Evaluation of carbapenemase screening and confirmation tests in. Enterobacteriaceae and development of a practical diagnostic algorithm
|
|
- Irma Montgomery
- 5 years ago
- Views:
Transcription
1 JCM Accepts, published online ahead of print on 29 October 2014 J. Clin. Microbiol. doi: /jcm Copyright 2014, American Society for Microbiology. All Rights Reserved. 1 2 Evaluation of carbapenemase screening and confirmation tests in Enterobacteriaceae and development of a practical diagnostic algorithm Florian P. Maurer 1, Claudio Castelberg 1, Chantal Quiblier 1, Guido V. Bloemberg 1, Michael Hombach 1, ) Institut für Medizinische Mikrobiologie, Universität Zürich, 8006 Zürich, Schweiz Running title: Diagnostic algorithm for carbapenemase detection Keywords: meropenem, imipenem, ertapenem, ESBL, AmpC, Carba NP, antibiotic resistance Corresponding author: Michael Hombach, M.D. Institut für Medizinische Mikrobiologie Universität Zürich Gloriastr. 30/ Zürich Switzerland Phone: Fax: mhombach@imm.uzh.ch 1
2 30 Abstract Reliable identification of carbapenemase producing Enterobacteriaceae is necessary to limit their spread. This study aimed at developing a diagnostic flowchart suitable for implementation in different types of clinical laboratories using phenotypic screening and confirmation tests. In total, 334 clinical Enterobacteriaceae isolates genetically characterized with respect to carbapenemase, extended-spectrumbeta-lactamase (ESBL), and AmpC genes were analyzed. 142/334 isolates (42.2%) were suspicious for carbapenemase production, i.e. intermediate or resistant to ertapenem AND/OR meropenem AND/OR imipenem according to EUCAST clinical breakpoints (CBPs). A group of 193/334 isolates (57.8%) showing susceptibility to ertapenem AND meropenem AND imipenem was considered as negative control group for this study. CLSI and EUCAST carbapenem CBPs and the new EUCAST MEM screening cut-off were evaluated as screening parameters. ETP, MEM and IPM +/- aminophenylboronic acid (APBA) or EDTA combined-disc tests (CDTs), and the Carba NP-II test were evaluated as confirmation assays. EUCAST temocillin cut-offs were evaluated for OXA-48 detection. The EUCAST MEM screening cut-off (< 25 mm) showed a sensitivity of 100%. The ETP APBA-CDT on Muller-Hinton agar containing cloxacillin (MH-CLX) displayed 100% sensitivity and specificity for class A carbapenemase confirmation. ETP and MEM EDTA-CDTs showed 100% sensitivity and specificity for class B carbapenemases. Temocillin diameters/mic testing on MH-CLX was highly specific for OXA-48 producers. The overall sensitivity, specificity, PPV, and NPV of the Carba NP-II test were 78.9%, 100%, 100%, and 98.7%, respectively. Combining the EUCAST MEM carbapenemasescreening cut-off (< 25 mm), ETP (or MEM) APBA- and EDTA-CDTs, and 2
3 54 55 temocillin disk diffusion on MH-CLX agar promises excellent performance for carbapenemase detection. 3
4 56 Introduction In recent years, the emergence of diverse carbapenemases in Enterobacteriaceae has become a major challenge for healthcare systems (1). Carbapenemase producing bacterial isolates pose a severe clinical problem as non-susceptibility to beta-lactams is frequently accompanied by co-resistance to additional drug classes, e.g. aminoglycosides or quinolones (2, 3). As a consequence, treatment options for carbapenemase producers are alarmingly limited and often drugs displaying significant side effects need to be administered as a last resort (4). β-lactamases are classified according to their functional properties and molecular structure by Ambler and Bush (5, 6). Some of these enzymes also display hydrolytic activity towards carbapenems, e.g. Klebsiella pneumoniae carbapenemase (KPC, Ambler/Bush class A), the New Delhi metallo-β-lactamase (NDM-1), VIM, and GIM type enzymes (all Ambler/Bush class B), or OXA-48 (Ambler/Bush class D). A key characteristic used for discriminating enzymes belonging to different Ambler/Bush classes is the responsiveness to specific inhibitors: Class A enzymes are inhibited by clavulanic and aminophenylboronic acid (APBA), class B enzymes are inhibited by EDTA, and class D enzymes do not respond to any inhibitors used in β-lactamase diagnostics (5, 6). KPC enzymes were first detected in the USA in 1996 and have subsequently spread worldwide (7). In Europe, KPC is endemic in Italy, Greece, Poland, and northwestern England (7). In Central Europe, France, and Spain other carbapenemases are reported more frequently. NDM-1 is endemic in India, Bangladesh, and Pakistan. In Europe, most NDM-1 are being isolated in Great Britain (8). OXA-48 is endemic in Turkey and Morocco, but is increasingly reported from other European countries mostly in repatriated patients (8, 9). Scandinavian countries, the Netherlands, and other 4
5 countries such as Switzerland generally report low prevalence rates for all carbapenemases. Thus, rapid and reliable detection of carbapenemases is desirable in order to limit the spread of these enzymes Detection of carbapenemase producing bacteria comprises carrier screening and detection of carbapenemase production in routine antimicrobial susceptibility testing (AST). While chromogenic media are often used for carrier screening, laboratory strategies for β-lactamase detection in routine AST consist of a screening and a confirmation step (10-14). A variety of phenotypic and molecular, commercially available and in-house laboratory tests have been described for carbapenemase detection. Molecular techniques comprise end point and real-time PCRs as well as microarray techniques (15-17). Critical diameters/mics of ertapenem (ETP), meropenem (MEM), and imipenem (IPM), and automated microdilution expert systems have been evaluated as screening methods (14, 18-20). For carbapenemase confirmation, the modified Hodge test is recommended by CLSI and various commercial and in-house combined disk tests (CDTs) using boronic acid derivatives and EDTA/dipicolinic acid as specific inhibitors have been described (13, 19-25). In 2014, EUCAST published new guidelines for the detection of resistance mechanisms including carbapenemases, in which a CDT is recommended for carbapenemase confirmation (14, 22, 25). Recently, Nordmann et al. described a new inhibitor-based biochemical assay for carbapenemase detection, the Carba NP test, which has been published in two versions: The Carba NP-I assay provides a positive or negative result ( carbapenemase detected/not detected ) whereas the Carba NP-II test has been designed to also discriminate between carbapenemase classes A, B, and D (26-29). Apart from the original publications, few studies have systematically evaluated the Carba NP-I test for 5
