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Structural and Biochemical Features of OXA-517: a Carbapenem and Expanded-Spectrum Cephalosporin Hydrolyzing OXA-48 Variant. Antimicrob Agents Chemother 2023; 67:e0109522. [PMID: 36648230 PMCID: PMC9933634 DOI: 10.1128/aac.01095-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OXA-48-producing Enterobacterales have now widely disseminated throughout the world. Several variants have now been reported, differing by just a few amino-acid substitutions or deletions, mostly in the region of the loop β5-β6. As OXA-48 hydrolyzes carbapenems but lacks significant expanded-spectrum cephalosporin (ESC) hydrolytic activity, ESCs were suggested as a therapeutic option. Here, we have characterized OXA-517, a natural variant of OXA-48- with an Arg214Lys substitution and a deletion of Ile215 and Glu216 in the β5-β6 loop, capable of hydrolyzing at the same time ESC and carbapenems. MICs values of E. coli expressing blaOXA-517 gene revealed reduced susceptibility to carbapenems (similarly to OXA-48) and resistance to ESCs. Steady-state kinetic parameters revealed high catalytic efficiencies for ESCs and carbapenems. The blaOXA-517 gene was located on a ca. 31-kb plasmid identical to the prototypical IncL blaOXA-48-carrying plasmid except for an IS1R-mediated deletion of 30.7-kb in the tra operon. The crystal structure of OXA-517, determined to 1.86 Å resolution, revealed an expanded active site compared to that of OXA-48, which allows for accommodation of the bulky ceftazidime substrate. Our work illustrates the remarkable propensity of OXA-48-like carbapenemases to evolve through mutation/deletion in the β5-β6 loop to extend its hydrolysis profile to encompass most β-lactam substrates.
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Mitteregger D, Wessely J, Barišić I, Bedenić B, Kosak D, Kundi M. Reply to Muntean et al. Comment on “Mitteregger et al. A Variant Carbapenem Inactivation Method (CIM) for Acinetobacter baumannii Group with Shortened Time-to-Result: rCIM-A. Pathogens 2022, 11, 482”. Pathogens 2022; 11:pathogens11070767. [PMID: 35890012 PMCID: PMC9324351 DOI: 10.3390/pathogens11070767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 06/25/2022] [Accepted: 07/01/2022] [Indexed: 01/27/2023] Open
Affiliation(s)
- Dieter Mitteregger
- Department of Clinical Microbiology, Laboratory Dr. Kosak, Dr. Reckendorfer and Partner, 1090 Vienna, Austria;
- Correspondence:
| | - Julian Wessely
- Department of Clinical Microbiology, Laboratory Dr. Kosak, Dr. Reckendorfer and Partner, 1090 Vienna, Austria;
| | - Ivan Barišić
- Molecular Diagnostics, Center for Health & Bioressources, AIT Austrian Institute of Technology GmbH, 2444 Vienna, Austria;
| | - Branka Bedenić
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; or
- Clinical Department of Clinical and Molecular Microbiology, University Hospital Center Zagreb, 10000 Zagreb, Croatia
| | - Dieter Kosak
- Department of Clinical Pathology, Laboratory Dr. Kosak, Dr. Reckendorfer and Partner, 1090 Vienna, Austria;
| | - Michael Kundi
- Center for Public Health, Department of Environmental Health, Medical University of Vienna, 1090 Vienna, Austria;
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Muntean AA, Muntean MM, Oueslati S, Bonnin R, Naas T, Popa MI. Comment on Mitteregger et al. A Variant Carbapenem Inactivation Method (CIM) for Acinetobacter baumannii Group with Shortened Time-to-Result: rCIM-A. Pathogens 2022, 11, 482. Pathogens 2022; 11:pathogens11070751. [PMID: 35889996 PMCID: PMC9317618 DOI: 10.3390/pathogens11070751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/13/2022] [Accepted: 06/27/2022] [Indexed: 02/05/2023] Open
Affiliation(s)
- Andrei-Alexandru Muntean
- Cantacuzino National Medical Military Institute for Research and Developement, Carol Davila University of Medicine and Pharmacy, 050096 Bucharest, Romania; (A.-A.M.); (M.-M.M.)
| | - Madalina-Maria Muntean
- Cantacuzino National Medical Military Institute for Research and Developement, Carol Davila University of Medicine and Pharmacy, 050096 Bucharest, Romania; (A.-A.M.); (M.-M.M.)
| | - Saoussen Oueslati
- University of Paris-Saclay, Kremlin-Bicetre Hospital, 94270 Le Kremlin-Bicêtre, France;
| | - Remy Bonnin
- University of Paris-Saclay, Kremlin Bicetre Hospital, Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriaceae, 94270 Le Kremlin-Bicêtre, France; (R.B.); (T.N.)
| | - Thierry Naas
- University of Paris-Saclay, Kremlin Bicetre Hospital, Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriaceae, 94270 Le Kremlin-Bicêtre, France; (R.B.); (T.N.)
| | - Mircea Ioan Popa
- Cantacuzino National Medical Military Institute for Research and Developement, Carol Davila University of Medicine and Pharmacy, 050096 Bucharest, Romania; (A.-A.M.); (M.-M.M.)
- Correspondence:
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Muntean M, Muntean AA, Preda M, Manolescu L, Dragomirescu C, Popa MI, Popa G. Phenotypic and genotypic detection methods for antimicrobial resistance in ESKAPE pathogens (Review). Exp Ther Med 2022; 24:508. [PMID: 35837033 PMCID: PMC9257796 DOI: 10.3892/etm.2022.11435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/05/2021] [Indexed: 11/10/2022] Open
Abstract
Antimicrobial resistance (AMR) represents a growing public health problem worldwide. Infections with such bacteria lead to longer hospitalization times, higher healthcare costs and greater morbidity and mortality. Thus, there is a greater need for rapid detection methods in order to limit their spread. The ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp.) are a series of epidemiologically-important microorganisms of great concern due to their high levels of resistance. This review aimed to update the background information on the ESKAPE pathogens as well as to provide a summary of the numerous phenotypic and molecular methods used to detect their AMR mechanisms. While they are usually linked to hospital acquired infections, AMR is also spreading in the veterinary and the environmental sectors. Yet, the epidemiological loop closes with patients which, when infected with such pathogens, often lack therapeutic options. Thus, it was aimed to give the article a One Health perspective.
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Affiliation(s)
- Mădălina Muntean
- Department of Microbiology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Andrei-Alexandru Muntean
- Department of Microbiology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Mădălina Preda
- Department of Microbiology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Loredana Manolescu
- Department of Microbiology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Cerasella Dragomirescu
- Department of Microbiology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Mircea-Ioan Popa
- Department of Microbiology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Gabriela Popa
- Department of Microbiology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Comparative Evaluation of Phenotypic Synergy Tests versus RESIST-4 O.K.N.V. and NG Test Carba 5 Lateral Flow Immunoassays for the Detection and Differentiation of Carbapenemases in Enterobacterales and Pseudomonas aeruginosa. Microbiol Spectr 2022; 10:e0108021. [PMID: 35107384 PMCID: PMC8809327 DOI: 10.1128/spectrum.01080-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The spread of carbapenem-resistant Pseudomonas aeruginosa and carbapenemase-producing Enterobacterales (CPE) has dramatically impacted morbidity and mortality. COVID-19 pandemic has favored the selection of these microorganisms because of the excessive and prolonged use of broad-spectrum antibiotics and the outbreaks related to patient transfer between hospitals and inadequate personal protective equipment. Therefore, early CPE detection is considered essential for their control. We aimed to compare conventional phenotypic synergy tests and two lateral flow immunoassays for detecting carbapenemases in Enterobacterales and P. aeruginosa. We analyzed 100 carbapenem-resistant Gram-negative bacilli isolates, 80 Enterobacterales, and 20 P. aeruginosa (86 isolates producing KPC, NDM, OXA-48, IMP, and VIM carbapenemases and 14 non-carbapenemase-producing isolates). We performed a modified Hodge test, boronic acid and ethylenediaminetetraacetic acid (EDTA) synergy tests, and two lateral flow immunoassays: RESIST-4 O.K.N.V. (Coris Bioconcept) and NG Test Carba 5 (NG Biotech). In total, 76 KPC, seven VIM, one NDM, one OXA-48, and one isolate coproducing KPC + NDM enzymes were included. The concordance of different methods estimated by the Kappa index was 0.432 (standard error: 0.117), thus showing a high variability with the synergy tests with boronic acid and EDTA and reporting 16 false negatives that were detected by the two immunochromatographic methods. Co-production was only detected using immunoassays. Conventional phenotypic synergy tests with boronic acid and EDTA for detecting carbapenemases are suboptimal, and their routine use should be reconsidered. These tests depend on the degree of enzyme expression and the distance between disks. Lateral flow immunoassay tests are a rapid and cost-effective tool to detect and differentiate carbapenemases, improving clinical outcomes through targeted therapy and promoting infection prevention measures. IMPORTANCE Infections due to multidrug-resistant pathogens are a growing problem worldwide. The production of carbapenemases in Pseudomonas aeruginosa and Enterobacterales cause a high impact on the mortality of infected patients. Therefore, it is of great importance to have methods that allow the early detection of these multi-resistant microorganisms, achieving the confirmation of the type of carbapenemase present, with high sensitivity and specificity, with the aim of improving epidemiological control, dissemination, the clinical course to through targeted antibiotic therapy and promoting infection control in hospitals.
