strains, and 91.6% for carbapenem-resistant strains resulted negative for carbapenamase production with the routine methods used in this study. In this study, the MBT STAR-Carba assay proved to be a highly reliable method for the detection of carbapenemase-producing Enterobacterales, regardless of the enzyme family, and from both plate cultures and positive blood culture bottles.
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Affiliation(s)
- Miriam Cordovana
- Unit of Microbiology, University Hospital Sant'Orsola-Malpighi of Bologna, Bologna, Italy
| | - Mohammad Abdalla
- Department of Pathology and Microbiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Simone Ambretti
- Unit of Microbiology, University Hospital Sant'Orsola-Malpighi of Bologna, Bologna, Italy
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5
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Gandra S, Choi J, McElvania E, Green SJ, Harazin M, Thomson RB, Dantas G, Singh KS, Das S. Faropenem resistance causes in vitro cross-resistance to carbapenems in ESBL-producing Escherichia coli. Int J Antimicrob Agents 2020; 55:105902. [PMID: 31954833 DOI: 10.1016/j.ijantimicag.2020.105902] [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: 08/30/2019] [Revised: 01/07/2020] [Accepted: 01/11/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Faropenem is an oral penem drug with activity against Gram-positive and Gram-negative bacteria, including CTX-M-15-type extended spectrum beta-lactamase (ESBL)-producing Enterobacteriales and anaerobic bacteria. As there are structural similarities, there is concern for the development of carbapenem cross-resistance; however, there are no studies confirming this. This study examined whether in vitro development of faropenem resistance in Escherichia coli isolates would result in cross-resistance to carbapenems. METHODS Four well-characterized E. coli isolates from the US Centers for Disease Control and Prevention antibiotic resistance isolate bank were utilized. Three isolates (NSF1, NSF2 and NSF3) are ESBL producers (CTX-M-15) and one (NSF4) is pan-susceptible. Faropenem minimum inhibitory concentrations (MICs) were determined and resistance was induced by serial passaging in increasing concentrations of faropenem. Susceptibility to carbapenems was determined and whole-genome sequencing (WGS) was performed to identify the underlying genetic mechanism leading to carbapenem resistance. RESULTS Faropenem MIC increased from 1 mg/L to 64 mg/L within 10 days for NSF2 and NSF4 isolates, and from 2 mg/L to 64 mg/L within 7 days for NSF1 and NSF3 isolates. Reduced carbapenem susceptibility (ertapenem MIC ≥8 mg/L, doripenem/meropenem ≥2 mg/L and imipenem ≥1 mg/L) developed among three CTX-M-15-producing isolates that were faropenem-resistant, but not in NSF4 isolate that lacked ESBL enzyme. WGS analysis revealed non-synonymous changes in the ompC gene among three CTX-M-15-producing isolates, and a single nucleotide polymorphism (SNP) in the envZ gene in NSF4 isolate. CONCLUSION Induced resistance to faropenem causes cross-resistance to carbapenems among E. coli isolates containing CTX-M-15-type ESBL enzymes.
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Affiliation(s)
- Sumanth Gandra
- Clinical Microbiology Laboratory, Department of Pathology, NorthShore University HealthSystem, Evanston, Illinois; Department of Pathology, The University of Chicago Pritzker School of Medicine, Chicago, Illinois.