6 Enterobacteriaceae, and both the originally published protocol and modified versions were used. Reported sensitivities varied between 72.5% and 100%, whereas specificity generally was reported to be 100% (30-33). Except for its original description the Carba NP-II assay has been systematically evaluated for Pseudomonas aeruginosa only (30, 31, 34-36) Several issues of carbapenemase detection remain challenging: i) Enterobacteriaceae overexpressing AmpC β-lactamases in combination with reduced cell-wall permeability compromise the specificity of APBA-CDTs as the inhibitor (APBA) affects both AmpC and carbapenemases (37-44); ii) Detection of OXA-48 and related enzymes remains problematic as no specific inhibitor is available. Temocillinresistance was suggested as an indicator for OXA-48 production, but not for OXA-48 confirmation (14, 25, 31, 45, 46). This study aimed at developing a modular diagnostic flow-chart suitable for all types of clinical laboratories, which integrates various phenotypic screening and confirmation tests for highly sensitive and specific carbapenemase detection. 6
7 131 Materials and Methods Bacterial isolates. In total, 334 non-duplicate clinical isolates recovered in our laboratory from 2009 until 2014 were included in the study (Table 1). All isolates were genetically characterized for the presence of ESBL (TEM-ESBL, SHV-ESBL, and CTX-M types), plasmid-encoded AmpCs, chromosomal ampc promoter/attenuator mutations leading to overexpression (Escherichia coli only), and for the presence of carbapenemases (16, 47, 48). 142/334 isolates (42.2%) were considered suspicious for carbapenemase production due to non-susceptibility to ertapenem AND/OR meropenem AND/OR imipenem (intermediate or resistant zone diameters according to EUCAST CBPs), whereas 193/334 isolates (57.8%) considered non-suspicious for carbapenemase production (susceptible to ertapenem AND meropenem AND imipenem) served as a negative control group. Genetic detection of carbapenemase, ESBL and ampc genes. Total DNA was extracted from bacterial colonies after growth on sheep blood agar medium using the InstaGene Matrix (Bio-Rad, Reinach, Switzerland). Genetic detection of carbapenemase genes was done by performing a carbapenemase multiplex PCR (16). For variant analysis OXA-48 genes were amplified with primers described(49). PCR amplicons were sequenced using PCR primers and sequences analyzed using GenBank and DNASTAR Lasergene software (DNASTAR Inc., Madison, Wisconsin USA). The AID ESBL line probe assay (AID Autoimmun Diagnostika GmbH, Germany) was used for the detection of ESBL genes (50). Bacterial isolates were genetically characterized for the presence of plasmid-mediated AmpC type β-lactamase genes by multiplex PCR (51). Chromosomal ampc promoter mutations of E. coli isolates were analyzed as described previously (52). 7
8 Susceptibility testing. Disk diffusion susceptibility testing was done according to EUCAST recommendations (53). Antibiotic disks and Mueller-Hinton (MH) agar were obtained from Becton Dickinson, Franklin Lakes, NJ. Cloxacillin supplemented Mueller-Hinton (MH-CLX) agar was obtained from Axonlab AG, Baden, Switzerland. Zone diameters were recorded using the Sirweb/Sirscan system (i2a, Montpellier, France). Minimal inhibitory concentrations (MICs) were determined by gradient diffusion (Etest, biomérieux, Marcy L Etoile, France) according to the manufacturer s instructions. Combined-disk tests (CDTs) for carbapenemase detection. CDTs were performed as described elsewhere (19, 24). Sets of two disks each containing IPM (10 μg), MEM (10 μg), or ETP (10 μg, all Becton Dickinson) were placed onto MH (EDTA-CDT) or both MH and MH-CLX (APBA-CDT) plates inoculated with a sample of the tested isolate (0.5 McFarland turbidity standard). Immediately after placing the disks onto the agar, 10 μl of a 29.2-mg/mL (0.1 M) EDTA solution (EDTA-CDT), or 10 μl of a 30- mg/ml APBA solution (APBA-CDT) were added to one of the two carbapenem disks in each set. Plates were incubated at 35 C for 16 to 20 hours, and zone diameters were recorded using the Sirweb/Sirscan system (i2a). Disc diameter differences of 5 mm between the APBA-free and APBA-containing discs or between the EDTA-free and EDTA-containing discs were considered indicative for production of a class A carbapenemases and class B carbapenemase, respectively Carba NP-II test. The Carba NP-II test was performed and interpreted as described (26). Reactions were read after 0, 30, 60 and 120 minutes of incubation. Color changes from red to yellow-orange were interpreted as follows: wells 2 and 4, positive (Ambler class A carbapenemase); wells 2 and 3, positive (Ambler class B carbapenemase); wells 2, 3 and 4: positive (probably Ambler class D carbapenemase); no well, 8
9 carbapenemase negative; all wells, test not interpretable. The Carba NP-II test was performed by experienced personal, and all discrepant results were additionally repeated at least 3 times. Software. All calculations were done using the IBM SPSS statistics software version 20 (IBM Corporation, Armonk, NY) and the Microsoft Excel 2010 software (Microsoft Corporation, Redmond, WA). 9
10 186 Results Evaluation of screening parameters for carbapenemase production The EUCAST non-susceptible ETP CBP (< 25 mm), and the EUCAST recommended carbapenemase MEM screening cut-off (< 25 mm) for carbapenemase production displayed highest sensitivity of all evaluated cut-offs (100%, Table 2). ETP, however, had a lower specificity (62.5%) than MEM (90.7%, Table 2). The ETP nonsusceptible CLSI CBP (< 22 mm) and the non-susceptible CLSI CBP for MEM (< 23 mm) displayed lower sensitivity (95.5% for both compounds, Table 2). The IPM nonsusceptible EUCAST CBP (< 22 mm) had the lowest sensitivity (81.8%), whereas the non-susceptible CLSI IPM CBP (23 mm) had a sensitivity of 90.9%. Performance of carbapenemase confirmation tests Combined-disc tests (CDTs) The ETP APBA-CDT on MH-CLX agar displayed highest sensitivity and NPV for class A carbapenemase detection (100%, Table 2). Specificity of 100% was found for the ETP APBA-CDT, the IPM APBA-CDT, and the MEM APBA-CDT on MH-CLX, whereas the same CDTs on conventional MH agar showed a specificity of 96.9%, 99.4%, and 96.6%, respectively (Table 2). 9/10 false-positive ETP APBA-CDTs on conventional MH agar occurred in species with chromosomal AmpC (6 Enterobacter cloacae, 1 Enterobacter aerogenes, and 2 Hafnia alvei). 9/11 false-positive MEM APBA-CDTs on conventional MH agar were also found in AmpC positive species, i.e. 6 Enterobacter cloacae, 1 Enterobacter aerogenes, 1 Hafnia alvei, and 1 E. coli harboring a CIT type plasmid-encoded AmpC. One K. pneumoniae isolate lacking AmpC or ESBL was borderline positive in both ETP and MEM APBA-CDT on conventional MH (5 mm and 7 mm zone difference, respectively). Another 10