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To Be or Not to Be an OXA-48 Carbapenemase. Microorganisms 2022; 10:microorganisms10020258. [PMID: 35208713 PMCID: PMC8875484 DOI: 10.3390/microorganisms10020258] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/11/2022] [Accepted: 01/19/2022] [Indexed: 12/03/2022] Open
Abstract
Since the first description of OXA-48, more than forty variants have been recovered from Enterobacterales isolates. Whereas some OXA-48-related enzymes have been reported as conferring similar resistance patterns, namely, the hydrolysis of carbapenems and penicillins with very weak or almost no activity against expanded-spectrum cephalosporins, some have reduced carbapenem and temocillin hydrolysis, and others hydrolyze expanded-spectrum cephalosporins and carbapenems only marginally. With such drastic differences in the hydrolytic profile, especially of carbapenems, it becomes urgent to establish hydrolytic cutoffs in order to determine when an OXA-48-like enzyme may be considered as a carbapenemase or not. With this aim, the coefficient of activity for imipenem (kcat/Km) was determined for a total of 30 enzymes, including OXA-48, OXA-48-like natural variants, and OXA-48 synthetic mutants. In addition, six different methods for the detection of carbapenemase-producers were performed. The coefficients of activity for imipenem for all the different enzymes went from 550 mM−1·s−1 to 0.02 mM−1·s−1. In order to match the coefficient of activity results with the biochemical confirmatory tests, we suggest the value of 0.27 mM−1·s−1 as the cutoff above which an OXA-48 variant may be considered a carbapenem-hydrolyzing enzyme.
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Nockelmann L, Cremanns M, Gatermann SG, Pfennigwerth N. Evaluation of the rCIM for carbapenemase detection in Enterobacterales and Pseudomonas aeruginosa and description of the TSBrCIM, an optimized variant. J Microbiol Methods 2021; 190:106345. [PMID: 34662678 DOI: 10.1016/j.mimet.2021.106345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/24/2021] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The rapid Carbapenem Inactivation Method (rCIM) was evaluated with a strain collection of 164 and 69 carbapenem-resistant Enterobacterales and Pseudomonas aeruginosa, respectively, that produced various carbapenemases. For an improved carbapenemase detection in Enterobacterales, an optimized variant of the rCIM named TSBrCIM was developed. METHODS Bacterial isolates were incubated with two meropenem disks in distilled water (rCIM) or tryptic soy broth (TSBrCIM). After centrifugation, the supernatant was incubated with a susceptible E. coli indicator strain in tryptic soy broth. Growth of the indicator strain implied carbapenemase activity in the test strain. RESULTS The rCIM detected 100/113 carbapenemase-producing Enterobacterales, resulting in a sensitivity of 88.5% and a specificity of 94.1%. For P. aeruginosa, sensitivity and specificity were 96.0% and 100%, respectively. The TSBrCIM was able to detect 105/113 carbapenemase-producing Enterobacterales, resulting in a sensitivity of 92.9% and a specificity of 96.1%. CONCLUSION This study shows that the TSBrCIM can be valuable tool for detection of carbapenemases in Enterobacterales in the clinical laboratory, while the rCIM showed the best results for carbapenemase detection in P. aeruginosa.
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Affiliation(s)
- Laura Nockelmann
- German National Reference Centre for Multidrug-resistant Gram-negative Bacteria, Department of Medical Microbiology, Ruhr-University Bochum, Universitätsstraße 150, 44801 Bochum, Germany
| | - Martina Cremanns
- German National Reference Centre for Multidrug-resistant Gram-negative Bacteria, Department of Medical Microbiology, Ruhr-University Bochum, Universitätsstraße 150, 44801 Bochum, Germany
| | - Sören G Gatermann
- German National Reference Centre for Multidrug-resistant Gram-negative Bacteria, Department of Medical Microbiology, Ruhr-University Bochum, Universitätsstraße 150, 44801 Bochum, Germany
| | - Niels Pfennigwerth
- German National Reference Centre for Multidrug-resistant Gram-negative Bacteria, Department of Medical Microbiology, Ruhr-University Bochum, Universitätsstraße 150, 44801 Bochum, Germany.
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Rizvi M, Sami H, Azam M, Ben Khalid D, Al Jabri Z, Khan F, Sultan A, Singh A, Perween N, Al Quraini M, Al Muharrmi Z, Rizvi SG. Reliability of carbapenem inactivation method (CIM) and modified carbapenem inactivation method (mCIM) for detection of OXA-48-like and NDM-1. Indian J Med Microbiol 2021; 39:451-456. [PMID: 34330546 DOI: 10.1016/j.ijmmb.2021.07.004] [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: 04/10/2021] [Revised: 07/15/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Carbapenem inactivation method (CIM) and modified carbapenem inactivation method (mCIM) were recently developed for rapid detection of carbapenemase producing Gram negative bacilli (CP-GNB). In this study we compared the ability of modified Hodge test (MHT), CIM and mCIM to identify CP-GNB in Oman and India. METHODS Fifty fully characterized and genotyped CP-GNB (26 OXA-48-like, 2 NDM-1 from Oman and 22 NDM-1 from India) and 8 AmpC as controls in India were subjected to MHT, CIM, mCIM and mCIM with in-house modifications. Wilcoxon paired test and receiver operating characteristics (ROC) were utilised for statistical analysis. RESULTS Isolates were predominantly OXA-48-like genes producing Klebsiella pneumoniae from Oman and NDM-1 producing Escherichia coli from India. MHT was positive in all except one OXA-48-like producers and in 70.8 % of the NDM-1 isolates. The sensitivity of CIM in detecting 0XA-48 like and NDM-1 carbapenemases were 39.2% and 87.5% respectively. mCIM at 4 h detected 92.3 % and 79.1% of 0XA-48 and NDM-1 respectively. Using receiver operative characteristics (ROC), highest sensitivity and specificity for detection of OXA-48-like was obtained by mCIM at 4 h at cut off 17 mm while for NDM-1 CIM was the test of choice at 16 mm. CONCLUSION CIM and mCIM are simple, cheap and easy tests to perform. CIM gave excellent results with NDM1 strains while it was quite poor in predicting OXA-48-like. We recommend CIM and eCIM for rapid identification of NDM-1 producers and mCIM at 4 h and MHT for detection of OXA-48-like. No one method can correctly detect both genotypes. As determined by ROC curves a zone of inhibition of 17 mm was considered adequate for detection of OXA-48-like and 16 mm of NDM-1 by mCIM at 4 h and CIM respectively.
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Affiliation(s)
- Meher Rizvi
- Department of Microbiology and Immunology, College of Medicine and Health Sciences, Sultan Qaboos University Hospital, Muscat, Oman.
| | - Hiba Sami
- Department of Microbiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India
| | - Mohammad Azam
- Department of Medical Laboratories, College of Applied Medical Science, Qassim University, Buraydah, Saudi Arabia
| | - Dhoha Ben Khalid
- Department of Microbiology and Immunology, College of Medicine and Health Sciences, Sultan Qaboos University Hospital, Muscat, Oman
| | - Zaaima Al Jabri
- Department of Microbiology and Immunology, College of Medicine and Health Sciences, Sultan Qaboos University Hospital, Muscat, Oman.
| | - Fatima Khan
- Department of Microbiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India
| | - Asfia Sultan
- Department of Microbiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India
| | - Anuradha Singh
- Department of Microbiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India
| | - Nusrat Perween
- Department of Microbiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India
| | - Munawer Al Quraini
- Department of Microbiology and Immunology, College of Medicine and Health Sciences, Sultan Qaboos University Hospital, Muscat, Oman.
| | - Zakariya Al Muharrmi
- Department of Microbiology and Immunology, College of Medicine and Health Sciences, Sultan Qaboos University Hospital, Muscat, Oman.
| | - Syed G Rizvi
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University Hospital, Muscat, Oman.
