The combined-disk boronic acid test as an accurate strategy for the detection of KPC carbapenemase in Central America

Abstract

Introduction: Carbapenemase-producing Klebsiella pneumoniae (KPC) outbreaks may cause a huge economical burden on developing countries. Furthermore, KPC can be challenging to detect. We describe the laboratory strategy for the detection of KPC from 2011 to 2013 in a tertiary care hospital in Central America with approximately 1,000 beds. Methodology: A retrospective analysis of a clinical laboratory database was done to determine the pragmatic application of the combined-disk boronic acid test during a KPC outbreak in Panama. A total of 1,026 Klebsiella pneumoniae isolates were found, of which 133 were positive for KPC. The strategy during two phases was described according to the test employed as a confirmatory test for KPC. After the K. pneumoniae isolates were detected by the VITEK 2 system, blaKPC polymerase chain reaction (PCR) and the combined-disk boronic acid test were employed as a confirmatory test during phase one. The combined-disk boronic acid test was employed as a confirmatory test for KPC during phase two. Results: The sensitivity, specificity, positive predictive value, and negative predictive value of the boronic acid test were 100%, 97%, 91%, and 100%, respectively, when blaKPC PCR was employed as a confirmatory test during the start of the outbreak. Afterwards, modified VITEK 2 system parameters resulted in 116 suspicious KPC samples and the boronic acid test confirmed 102 isolates. Conclusions: The use of an automated bacterial identification system and the boronic acid test for the detection of KPC was an effective and low-cost strategy for a clinical laboratory in Panama during an outbreak.

Emergence of New Delhi Metallo-Beta-Lactamase (NDM) and Klebsiella pneumoniae Carbapenemase (KPC) Production by Escherichia coli and Klebsiella pneumoniae in Southern Vietnam and Appropriate Methods of Detection: A Cross-Sectional Study

“…A study conducted by Ting-ting Qu et al in 2009 showed that CDT also detected other types of carbapenemase including Verona integron-borne metallo- β -lactamase (VIM), which was the most widespread metallo- β -lactamase in P. aeruginosa [41, 42]. Our results for KPC detection using PBA disk test K. pneumoniae (Table 4) were in accordance with findings obtained by Athanasios Tsakris et al (using PBA-400 μ g) [31] and Julio Zúñiga et al (using 300 μ g APBA) [43]. The efficiency of PBA disk test in E. coli was low, particularly in sensitivity and PPV because of the sample size of KPC-producing E. coli , only 3 strains with one of them being a false negative.…”

Antimicrobial susceptibility among Gram-positive and Gram-negative organisms collected from the Latin American region between 2004 and 2015 as part of the Tigecycline Evaluation and Surveillance Trial

“…Also of concern are carbapenemase-producing Klebsiella pneumoniae. There have been many outbreaks in the Latin American region [5], particularly in Panama where there was an outbreak from 2011 to 2013 that was difficult to control [6]. Carbapenemases of the metallo-β-lactamases type, such as NDM-1 and VIM, have also emerged in the region [5, 7].…”