11 K. pneumoniae isolate producing an ESBL was borderline positive only in the MEM APBA-CDT on conventional MH (5 mm difference). Both the ETP and the MEM EDTA-CDTs displayed 100% sensitivity and specificity for class B carbapenemase detection, whereas the sensitivity of the IPM EDTA-CDT was significantly lower (70%, Table 2) Carba NP-II test The overall sensitivity, specificity, PPV, and NPV of the Carba NP-II test were 78.9%, 100%, 100%, and 98.7%, respectively (Table 2). The test created some reading problems resulting in ambiguous results that were treated as follows: One Enterobacter aerogenes isolate possessing a blavim gene gave ambiguous results in terms of class assignment (see isolate 8, Figure 1). After 30 min of incubation the pattern was consistent with a class B carbapenemase, while after 120 min of incubation the pattern was consistent with a class D carbapenemase (e.g. OXA-48).. For calculation of performance parameters this isolate was rated carbapenemase positive (Table 3). Three Klebsiella pneumoniae isolates co-producing OXA-48 and CTX-M ESBL gave inconclusive results (Table 3): the NP-II patterns were negative for carbapenemase production until 60 min of incubation. After 120 min of incubation, the patterns could either still be rated negative or weakly positive for class A carbapenemases (see Figure 1, isolates 20, 99, 51, results were reproduced three times with independent preparations); these isolates were excluded from the calculation of performance parameters. In addition, one OXA-48 producing Klebsiella pneumoniae (see isolate 19, Figure 1) and three NDM producing isolates of Providencia rettgeri, Providencia stuartti, and Proteus mirabilis, respectively, gave false-negative results with the NP-II test (see Table 3, isolates 136, 138, and 139, Figure 1). One Enterobacter cloacae isolate producing a GIM (class B) gave an OXA-48-like pattern (class D, see isolate 95, 11
12 Figure 1). For the calculation of sensitivity and specificity this isolate was rated carbapenemase positive (Table 3) Temocillin testing on MH-CLX agar Nineteen representative carbapenem non-susceptible isolates were tested for temocillin zone diameters and MICs on MH and MH-CLX agar as indicators for the presence of OXA-48. Five isolates harbored blaoxa-48 genes, nine isolates were blaoxa-48 gene negative but showed overexpression of a chromosomally encoded AmpC, and five isolates harbored ESBL genes (but not blaoxa-48, Table 4). All OXA-48 producers showed high-level temocillin resistance on both MH and MH-CLX agar (median diameter 6 mm, median MIC >1024 mg/l, Table 4). Five out of nine AmpC hyperproducers displayed temocillin zone diameters lower than 11 mm on MH (EUCAST screening cut-off for OXA-48 like enzymes) (14). On MH-CLX, the temocillin median diameter of the AmpC hyperproducers increased by 7 mm (corresponding to a median Etest-determined MIC decrease of 2 dilution steps, Table 4), and the five EUCAST OXA-48 screen false-positive isolates became true-negatives. Temocillin median diameters and gradient diffusion MICs of the five ESBL producers were not altered by the use of MH-CLX as compared to conventional MH agar. Median temocillin diameters/mics were 11 mm and 32 mg/l, respectively, on both media (Table 4). The only false-positive temocillin-based OXA-48 screening result originated from an CTX-M type ESBL-producing Klebsiella pneumoniae isolate displaying temocillin diameters/mics of 10 mm and 64 mg/l on both MH and MH-CLX agar Genetic characterization of isolates In total, 23 carbapenemase genes were detected in 22 Enterobacteriaceae isolates: 7 blakpc, 1 blaimi, 4 blavim, 4 blandm, 1 blagim, and 4 blaoxa-48; 1 isolate coproduced VIM and OXA-48 enzymes (Tables 1 and 2). Seventy-eight (23.4%) of the 12
13 studied isolates were genetically negative for ESBL, AmpC, and carbapenemases; 178 (53.3%) of the isolates produced an AmpC β-lactamase (including those species with chromosomally encoded AmpC, i.e. Enterobacter cloacae, Enterobacter aerogenes, Citrobacter freundii, Hafnia alvei, Morganella morganii, Serratia marcescens, and Providencia stuartii, Table 1) (54); 105 (31.4%) of the isolates harbored an ESBL (Table 1). 13
14 266 Discussion Screening parameters for carbapenemases Disk diffusion critical diameters have been reported to display high sensitivity for the detection of carbapenemases (13, 20). This study found 100% sensitivity for the EUCAST critical MEM diameter (< 25 mm) with a comparably high specificity of 90.7% (Table 2). ETP screening using the EUCAST non-susceptible CBP (< 25 mm) also showed high sensitivity (100%), but low specificity (62.5%, Table 2). Thus, our results confirm the current EUCAST recommendation (15). CLSI non-susceptible ETP (< 22 mm) and MEM (< 23 mm) CBPs displayed lower sensitivity as compared to the current EUCAST recommendation (95.5%, Table 2). Based on the findings of this study, carbapenemase screening using MEM is recommended, whereas the use of IMP as screening drug is discouraged (IMP sensitivity EUCAST < 22 mm / CLSI < 23 mm 81.8% and 90.9%, respectively). Since automated microdilution AST reportedly lacks sensitivity and specificity due to antibiotic panel composition and drug concentrations tested (18, 55), disk diffusion critical MEM diameters promise the best performance for carbapenemase detection among all evaluated techniques. In addition, disk diffusion is cheap, simple, and widely implemented by many laboratories for routine AST. Carbapenemase confirmation tests The modified Hodge test, which is recommended by CLSI for carbapenemase confirmation, is cheap and, in principle, simple to perform (23). However, it displays significant investigator dependence, practical interpretation is technically demanding, the test cannot distinguish between the different carbapenemase classes, and reportedly shows low specificity due to AmpC β-lactamase overproduction and decreased permeability, e.g. caused by porin loss (13, 20, 55). The problem of discriminating 14
15 carbapenemase activity from AmpC and impermeability is well known both for species possessing a chromosomal AmpC (e.g. Enterobacter spp., Citrobacter spp., or Hafnia alvei), and for producers of plasmid-encoded AmpC, in particular Klebsiella pneumoniae (39, 44, 56). Even E. coli overproducing AmpC due to mutations in the promoter/attenuator region and/or showing mutations in the active center of the enzyme resulting in an extended spectrum AmpC (ESAC) phenotype display carbapenem nonsusceptibility (41, 43). The same pattern accounts for ESBL producers in combination with porin loss (37, 38). AmpC and ESBL production interferes not only with carbapenemase screening, but also with APBA-CDT confirmation for class A carbapenemases (14, 19, 57). False positive results occur as APBA is not only an inhibitor of class A carbapenemases, but also of AmpC β-lactamases. To improve specificity of APBA-CDTs, MEM/CLX disks are used to check for AmpC interference (indirect approach) (13, 14, 20, 22, 25). However, based on the current EUCAST algorithm, class A carbapenemases in isolates co-producing AmpC may be missed as synergy of MEM with both CLX and APBA is interpreted as AmpC and porin loss (14). A recent study found two Enterobacter cloacae isolates overproducing AmpC, but also harboring KPC and NMC-A enzymes that would have been misclassified using this approach (13). Other authors pointed out that MEM-MEM/CLX zone diameter differences are relatively lower in AmpC hyperproducers co-expressing a class A carbapenemase (i.e. mean difference 1 mm) than in AmpC hyperproducers without a class A carbapenemase (mean difference 5 mm) (22). Another study, however, described MEM-MEM/CLX zone diameter differences of 6 to 7 mm and 0-7 mm for AmpC hyperproducing E. cloacae harboring class A carbapenemases and AmpC hyperproducers devoid of carbapenemases, respectively (13). Thus the discriminative power of relative MEM-MEM/CLX diameter differences may be insufficient. In addition, classification based on the relative degree of MEM-MEM/CLX diameter 15