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Bogiel T, Rzepka M, Gospodarek-Komkowska E. An Application of Imipenem Discs or P. aeruginosa ATCC 27853 Reference Strain Increases Sensitivity of Carbapenem Inactivation Method for Non-Fermenting Gram-Negative Bacteria. Antibiotics (Basel) 2021; 10:antibiotics10070875. [PMID: 34356796 PMCID: PMC8300646 DOI: 10.3390/antibiotics10070875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/08/2021] [Accepted: 07/16/2021] [Indexed: 01/04/2023] Open
Abstract
Non-fermenting Gram-negative rods are one of the most commonly isolated bacteria from human infections. These microorganisms are typically opportunistic pathogens that pose a serious threat to public health due to possibility of transmission in the human population. Resistance to beta-lactams, due to carbapenemases synthesis, is one of the most important antimicrobial resistance mechanisms amongst them. The aim of this study was to evaluate the usefulness of the Carbapenem Inactivation Method (CIM), and its modifications, for the detection of carbapenemase activity amongst non-fermenting Gram-negative rods. This research involved 81 strains of Gram-negative rods. Of the tested strains, 55 (67.9%) synthesized carbapenemases. For non-fermenting rods, 100% sensitivity and specificity was obtained in the version of the CIM test using imipenem discs and E. coli ATCC 25922 strain. The CIM test allows for differentiation of carbapenems resistance mechanisms resulting from carbapenemase synthesis from other resistance types. It is a reliable diagnostic method for the detection of carbapenemase activity amongst non-fermenting Gram-negative rods. Application of imipenem discs and P. aeruginosa ATCC 27853 reference strain increases CIM results sensitivity, while imipenem discs and E. coli ATCC 25922 strain use maintains full precision of the test for non-fermenting rods.
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Girlich D, Bogaerts P, Bouchahrouf W, Bernabeu S, Langlois I, Begasse C, Arangia N, Dortet L, Huang TD, Glupczynski Y, Naas T. Evaluation of the Novodiag CarbaR+, a Novel Integrated Sample to Result Platform for the Multiplex Qualitative Detection of Carbapenem and Colistin Resistance Markers. Microb Drug Resist 2021; 27:170-178. [DOI: 10.1089/mdr.2020.0132] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Delphine Girlich
- 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
| | - Pierre Bogaerts
- Laboratory of Clinical Microbiology, National Reference Center for Monitoring Antimicrobial Resistance in Gram-Negative Bacteria, CHU UCL Namur, Yvoir, Belgium
| | - Warda Bouchahrouf
- Laboratory of Clinical Microbiology, National Reference Center for Monitoring Antimicrobial Resistance in Gram-Negative Bacteria, CHU UCL Namur, Yvoir, Belgium
| | - Sandrine Bernabeu
- 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
- Bacteriology-Hygiene Unit, Assistance Publique–Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France
- Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriaceae, Le Kremlin-Bicêtre, France
| | - Isabelle Langlois
- Bacteriology-Hygiene Unit, Assistance Publique–Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Christine Begasse
- Bacteriology-Hygiene Unit, Assistance Publique–Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Nicolas Arangia
- Bacteriology-Hygiene Unit, Assistance Publique–Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, 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
- Evolution and Ecology of Resistance to Antibiotics Unit, Institut Pasteur–APHP–Université Paris-Sud, Paris, France
- Bacteriology-Hygiene Unit, Assistance Publique–Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France
- Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriaceae, Le Kremlin-Bicêtre, France
| | - Te-Din Huang
- Laboratory of Clinical Microbiology, National Reference Center for Monitoring Antimicrobial Resistance in Gram-Negative Bacteria, CHU UCL Namur, Yvoir, Belgium
| | - Youri Glupczynski
- Laboratory of Clinical Microbiology, National Reference Center for Monitoring Antimicrobial Resistance in Gram-Negative Bacteria, CHU UCL Namur, Yvoir, Belgium
| | - 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
- Evolution and Ecology of Resistance to Antibiotics Unit, Institut Pasteur–APHP–Université Paris-Sud, Paris, France
- Bacteriology-Hygiene Unit, Assistance Publique–Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France
- Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriaceae, Le Kremlin-Bicêtre, France
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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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12
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Gelmez GA, Can B, Hasdemir U, Soyletir G. Evaluation of phenotypic tests for detection of carbapenemases: New modifications with new interpretation. J Infect Chemother 2020; 27:226-231. [PMID: 33008736 DOI: 10.1016/j.jiac.2020.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/15/2020] [Accepted: 09/17/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The emergence and spread of carbapenemase-producing Enterobacterales (CPE) is a worldwide public health threat. Rapid and accurate detection of CPE is essential to prevent their dissemination within health care settings. The aim of this study was to evaluate the performance of CIM, mCIM and mCIM with ammonium bicarbonate (mCIM-A) methods by using different interpretation criteria for detection of carbapenemases. METHODS One hundred and fifty-three Klebsiella pneumoniae isolates previously characterized by molecular tests, including 133 carbapenemase producers and 20 non-carbapenemase producers, were collected in this study. CIM and mCIM tests were performed as described previously. mCIM-A by adding 50 mM ammonium bicarbonate to the bacterial suspension prepared in tryptic soy broth. The inhibition zone diameter of around meropenem disc was measured and interpreted as positive according to i) Pierce and colleagues (<19 mm), ii) EUCAST meropenem susceptibility breakpoint (<22). RESULTS CIM, although seems to be good for carbapenemases other than OXA-48-like and NDM, is not satisfactory (42.3% and 83.4%, respectively) for those enzymes with any of the interpretation criteria. OXA-48-like and NDM were detected with a better performance (88.7% and 92.8, respectively) with mCIM when results were interpreted according to <22 mm zone diameter for OXA-48-like and NDM. The best results were obtained with mCIM-A using <22 mm criteria without any difference in the results of other enzymes and negative strains. CONCLUSIONS mCIM-A method interpreted with <22 mm meropenem zone diameter seems to be preferable compared to CIM and mCIM. mCIM-A is simple and useful tool for identification of CPEs in clinical microbiology laboratories.
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Affiliation(s)
| | - Baris 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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13
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Oho M, Funashima Y, Nagasawa Z, Miyamoto H, Sueoka E. Rapid detection method of carbapenemase-producing Enterobacteriaceae by MALDI-TOF MS with imipenem/cilastatin (KB) disc and zinc sulfate solution. J Infect Chemother 2020; 27:205-210. [PMID: 33008738 DOI: 10.1016/j.jiac.2020.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/20/2020] [Accepted: 09/08/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Carbapenemase-producing Enterobacteriaceae (CPE) is a major global health threat, and development of rapid detection methods is desired. Here, we established a cost-effective and relatively rapid CPE detection method using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). METHODS We examined 134 CPE strains (IMP-type, NDM-type, VIM-type, KPC-type, OXA-48-like-type, and GES-type) and 107 non-CPE strains, previously confirmed by genetic tests. The proposed MALDI-TOF MS method involves mixing of a carbapenem drug [here, the commercially available imipenem (IPM) KB disc] and the bacterial strains to be tested, and the consequent drug hydrolysis owing to bacterial carbapenemase activity is confirmed by a waveform spectrum before and after 2 h of the mixing. As metallo-beta-lactamases require zinc in their active site, the false-negatives obtained from our method were cultured in presence of zinc sulfate solution and tested again. RESULTS Based on the presence or absence of the IPM (+cyano-4-hydroxy-cinnamic acid)-specific waveform peak near 489.45 m/z (±500 ppm), the detection sensitivity and specificity of our method for CPE were determined to be 94.8% and 91.6%, respectively. Seven false-negatives of IMP-type (4), VIM-type (2), and GES-type (1) were found, of which the IMP- and VIM-types tested positive as CPE after culture with zinc sulfate solution. Thus, the overall detection sensitivity improved to 99.3%. CONCLUSION Our study proposes a new approach for CPE detection using MALDI-TOF MS. Moreover, we propose cultivation of test strains with zinc sulfate solution for efficient detection of IMP-type CPE, not only for MALDI-TOF MS, but also for other detection methods.