| | - JooHee Choi
- The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Erin McElvania
- Clinical Microbiology Laboratory, Department of Pathology, NorthShore University HealthSystem, Evanston, Illinois
| | - Stefan J Green
- Sequencing Core, Research Resources Center, University of Illinois at Chicago, Chicago, Illinois
| | - Maureen Harazin
- Clinical Microbiology Laboratory, Department of Pathology, NorthShore University HealthSystem, Evanston, Illinois
| | - Richard B Thomson
- Clinical Microbiology Laboratory, Department of Pathology, NorthShore University HealthSystem, Evanston, Illinois; Department of Pathology, The University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Gautam Dantas
- The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kamal S Singh
- Clinical Microbiology Laboratory, Department of Pathology, NorthShore University HealthSystem, Evanston, Illinois; Department of Pathology, The University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Sanchita Das
- Clinical Microbiology Laboratory, Department of Pathology, NorthShore University HealthSystem, Evanston, Illinois; Department of Pathology, The University of Chicago Pritzker School of Medicine, Chicago, Illinois
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Abstract
Surveillance studies have shown that OXA-48-like carbapenemases are the most common carbapenemases in Enterobacterales in certain regions of the world and are being introduced on a regular basis into regions of nonendemicity, where they are responsible for nosocomial outbreaks. OXA-48, OXA-181, OXA-232, OXA-204, OXA-162, and OXA-244, in that order, are the most common enzymes identified among the OXA-48-like carbapenemase group. OXA-48 is associated with different Tn1999 variants on IncL plasmids and is endemic in North Africa and the Middle East. OXA-162 and OXA-244 are derivatives of OXA-48 and are present in Europe. OXA-181 and OXA-232 are associated with ISEcp1, Tn2013 on ColE2, and IncX3 types of plasmids and are endemic in the Indian subcontinent (e.g., India, Bangladesh, Pakistan, and Sri Lanka) and certain sub-Saharan African countries. Overall, clonal dissemination plays a minor role in the spread of OXA-48-like carbapenemases, but certain high-risk clones (e.g., Klebsiella pneumoniae sequence type 147 [ST147], ST307, ST15, and ST14 and Escherichia coli ST38 and ST410) have been associated with the global dispersion of OXA-48, OXA-181, OXA-232, and OXA-204. Chromosomal integration of bla OXA-48 within Tn6237 occurred among E. coli ST38 isolates, especially in the United Kingdom. The detection of Enterobacterales with OXA-48-like enzymes using phenotypic methods has improved recently but remains challenging for clinical laboratories in regions of nonendemicity. Identification of the specific type of OXA-48-like enzyme requires sequencing of the corresponding genes. Bacteria (especially K. pneumoniae and E. coli) with bla OXA-48, bla OXA-181, and bla OXA-232 are emerging in different parts of the world and are most likely underreported due to problems with the laboratory detection of these enzymes. The medical community should be aware of the looming threat that is posed by bacteria with OXA-48-like carbapenemases.
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Ohsaki Y, Kubo R, Hobson J, Davies M, Osaka S, Hayashi W, Taniguchi Y, Koide S, Nagano Y, Nagano N. MASTDISCS combi Carba plus, a simple method for discriminating carbapenemase-producing Enterobacteriaceae, including OXA-48-type producers. Microbiol Immunol 2018; 62:60-65. [PMID: 29115680 DOI: 10.1111/1348-0421.12553] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 10/15/2017] [Accepted: 11/01/2017] [Indexed: 11/28/2022]
Abstract
Accurate and rapid detection of carbapenemases and identification of their types in Enterobacteriaceae are both still major challenges for clinical laboratories in attempting to prevent the intrusion and transmission of carbapenemase-producing Enterobacteriaceae. This study aimed to evaluate the performance of the MASTDISCS combi Carba plus disc system in identification of different carbapenemase types, including OXA-48-type carbapenemase, for which no specific enzyme inhibitors have so far been available. The simple disc system discriminates carbapenemases, including OXA-48-types exhibiting low carbapenem minimum inhibitory concentrations, by targeting Enterobacteriaceae isolates with a EUCAST meropenem screening cut-off of ≥0.25 mg/L.
