Accuracy and applicability of different phenotypic methods for carbapenemase detection in Enterobacteriaceae: A systematic review and meta-analysis

Zhong, Hong; Wu, Minghui; Feng, Wen-Juan; Huang, Shifeng; Yang, Ping

doi:10.1016/j.jgar.2019.10.010

Cited by 18 publications

(15 citation statements)

References 55 publications

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“…On the other hand, PCR detects only the genes encoding the known enzymes and hence the organisms harbor novel carbapenemase genes are possibly undetected [12]. In recent years, a number of simple phenotypic methods have been developed for the identification of carbapenemase production, including colorimetric biochemical assays (eg: Carbapenemase Nordmann-Poirel or Carba NP test) and growth based carbapenem inactivation disc assays (eg: modified Hodge test (MHT), modified carbapenem inactivation method) [13].…”

Section: Introductionmentioning

confidence: 99%

Comparison of four low-cost carbapenemase detection tests and a proposal of an algorithm for early detection of carbapenemase-producing Enterobacteriaceae in resource-limited settings

2021

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Rapidly progressing antibiotic resistance is a great challenge in therapy. In particular, the infections caused by carbapenem-resistant Enterobacteriaceae (CRE) are exceedingly difficult to treat. Carbapenemase production is the predominant mechanism of resistance in CRE. Early and accurate identification of carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) is extremely important for the treatment and prevention of such infections. In the present study, four phenotypic carbapenemase detection tests were compared and an algorithm was developed for rapid and cost-effective identification of CP-CRE. A total of 117 Enterobacteriaceae (54 CP-CRE, 3 non-CP-CRE, and 60 non-CRE) isolates were tested for carbapenemase production using modified Hodge test (MHT), modified carbapenem inactivation method (mCIM), Carba NP test (CNPt), and CNPt-direct test. The overall sensitivity/specificity values were 90.7%/92.1% for MHT, 100%/100% for mCIM, 75.9%/100% for CNPt, and 83.3%/100% for CNPt-direct. OXA-48-like enzymes were detected with 93.2% sensitivity by MHT and >77.3% sensitivity by two Carba NP tests. MHT could only detect half of the NDM carbapenemase producers. CNPt-direct exhibited enhanced sensitivity compared to CNPt (100% vs 25%) for detection of NDM producers. Considering these findings we propose CNPt-direct as the first test followed by mCIM for rapid detection of CP-CRE. With this algorithm >80% of the CP-CRE could be detected within 24 hours from the time the sample is received and 100% CP-CRE could be detected in day two. In conclusion, mCIM was the most sensitive assay for the identification of CP-CRE. CNPt-direct performed better than CNPt. An algorithm consisting CNPt-direct and mCIM allows rapid and reliable detection of carbapenemase production in resource-limited settings.

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Section: Introductionmentioning

confidence: 99%

Comparison of four low-cost carbapenemase detection tests and a proposal of an algorithm for early detection of carbapenemase-producing Enterobacteriaceae in resource-limited settings

2021

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“…The mCIM is a reliable and simple method and has a sensitivity of 98-100% in comparison with the modi ed Hodge test and the carbapenemase Nordmann-Poirel (carba NP) test with sensitivities of 93-98% and 73-100%, respectively. Furthermore, due to being expensive of PCR, mCIM could be a suitable alternative method for detecting of carbapenemase producers [12,[31][32][33].…”

Section: Discussionmentioning

confidence: 99%

Emergence of OXA-10 and OXA-48 like carbapenemases among Enterobacter isolates from inpatients in southern Iran