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Affiliation(s)
- Megumi Oho
- Department of Clinical Laboratory, Saga University Hospital, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Yumiko Funashima
- Department of Medical Technology and Sciences, School of Health Sciences, Fukuoka International University of Health and Welfare, 137-1 Enokizu, Okawa, Fukuoka, 831-8501, Japan
| | - Zenzo Nagasawa
- Department of Medical Technology and Sciences, School of Health Sciences, Fukuoka International University of Health and Welfare, 137-1 Enokizu, Okawa, Fukuoka, 831-8501, Japan
| | - Hiroshi Miyamoto
- Division of Microbiology, Department of Pathology & Microbiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
| | - Eisaburo Sueoka
- Department of Clinical Laboratory, Saga University Hospital, 5-1-1 Nabeshima, Saga, 849-8501, Japan; Department of Laboratory Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
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14
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Mabrouk SS, Abdellatif GR, El-Ansary MR, Aboshanab KM, Ragab YM. Carbapenemase Producers Among Extensive Drug-Resistant Gram-Negative Pathogens Recovered from Febrile Neutrophilic Patients in Egypt. Infect Drug Resist 2020; 13:3113-3124. [PMID: 32982326 PMCID: PMC7495499 DOI: 10.2147/idr.s269971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/16/2020] [Indexed: 01/19/2023] Open
Abstract
Purpose This study aimed to detect the prevalence of carbapenemase producers (CPs) among extensive drug-resistant (XDR)-carbapenemase producing Gram-negative bacteria (GNB) recovered from various clinical specimens of hospitalized neutrophilic febrile patients in two major tertiary care hospitals in Egypt. Methods Standard methods were used to evaluate the antimicrobial susceptibility of clinical isolates according to the guidelines of the Clinical and Laboratory Standards Institute (CLSI). Phenotypic and genotypic analysis of CPs were carried out and statistically analyzed using standard methods. Results Three hundred and forty-two GNB were obtained from 342 clinical specimens during the period of the study, where 162 (47%) were enterobacterial isolates, including, 63 (18.4%) Escherichia coli, 87 (25.4%) Klebsiella spp., 5 (1.46%) Enterobacter cloacae, 5 (1.46%) Salmonella spp. and 2 (0.6%) Proteus and 180 (53%) were non-fermentative bacilli including, 129 (37.7%), Acinetobacter baumannii, and 51 (14.9%), Pseudomonas spp. Out of the 342 GNB, 188 (54.9%) isolates were multi-drug resistant (MDR). Of these, 52 (27.6%) were XDR as well as CPs as confirmed phenotypically. The MIC of imipenem against the XDR GNB against showed either low (11 isolates; 21.1%; MIC range =4–32 µg/mL) or high levels of resistance (41 isolates; 78.8%; MIC range = 64-≥1024). The most prevalent carbapenem resistance (CR) genes were blaKPC (63.5%) followed by blaOXA-48 (55.7%) and blaVIM (28.8%). No significant association could be observed between the MIC level and the presence of CR genes (P value >0.05). Conclusion High prevalence of MDR (54.9%) and XDR (27.6%) GNB pathogens associated with high levels of resistance to carbapenems were observed. All XDR GNB were CPs and tested positive for at least one of the CR genes. However, most of them (78.8%) showed a high level of CR (MIC range = 64-≥1024) with no significant association with the CR genes.
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Affiliation(s)
- Samar S Mabrouk
- Department of Microbiology, Faculty of Pharmacy, Ahram Canadian University (ACU), 6th of October, Giza, Egypt
| | - Ghada R Abdellatif
- Department of Microbiology, Faculty of Pharmacy, Ahram Canadian University (ACU), 6th of October, Giza, Egypt
| | - Mona R El-Ansary
- Department of Biochemistry, Modern University for Technology and Information (MTI), Cairo, Egypt
| | - Khaled M Aboshanab
- Department of Microbiology and Immunology, Faculty of Pharmacy, Ain Shams University (ASU), Cairo, Egypt
| | - Yasser M Ragab
- Department of Microbiology & Immunology, Faculty of Pharmacy, Cairo University (CU), Cairo, Egypt
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15
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Oueslati S, Iorga BI, Tlili L, Exilie C, Zavala A, Dortet L, Jousset AB, Bernabeu S, Bonnin RA, Naas T. Unravelling ceftazidime/avibactam resistance of KPC-28, a KPC-2 variant lacking carbapenemase activity. J Antimicrob Chemother 2020; 74:2239-2246. [PMID: 31127297 DOI: 10.1093/jac/dkz209] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 04/09/2019] [Accepted: 04/18/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND KPC-like carbapenemases have spread worldwide with more than 30 variants identified that differ by single or double amino-acid substitutions. OBJECTIVES To describe the steady-state kinetic parameters of KPC-28, which differs from KPC-2 by a H274Y substitution and the deletion of two amino acids (Δ242-GT-243). METHODS The blaKPC-2, blaKPC-3, blaKPC-14 and blaKPC-28 genes were cloned into a pTOPO vector for susceptibility testing or into pET41b for overexpression, purification and subsequent kinetic parameter (Km, kcat) determination. Molecular docking experiments were performed to explore the role of the amino-acid changes in the carbapenemase activity. RESULTS Susceptibility testing revealed that Escherichia coli producing KPC-28 displayed MICs that were lower for carbapenems and higher for ceftazidime and ceftazidime/avibactam as compared with KPC-2. The catalytic efficiencies of KPC-28 and KPC-14 for imipenem were 700-fold and 200-fold lower, respectively, than those of KPC-2, suggesting that Δ242-GT-243 in KPC-28 and KPC-14 is responsible for reduced carbapenem hydrolysis. Similarly, the H274Y substitution resulted in KPC-28 in a 50-fold increase in ceftazidime hydrolysis that was strongly reversed by clavulanate. CONCLUSIONS We have shown that KPC-28 lacks carbapenemase activity, has increased ceftazidime hydrolytic activity and is strongly inhibited by clavulanate. KPC-28-producing E. coli isolates display an avibactam-resistant ESBL profile, which may be wrongly identified by molecular and immunochromatographic assays as the presence of a carbapenemase. Accordingly, confirmation of carbapenem hydrolysis will be mandatory with assays based solely on blaKPC gene or gene product detection.
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Affiliation(s)
- Saoussen Oueslati
- EA7361 'Structure, Dynamic, Function and Expression of Broad Spectrum β-Lactamases', Faculty of Medicine, Université Paris-Sud, LabEx Lermit, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Bogdan I Iorga
- Institut de Chimie des Substances Naturelles, CNRS UPR 2301, Université Paris-Saclay, LabEx LERMIT, Gif-sur-Yvette, France
| | - Linda Tlili
- EA7361 'Structure, Dynamic, Function and Expression of Broad Spectrum β-Lactamases', Faculty of Medicine, Université Paris-Sud, LabEx Lermit, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Cynthia Exilie
- EA7361 'Structure, Dynamic, Function and Expression of Broad Spectrum β-Lactamases', Faculty of Medicine, Université Paris-Sud, LabEx Lermit, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Agustin Zavala
- Institut de Chimie des Substances Naturelles, CNRS UPR 2301, Université Paris-Saclay, LabEx LERMIT, Gif-sur-Yvette, France
| | - Laurent Dortet
- EA7361 'Structure, Dynamic, Function and Expression of Broad Spectrum β-Lactamases', Faculty of Medicine, Université Paris-Sud, LabEx Lermit, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Bacteriology-Hygiene Unit, Assistance Publique/Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France.,Associated French National Reference Centre for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriaceae, Le Kremlin-Bicêtre, France
| | - Agnès B Jousset
- EA7361 'Structure, Dynamic, Function and Expression of Broad Spectrum β-Lactamases', Faculty of Medicine, Université Paris-Sud, LabEx Lermit, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Bacteriology-Hygiene Unit, Assistance Publique/Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France.,Associated French National Reference Centre for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriaceae, Le Kremlin-Bicêtre, France
| | - Sandrine Bernabeu
- EA7361 'Structure, Dynamic, Function and Expression of Broad Spectrum β-Lactamases', Faculty of Medicine, Université Paris-Sud, LabEx Lermit, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Bacteriology-Hygiene Unit, Assistance Publique/Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Rémy A Bonnin
- EA7361 'Structure, Dynamic, Function and Expression of Broad Spectrum β-Lactamases', Faculty of Medicine, Université Paris-Sud, LabEx Lermit, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Associated French National Reference Centre for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriaceae, Le Kremlin-Bicêtre, France
| | - Thierry Naas
- EA7361 'Structure, Dynamic, Function and Expression of Broad Spectrum β-Lactamases', Faculty of Medicine, Université Paris-Sud, LabEx Lermit, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Bacteriology-Hygiene Unit, Assistance Publique/Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France.,Associated French National Reference Centre for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriaceae, Le Kremlin-Bicêtre, France
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16
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Howard J, Creighton J, Ikram R, Werno A. Comparison of the performance of three variations of the Carbapenem Inactivation Method (CIM, modified CIM [mCIM] and in-house method (iCIM)) for the detection of carbapenemase-producing Enterobacterales and non-fermenters. J Glob Antimicrob Resist 2020; 21:78-82. [DOI: 10.1016/j.jgar.2020.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 02/23/2020] [Accepted: 03/21/2020] [Indexed: 10/24/2022] Open
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17
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Accuracy and applicability of different phenotypic methods for carbapenemase detection in Enterobacteriaceae: A systematic review and meta-analysis. J Glob Antimicrob Resist 2020; 21:138-147. [DOI: 10.1016/j.jgar.2019.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 11/23/2022] Open
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18
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Performance of a Novel Fluorogenic Assay for Detection of Carbapenemase-Producing Enterobacteriaceae from Bacterial Colonies and Directly from Positive Blood Cultures. J Clin Microbiol 2019; 58:JCM.01026-19. [PMID: 31666362 DOI: 10.1128/jcm.01026-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 10/23/2019] [Indexed: 12/13/2022] Open
Abstract
Rapid and accurate detection of carbapenemase-producing Enterobacteriaceae (CPE) is critical for appropriate treatment and infection control. We compared a rapid fluorogenic assay using a carbapenem-based fluorogenic probe with other phenotypic assays: modified carbapenem inactivation method (mCIM), Carba NP test (CNP), and carbapenemase inhibition test (CIT). A total of 217 characterized isolates of Enterobacteriaceae were included as follows: 63 CPE; 48 non-carbapenemase-producing carbapenem-resistant Enterobacteriaceae (non-CP-CRE); 53 extended-spectrum β-lactamase producers; and 53 third-generation-cephalosporin-susceptible isolates. The fluorogenic assay using bacterial colonies (Fluore-C) was conducted by lysing the isolates followed by centrifugation and mixing the supernatant with fluorogenic probe. In addition, for the fluorogenic assay using spiked blood culture bottles (Fluore-Direct), pellets were obtained via the saponin preparation method, which can directly identify the pathogens using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The fluorescence signal was measured over 50 min using a fluorometer. The fluorescent signal of CPE was significantly higher than that of non-CPE in both Fluore-C (median relative fluorescence units [RFU] [range], 5,814 [240 to 32,009] versus 804 [36 to 2,480], respectively; P < 0.0001) and Fluore-Direct (median RFU [range], 10,355 [1,689 to 31,463] versus 1,068 [428 to 2,155], respectively; P < 0.0001) tests. Overall, positive and negative percent agreements of Fluore-C, mCIM, CNP, CIT, and Fluore-Direct were 100% and 98.7%, 98.3% and 97.5%, 88.1% and 100%, 96.4% and 98.7%, and 98.3% and 98.1%, respectively. The relatively lower positive percent agreement (PPA) of CNP was mainly observed in OXA-type CPE. The fluorogenic assay showed excellent performance with bacterial colonies and also directly from positive blood cultures. We included many non-CP-CRE isolates for strict evaluation. The fluorogenic assay will be a useful tool for clinical microbiology laboratories.