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Affiliation(s)
- Yusuke Ohsaki
- Department of Health and Medical Sciences, Shinshu University Graduate School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Ryoichi Kubo
- Kanto Chemical Co., Inc., East Muromachi Mitsui BLDG 2-l, Nihombashi Muromachi 2-chome, Chuo-ku, Tokyo 103-0022, Japan
| | - Jonathan Hobson
- Mast Group Ltd., Mast House, Derby Road, Bootle, Merseyside, L20 1EA, UK.,School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, James Parsons Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Mya Davies
- Mast Group Ltd., Mast House, Derby Road, Bootle, Merseyside, L20 1EA, UK.,School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, James Parsons Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Shunsuke Osaka
- Department of Health and Medical Sciences, Shinshu University Graduate School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Wataru Hayashi
- Department of Health and Medical Sciences, Shinshu University Graduate School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Yui Taniguchi
- Department of Health and Medical Sciences, Shinshu University Graduate School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Shota Koide
- Department of Health and Medical Sciences, Shinshu University Graduate School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Yukiko Nagano
- Department of Bacteriology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Noriyuki Nagano
- Department of Health and Medical Sciences, Shinshu University Graduate School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
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8
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Fröding I, Vondracek M, Giske CG. Rapid EUCAST disc diffusion testing of MDR Escherichia coli and Klebsiella pneumoniae: inhibition zones for extended-spectrum cephalosporins can be reliably read after 6 h of incubation. J Antimicrob Chemother 2017; 72:1094-1102. [PMID: 27999046 DOI: 10.1093/jac/dkw515] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 11/02/2016] [Indexed: 01/20/2023] Open
Abstract
Objectives The need for rapid antibiotic susceptibility testing increases with escalating levels of antimicrobial resistance in Enterobacteriaceae. Our objective was to evaluate the accuracy of reading EUCAST disc diffusion, ROSCO ESBL and carbapenemase detection kits and the Mast Carbapenemase Activity Test (CAT-ID) disc, after 6 h of incubation. Methods We used a collection of 128 isolates of Escherichia coli and Klebsiella pneumoniae with a wide variety of resistance mechanisms. Inhibition zones read from digital photo images with the BD Kiestra™ Total Lab Automation System after 6 h of incubation were compared with standard reading, after 18 h, of the same Mueller-Hinton agar plates. Results For WT isolates, zones were generally smaller at 6 h than at 18 h. Cefotaxime had excellent categorical agreement of 99%, despite the high number of challenge isolates. However, for some other antimicrobials, hetero-resistant subpopulations were commonly invisible at 6 h, which resulted in an unacceptable number of errors when using standard EUCAST breakpoints. Accurate ESBL detection was possible at 6 h for isolates lacking other β-lactamases. Carbapenemase detection was not reliable after 6 h. Conclusions Inhibition zone reading at 6 h is an accurate method for susceptibility testing of extended-spectrum cephalosporins for Enterobacteriaceae. For other antimicrobials, 6 h reading can be used for preliminary reports of clearly resistant or susceptible isolates, preferably with application of adjusted breakpoints including an area of uncertainty between susceptible and resistant values.
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Affiliation(s)
- Inga Fröding
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Vondracek
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Christian G Giske
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
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Aguirre-Quiñonero A, Martínez-Martínez L. Non-molecular detection of carbapenemases in Enterobacteriaceae clinical isolates. J Infect Chemother 2017; 23:1-11. [DOI: 10.1016/j.jiac.2016.09.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 09/28/2016] [Accepted: 09/28/2016] [Indexed: 01/11/2023]
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Comparison of Phenotypic Tests and an Immunochromatographic Assay and Development of a New Algorithm for Detection of OXA-48-like Carbapenemases. J Clin Microbiol 2016; 55:877-883. [PMID: 28031433 DOI: 10.1128/jcm.01929-16] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 12/19/2016] [Indexed: 01/20/2023] Open
Abstract
OXA-48 is the most prevalent carbapenemase in Enterobacteriaceae in Europe and the Middle East, but it is frequently missed because many isolates display low MICs for carbapenems. Furthermore, in contrast to metallo-β-lactamases or Klebsiella pneumoniae carbapenemases (KPC), no specific inhibitor is available for the phenotypic detection of OXA-48. Molecular detection of blaOXA-48 is the "gold standard" but is not available in many laboratories. A few phenotypic assays have been described but have not been independently evaluated. The aim of this study was the systematic comparison of phenotypic tests and an immunochromatographic assay (ICT) for the detection of OXA-48/OXA-48-like carbapenemases and the development of an algorithm for reliable phenotypic detection of OXA-48. Four phenotypic tests (temocillin disk test, faropenem disk test, OXA-48 disk test, and high-inoculum [HI] OXA-48 disk test) and a new ICT (OXA-48 K-SeT) were compared by using a set of 166 Enterobacteriaceae isolates, including isolates producing OXA-48/OXA-48-like carbapenemases (n = 84) or Ambler class A and B carbapenemases (n = 41) and carbapenemase-negative isolates (n = 41). The sensitivity and specificity for the different assays were 100% and 43.9% for temocillin, 57.1% and 98.8% for faropenem, 53.6% and 100% for the OXA-48 disk test, 98.8% and 97.6% for the HI OXA-48 disk test, and 100% and 100% for the ICT, respectively. The ICT displayed the highest sensitivity and specificity and was the most rapid assay, but it is more costly than phenotypic assays. Based on these results, a new algorithm incorporating temocillin, faropenem, and ICT which allows cost-effective detection of OXA-48 with 100% sensitivity and specificity was developed.