16 differences is difficult to standardize and requires significant expertise. The present study on 178 (53.3%) AmpC producing isolates shows that APBA-CDTs performed on MH-CLX agar reliably detect class A carbapenemases with increased specificity (100%) due to suppression of AmpC activity (Table 2). The approach is simple to interpret as it uses a single critical zone diameter difference (5 millimeters), and it can be integrated in one step with ESBL confirmation testing on the same MH-CLX agar plate (48). In the present study, the Carba NP-II showed an overall sensitivity of 78.9% and a NPV of 98.7% (Table 2). Our results closely parallel those of a recent study, which found a sensitivity of 72.5% for the Carba NP-I and a NPV of 69.2%. The difference in NPV is well explained by the different prevalence of carbapenemase producers in the study populations, i.e. 6.6% (n = 22) in this study and >45% (n =145) in the study of Tijet et al. (31). Other authors found higher sensitivities for the Carba NP-I test using different types of protocols (32, 33). Our data confirm ambiguities in the reading of the Carba NP-I/II test in particular for OXA-48 producing isolates that tend to produce inconclusive, or false-negative results (see Figure 1, isolates 19, 20, 51, and 99) (31). If the inconclusive OXA-48 results from Figure 1 would have been rated negative (only a slight color-change was visible after 120 min of incubation), sensitivity would have been 68.2% (Table 2). If rated positive, the three ambiguous OXA-48 results would have been consistent with a class A carbapenemase pattern, most likely due to the simultaneous presence of a CTX-M type ESBL (class A enzyme), which may be responsible for the weak color-change in wells II and IV after 120 min of incubation, and which is inhibited by tazobactam in well III (see Figure 1). False-negative Carba NP results have also been described for mucoid colonies, e.g. of Providencia rettgeri, Providencia stuartii, or Proteus mirabilis isolates (29, 31). Negative results were 16
17 attributed to difficulties in protein extraction, species-specific traits, or the influence of the agar type and ion content on the Carba NP test (30, 31, 36). Besides OXA-48 producers, false-negative results in the present study also occurred in non-mucoid isolates of Providencia rettgeri, Providencia stuartii, and Proteus mirabilis producing NDM enzymes. All tests for these isolates were repeated three times with the standard protocol and additionally performed using colonies grown on various agar media of different manufacturers, i.e. MH (Becton Dickinson), MH-CLX (Axonlab), Columbia sheep blood, MacConkey (biomérieux), and Uriselect4 agar (BioRad). Despite reports that the Carba NP I test performed better from Columbia sheep blood and Uriselect4 agar results for these isolates remained false-negative for all media types pointing to species-specific issues related to Providencia and Proteus isolates, and a low sensitivity for OXA-48 enzymes (34). Other authors recently found a higher sensitivity and specificity for the detection of OXA-48 (28). In summary, due to the higher NPV, the Carba NP-II test may perform better in a low prevalence environment (i.e. our study) as compared to high prevalence settings such as those investigated by Tijet et al. (31). However, the issues of false-negative OXA-48 producers and species specific falsenegative results due to the unknown impact of different genetic backgrounds need to be further analyzed. The phenotypic detection of OXA-48-like carbapenemases remains challenging. EUCAST recommends indirect OXA-48 confirmation by decreased zone diameters or increased MICs for temocillin (< 11 mm, and > 32 mg/l, respectively) to exclude ESBLs in combination with porin loss in cases where both APBA-CDT and EDTA- CDT are negative (14). Temocillin MICs, however, are not recommended to discriminate AmpC overproduction combined with porin loss from OXA-48 as temocillin MICs are variable in this setting resulting in poor specificity. By suppressing 17
18 potential AmpC activity, temocillin disk diffusion testing or MIC determination by a gradient diffusion method on MH-CLX can help to clearly increase specificity of temocillin-based OXA-48 screening without compromising sensitivity (Table 4). In summary, a combination of the EUCAST MEM carbapenemase-screening cut-off (< 25 mm) and ETP (or MEM) APBA- and EDTA-CDTs plus temocillin disk diffusion (or gradient diffusion-based MIC determination) on MH-CLX agar promises excellent performance for carbapenemase detection. The proposed diagnostic flow-chart (Figure 2) would have resulted in a sensitivity, specificity, PPV, and NPV of 100% in the study population. This algorithm is simple, easy to use, cost-efficient and applicable in the majority of clinical microbiology laboratories. Downloaded from on August 14, 2018 by guest 18
19 Acknowledgments We are grateful to the laboratory technicians of the Institute of Medical Microbiology, University of Zurich for their dedicated help, and to Erik C. Böttger and Reinhard Zbinden for valuable discussions Funding This work was supported by the University of Zurich. Transparency declaration All authors: No conflicts of interest to declare. 19
20 395 References Bush K, Fisher JF Epidemiological expansion, structural studies, and clinical challenges of new beta-lactamases from Gram-negative bacteria. Annu Rev Microbiol 65: Hirsch EB, Tam VH Detection and treatment options for Klebsiella pneumoniae carbapenemases (KPCs): an emerging cause of multidrug-resistant infection. J Antimicrob Chemother 65: Leski T, Vora GJ, Taitt CR Multidrug resistance determinants from NDM- 1-producing Klebsiella pneumoniae in the USA. Int J Antimicrob Agents 40: Kelesidis T, Karageorgopoulos DE, Kelesidis I, Falagas ME Tigecycline for the treatment of multidrug-resistant Enterobacteriaceae: a systematic review of the evidence from microbiological and clinical studies. J Antimicrob Chemother 62: Bush K The ABCD's of beta-lactamase nomenclature. J Infect Chemother 19: Queenan AM, Bush K Carbapenemases: the versatile beta-lactamases. Clin Microbiol Rev 20: Munoz-Price LS, Poirel L, Bonomo RA, Schwaber MJ, Daikos GL, Cormican M, Cornaglia G, Garau J, Gniadkowski M, Hayden MK, Kumarasamy K, Livermore DM, Maya JJ, Nordmann P, Patel JB, Paterson DL, Pitout J, Villegas MV, Wang H, Woodford N, Quinn JP Clinical epidemiology of 20
21 the global expansion of Klebsiella pneumoniae carbapenemases. Lancet Infectious Diseases 13: Canton R, Akova M, Carmeli Y, Giske CG, Glupczynski Y, Gniadkowski M, Livermore DM, Miriagou V, Naas T, Rossolini GM, Samuelsen O, Seifert H, Woodford N, Nordmann P, European Network on C Rapid evolution and spread of carbapenemases among Enterobacteriaceae in Europe. Clin Microbiol Infect 18: Potron A, Poirel L, Rondinaud E, Nordmann P Intercontinental spread of OXA-48 beta-lactamase-producing Enterobacteriaceae over a 11-year period, 2001 to Euro Surveill Girlich D, Poirel L, Nordmann P Comparison of the SUPERCARBA, CHROMagar KPC, and Brilliance CRE screening media for detection of Enterobacteriaceae with reduced susceptibility to carbapenems. Diagn Microbiol Infect Dis 75: Hornsey M, Phee L, Woodford N, Turton J, Meunier D, Thomas C, Wareham DW Evaluation of three selective chromogenic media, CHROMagar ESBL, CHROMagar CTX-M and CHROMagar KPC, for the detection of Klebsiella pneumoniae producing OXA-48 carbapenemase. J Clin Pathol 66: Papadimitriou-Olivgeris M, Bartzavali C, Christofidou M, Bereksi N, Hey J, Zambardi G, Spiliopoulou I Performance of chromid(r) CARBA medium for carbapenemases-producing Enterobacteriaceae detection during rectal screening. Eur J Clin Microbiol Infect Dis 33:
22 Seah C, Low DE, Patel SN, Melano RG Comparative evaluation of a chromogenic agar medium, the modified Hodge test, and a battery of meropeneminhibitor discs for detection of carbapenemase activity in Enterobacteriaceae. J Clin Microbiol 49: European Committee on Antimicrobial Susceptibility Testing. Guidelines for detection of resistance mechanisms and specific resistances of clinical and/or epidemiological importance. Version 1.0, (last accessed 16th June 2014). 15. Tenover FC, Canton R, Kop J, Chan R, Ryan J, Weir F, Ruiz-Garbajosa P, LaBombardi V, Persing DH Detection of colonization by carbapenemaseproducing Gram-negative Bacilli in patients by use of the Xpert MDRO assay. J Clin Microbiol 51: Poirel L, Walsh TR, Cuvillier V, Nordmann P Multiplex PCR for detection of acquired carbapenemase genes. Diagn Microbiol Infect Dis 70: Cuzon G, Naas T, Bogaerts P, Glupczynski Y, Nordmann P Evaluation of a DNA microarray for the rapid detection of extended-spectrum beta-lactamases (TEM, SHV and CTX-M), plasmid-mediated cephalosporinases (CMY-2-like, DHA, FOX, ACC-1, ACT/MIR and CMY-1-like/MOX) and carbapenemases (KPC, OXA-48, VIM, IMP and NDM). J Antimicrob Chemother 67: Doern CD, Dunne WM, Jr., Burnham CA Detection of Klebsiella pneumoniae carbapenemase (KPC) production in non-klebsiella pneumoniae Enterobacteriaceae isolates by use of the Phoenix, Vitek 2, and disk diffusion methods. J Clin Microbiol 49:
23 Pasteran F, Mendez T, Guerriero L, Rapoport M, Corso A Sensitive screening tests for suspected class A carbapenemase production in species of Enterobacteriaceae. J. Clin. Microbiol. 47: Willems E, Verhaegen J, Magerman K, Nys S, Cartuyvels R Towards a phenotypic screening strategy for emerging beta-lactamases in Gram-negative bacilli. Int J Antimicrob Agents 41: Doyle D, Peirano G, Lascols C, Lloyd T, Church DL, Pitout JD Laboratory detection of Enterobacteriaceae that produce carbapenemases. J Clin Microbiol 50: Giske CG, Gezelius L, Samuelsen O, Warner M, Sundsfjord A, Woodford N A sensitive and specific phenotypic assay for detection of metallo-betalactamases and KPC in Klebsiella pneumoniae with the use of meropenem disks supplemented with aminophenylboronic acid, dipicolinic acid and cloxacillin. Clin Microbiol Infect 17: Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-fourth Informational Supplement. CLSI document M 100-S 24. CLSI, Wayne, PA, USA, Tsakris A, Poulou A, Pournaras S, Voulgari E, Vrioni G, Themeli-Digalaki K, Petropoulou D, Sofianou D A simple phenotypic method for the differentiation of metallo-beta-lactamases and class A KPC carbapenemases in Enterobacteriaceae clinical isolates. J Antimicrob Chemother 65: van Dijk K, Voets GM, Scharringa J, Voskuil S, Fluit AC, Rottier WC, Leverstein-Van Hall MA, Cohen Stuart JW A disc diffusion assay for 23
24 detection of class A, B and OXA-48 carbapenemases in Enterobacteriaceae using phenyl boronic acid, dipicolinic acid and temocillin. Clin Microbiol Infect 20: Dortet L, Poirel L, Nordmann P Rapid identification of carbapenemase types in Enterobacteriaceae and Pseudomonas spp. by using a biochemical test. Antimicrob Agents Chemother 56: Nordmann P, Poirel L, Dortet L Rapid Detection of Carbapenemaseproducing Enterobacteriaceae. Emerging Infectious Diseases 18: Huang TD, Berhin C, Bogaerts P, Glupczynski Y Comparative evaluation of two chromogenic tests for the rapid detection of carbapenemase in Enterobacteriaceae and in Pseudomonas aeruginosa isolates. J Clin Microbiol 52: Milillo M, Kwak YI, Snesrud E, Waterman PE, Lesho E, McGann P Rapid and simultaneous detection of blakpc and blandm by use of multiplex real-time PCR. J Clin Microbiol 51: Dortet L, Poirel L, Nordmann P Further proofs of concept for the Carba NP test. Antimicrob Agents Chemother 58: Tijet N, Boyd D, Patel SN, Mulvey MR, Melano RG Evaluation of the Carba NP test for rapid detection of carbapenemase-producing Enterobacteriaceae and Pseudomonas aeruginosa. Antimicrob Agents Chemother 57: Vasoo S, Cunningham SA, Kohner PC, Simner PJ, Mandrekar JN, Lolans K, Hayden MK, Patel R Comparison of a novel, rapid chromogenic 24
25 biochemical assay, the Carba NP test, with the modified Hodge test for detection of carbapenemase-producing Gram-negative bacilli. J Clin Microbiol 51: Yusuf E, Van Der Meeren S, Schallier A, Pierard D Comparison of the Carba NP test with the Rapid CARB Screen Kit for the detection of carbapenemase-producing Enterobacteriaceae and Pseudomonas aeruginosa. Eur J Clin Microbiol Infect Dis. Epub ahead of print. 34. Dortet L, Brechard L, Poirel L, Nordmann P Impact of the isolation medium for detection of carbapenemase-producing Enterobacteriaceae using an updated version of the Carba NP test. J Med Microbiol 63: Peter S, Lacher A, Marschal M, Holzl F, Buhl M, Autenrieth I, Kaase M, Willmann M Evaluation of phenotypic detection methods for metallo-betalactamases (MBLs) in clinical isolates of Pseudomonas aeruginosa. Eur J Clin Microbiol Infect Dis 33: Tijet N, Boyd D, Patel SN, Mulvey MR, Melano RG Reply to "further proofs of concept for the Carba NP test". Antimicrob Agents Chemother 58: Doumith M, Ellington MJ, Livermore DM, Woodford N Molecular mechanisms disrupting porin expression in ertapenem-resistant Klebsiella and Enterobacter spp. clinical isolates from the UK. J Antimicrob Chemother 63: Elliott E, Brink AJ, van Greune J, Els Z, Woodford N, Turton J, Warner M, Livermore DM In vivo development of ertapenem resistance in a patient with pneumonia caused by Klebsiella pneumoniae with an extended-spectrum betalactamase. Clin Infect Dis 42:e
26 Fernandez-Cuenca F, Rodriguez-Martinez JM, Martinez-Martinez L, Pascual A In vivo selection of Enterobacter aerogenes with reduced susceptibility to cefepime and carbapenems associated with decreased expression of a 40 kda outer membrane protein and hyperproduction of AmpC beta-lactamase. Int J Antimicrob Agents 27: Garcia-Sureda L, Domenech-Sanchez A, Barbier M, Juan C, Gasco J, Alberti S OmpK26, a novel porin associated with carbapenem resistance in Klebsiella pneumoniae. Antimicrob Agents Chemother 55: Guillon H, Tande D, Mammeri H Emergence of ertapenem resistance in an Escherichia coli clinical isolate producing extended-spectrum beta-lactamase AmpC. Antimicrob Agents Chemother 55: Lee YT, Chen TL, Siu LK, Chen CP, Fung CP Impact of derepressed AmpC beta-lactamase ACT-9 on the clinical efficacy of ertapenem. Antimicrob Agents Chemother 55: Mammeri H, Nordmann P, Berkani A, Eb F Contribution of extendedspectrum AmpC (ESAC) beta-lactamases to carbapenem resistance in Escherichia coli. FEMS Microbiol Lett 282: Skurnik D, Nucci A, Ruimy R, Lasocki S, Muller-Serieys C, Montravers P, Andremont A, Courvalin P Emergence of carbapenem-resistant Hafnia: the fall of the last soldier. Clin Infect Dis 50: Hartl R, Widhalm S, Kerschner H, Apfalter P Temocillin and meropenem to discriminate resistance mechanisms leading to decreased 26