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19
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Bianco G, Boattini M, Iannaccone M, Fossati L, Cavallo R, Costa C. Direct β-Lactam Inactivation Method: a New Low-Cost Assay for Rapid Detection of Carbapenemase- or Extended-Spectrum-β-Lactamase-Producing Enterobacterales Directly from Positive Blood Culture Bottles. J Clin Microbiol 2019; 58:e01178-19. [PMID: 31694972 PMCID: PMC6935928 DOI: 10.1128/jcm.01178-19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/31/2019] [Indexed: 01/05/2023] Open
Abstract
We validate and evaluate a new phenotypic assay, named the direct β-lactam inactivation method (dBLIM), for the rapid and simultaneous detection of carbapenemase or extended-spectrum-cephalosporinase activity directly from Enterobacterales (EB)-positive blood cultures (BCs). It originates from the carbapenem inactivation method (CIM), an inexpensive and highly sensitive assay for carbapenemase activity detection. dBLIM cutoff values to detect extended-spectrum β-lactamase (ESBL) and carbapenemase activities resulted in diameters of ≤12 mm for a 5-μg-cefotaxime disk and for a 10-μg-meropenem disk. dBLIM assessment was determined with both aerobic and anaerobic BC bottles spiked with 422 characterized EB strains, classifiable into the following 4 phenotypic groups: (i) ESBL/AmpC-type β-lactamase (ACBL)/carbapenemase (CARB)-nonproducing (np-ESBL/ACBL/CARB) EB (n = 116), (ii) ESBL-producing EB (n = 111), (iii) AmpC-β-lactamase-producing EB (n = 33), and (iv) carbapenemase-producing EB (n = 162). No false-positive results were obtained in any of the np-ESBL/ACBL/CARB EB, ESBL, and AmpC groups, demonstrating an overall assay specificity of 100%. There were no significant discrepancies in dBLIM performance between aerobic and anaerobic BCs across all groups, except with VIM-type carbapenemase-expressing EB. Interestingly, among BCs spiked with blaVIM-harboring EB, the sensitivity rates of the assay in anaerobic and aerobic bottles were 53.6% and 100%, respectively. In contrast, dBLIM performance was deemed excellent for the KPC, OXA-48, and NDM carbapenemase producers regardless of the type of bottle being tested, with a sensitivity rate ranging between 99% and 100%. Concerning the detection of the extended-spectrum cephalosporinases of the ESBL-producing and AmpC types, dBLIM sensitivities was 100% and 84 to 87%, respectively. dBLIM may be a cost-effective and highly robust phenotypic screening method for the reliable detection of carbapenemases or extended-spectrum cephalosporinases directly from BCs on the same day of bottle positivity detection.
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Affiliation(s)
- Gabriele Bianco
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Matteo Boattini
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Marco Iannaccone
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Lucina Fossati
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Rossana Cavallo
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Cristina Costa
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
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20
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Byun JH, Seo Y, Kim D, Kim M, Lee H, Yong D, Lee K, Chong Y. An agar plate-based modified carbapenem inactivation method (p-mCIM) for detection of carbapenemase-producing Enterobacteriaceae. J Microbiol Methods 2019; 168:105781. [PMID: 31756348 DOI: 10.1016/j.mimet.2019.105781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/13/2019] [Accepted: 11/18/2019] [Indexed: 12/15/2022]
Abstract
Detecting carbapenemase-producing Enterobacteriaceae (CPE) has become increasingly difficult due to the emergence of diverse enzymes. The aim of the study was to evaluate an agar plate-based modified carbapenem inactivation method (p-mCIM) for detection of CPE. Stock strains and clinical isolates of CPE were used to evaluate the p-mCIM. The p-mCIM was performed as described for the mCIM, except that meropenem disks were placed on the lawn of test organisms on Mueller-Hinton agar (MHA) plates. Among 17 stock strains of CPE, six of eight KPC-2-like- and all six NDM-1-like carbapenemase-producing strains were positive by the p-mCIM without incubation in the carbapenem inactivation (CI) step. Among 380 CPE clinical isolates detected, 308 and 38 were KPC-2-like and NDM-1-like enzyme producers, respectively. The required incubation time in the CI step to show all isolates were positive by p-mCIM was 3 h for isolates with KPC-2-like enzyme and 1 h for isolates with metallo-β-lactamases. Twenty-eight of 30 isolates with OXA-48-like enzymes were p-mCIM positive. Sensitivities of both the p-mCIM and the mCIM (based on inhibition zone of ≤15 mm) for detection of CPE were 100%. All 70 ertapenem-nonsusceptible, but carbapenemase gene-negative isolates tested were both p-mCIM (based on inhibition zone of ≥21 mm) and mCIM negative. In conclusion, performance of the p-mCIM, which uses a lawn of bacterial colonies on MHA plate instead of a bacteria-suspended Tryptic soy broth tube in the CI step, is essentially identical to that of the CLSI-recommended mCIM in the detection of clinical isolates of Enterobacteriaceae producing carbapenemases including difficult to detect blaOXA-48-like enzymes.
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Affiliation(s)
- Jung-Hyun Byun
- Department of Laboratory Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, (52727) 79 Gangnam-ro, Jinju, Gyeongnam, South Korea
| | - Yonghee Seo
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Severance Hospital, Yonsei University College of Medicine, (03722) 50-1 Yonsei-ro, Seodaemun-gu, Seoul, South Korea
| | - Daewon Kim
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Severance Hospital, Yonsei University College of Medicine, (03722) 50-1 Yonsei-ro, Seodaemun-gu, Seoul, South Korea.
| | - Myungsook Kim
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Severance Hospital, Yonsei University College of Medicine, (03722) 50-1 Yonsei-ro, Seodaemun-gu, Seoul, South Korea.
| | - Hyukmin Lee
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Severance Hospital, Yonsei University College of Medicine, (03722) 50-1 Yonsei-ro, Seodaemun-gu, Seoul, South Korea.
| | - Dongeun Yong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Severance Hospital, Yonsei University College of Medicine, (03722) 50-1 Yonsei-ro, Seodaemun-gu, Seoul, South Korea.
| | - Kyungwon Lee
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Severance Hospital, Yonsei University College of Medicine, (03722) 50-1 Yonsei-ro, Seodaemun-gu, Seoul, South Korea.
| | - Yunsop Chong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Severance Hospital, Yonsei University College of Medicine, (03722) 50-1 Yonsei-ro, Seodaemun-gu, Seoul, South Korea.