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Intestinal Carriage of Carbapenemase-Producing Organisms: Current Status of Surveillance Methods. Clin Microbiol Rev 2016; 29:1-27. [PMID: 26511484 DOI: 10.1128/cmr.00108-14] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Carbapenemases have become a significant mechanism for broad-spectrum β-lactam resistance in Enterobacteriaceae and other Gram-negative bacteria such as Pseudomonas and Acinetobacter spp. Intestinal carriage of carbapenemase-producing organisms (CPOs) is an important source of transmission. Isolation of carriers is one strategy that can be used to limit the spread of these bacteria. In this review, we critically examine the clinical performance, advantages, and disadvantages of methods available for the detection of intestinal carriage of CPOs. Culture-based methods (Centers for Disease Control and Prevention [CDC] protocols, chromogenic media, specialized agars, and double-disk synergy tests) for detecting carriage of CPOs are convenient due to their ready availability and low cost, but their limited sensitivity and long turnaround time may not always be optimal for infection control practices. Contemporary nucleic acid amplification techniques (NAATs) such as real-time PCR, hybridization assays, loop-mediated isothermal amplification (LAMP), or a combined culture and NAAT approach may provide fast results and/or added sensitivity and specificity compared with culture-based methods. Infection control practitioners and clinical microbiologists should be aware of the strengths and limitations of available methods to determine the most suitable approach for their medical facility to fit their infection control needs.
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12
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Matsumura Y, Pitout JD. Recent advances in the laboratory detection of carbapenemase-producing Enterobacteriaceae. Expert Rev Mol Diagn 2016; 16:783-94. [PMID: 27042955 DOI: 10.1586/14737159.2016.1172964] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Carbapenemase-producing Enterobacteriaceae (CPE), mainly Klebsiella pneumoniae and Escherichia coli, have been increasing rapidly on a global scale and are considered to be significant health threats. The most common carbapenemases are KPCs, NDMs, OXA-48-like, IMPs and VIMs but their distribution and prevalence differs between countries. The accurate, simple, cost effective and rapid detection of carbapenemases in clinical laboratories is an important initial step to control the spread of CPE within institutions. The diversity of carbapenemases in general, has challenged a simple approach for the detection of most types of CPE. This article summarizes the current and describes newer techniques available for the detection of carbapenemases among Enterobacteriaceae. The authors also provide a simplified approach for the accurate and rapid detection of CPEs that can easily be implemented in a clinical diagnostic laboratory.