27 carbapenem susceptibility with focus on OXA-48 in Enterobacteriaceae. Clin Microbiol Infect 19:E Poirel L, Naas T, Nordmann P Diversity, epidemiology, and genetics of class D beta-lactamases. Antimicrob Agents Chemother 54: Polsfuss S, Bloemberg GV, Giger J, Meyer V, Bottger EC, Hombach M Practical approach for reliable detection of AmpC beta-lactamase-producing Enterobacteriaceae. J Clin Microbiol 49: Polsfuss S, Bloemberg GV, Giger J, Meyer V, Bottger EC, Hombach M Evaluation of a diagnostic flow chart for detection and confirmation of extended spectrum beta-lactamases (ESBL) in Enterobacteriaceae. Clin Microbiol Infect 18: Poirel L, Potron A, Nordmann P OXA-48-like carbapenemases: the phantom menace. J Antimicrob Chemother 67: Bloemberg GV, Polsfuss S, Meyer V, Bottger EC, Hombach M Evaluation of the AID ESBL line probe assay for rapid detection of extendedspectrum beta-lactamase (ESBL) and KPC carbapenemase genes in Enterobacteriaceae. J Antimicrob Chemother 69: Perez-Perez FJ, Hanson ND Detection of plasmid-mediated AmpC betalactamase genes in clinical isolates by using multiplex PCR. J. Clin. Microbiol. 40: Peter-Getzlaff S, Polsfuss S, Poledica M, Hombach M, Giger J, Böttger EC, Zbinden R, Bloemberg GV Detection of AmpC beta-lactamase in 27
28 Escherichia coli: comparison of three phenotypic confirmation assays and genetic analysis. J Clin Microbiol 49: European Committee on Antimicrobial Susceptibility Testing. Disk diffusion manual v (11th June 2014, date last accessed). 54. Jacoby GA AmpC beta-lactamases. Clin. Microbiol. Rev. 22: Pasteran F, Lucero C, Soloaga R, Rapoport M, Corso A Can we use imipenem and meropenem Vitek 2 MICs for detection of suspected KPC and othercarbapenemase producers among species of Enterobacteriaceae? J Clin Microbiol 49: Cai JC, Hu YY, Zhang R, Zhou HW, Chen GX Detection of OmpK36 porin loss in Klebsiella spp. by matrix-assisted laser desorption ionization-time of flight mass spectrometry. J Clin Microbiol 50: Pournaras S, Poulou A, Tsakris A Inhibitor-based methods for the detection of KPC carbapenemase-producing Enterobacteriaceae in clinical practice by using boronic acid compounds. J Antimicrob Chemother 65:
29 Tables and Figures Table 1: Species identification and beta-lactamase genotypes of studied isolates. Species N % ESBL, AmpC, Carbapenemase negative AmpC ESBL Carbapenemases KPC IMI VIM NDM GIM OXA-48 Escherichia coli total Enterobacter cloacae NA NA NA NA NA + + total Klebsiella pneumoniae total Enterobacter aerogenes NA NA + + total NA + + Klebsiella oxytoca total
30 Species N % ESBL, AmpC, Carbapenemase negative Table 1 continued AmpC ESBL Citrobacter freundii NA + + total NA NA + Hafnia alvei NA + total NA + + NA, not applicable, for species naturally harboring chromosomally-encoded AmpC beta-lactamases 30 Carbapenemases KPC IMI VIM NDM GIM OXA-48 Proteus mirabilis total Morganella morganii NA + + total NA + Serratia marcescens NA + Citrobacter koseri Salmonella spp Providencia rettgeri Providencia stuartii NA + + Enterobacter sp NA + Pantoea spp Citrobacter spp NA + Serratia spp NA + Total Genotypes (%)
31 Table 2: Performance parameters of screening and confirmation assays and the proposed diagnostic flow chart (see Figure 2). Parameter TP (N) FP (N) TN (N) FN (N) Total (N) Sensitivity (%) Specificity (%) PPV (%) NPV (%) Screening cut-offs / CBPs MEM Screen EUCAST (< 25 mm) ETP EUCAST I/R (< 25 mm) IPM EUCAST I/R (< 22 mm) MEM EUCAST I/R (< 22 mm) ETP CLSI I/R (< 22 mm) IPM CLSI I/R (< 23 mm) MEM CLSI I/R (< 23 mm) CDTs ETP-BA MH IPM-BA MH MEM-BA MH ETP-BA MH-CLX IPM-BA MH-CLX MEM-BA MH-CLX ETP-EDTA MH IPM-EDTA MH MEM-EDTA MH Carba NP-II Carba NP-II Proposed algorithm TP, true-positive; FP, false-positive; TN, true-negative; FN, false-negative; MEM, meropenem; ETP, ertapenem; CDT, combined-disk test; APBA, aminophenylboronic acid; MH-CLX agar, Muller Hinton agar supplemented with cloxacillin; MH agar, Muller Hinton agar without cloxacillin. 1 inconclusives were excluded from the calculation; 2 inconclusives rated negative. 31
32 Table 3: Carbapenemase-positive isolates with characteristics and confirmation test results. Isolate number Species AmpC ESBL Carbapenemase type Carbapenemase class NP-II 32 CDTs (Δ mm) BA on MH BA on MH-CLX EDTA on MH ETP IMI MEM ETP IMI MEM ETP IMI MEM 7 Klebsiella pneumoniae - - KPC A Klebsiella pneumoniae - SHV-ESBL KPC A Klebsiella pneumoniae - - KPC A Klebsiella pneumoniae - - KPC A Klebsiella pneumoniae - - KPC A Enterobacter cloacae campc - IMI A Escherichia coli - - KPC A Klebsiella pneumoniae - CTX-M KPC A Enterobacter aerogenes campc - VIM B Klebsiella pneumoniae - - NDM B Enterobacter cloacae campc - VIM B Citrobacter freundii campc - VIM B Klebsiella pneumoniae - - VIM B Enterobacter cloacae campc - GIM-1 B Providencia rettgeri campc - NDM B Providencia stuartii campc - NDM B Proteus mirabilis CIT - NDM B Enterobacter cloacae campc SHV-ESBL VIM B Klebsiella pneumoniae - CTX-M OXA-48 D inconclusive Klebsiella pneumoniae - CTX-M OXA-48 D inconclusive Klebsiella pneumoniae - CTX-M OXA-48 D inconclusive Klebsiella pneumoniae - - OXA-48 D MEM, meropenem; ETP, ertapenem; CDT, combined-disk test; APBA, aminophenylboronic acid; MH-CLX, Muller Hinton agar supplemented with cloxacillin; MH, Muller Hinton agar without cloxacillin; ESBL, extended-spectrum beta-lactamase; campc, chromosomally encoded ampc gene
33 Table 4: Temocillin critical zone diameters and MICs for confirmation of OXA-48-like carbapenemases. 672 ID Species ESBL AmpC Carbapenemase Temocillin zone (mm) Temocillin MIC (mg/l) MH MH-CLX MH MH-CLX 19 Klebsiella pneumoniae - - OXA Klebsiella pneumoniae + - OXA Klebsiella pneumoniae + - OXA Klebsiella pneumoniae + - OXA Enterobacter cloacae + campc VIM Hafnia alvei - campc Enterobacter cloacae - campc Enterobacter cloacae - campc Enterobacter cloacae - campc Hafnia alvei - campc Enterobacter cloacae - campc Enterobacter cloacae - campc Enterobacter cloacae - campc Enterobacter aerogenes - campc Klebsiella pneumoniae Escherichia coli Proteus mirabilis Klebsiella pneumoniae Klebsiella pneumoniae median values OXA-48 positive isolates AmpC overexpression ESBL ID, isolate identification number, ESBL, extended-spectrum beta-lactamase, MH-CLX: Muller Hinton agar supplemented with cloxacillin, MH: Muller Hinton agar without cloxacillin, campc, chromosomally-encoded AmpC beta-lactamase
34 isolate number Figure 1: Discrepant test results of the Carba NP-II test and the carbapenemase genotype species Enterobacter aerogenes Klebsiella pneumoniae Klebsiella pneumoniae Klebsiella pneumoniae Klebsiella pneumoniae Providencia rettgeri Providencia stuartii Proteus mirabilis Enterobacter cloacae genotype / Ambler class VIM OXA-48, CTX-M OXA-48, CTX-M OXA-48, CTX-M OXA-48 NDM NDM NDM GIM B D D D D B B B B Carba NP-II result (examples of replicate testing) t = 0 minutes t = 30 minutes t = 60 minutes t = 120 minutes 34 interpretation (expected test result) negative result class A carbapenemase class B carbapenemase class D carbapenemase