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Lahiri S, Venkataraman R, Jagan A, Deshmukh G, Patra S, Reddy V, Sangeetha V, Solanki R, Gupta J, Patel K, De A, Mukhopadhyay C, Dias M, Kanungo R, Mendiratta D, Nawal P, Shastri J, Vemu L, Rangarajan R. Evaluation of LAMP-based assays for carbapenemase genes. J Med Microbiol 2019; 68:1431-1437. [DOI: 10.1099/jmm.0.001050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Surobhi Lahiri
- Vitas Pharma Research Private Limited, TBI, University of Hyderabad, Hyderabad, India
| | - Rasika Venkataraman
- Vitas Pharma Research Private Limited, TBI, University of Hyderabad, Hyderabad, India
| | - Akshaya Jagan
- Vitas Pharma Research Private Limited, TBI, University of Hyderabad, Hyderabad, India
| | - Gargi Deshmukh
- Vitas Pharma Research Private Limited, TBI, University of Hyderabad, Hyderabad, India
| | - Sudipta Patra
- Department of Microbiology, Kasturba Medical College, Manipal, India
| | - Vani Reddy
- Department of Microbiology, St. John’s Medical College, Bangalore, India
| | - V. Sangeetha
- Department of Microbiology, Pondicherry Institute of Medical Sciences, Puducherry, India
| | | | - Jyoti Gupta
- Department of Microbiology, Chirayu Medical College & Hospital, Bhopal, India
| | | | - Anuradha De
- Department of Microbiology, T. N. Medical College, Mumbai, India
| | | | - Mary Dias
- Department of Microbiology, St. John’s Medical College, Bangalore, India
| | - Reba Kanungo
- Department of Microbiology, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Deepak Mendiratta
- Department of Microbiology, Chirayu Medical College & Hospital, Bhopal, India
| | | | - Jayanthi Shastri
- Department of Microbiology, T. N. Medical College, Mumbai, India
| | - Lakshmi Vemu
- Department of Microbiology, Kamineni Academy of Medical Sciences & Research Centre, Hyderabad, India
| | - Radha Rangarajan
- Vitas Pharma Research Private Limited, TBI, University of Hyderabad, Hyderabad, India
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22
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Muntean MM, Muntean AA, Gauthier L, Creton E, Cotellon G, Popa MI, Bonnin RA, Naas T. Evaluation of the rapid carbapenem inactivation method (rCIM): a phenotypic screening test for carbapenemase-producing Enterobacteriaceae. J Antimicrob Chemother 2019; 73:900-908. [PMID: 29351668 DOI: 10.1093/jac/dkx519] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 12/13/2017] [Indexed: 01/07/2023] Open
Abstract
Objectives Fast and accurate diagnostic tests to identify carbapenemase-producing Enterobacteriaceae (CPE) are mandatory for proper antimicrobial therapy and implementing infection control measures. Here, we have developed a rapid Carbapenem Inactivation Method (rCIM) for CPE detection. Methods The rCIM consists of the incubation of a potential carbapenemase producer with meropenem discs and use of the resulting supernatant to challenge a susceptible indicator strain. Growth of the indicator strain is monitored using a nephelometer. The performances of the rCIM were compared with the CIM and Carba NP tests using a collection of 113 well-characterized carbapenem-resistant enterobacterial isolates, including 85 carbapenemase producers and 28 non-carbapenemase producers. In addition, rCIM was compared with the Carba NP test and PCR sequencing in a prospective analysis of 101 carbapenem-resistant enterobacterial isolates addressed to the French National Reference Center for Antimicrobial Resistance in July 2017. Results and discussion The rCIM correctly identified 84/85 carbapenemase producers and 28/28 non-carbapenemase producers, yielding a sensitivity of 99% and a specificity of 100%, slightly higher than the CIM and Carba NP test. In the prospective validation study, the rCIM showed a sensitivity and specificity of 97% and 95%, respectively. Two cephalosporinase-hyperproducing Enterobacter cloacae gave false-positive results, whereas an IMI-17-producing Enterobacter asburiae gave a false-negative result. The result was, however, positive when the isolate was grown on selective antibiotic-containing media. Conclusions The rCIM is a rapid (less than 3 h), cheap and accurate test for the detection of CPEs, which can be implemented in low-resource settings, making it a useful tool for microbiology laboratories.
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Affiliation(s)
- Madalina-Maria Muntean
- Research Unit EA7361 'Structure, dynamic, function and expression of broad spectrum β-lactamases', Faculty of Medicine, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Department of Bacteriology-Hygiene, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Le Kremlin-Bicêtre, France.,The 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
| | - Andrei-Alexandru Muntean
- The 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania.,Department of Pneumology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Lauraine Gauthier
- Research Unit EA7361 'Structure, dynamic, function and expression of broad spectrum β-lactamases', Faculty of Medicine, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Department of Bacteriology-Hygiene, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Le Kremlin-Bicêtre, France.,Associated French National Reference Center for Antibiotic Resistance, Le Kremlin-Bicêtre, France.,Joint Research Unit EERA « Evolution and Ecology of Resistance to Antibiotics », Institut Pasteur - APHP - Université Paris Paris-Sud, France
| | - Elodie Creton
- Research Unit EA7361 'Structure, dynamic, function and expression of broad spectrum β-lactamases', Faculty of Medicine, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Department of Bacteriology-Hygiene, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Le Kremlin-Bicêtre, France.,Associated French National Reference Center for Antibiotic Resistance, Le Kremlin-Bicêtre, France.,Joint Research Unit EERA « Evolution and Ecology of Resistance to Antibiotics », Institut Pasteur - APHP - Université Paris Paris-Sud, France
| | - Garance Cotellon
- Research Unit EA7361 'Structure, dynamic, function and expression of broad spectrum β-lactamases', Faculty of Medicine, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Department of Bacteriology-Hygiene, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Le Kremlin-Bicêtre, France.,Associated French National Reference Center for Antibiotic Resistance, Le Kremlin-Bicêtre, France.,Joint Research Unit EERA « Evolution and Ecology of Resistance to Antibiotics », Institut Pasteur - APHP - Université Paris Paris-Sud, France
| | - Mircea Ioan Popa
- The 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania.,The 'Cantacuzino' National Research Institute, Bucharest, Romania
| | - Rémy A Bonnin
- Research Unit EA7361 'Structure, dynamic, function and expression of broad spectrum β-lactamases', Faculty of Medicine, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Department of Bacteriology-Hygiene, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Le Kremlin-Bicêtre, France.,Associated French National Reference Center for Antibiotic Resistance, Le Kremlin-Bicêtre, France.,Joint Research Unit EERA « Evolution and Ecology of Resistance to Antibiotics », Institut Pasteur - APHP - Université Paris Paris-Sud, France
| | - Thierry Naas
- Research Unit EA7361 'Structure, dynamic, function and expression of broad spectrum β-lactamases', Faculty of Medicine, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Department of Bacteriology-Hygiene, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Le Kremlin-Bicêtre, France.,Associated French National Reference Center for Antibiotic Resistance, Le Kremlin-Bicêtre, France.,Joint Research Unit EERA « Evolution and Ecology of Resistance to Antibiotics », Institut Pasteur - APHP - Université Paris Paris-Sud, France
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Zhou M, Kudinha T, Du B, Peng J, Ma X, Yang Y, Zhang G, Zhang J, Yang Q, Xu YC. Active Surveillance of Carbapenemase-Producing Organisms (CPO) Colonization With Xpert Carba-R Assay Plus Positive Patient Isolation Proves to Be Effective in CPO Containment. Front Cell Infect Microbiol 2019; 9:162. [PMID: 31157176 PMCID: PMC6528581 DOI: 10.3389/fcimb.2019.00162] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 04/29/2019] [Indexed: 12/26/2022] Open
Abstract
Background: Rapid screening of patients for colonization with carbapenemase-producing organisms (CPO), coupled with implementation of infection prevention strategies, has the potential to contain the spread of CPO. Methods: We first evaluated the performance of Xpert Carba-R assay (in comparison with other phenotypic methods) for carbapenemase detection using clinical isolates, and then used it to determine the intestinal CPO colonization in hospitalized patients. We then assessed the effectiveness of patient isolation in controlling the spread of CPO in a medical intensive care unit. Results: The Xpert Carba-R assay required the least processing time to reveal results and showed a 94.5% sensitivity and specificity in carbapenemase detection, except for IMP-8 (n = 4). During a 6-month study period, 134 patients in one ward were studied for CPO colonization and infection. Fifteen patients (11.2%) were colonized by CPO as detected by Xpert Carba-R assay, including three NDM, three IMP, and nine KPC possessing strains. The overall colonization and CPO infection rates were both 11.2% each. Isolation of patients with CPO led to a reduction in both colonization (from 28.6 to 5.6%) and infection rates (from 35.7 to 2.8%) during the study period (p < 0.05). Conclusion: Active surveillance of CPO utilizing the Xpert Carba-R assay supplemented with immediate patient isolation, proved to be an effective strategy to limit the spread of CPO in a health care setting.
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Affiliation(s)
- Menglan Zhou
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, China
| | - Timothy Kudinha
- Department of Clinical Laboratory, Charles Sturt University, Orange, NSW, Australia
| | - Bin Du
- Department of Medical Intensive Care Unit, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jinmin Peng
- Department of Medical Intensive Care Unit, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaojun Ma
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yang Yang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, China
| | - Ge Zhang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, China
| | - Jingjia Zhang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, China
| | - Qiwen Yang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, China
| | - Ying-Chun Xu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, China
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24
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da Silva IR, Aires CAM, Conceição-Neto OC, de Oliveira Santos IC, Ferreira Pereira N, Moreno Senna JP, Carvalho-Assef APD, Asensi MD, Rocha-de-Souza CM. Distribution of Clinical NDM-1-Producing Gram-Negative Bacteria in Brazil. Microb Drug Resist 2019; 25:394-399. [PMID: 30676240 DOI: 10.1089/mdr.2018.0240] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
New Delhi metallo-β-lactamase (NDM)-producing bacteria have been identified at a worrying rate in Brazil since 2013. Owing to the need to understand the extent of their spread, this study reports the dissemination of blaNDM in different species of Gram-negative bacilli in different regions and states of Brazil. A total of 81 isolates from nine states were studied, including 11 species. All isolates carried blaNDM-1 variant and were considered multidrug resistant. Colistin and amikacin were the agents with higher activity compared with the other drugs tested. The findings indicate that the NDM-1 enzyme is already widespread in the country.