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Affiliation(s)
- Yasufumi Matsumura
- a Department of Clinical Laboratory Medicine , Kyoto University Graduate School of Medicine , Kyoto , Japan.,b Departments of Pathology & Laboratory Medicine , University of Calgary , Calgary , Canada.,c Microbiology, Immunology and Infectious Diseases , University of Calgary , Calgary , Canada.,d Snyder Institute for Chronic Diseases , University of Calgary , Calgary , Canada
| | - Johann D Pitout
- b Departments of Pathology & Laboratory Medicine , University of Calgary , Calgary , Canada.,c Microbiology, Immunology and Infectious Diseases , University of Calgary , Calgary , Canada.,d Snyder Institute for Chronic Diseases , University of Calgary , Calgary , Canada.,e Division of Microbiology, Calgary Laboratory Services , University of Calgary , Calgary , Canada.,f Department of Medical Microbiology , University of Pretoria , Pretoria , South Africa
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Gandra S, Klein EY, Pant S, Malhotra-Kumar S, Laxminarayan R. Faropenem Consumption is Increasing in India. Clin Infect Dis 2016; 62:1050-2. [PMID: 26908807 DOI: 10.1093/cid/ciw055] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sumanth Gandra
- Center for Disease Dynamics, Economics & Policy, New Delhi
| | - Eili Y Klein
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland Center for Disease Dynamics, Economics & Policy, Washington D.C
| | - Suraj Pant
- Center for Disease Dynamics, Economics & Policy, Washington D.C
| | - Surbhi Malhotra-Kumar
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Belgium
| | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics & Policy, New Delhi Public Health Foundation of India, Gurgaon Princeton Environmental Institute, New Jersey
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Mirande C, Canard I, Buffet Croix Blanche S, Charrier JP, van Belkum A, Welker M, Chatellier S. Rapid detection of carbapenemase activity: benefits and weaknesses of MALDI-TOF MS. Eur J Clin Microbiol Infect Dis 2015; 34:2225-34. [DOI: 10.1007/s10096-015-2473-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 08/16/2015] [Indexed: 11/28/2022]
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Al-Bayssari C, Dabboussi F, Hamze M, Rolain JM. Detection of expanded-spectrum β-lactamases in Gram-negative bacteria in the 21st century. Expert Rev Anti Infect Ther 2015; 13:1139-58. [PMID: 26162631 DOI: 10.1586/14787210.2015.1066247] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Emerging β-lactamase-producing-bacteria (ESBL, AmpC and carbapenemases) have become a serious problem in our community due to their startling spread worldwide and their ability to cause infections which are difficult to treat. Diagnosis of these β-lactamases is of clinical and epidemiological interest. Over the past 10 years, several methods have been developed aiming to rapidly detect these emerging enzymes, thus preventing their rapid spread. In this review, we describe the range of screening and detection methods (phenotypic, molecular and other) for detecting these β-lactamases but also whole genome sequencing as a tool for detecting the genes encoding these enzymes.
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Affiliation(s)
- Charbel Al-Bayssari
- Laboratoire Microbiologie Santé et Environnement (LMSE), Centre Azm pour la Recherche en Biotechnologie et ses Applications, Ecole Doctorale de Sciences et de Technologie, Université Libanaise, Tripoli, Liban
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Jamal WY, Albert MJ, Khodakhast F, Poirel L, Rotimi VO. Emergence of New Sequence Type OXA-48 Carbapenemase-ProducingEnterobacteriaceaein Kuwait. Microb Drug Resist 2015; 21:329-34. [DOI: 10.1089/mdr.2014.0123] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Wafaa Y. Jamal
- Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
- Microbiology Unit, Mubarak Al-Kabir Hospital, Jabriya, Kuwait
| | - M. John Albert
- Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
- Microbiology Unit, Mubarak Al-Kabir Hospital, Jabriya, Kuwait
| | - Fatima Khodakhast
- Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
- Microbiology Unit, Mubarak Al-Kabir Hospital, Jabriya, Kuwait
| | - Laurent Poirel
- Medical and Molecular Microbiology Unit, Department of Medicine, Faculty of Science, University of Fribourg, Fribourg, Switzerland
- INSERM U914, South-Paris Medical School, K.-Bicêtre, Paris, France
| | - Vincent O. Rotimi
- Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
- Microbiology Unit, Mubarak Al-Kabir Hospital, Jabriya, Kuwait
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17
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Faropenem disks for screening of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae. J Clin Microbiol 2015; 52:3501-2. [PMID: 25143417 DOI: 10.1128/jcm.02837-13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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18
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Prevalence and clinical burden of NDM-1 positive infections in pediatric and neonatal patients in Pakistan. Pediatr Infect Dis J 2015; 34:452-4. [PMID: 25764102 DOI: 10.1097/inf.0000000000000582] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In a neonatal/pediatric Gram-negative infection study from Islamabad, 71/82 strains were carbapenem resistant with 12/82 positive for New Delhi Metallo-β-lactamase and many being extensively antibiotic resistant. Burden and outcome analysis on 9 patients showed that 4/9 died after inadequate therapy regardless of organism type.