35 81 Figure 2: Proposed diagnostic flow chart for carbapenemase detection. No No carbapenemase suspicion Enterobacteriaceae isolates Inhibition zone diameter MEM < 25mm Yes CDT ETP versus ETP/APBA on MH-CLX agar 1 Initial screening step Time to result 24 h (regular antibiogram) Carbapenemases excluded for 57.8% of study population 82 Δ(ETP/EDTA ETP) < 5 mm Carbapenemases class A class B Δ(ETP/APBA ETP) < 5 mm CDT ETP versus ETP/EDTA on MH agar 1 No No class D? Temocillin disk diffusion or MIC on MH-CLX agar 11 mm or 32 mg/l Oxa-48- like enzyme unlikely 2 < 11 mm or >32 mg/l Suspicion for Oxa-48- like enzyme Δ(ETP/EDTA ETP) 5 mm Carbapenemases class A class B No Yes class D? Δ(ETP/EDTA ETP) < 5 mm Carbapenemases class A class B Δ(ETP/APBA ETP) 5 mm CDT ETP versus ETP/EDTA on MH agar 1 Yes No class D? Δ(ETP/EDTA ETP) 5 mm Carbapenemases class A class B Perform molecular assay for the detection of class D carbapenemases Yes Yes class D? Phenotypic confirmation step Additional time to result 24 h (total 48 h) Carbapenemases excluded/confirmed for 98.5% of study population Genotypic confirmation step Additional time to result 24 h (total 72 h) (1.5% of study population, OXA-48 only) MEM, meropenem; ETP, ertapenem; CDT, combined-disk test; APBA, aminophenylboronic acid; MH-CLX agar, Muller Hinton agar supplemented with cloxacillin; MH agar, Muller Hinton agar without cloxacillin. 1 MEM can be used alternatively with slightly lower sensitivity. 2 Carbapenem resistance phenotype is most likely due to a combination of AmpC and/or ESBL overexpression and decreased permeability, e,g, due to porin deficiency. 35
In recent years, the emergence of diverse carbapenemases in
Evaluation of Carbapenemase Screening and Confirmation Tests with Enterobacteriaceae and Development of a Practical Diagnostic Algorithm Florian P. Maurer, Claudio Castelberg, Chantal Quiblier, Guido V.
More informationReceived 31 January 2011/Returned for modification 2 March 2011/Accepted 15 March 2011
JOURNAL OF CLINICAL MICROBIOLOGY, May 2011, p. 1965 1969 Vol. 49, No. 5 0095-1137/11/$12.00 doi:10.1128/jcm.00203-11 Copyright 2011, American Society for Microbiology. All Rights Reserved. Comparative
More informationDetermining the Optimal Carbapenem MIC that Distinguishes Carbapenemase-Producing
AAC Accepted Manuscript Posted Online 8 August 2016 Antimicrob. Agents Chemother. doi:10.1128/aac.00838-16 Copyright 2016, American Society for Microbiology. All Rights Reserved. 1 1 2 Determining the
More informationComparison of phenotypic methods for the detection of carbapenem non-susceptible Enterobacteriaceae
Bartolini et al. Gut Pathogens 2014, 6:13 RESEARCH Comparison of phenotypic methods for the detection of carbapenem non-susceptible Enterobacteriaceae Andrea Bartolini 1, Ilaria Frasson 2, Antonietta Cavallaro
More informationUse of Faropenem as an Indicator of Carbapenemase Activity
JCM Accepts, published online ahead of print on 10 April 2013 J. Clin. Microbiol. doi:10.1128/jcm.00720-13 Copyright 2013, American Society for Microbiology. All Rights Reserved. 1 2 Use of Faropenem as
More informationOriginal Article Clinical Microbiology
Original Article Clinical Microbiology Ann Lab Med 2015;35:212-219 http://dx.doi.org/10.3343/alm.2015.35.2.212 ISSN 2234-3806 eissn 2234-3814 Combined Use of the Modified Hodge Test and Carbapenemase Inhibition
More informationImpact of the isolation medium for detection of carbapenemase-producing Enterobacteriaceae using an updated version of the Carba NP test
Published in which should be cited to refer to this work. Impact of the isolation medium for detection of carbapenemase-producing Enterobacteriaceae using an updated version of the Carba NP test Carbapenem
More informationSensitive and specific Modified Hodge Test for KPC and metallo-beta-lactamase
JCM Accepts, published online ahead of print on 19 October 2011 J. Clin. Microbiol. doi:10.1128/jcm.05602-11 Copyright 2011, American Society for Microbiology and/or the Listed Authors/Institutions. All
More informationScreening and detection of carbapenemases
Screening and detection of carbapenemases For many isolates with carbapenemases the MICs of carbapenems are around the susceptible breakpoint making resistance difficult to detect - particularly with automated
More informationEvaluation of Six Phenotypic Methods for the Detection of Carbapenemases in Gram-Negative Bacteria With Characterized Resistance Mechanisms
Original Article Clinical Microbiology Ann Lab Med 2017;37:305-312 https://doi.org/10.3343/alm.2017.37.4.305 ISSN 2234-3806 eissn 2234-3814 Evaluation of Six Phenotypic Methods for the Detection of Carbapenemases
More informationDetection of Carbapenem Resistant Enterobacteriacae from Clinical Isolates
International Journal of Current Microbiology and Applied Sciences ISSN: 2319-7706 Volume 5 Number 5 (2016) pp. 864-869 Journal homepage: http://www.ijcmas.com Original Research Article http://dx.doi.org/10.20546/ijcmas.2016.505.089
More informationPhenotypic detection of ESBLs and carbapenemases
Phenotypic detection of ESBLs and carbapenemases Standardized susceptibility testing residential workshop 2016 Katie Hopkins PhD Clinical Scientist Antimicrobial Resistance and Healthcare Associated Infections
More informationCombined disk methods for the detection of KPC- and/or VIM-positive. Klebsiella pneumoniae: improving reliability for the double carbapenemase
Received Date : 27-Dec-2012 Revised Date : 30-Mar-2013 Accepted Date : 31-Mar-2013 Article type : Research Note - online only Combined disk methods for the detection of KPC- and/or VIM-positive Klebsiella
More informationALERT. Clinical microbiology considerations related to the emergence of. New Delhi metallo beta lactamases (NDM 1) and Klebsiella
ALERT Clinical microbiology considerations related to the emergence of New Delhi metallo beta lactamases (NDM 1) and Klebsiella pneumoniae carbapenemases (KPC) amongst hospitalized patients in South Africa
More informationCarbapenem Disks on MacConkey agar as screening methods for the detection of. Carbapenem-Resistant Gram negative rods in stools.
JCM Accepts, published online ahead of print on 7 November 2012 J. Clin. Microbiol. doi:10.1128/jcm.02878-12 Copyright 2012, American Society for Microbiology. All Rights Reserved. 1 2 Carbapenem Disks
More informationRapid detection of carbapenemase-producing Enterobacteriaceae from blood cultures
ORIGINAL ARTICLE BACTERIOLOGY Rapid detection of carbapenemase-producing Enterobacteriaceae from blood cultures L. Dortet 1,L.Brechard 1, L. Poirel 1,2 and P. Nordmann 1,2 1) Service de Bacteriologie-Virologie,
More informationIn-House Standardization of Carba NP Test for Carbapenemase Detection in Gram Negative Bacteria
International Journal of Current Microbiology and Applied Sciences ISSN: 2319-7706 Volume 7 Number 01 (2018) Journal homepage: http://www.ijcmas.com Original Research Article https://doi.org/10.20546/ijcmas.2018.701.342
More informationDetecting Carbapenemase-Producing Enterobacteriaceae: why isn t there a single best method?
