Evaluation of Updated Interpretative Criteria for Categorizing
            <i>Klebsiella pneumoniae</i>
            with Reduced Carbapenem Susceptibility

Endimiani, Andrea; Pérez, Federico; Bajaksouzian, Saralee; Windau, Anne; Good, Caryn E.; Choudhary, Yuvraj; Hujer, Andrea M.; Bethel, Christopher R.; Jacobs, Michael

doi:10.1128/jcm.02458-09

Cited by 50 publications

(38 citation statements)

References 41 publications

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“…Out of 31 potential carbapenemase producers, fifteen strains were found positive for carbapenemase production by MHT and of these; one strain (C-26) has exhibited reduced susceptibility to carbapenems (2 µg/ml) and was also found positive by MHT. This validates the findings that the isolate with reduced susceptibility to carbapenems can produce carbapenemase [30].…”

Section: Discussionsupporting

confidence: 87%

Frequency of Carbapenemase Producing Klebsiella pneumoniae in Makkah, Saudi Arabia

Khan¹

2016

Journal of Microbiology and Infectious Diseases

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Objective: Carbapenemase producing Klebsiella pneumoniae is emerging as an important pathogen worldwide which has alarming clinical threat with serious effects on patients' outcome. The aim of our study is to determine prevalence of carbapenemase producing K. pneumoniae and its antibiotic susceptibility pattern in tertiary care hospitals. Methods:A prospective study was performed on 260 clinical isolates of K. pneumoniae collected from five different hospitals of Makkah, Saudi Arabia from January to July 2015. All clinical isolates were confirmed as K. pneumoniae using Vitek 2 system. These isolates were then screened for potential carbapenemase producers by determining reduced susceptibility to carbapenems using representative antibiotic disks of third generation cephalosporins and carbapenems in the disk diffusion test following guidelines of Clinical and Laboratory Standards Institute. Minimum inhibitory concentration of isolates found positive in screening test were determined for cephalosporins, carbapenems, aminoglycosides and tigecycline and colistin using Vitek-2 system. Modified Hodge test was performed to detect carbapenemase production on the isolates suspected for carbapenemase production.Results: Out of 260 K. pneumoniae isolates, 31 (11.9%) have shown 100% resistance to all cephalosporins. Of 31 K. pneumoniae isolates, 15 (48.4%) were found positive for carbapenemase. All carbapenem resistant isolates were sensitive to colistin and tigecycline. However, these isolates have shown resistance to amikacin (41.9%) and gentamicin (51.6%), respectively. Conclusion:This is the first report from Makkah reporting carbapenamse producing K.pneumoniae. Of 12% potential carbapenemase producing K.pneumoniae, 48.4% were found positive for carbapenemase production. Molecular characterization of these strains will help to determine the type of carbapenemase prevalent in this area. J Microbiol Infect Dis 2016;6(3): 121-127

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Section: Discussionsupporting

confidence: 87%

Frequency of Carbapenemase Producing Klebsiella pneumoniae in Makkah, Saudi Arabia

Khan¹

2016

Journal of Microbiology and Infectious Diseases

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“…While the latter assay has been found to be useful for KPC detection (1), its interpretation is often difficult and subjective (3,10,16) and does not distinguish between carbapenemase types (32). There is also increasing evidence that the MHT may give false-positive results among CTX-M ESBL-positive or AmpC-hyperproducing Enterobacteriaceae (14,25). Recently, there has been increasing interest in the use of boronic acid compounds as KPC inhibitors for the phenotypic detection of KPCs.…”

Section: ␤-Lactamasementioning

confidence: 99%

Comparative Evaluation of Combined-Disk Tests Using Different Boronic Acid Compounds for Detection of Klebsiella pneumoniae Carbapenemase-Producing Enterobacteriaceae Clinical Isolates

