Evaluation of rapid polymyxin NP test to detect colistin-resistant Klebsiella pneumoniae isolated in a tertiary Greek hospital

Malli, Ergina; Florou, Zoi; Tsilipounidaki, Katerina; Voulgaridi, Ioanna; Stefos, Aggelos; Xitsas, Stelios; Papagiannitsis, Costas C.; Petinaki, Efthimia

doi:10.1016/j.mimet.2018.08.010

Cited by 25 publications

(13 citation statements)

References 22 publications

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“…Gradient diffusion is generally regarded as an inaccurate method for colistin susceptibility testing. However, historical data have been highly variable, ranging from excellent agreement for Enterobacterales (16)(17)(18) to either moderate (9,(19)(20)(21) or high (2,8,11,12,22,23) rates of errors, particularly VMEs. This variability is likely attributable to multiple factors, in particular the diversity of isolates evaluated in each study, as represented by MIC distributions, species and strain types, and mechanisms of resistance, including heteroresistance.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Calcium-Enhanced Media for Colistin Susceptibility Testing by Gradient Agar Diffusion and Broth Microdilution

et al. 2020

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Despite the increasing reliance on polymyxin antibiotics (polymyxin B and colistin) for treatment of multidrug-resistant Gram-negative infections, many clinical laboratories are unable to perform susceptibility testing due to the lack of accurate and reliable methods. Although gradient agar diffusion is commonly performed for other antimicrobials, its use for polymyxins is discouraged due to poor performance characteristics. Performing gradient agar diffusion with calcium enhancement of susceptibility testing media has been shown to improve the identification of polymyxin-resistant isolates with plasmid-mediated resistance (mcr-1). We therefore sought to evaluate the broad clinical applicability of this approach for colistin susceptibility testing by assessing a large and diverse collection of resistant and susceptible patient isolates collected from multiple U.S. medical centers. Among 217 isolates, the overall categorical and essential agreement for calcium-enhanced gradient agar diffusion were 73.7% and 65.5%, respectively, compared to the results for reference broth microdilution. Performance varied significantly by organism group, with agreement being highest for Enterobacterales and lowest for Pseudomonas aeruginosa. Nevertheless, even for Enterobacterales, there was a high rate of very major errors (9.2%). Performance was similarly poor for calcium-enhanced broth microdilution. While calcium enhancement did allow for more accurate categorization of mcr-1-resistant isolates, there were unacceptably high rates of errors for both susceptible and non-mcr-1-resistant isolates, raising serious doubts about the suitability of these calcium-enhanced methods for routine colistin susceptibility testing in clinical laboratories.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Calcium-Enhanced Media for Colistin Susceptibility Testing by Gradient Agar Diffusion and Broth Microdilution

et al. 2020

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“…All the pathogens that had meropenem MICs of Ͼ2 mg/liter were tested for the production of carbapenemase using the protocol proposed by EUCAST. In brief, to identify class A and B carbapenemases, the combination disk test was applied, using boronic and dipicolinic acid, respectively (30). In the CAZ-AVI group, for patients presenting with a relapse, if the isolate's susceptibility to CAZ-AVI was different from that of the index isolate, further testing for the presence of the bla VIM , bla NDM , bla OXA-48 , and bla KPC genes was performed by PCR.…”

Section: Methodsmentioning

confidence: 99%

Ceftazidime-Avibactam To Treat Life-Threatening Infections by Carbapenem-Resistant Pathogens in Critically Ill Mechanically Ventilated Patients

Tsolaki

Mantzarlis

Mpakalis

et al. 2020

Antimicrob Agents Chemother

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Data on the effectiveness of ceftazidime-avibactam (CAZ-AVI) in critically ill, mechanically ventilated patients are limited. The present retrospective observational cohort study, which was conducted in two general intensive care units (ICUs) in central Greece, compared critically ill, mechanically ventilated patients suffering from carbapenem-resistant Enterobacteriaceae (CRE) infections receiving CAZ-AVI to patients who received appropriate available antibiotic therapy. Clinical and microbiological outcomes and safety issues were evaluated. A secondary analysis in patients with bloodstream infections (BSIs) was conducted. Forty-one patients that received CAZ-AVI (the CAZ-AVI group) were compared to 36 patients that received antibiotics other than CAZ-AVI (the control group). There was a significant improvement in the Sequential Organ Failure Assessment (SOFA) score on days 4 and 10 in the CAZ-AVI group compared to that in the control group (P = 0.006, and P = 0.003, respectively). Microbiological eradication was accomplished in 33/35 (94.3%) patients in the CAZ-AVI group and 21/31 (67.7%) patients in the control group (P = 0.021), and clinical cure was observed in 33/41 (80.5%) versus 19/36 (52.8%) patients (P = 0.010), respectively. The results were similar in the BSI subgroups for both outcomes (P = 0.038 and P = 0.014, respectively). The 28-day survival was 85.4% in the CAZ-AVI group and 61.1% in the control group (log-rank test = 0.035), while there were 2 and 12 relapses in the CAZ-AVI and control groups, respectively (P = 0.042). A CAZ-AVI-containing regime was an independent predictor of survival and clinical cure (odds ratio [OR] = 5.575 and P = 0.012 and OR = 5.125 and P = 0.004, respectively), as was illness severity. No significant side effects were recorded. In conclusion, a CAZ-AVI-containing regime was more effective than other available antibiotic agents for the treatment of CRE infections in the high-risk, mechanically ventilated ICU population evaluated.