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Sahuquillo-Arce JM, Hernández-Cabezas A, Yarad-Auad F, Ibáñez-Martínez E, Falomir-Salcedo P, Ruiz-Gaitán A. Carbapenemases: A worldwide threat to antimicrobial therapy. World J Pharmacol 2015; 4:75-95. [DOI: 10.5497/wjp.v4.i1.75] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 11/07/2014] [Accepted: 12/01/2014] [Indexed: 02/07/2023] Open
Abstract
Carbapenems are potent β-lactams with activity against extended-spectrum cephalosporinases and β-lactamases. These antibiotics, derived from thienamycn, a carbapenem produced by the environmental bacterium Streptomyces cattleya, were initially used as last-resort treatments for severe Gram-negative bacterial infections presenting resistance to most β-lactams but have become an empirical option in countries with high prevalence of Extended Spectrum β-lactamase-producing bacterial infections. Imipenem, the first commercially available carbapenem, was approved for clinical use in 1985. Since then, a wide variety of carbapenem-resistant bacteria has appeared, primarily Enterobacteriaceae such as Escherichia coli or Klebsiella pneumoniae (K. pneumoniae), Pseudomonas aeruginosa and Acinetobacter baumannii, presenting different resistance mechanisms. The most relevant mechanism is the production of carbapenem-hydrolyzing β-lactamases, also known as carbapenemases. These enzymes also inactivate all known β-lactams, and some of these enzymes can be acquired through horizontal gene transfer. Moreover, plasmids, transposons and integrons harboring these genes typically carry other resistance determinants, rendering the recipient bacteria resistant to almost all currently used antimicrobials, as is the case for K. pneumoniae carbapenemase - or New Delhi metallo-β-lactamases-type enzymes. The recent advent of these enzymes in the health landscape presents a serious challenge. First, the emergence of carbapenemases limits the currently available treatment options; second, these enzymes pose a risk to patients, as some studies have demonstrated high mortality associated with carbapenemase-producing bacterial infections; and third, these circumstances require an extra cost to sanitary systems, which are particularly cumbersome in developing countries. Therefore, emphasis should be placed on the early detection of these enzymes, the prevention of the spread of carbapenemase-producing bacteria and the development of new drugs resistant to carbapenemase hydrolysis.
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Hrabák J, Chudáčková E, Papagiannitsis CC. Detection of carbapenemases in Enterobacteriaceae: a challenge for diagnostic microbiological laboratories. Clin Microbiol Infect 2014; 20:839-53. [PMID: 24813781 DOI: 10.1111/1469-0691.12678] [Citation(s) in RCA: 154] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Carbapenemase-producing bacteria have now spread all over the world. Infections caused by those bacteria are difficult to treat. Therefore, there is an urgent need for accurate and fast detection of carbapenemases in diagnostic laboratories. In this review, we summarize screening methods for suspected isolates, direct assays for confirmation of carbapenemase activity (e.g. the Carba NP test and matrix-assisted laser desorption ionization time-of-flight mass spectrometry carbapenem hydrolysis assay), inhibitor-based methods for carbapenemase classification, and molecular-genetic techniques for precise identification of carbapenemase genes. We also propose a workflow for carbapenemase identification in diagnostic laboratories.