et al. 2011

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The accurate phenotypic detection of Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae is an increasing necessity worldwide. We evaluated the performance of boronic acid combined-disk tests using as substrate imipenem or meropenem and as inhibitor of KPC production 300 g aminophenylboronic acid (APBA), 600 g APBA, or 400 g phenylboronic acid (PBA). Tests were considered positive when an increase in the growth-inhibitory zone around a carbapenem disk with KPC inhibitor was 5 mm or greater of the growth-inhibitory zone diameter around the disk containing carbapenem alone. The comparison of the combined-disk tests was performed with 112 genotypically confirmed KPC-possessing Enterobacteriaceae isolates. To measure the specificity of the tests, 127 genotypically confirmed KPC-negative Enterobacteriaceae isolates that were nonsusceptible to at least one carbapenem were chosen for testing. Using disks containing imipenem without and with 300 g APBA, 600 g APBA, or 400 g PBA, 72, 92, and 112 of the KPC producers, respectively, gave positive results (sensitivities, 64.3%, 82.1%, and 100%, respectively). Using disks containing meropenem without and with 300 g APBA, 600 g APBA, or 400 g PBA, 87, 108, and 112 of the KPC producers, respectively, gave positive results (sensitivities, 77.7%, 96.4%, and 100%, respectively). Among KPC producers, the disk potentiation tests using meropenem and PBA demonstrated the largest differences in inhibition zones (P < 0.001). All combined-disk tests correctly identified 124 of the 127 non-KPC producers (specificity, 97.6%). This comparative study showed that PBA is the most effective inhibitor of KPC enzymes, and its use in combined-disk tests with meropenem may give the most easily interpreted results.

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“…Many researchers have found that standard phenotypic tests may fail, yielding unacceptable numbers of false-negative results (12,17,33). The lowering of clinical breakpoints has improved the sensitivity of phenotypic tests; nevertheless, it is prudent to remain cautious, since some isolates that give test results in the susceptible range may result in to clinical failure when part of an infection (11,34). PCR followed by DNA sequencing (PCR-sequencing) is still the most widely used molecular technique for characterization of ESBLs; however, these methods remain time-consuming.…”

mentioning

confidence: 99%

Using Nucleic Acid Microarrays To Perform Molecular Epidemiology and Detect Novel β-Lactamases: a Snapshot of Extended-Spectrum β-Lactamases throughout the World

Lascols¹,

Hackel²,

Hujer

et al. 2012

J Clin Microbiol

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The worldwide dissemination of extended-spectrum-␤-lactamase (ESBL)-and carbapenemase-producing Enterobacteriaceae is a major concern in both hospital and community settings. Rapid identification of these resistant pathogens and the genetic determinants they possess is needed to assist in clinical practice and epidemiological studies. A collection of Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, and Proteus mirabilis isolates, including phenotypically ESBL-positive (n ‫؍‬ 1,093) and ESBL-negative isolates (n ‫؍‬ 59), obtained in 2008 -2009 from a longitudinal surveillance study (SMART) was examined using an in vitro nucleic acid-based microarray. This approach was used to detect and identify bla ESBL (bla SHV , bla TEM , and bla CTX-M genes of groups 1, 2, 9, and 8/25) and bla KPC genes and was combined with selective PCR amplification and DNA sequencing for complete characterization of the bla ESBL and bla KPC genes. Of the 1,093 phenotypically ESBL-positive isolates, 1,041 were identified as possessing at least one bla ESBL gene (95.2% concordance), and 59 phenotypically ESBL-negative isolates, used as negative controls, were negative. Several ESBL variants of bla TEM (n ‫؍‬ 5), bla SHV (n ‫؍‬ 11), bla CTX-M (n ‫؍‬ 19), and bla KPC (n ‫؍‬ 3) were detected. A new bla SHV variant, bla SHV-129 , and a new bla KPC variant, bla KPC-11 , were also identified. The most common bla genes found in this study were bla CTX-M-15 , bla CTX-M-14 , and bla SHV-12 . Using nucleic acid microarrays, we obtained a "molecular snapshot" of bla ESBL genes in a current global population; we report that CTX-M-15 is still the dominant ESBL and provide the first report of the new ␤-lactamase variants bla SHV-129 and bla KPC-11 .

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Evaluation of Updated Interpretative Criteria for Categorizing Klebsiella pneumoniae with Reduced Carbapenem Susceptibility

Cited by 50 publications

References 41 publications

Frequency of Carbapenemase Producing Klebsiella pneumoniae in Makkah, Saudi Arabia

Frequency of Carbapenemase Producing Klebsiella pneumoniae in Makkah, Saudi Arabia

Comparative Evaluation of Combined-Disk Tests Using Different Boronic Acid Compounds for Detection of Klebsiella pneumoniae Carbapenemase-Producing Enterobacteriaceae Clinical Isolates

Using Nucleic Acid Microarrays To Perform Molecular Epidemiology and Detect Novel β-Lactamases: a Snapshot of Extended-Spectrum β-Lactamases throughout the World

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