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“…This test has demonstrated an excellent detection of colistin resistance in several studies, including detecting colistin resistance directly from blood cultures with a sensitivity of 100% 40, 42, 43 . However, in a study using ComASP as the reference, the Rapid Polymyxin NP test had a lower specificity than BD Phoenix, Vitek 2 and E-test with K. pneumoniae isolates (Table 1) 36 . In another study, Rapid Polymyxin NP test recorded a lower sensitivity and specificity (71.1% and 88.6%) than E-test, which had a sensitivity and specificity of 80.4% and 95.8% respectively 44 .…”

Section: Phenotypic Testsmentioning

confidence: 95%

“…Vitek 2 had the highest rate of VMEs at 36% for mcr -1-producing isolates and failed to detect colistin resistance in eight mcr -negative E. cloacae complex isolates 25 . However, another study found that Vitek 2 had VMEs of 2.04% for K. pneumoniae isolates that were mcr -negative 36 . MICRONAUT-S (MERLIN Diagnostika GmbH, Bornheim, Germany) performed similarly to the Sensititre although it had two VMEs whereas the Sensititre had none 30 .…”

Section: Phenotypic Testsmentioning

confidence: 96%

Current and emerging polymyxin resistance diagnostics: a systematic review of established and novel detection methods

Leshaba¹,

Mbelle²,

Sekyere³

2020

Preprint

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Background. The escalation of colistin resistance, due to transferable mcr-genes, threatens public and animal health as there are limited therapeutic options. Given that colistin is a last-line antibiotic, there is a need to contain the spread of its resistance to conserve its efficacy. Herein, current and emerging colistin resistance diagnostics are described to inform faster clinical diagnostic choices. Methods. A literature search in Pubmed, between 2016 and 2020, was performed. English articles evaluating colistin resistance methods/diagnostics were included. Results. Screening resulted in the inclusion of 89 journal articles. Current colistin resistance diagnostics are either phenotypic or molecular. Broth microdilution (BMD) is currently the only golden standard for determining colistin MIC values. However, other methods have been developed to overcome the challenges associated with the BMD. Phenotypic methods comprise agar-based methods i.e. ChromAgar Col-APSE, SuperPolymyxin, ChromID Colistin R etc., MIC-determiners i.e. Microscan, BD Phoenix, Sensitest colistin, Sensititre, Micronaut etc., MCR-detectors i.e. lateral flow immunoassay (LFI), chelator based assays i.e. EDTA- and DPA-based tests as well as biochemical colorimetric tests i.e. Rapid Polymyxin NP test, Rapid ResaPolymyxin NP test etc. Molecular methods only characterize mobile colistin resistance; they include PCR, LAMP, whole-genome sequencing (WGS) etc. Conclusion. Considering the efficiency (sensitivity, specificity, turnaround time) of the Rapid ResaPolymyxin NP test, it is recommended for the initial screening of colistin-resistant isolates. This can be followed by chelator-based tests or the LFI for the rapid screening of mcr-genes. However molecular assays such as LAMP, PCR may be considered for use in well-equipped clinical laboratories.

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Evaluation of rapid polymyxin NP test to detect colistin-resistant Klebsiella pneumoniae isolated in a tertiary Greek hospital

Cited by 25 publications

References 22 publications

Evaluation of Calcium-Enhanced Media for Colistin Susceptibility Testing by Gradient Agar Diffusion and Broth Microdilution

Evaluation of Calcium-Enhanced Media for Colistin Susceptibility Testing by Gradient Agar Diffusion and Broth Microdilution

Ceftazidime-Avibactam To Treat Life-Threatening Infections by Carbapenem-Resistant Pathogens in Critically Ill Mechanically Ventilated Patients

Current and emerging polymyxin resistance diagnostics: a systematic review of established and novel detection methods

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