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Affiliation(s)
- Isadora Rodrigues da Silva
- 1 Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz-Fiocruz, Rio de Janeiro, Brasil
| | - Caio Augusto Martins Aires
- 1 Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz-Fiocruz, Rio de Janeiro, Brasil.,2 Departamento de Ciências da Saúde, Universidade Federal Rural do Semi-Árido (UFERSA), Mossoró, Brasil
| | | | | | - Natacha Ferreira Pereira
- 1 Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz-Fiocruz, Rio de Janeiro, Brasil
| | - José Procópio Moreno Senna
- 3 Laboratório de Tecnologia Recombinante (LATER), Instituto de Tecnologia de Imunobiológicos-Fiocruz, Rio de Janeiro, Brasil
| | | | - Marise Dutra Asensi
- 1 Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz-Fiocruz, Rio de Janeiro, Brasil
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25
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Phenotypic Methods for Detection of Carbapenemase Production in Carbapenem-Resistant Organisms: What Method Should Your Laboratory Choose? ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.clinmicnews.2019.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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26
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Crowe A, Brenton L, Kingston M, Jardine D, Waters MJ. Comparison of the carbapenem inactivation method (CIM) and modified carbapenem inactivation method (mCIM) for the detection of carbapenemase-producing organisms. Pathology 2018; 50:764-766. [DOI: 10.1016/j.pathol.2018.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/08/2018] [Accepted: 05/21/2018] [Indexed: 11/25/2022]
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27
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Kamel NA, El-tayeb WN, El-Ansary MR, Mansour MT, Aboshanab KM. Phenotypic screening and molecular characterization of carbapenemase-producing Gram-negative bacilli recovered from febrile neutropenic pediatric cancer patients in Egypt. PLoS One 2018; 13:e0202119. [PMID: 30157188 PMCID: PMC6114715 DOI: 10.1371/journal.pone.0202119] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/28/2018] [Indexed: 11/18/2022] Open
Abstract
AIM Infections with carbapenem-resistant Gram-negative bacteria (GNB) are among the most frequent complications in the immunocompromised cancer patients because of their considerable morbidity and mortality. Therefore, the aim of the current study was to characterize the prevalence of carbapenemase-producing GNB recovered from febrile neutropenic pediatric cancer patients in Egypt. METHODS Standard methods were used for identification, sensitivity testing (Kirby-Bauer and broth microdilution method according to CLSI guidelines). Standard methods were applied for both phenotypic and genotypic detection of the carbapenemase-producing GNB. RESULTS A total of 185 GNB were recovered from different clinical specimens, Escherichia (E.) coli (86; 46.48%), followed by Klebsiella spp. (71; 38.37%), Acinetobacter (A.) baumannii (7; 3.78%) and others including Pseudomonas spp., Enterobacter (Ent.) cloacae and Proteus spp. (21; 11.35%). It is a matter of concern that 116 out of 171 enterobacterial isolates (94.15%) showed resistance to three or more antimicrobial classes and were considered multidrug resistant. Additionally, the rate of carbapenem-resistance displayed a worrisome trend as 113 out of 171 enterobacterial isolates (66.08%) and 12 out of 14 non fermenting bacilli (85.71%) showed resistance pattern to at least one of the tested carbapenems. After performing a series of phenotypic tests for initial screening of potential carbapenemase producers, molecular characterization to the 29 extracted plasmids were subjected to PCR (using 5 common carbapenemase primers). The results revealed that blaOXA-48 was the most prevalent 17 (58.62%), followed by blaNDM 8(27.58%), then blaVIM 3 (10.3%) and blaKPC 2 (6.89%). CONCLUSION These results are an alarming threat to public health that calls for urgent application of antimicrobial stewardship programs along with routine surveillance for controlling outbreaks.
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Affiliation(s)
- Noha A. Kamel
- Department of Microbiology, Faculty of Pharmacy, Misr International University (MIU), Cairo, Egypt
| | - Wafaa N. El-tayeb
- Department of Microbiology, Faculty of Pharmacy, Misr International University (MIU), Cairo, Egypt
| | - Mona R. El-Ansary
- Department of Biochemistry, Modern University for Technology and Information, Cairo, Egypt
| | - Mohamed T. Mansour
- Department of Virology and Immunology, 57357 Children’s Cancer Hospital, Cairo University, Cairo, Egypt
| | - Khaled M. Aboshanab
- Department of Microbiology & Immunology, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
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28
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Within-a-Day Detection and Rapid Characterization of Carbapenemase by Use of a New Carbapenem Inactivation Method-Based Test, CIMplus. J Clin Microbiol 2018; 56:JCM.00137-18. [PMID: 29950336 DOI: 10.1128/jcm.00137-18] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/30/2018] [Indexed: 11/20/2022] Open
Abstract
The dissemination of carbapenemase-producing Enterobacteriaceae (CPE) is a major threat to public health. Rapid and accurate detection of CPE is essential for initiating appropriate antimicrobial treatment and establishing infection control measures. The carbapenem inactivation method (CIM), which has good sensitivity and specificity but a detection time of 20 h, was recently described. In this study, we evaluated the performances of a new version, the CIMplus test, which allows detection of carbapenemases in 8 h and characterization of carbapenemase classes, according to the Ambler classification, in 20 h. A panel of 110 carbapenem-resistant Enterobacteriaceae strains, including 92 CPE strains (with NDM, VIM, IMP, KPC, GES, OXA-48, and OXA-48-like enzymes), was used to evaluate test performance. Carbapenemase activity was detected at 8 h and 20 h. Characterization of carbapenemase classes, using specific inhibitors, was possible in 20 h. The CIMplus test had sensitivities of 95.7% and 97.8% at 8 h and 20 h, respectively, and a specificity of 94.4%, independent of the culture duration. Using a decision algorithm, this test was successful in identifying the carbapenemase class for 98.9% of tested CPE isolates (87/88 isolates). In total, the characterization was correct for 100%, 96.9%, and 100% of Ambler class A, B, and D isolates, respectively. Therefore, this test allows detection of carbapenemase activity in 8 h and characterization of carbapenemase classes, according to the Ambler classification, in 20 h. The CIMplus test represents a simple, affordable, easy-to-read, and accurate tool that can be used without any specific equipment.
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29
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Comparative Evaluation of Four Phenotypic Methods for Detection of Class A and B Carbapenemase-Producing Enterobacteriaceae in China. J Clin Microbiol 2018; 56:JCM.00395-18. [PMID: 29769274 DOI: 10.1128/jcm.00395-18] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/08/2018] [Indexed: 01/05/2023] Open
Abstract
The objective of this study was to evaluate the performance of four phenotypic methods in the detection of carbapenemase-producing Enterobacteriaceae (CPE) in China. We evaluated the performance of four carbapenemase detection methods, the modified Hodge test (MHT), the Carba NP test, the meropenem hydrolysis assay (MHA) with 1- and 2-h incubation, and the modified carbapenem inactivation method (mCIM) with meropenem, imipenem, and ertapenem, on 342 carbapenem-resistant Enterobacteriaceae isolates (CRE) in China. PCR was used as the gold standard. The 2-h-incubation MHA performed the best in carbapenemase detection (overall sensitivity, specificity, positive predictive value, and negative predictive value all 100%). Second was the Carba NP test, with a sensitivity of 99.6%. The 1-h-incubation MHA performed poorly in Klebsiella pneumoniae carbapenemase (KPC) detection (sensitivity, 71.3%). For mCIM, the best performance was observed with the meropenem disk. The MHT exhibited the worst performance, with a specificity of 88.8%. All assays except 1-h-incubation MHA, which failed to identify 68 KPC-2s, had a sensitivity of >98% in the detection of 172 KPCs. Likewise, all assays had a sensitivity of >95% in the detection of 70 class B carbapenemases, except for MHT (82.9%). The 2-h-incubation MHA significantly improved the accuracy in CPE detection compared with that for 1-h incubation and performed the best in the detection of class A and B carbapenemases. Our findings suggest that the MHA is the most practical assay for carbapenemase detection. For those who cannot afford the associated equipment, both the Carba NP test and mCIM are good alternatives with regard to the practical requirements of time and cost.