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Affiliation(s)
- J Hrabák
- Department of Microbiology, Faculty of Medicine and University Hospital in Plzeň, Charles University in Prague, Plzeň, Czech Republic
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21
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Kruse EB, Aurbach U, Wisplinghoff H. Carbapenem-Resistant Enterobacteriaceae: Laboratory Detection and Infection Control Practices. Curr Infect Dis Rep 2013; 15:549-558. [PMID: 24122401 DOI: 10.1007/s11908-013-0373-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Over the past decade, carbapenem-resistant Enterobacteriaceae (CRE) have become one of the most challenging problems in infectious diseases. Fast and accurate detection of carbapenem resistance is crucial for guiding the treatment of the individual patient as well as for instituting proper infection control measures to limit the spread of the organism. Currently there are no consensus recommendations for screening, detection and confirmation of CRE either on the clinical or the laboratory side. In infection control, data from controlled intervention studies is largely missing and most recommendations have been deduced from outbreak situations. From the available limited evidence, infection control guidelines have been developed in most countries at national, regional and hospital levels. The aim of this review is to summarize the currently available laboratory methods and infection control options.
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Affiliation(s)
- Eva-Brigitta Kruse
- Laboratoriumsmedizin Köln, Dres. med. Wisplinghoff und Kollegen, Cologne, Germany
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Huang TD, Poirel L, Bogaerts P, Berhin C, Nordmann P, Glupczynski Y. Temocillin and piperacillin/tazobactam resistance by disc diffusion as antimicrobial surrogate markers for the detection of carbapenemase-producing Enterobacteriaceae in geographical areas with a high prevalence of OXA-48 producers. J Antimicrob Chemother 2013; 69:445-50. [PMID: 24055766 DOI: 10.1093/jac/dkt367] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To assess the performance of the agar disc diffusion method for the detection of carbapenemase-producing Enterobacteriaceae (CPE) referred to the national reference laboratories (NRLs) in Belgium and France. METHODS All Enterobacteriaceae isolates referred to the NRLs for the confirmation of CPE in 2012 were included. The inhibition zone diameters of meropenem, piperacillin/tazobactam and temocillin using CLSI disc diffusion methodology were recorded. Phenotypic and molecular detection of carbapenemases was performed on all isolates. RESULTS A total of 1354 Enterobacteriaceae isolates, including 435 (32.1%) confirmed CPE isolates [OXA-48 (n = 323), KPC (n = 60), VIM (n = 32) and NDM (n = 20)] and 919 carbapenemase-negative isolates, were tested. Using recommended interpretative criteria, non-susceptibility to meropenem had poor sensitivity (52.0% by CLSI susceptibility breakpoint and 80.0% by EUCAST screening breakpoints), while non-susceptibility to piperacillin/tazobactam (according to CLSI breakpoint) or to temocillin (according to Fuchs, Barry, Thornsberry et al. Eur J Clin Microbiol 1985; 4: 30-3) was highly sensitive (99.8% and 98.2%, respectively) but poorly specific (29.4% and 42.9%, respectively) for the detection of CPE. Temocillin diameters <12 mm alone had high specificity (90.0%) and the combination of temocillin diameters ≥12 mm with piperacillin/tazobactam diameters ≥16 mm observed in 40% of all referred isolates displayed excellent negative predictive value (99.2%). CONCLUSIONS In geographical areas with a high prevalence of OXA-48 producers, recommended meropenem susceptibility or screening breakpoints failed to detect CPE in a large proportion of isolates. The combination of modified zone diameter cut-offs for piperacillin/tazobactam (≥16 mm) and temocillin (≥12 mm) can be used to rule out the presence of carbapenemase and avoid unnecessary additional testing for confirmation of CPE.
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Affiliation(s)
- Te-Din Huang
- National Reference Laboratory for Monitoring of Antimicrobial Resistance in Gram-negative Bacteria, CHU Mont-Godinne, Université Catholique de Louvain (UCL), 1 Avenue Docteur Gaston Therasse, 5530 Yvoir, Belgium
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