Moradi

Khashei

Malekzadegan

et al. 2021

Preprint

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Background The global spread of carbapenemase-producing Enterobacteriaceae represents a public health concern. The aim of this study was to investigate prevalence of carbapenem resistance, oxacillinase types and the presence of class 1–3 integrons among Enterobacter clinical isolates from an Iranian inpatients’ population. Methods Ninety Enterobacter isolates recovered from hospitalized patients were diagnosed by the standard microbiological methods. Antibiogram pattern was also determined. The presence of class 1–3 integrons and four types of oxacillinase genes were assessed using PCR. Results Of the 90 Enterobacter isolates, the most common species was identified as E. aerogenes, (45.6%), followed by E. cloacae (30%). The highest resistance rate was against to ampicillin (96.7%). Multi-drug resistance (MDR) was substantial (93%). Carbapenemase producers were detected in 96% of carbapenem resistant isolates by mCIM test. The frequency of evaluated genes was as follows: intI1 = 50 (55.6%), intI2 = 12 (13.3%), blaoxa−1 =6 (6.7%), blaoxa−2 =5 (5.6%), blaoxa−10 =18 (20%), and blaoxa−48 =18 (20%). Conclusion The determinants of class 1 integron with OXA-10 and OXA-48 like carbapememases have been responsible of relatively considerable of carbapenem resistance among isolates. This is the first OXA-10 and OXA-48-producing Enterobacter spp. in Iran, indicating that the prevalence of oxacillinases might be on the rise in country.

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“…Resistance genes may be located both on the chromosome and on mobile genetic elements (i.e., integrons, transposons, and plasmids). Currently available methods to detect carbapenem-resistance differ in accuracy and efficiency [ 11 ]. Therefore, the implementation of different approaches, based on mass spectrometry and molecular methods, is ongoing [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…Currently available methods to detect carbapenem-resistance differ in accuracy and efficiency [ 11 ]. Therefore, the implementation of different approaches, based on mass spectrometry and molecular methods, is ongoing [ 11 ]. Amongst currently available therapeutic options, polymyxins, such as colistin and polymyxin B, are the antibiotics presenting the highest level of in vitro activity against MDR A. baumannii [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

In Vitro Antimicrobial Activity of the Siderophore Cephalosporin Cefiderocol against Acinetobacter baumannii Strains Recovered from Clinical Samples

et al. 2021

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Background: Cefiderocol is a siderophore cephalosporin that exhibits antimicrobial activity against most multi-drug resistant Gram-negative bacteria, including Enterobacterales, Pseudomonas aeruginosa, Acinetobacter baumannii, and Stenotrophomonas maltophilia. Methods: A total of 20 multidrug-resistant A. baumannii strains were isolated from 2020 to 2021, molecularly characterized and tested to assess the in vitro antibacterial activity of cefiderocol. Thirteen strains were carbapenem-hydrolysing oxacillinase OXA-23-like producers, while seven were non-OXA-23-like producers. Minimum inhibitory concentrations (MICs) were determined by broth microdilution, considered as the gold standard method. Disk diffusion test was also carried out using iron-depleted CAMHB plates for cefiderocol. Results: Cefiderocol MICs ranged from 0.5 to 1 mg/L for OXA-23-like non-producing A. baumannii strains and from 0.25 to >32 mg/L for OXA-23-like producers, using the broth microdilution method. Cefiderocol MIC90 was 8 mg/L. Diameter of inhibition zone of cefiderocol ranged from 18 to 25 mm for OXA-23-like non-producers and from 15 to 36 mm for OXA-23-like producers, using the diffusion disk method. A large variability and a low reproducibility were observed during the determination of diameter inhibition zone. Molecular characterization showed that all isolates presented the ISAba1 genetic element upstream the blaOXA-51. Among OXA-23-like non-producers, four were blaOXA-58 positive and two were negative for all the resistance determinants analyzed. Conclusions: Cefiderocol showed in vitro antimicrobial activity against both carbapenem-susceptible and non-susceptible A. baumannii strains, although some OXA-23-like producers were resistant. Further clinical studies are needed to consolidate the role of cefiderocol as an antibiotic against MDR A. baumannii.

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Accuracy and applicability of different phenotypic methods for carbapenemase detection in Enterobacteriaceae: A systematic review and meta-analysis

Cited by 18 publications

References 55 publications

Comparison of four low-cost carbapenemase detection tests and a proposal of an algorithm for early detection of carbapenemase-producing Enterobacteriaceae in resource-limited settings

Comparison of four low-cost carbapenemase detection tests and a proposal of an algorithm for early detection of carbapenemase-producing Enterobacteriaceae in resource-limited settings

Emergence of OXA-10 and OXA-48 like carbapenemases among Enterobacter isolates from inpatients in southern Iran

In Vitro Antimicrobial Activity of the Siderophore Cephalosporin Cefiderocol against Acinetobacter baumannii Strains Recovered from Clinical Samples

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