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30
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Bayraktar B, Barış A, Malkoçoğlu G, Erdemir D, Kına N. Comparison of Carba NP-Direct, Carbapenem Inactivation Method, and β-CARBA Tests for Detection of Carbapenemase Production in Enterobacteriaceae. Microb Drug Resist 2018; 25:97-102. [PMID: 29694266 DOI: 10.1089/mdr.2017.0427] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Rapid and accurate detection of carbapenemase-producing isolates are extremely important for management of antimicrobial therapy and the implementation of infection control measures. We evaluated the performance of Carba NP-direct, carbapenem inactivation method (CIM), and the commercial β-CARBA tests for detection of carbapenemase production in Enterobacteriaceae. Enterobacteriaceae isolates with previously characterized carbapenemase types (n = 110) and non-carbapenemase-producing Escherichia coli (n = 15) isolates were tested. Sensitivities of Carba NP-direct, CIM, and β-CARBA tests were 99.0%, 92.7%, and 93.6%, respectively, while specificity was 100% for all three tests. For β-CARBA test, a 60-min incubation time instead of 30 increased the sensitivity to 98.1%, and lessened false negativity, particularly with OXA-48-like producers. Our results showed that Carba NP-direct, CIM, and β-CARBA tests are useful tools for the reliable detection of carbapenemase activity in enterobacterial isolates. Carba NP-direct is a simple, rapid, and low-cost test for routine use.
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Affiliation(s)
- Banu Bayraktar
- 1 Clinical Microbiology Laboratory, Şişli Hamidiye Etfal Training and Research Hospital , Istanbul, Turkey
| | - Ayşe Barış
- 1 Clinical Microbiology Laboratory, Şişli Hamidiye Etfal Training and Research Hospital , Istanbul, Turkey
| | | | - Duygu Erdemir
- 1 Clinical Microbiology Laboratory, Şişli Hamidiye Etfal Training and Research Hospital , Istanbul, Turkey
| | - Nur Kına
- 1 Clinical Microbiology Laboratory, Şişli Hamidiye Etfal Training and Research Hospital , Istanbul, Turkey
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31
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Evaluation of the Amplidiag CarbaR+VRE Kit for Accurate Detection of Carbapenemase-Producing Bacteria. J Clin Microbiol 2018; 56:JCM.01092-17. [PMID: 29305547 DOI: 10.1128/jcm.01092-17] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 01/02/2018] [Indexed: 12/13/2022] Open
Abstract
As carbapenemase-producing Gram-negative bacilli (CP-GNB) (Enterobacteriaceae, Pseudomonadaceae, and Acinetobacter spp.) are becoming a major public health issue, there is an urgent need for accurate and fast diagnostic tests. The Amplidiag CarbaR+VRE assay is a multiplex nucleic acid-based in vitro diagnostic test intended for the detection of CP-GNB and vancomycin-resistant enterococci (VRE) from cultured colonies. We have evaluated its ability to detect carbapenemase genes in 100 well-characterized GNB and in 200 consecutive enterobacterial isolates with reduced susceptibility to carbapenems that were referred to the French National Reference Center for carbapenem resistance. The assay has been validated on purified DNA but also directly on colonies. The Amplidiag CarbaR+VRE assay could detect all KPC, NDM, VIM, IMP, and OXA-48-like variants tested and all acquired carbapenem-hydrolyzing oxacillinases from Acinetobacter baumannii (OXA-23, OXA-24/-40, and OXA-58) as well as the overexpressed chromosomally encoded OXA-51-like β-lactamase associated with an upstream inserted ISAba1 However, as claimed by the manufacturer, other carbapenemases such as GES-like carbapenemases (GES-2, GES-5, and GES-14), GIM-1, AIM-1, SPM-1, DIM-1, OXA-198 in Pseudomonas aeruginosa, or OXA-143-like in A. baumannii were not detected. Amplidiag CarbaR+VRE's performance values were high (100% sensitivity and 99% specificity) as it could detect the five major carbapenemases-NDM, VIM, IMP, KPC, and OXA-48-as well as OXA-type carbapenemases from Acinetobacter spp. that are currently emerging also among Proteus mirabilis and other enterobacterial isolates. It can provide a result directly from colonies growing on Mueller-Hinton (MH) agar or on selective screening medium in less than 2 h. Further evaluations are now necessary to determine the performance values directly on rectal swabs.
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32
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Girlich D, Bernabeu S, Fortineau N, Dortet L, Naas T. Evaluation of the CRE and ESBL ELITe MGB® kits for the accurate detection of carbapenemase- or CTX-M-producing bacteria. Diagn Microbiol Infect Dis 2018; 92:1-7. [PMID: 29983286 DOI: 10.1016/j.diagmicrobio.2018.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 12/12/2022]
Abstract
As carbapenemase-producing Enterobacteriaceae (CPE) and extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) are becoming a major public health issue, there is an urgent need for accurate and fast diagnostic tests. The ELITe InGenius is a fully automated sample-to-result system designed for the extraction and detection by multiplex real-time polymerase chain reaction of carbapenemases KPC, NDM, VIM, IMP, and OXA-48-like variants and CTX-M group 1 and 9-producers from diverse sample matrices such as colonies, positive blood cultures, and rectal swabs. CRE and ESBL ELITe MGB® kits were evaluated on 153 cultured colonies of enterobacterial isolates with characterized β-lactamase content, on 30 spiked blood cultures, and the CRE kit was also evaluated on 53 clinical rectal swabs collected prospectively during a 3-month period and 10 spiked rectal swabs. CRE ELITe MGB® kit's performances reached 100% sensitivity and 100% specificity, while for the ESBL ELITe kit, 100% sensitivity and 96.6% specificity were observed, with a sample to result of less than 3 h and a total percentage of agreement with expected results of 99.6% (255/256).
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Affiliation(s)
- Delphine Girlich
- EA7361 "Structure, Dynamic, Function and Expression of Broad Spectrum β-lactamases", Université Paris-Sud, Université Paris-Saclay, 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
| | - Sandrine Bernabeu
- EA7361 "Structure, Dynamic, Function and Expression of Broad Spectrum β-lactamases", Université Paris-Sud, Université Paris-Saclay, 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; Bacteriology-Hygiene unit, Assistance Publique - Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Nicolas Fortineau
- EA7361 "Structure, Dynamic, Function and Expression of Broad Spectrum β-lactamases", Université Paris-Sud, Université Paris-Saclay, 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; Bacteriology-Hygiene unit, Assistance Publique - Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France; Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-producing Enterobacteriaceae, Le Kremlin-Bicêtre, France
| | - Laurent Dortet
- EA7361 "Structure, Dynamic, Function and Expression of Broad Spectrum β-lactamases", Université Paris-Sud, Université Paris-Saclay, 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; Bacteriology-Hygiene unit, Assistance Publique - Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France; Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-producing Enterobacteriaceae, Le Kremlin-Bicêtre, France
| | - Thierry Naas
- EA7361 "Structure, Dynamic, Function and Expression of Broad Spectrum β-lactamases", Université Paris-Sud, Université Paris-Saclay, 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; Bacteriology-Hygiene unit, Assistance Publique - Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France; Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-producing Enterobacteriaceae, Le Kremlin-Bicêtre, France.
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Comparison of Two Phenotypic Algorithms To Detect Carbapenemase-Producing Enterobacteriaceae. Antimicrob Agents Chemother 2017; 61:AAC.00796-17. [PMID: 28607010 DOI: 10.1128/aac.00796-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 06/05/2017] [Indexed: 11/20/2022] Open
Abstract
A novel algorithm designed for the screening of carbapenemase-producing Enterobacteriaceae (CPE), based on faropenem and temocillin disks, was compared to that of the Committee of the Antibiogram of the French Society of Microbiology (CA-SFM), which is based on ticarcillin-clavulanate, imipenem, and temocillin disks. The two algorithms presented comparable negative predictive values (98.6% versus 97.5%) for CPE screening among carbapenem-nonsusceptible Enterobacteriaceae However, since 46.2% (n = 49) of the CPE were correctly identified as OXA-48-like producers by the faropenem/temocillin-based algorithm, it significantly decreased the number of complementary tests needed (42.2% versus 62.6% with the CA-SFM algorithm).
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Is This the Carbapenemase Test We've Been Waiting for? A Multicenter Evaluation of the Modified Carbapenem Inactivation Method. J Clin Microbiol 2017; 55:2309-2312. [PMID: 28615469 DOI: 10.1128/jcm.00538-17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
A plethora of phenotypic methods exist for the detection of carbapenemases; however, clinical laboratories have struggled for years with accurate, objective phenotypic detection of carbapenemase activity in Enterobacteriaceae In this issue of the Journal of Clinical Microbiology, V. M. Pierce et al. (J Clin Microbiol 55:2321-2333, 2017, https://doi.org/10.1128/JCM.00193-17) report on a multicenter evaluation of the modified carbapenem inactivation method (mCIM). The high sensitivity, specificity, reproducibility, and ease of interpretation associated with the mCIM for Enterobacteriaceae will likely lead to its adoption by clinical laboratories.
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