Detecting Carbapenemase-Producing Enterobacteriaceae: why isn t there a single best method? Professor Neil Woodford Antimicrobial Resistance & Healthcare Associated Infections (AMRHAI) Reference Unit Crown
More informationCarbapenemases in Enterobacteriaceae: Prof P. Nordmann Bicêtre hospital, South-Paris Med School
Carbapenemases in Enterobacteriaceae: 2012 Prof P. Nordmann Bicêtre hospital, South-Paris Med School March 21, 2012 Trends in Molecular Medecine NDM IMP OXA-48 KPC VIM ALERT VI M KPC KPC NDM I MP OXA-
More information#Corresponding author: Pathology Department, Singapore General Hospital, 20 College. Road, Academia, Level 7, Diagnostics Tower, , Singapore
AAC Accepts, published online ahead of print on 21 October 2013 Antimicrob. Agents Chemother. doi:10.1128/aac.01754-13 Copyright 2013, American Society for Microbiology. All Rights Reserved. 1 Title: Escherichia
More informationEducational Workshops 2016
Educational Workshops 2016 Keynote CPE Screening We are grateful to Dr Andrew Dodgson, Consultant Microbiologist, Public Health England and Central Manchester Hospitals NHS Foundation Trust Terminology
More informationEnterobacteriaceae with acquired carbapenemases, 2016
Enterobacteriaceae with acquired carbapenemases, 2016 Background The acquired or transferable (as opposed to chromosomally encoded) carbapenemases found in Enterobacteriaceae belong to three of the four
More informationDetecting carbapenemases in Enterobacteriaceae
Detecting carbapenemases in Enterobacteriaceae David Livermore Health Protection Agency, Colindale, London 12 August 2003 Mechanisms of carbapenem R in Enterobacteria Impermeability + AmpC or ESBL Metallo
More informationSupplementary Material Hofko M et al., Detection of carbapenemases by real-time PCR and melt-curve analysis on the BD MAX TM System
Supplementary Material Hofko M et al., Detection of carbapenemases by real-time PCR and melt-curve analysis on the BD MAX TM System Supplementary Material and Methods Characterization of isolates by the
More informationMHSAL Guidelines for the Prevention and Control of Antimicrobial Resistant Organisms (AROs) - Response to Questions
MHSAL Guidelines for the Prevention and Control of Antimicrobial Resistant Organisms (AROs) - Response to Questions Dr. Andrew Walkty Medical Microbiologist, Diagnostic Services Manitoba (DSM) June. 17,
More informationIdentification and screening of carbapenemase-producing Enterobacteriaceae
REVIEW 10.1111/j.1469-0691.2012.03815.x Identification and screening of carbapenemase-producing Enterobacteriaceae P. Nordmann 1, M. Gniadkowski 2, C. G. Giske 3, L. Poirel 1, N. Woodford 4, V. Miriagou
More informationsuspected KPC and other carbapenemase producers among species of Nacional de Enfermedades Infecciosas (INEI)- ANLIS Dr. Carlos G.
JCM Accepts, published online ahead of print on 1 December 0 J. Clin. Microbiol. doi:./jcm.0- Copyright 0, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights Reserved.
More informationCARBAPENEMASE PRODUCING ENTEROBACTERIACEAE
CARBAPENEMASE PRODUCING ENTEROBACTERIACEAE Veroniek Saegeman Veroniek Saegeman UZLeuven Carbapenemase producing Enterobacteriaceae (CPE) Introduction on antibiotic resistance Classification of ß-lactamases
More informationNONFERMENTING GRAM NEGATIVE RODS. April Abbott Deaconess Health System Evansville, IN
NONFERMENTING GRAM NEGATIVE RODS April Abbott Deaconess Health System Evansville, IN OBJECTIVES Discuss basic limitations to assessing carbapenem resistance in nonfermenting GNRs Discuss antimicrobial
More informationGuidance on screening and confirmation of carbapenem resistant Enterobacteriacae (CRE) December 12, 2011
Guidance on screening and confirmation of carbapenem resistant Enterobacteriacae (CRE) December 12, 2011 Objectives: To discuss the guidelines for detection of CRE in the laboratory setting. To review
More informationCarbapenemase-producing Enterobacteriaceae
Carbapenemase-producing Enterobacteriaceae 2012 CNR Associé Résistance aux Antibiotiques Prof. P. Nordmann Carbapenemases in Enterobacteriaceae May, 2012 Penicillins Cephalosporins Carbapenems Extended-spectrum
More informationEvaluation of CHROMagar msupercarba for the detection of carbapenemaseproducing Gram-negative organisms
ORIGINAL ARTICLE Evaluation of CHROMagar msupercarba for the detection of carbapenemaseproducing Gram-negative organisms Julie Creighton and Hui Wang Canterbury Health Laboratories, Christchurch ABSTRACT
More informationEnterobacteriaceae with acquired carbapenemases, 2015
Enterobacteriaceae with acquired carbapenemases, 2015 Background The acquired or transferable (as opposed to chromosomally encoded) carbapenemases found in Enterobacteriaceae belong to three of the four
More informationon July 8, 2018 by guest
JCM Accepts, published online ahead of print on 16 January 2013 J. Clin. Microbiol. doi:10.1128/jcm.03316-12 Copyright 2013, American Society for Microbiology. All Rights Reserved. 1 2 3 4 5 6 7 8 9 10
More informationDiscussion points CLSI M100 S19 Update. #1 format of tables has changed. #2 non susceptible category
Discussion points 2009 CLSI M100 S19 Update Nebraska Public Health Laboratory Changes most important to routine antimicrobial susceptibility testing. Documents available Janet Hindler discussion slide
More informationDifferentiation of Carbapenemase producing Enterobacteriaceae by Triple disc Test
Original article: Differentiation of Carbapenemase producing Enterobacteriaceae by Triple disc Test Manish Bansal 1, Nitya Vyas 2, Babita Sharma 3, R.K.Maheshwari 4 1PG Resident, 2 Professor, 3 Assistant
More informationEUCAST guidelines for detection of resistance mechanisms and specific resistances of clinical and/or epidemiological importance
EUCAST guidelines for detection of resistance mechanisms and specific resistances of clinical and/or epidemiological importance Version 2.0 1 July 2017 1 Based on version 1.0 from December 2013 by the
More informationGuideline for phenotypic screening and confirmation of carbapenemases in Enterobacteriaceae
Guideline for phenotypic screening and confirmation of carbapenemases in Enterobacteriaceae James Cohen Stuart, Maurine A. Leverstein-Van Hall To cite this version: James Cohen Stuart, Maurine A. Leverstein-Van
More informationStrains characterization Testing procedure of commercial carbapenemase detection assays
JCM Accepted Manuscript Posted Online 7 December 2016 J. Clin. Microbiol. doi:10.1128/jcm.01853-16 Copyright 2016, American Society for Microbiology. All Rights Reserved. Comparative evaluation of four
More informationInsert for Kit 98006/98010/ KPC/Metallo-B-Lactamase Confirm Kit KPC+MBL detection Kit KPC/MBL and OXA-48 Confirm Kit REVISION: DBV0034J
Insert for Kit 98006/98010/98015 KPC/Metallo-B-Lactamase Confirm Kit KPC+MBL detection Kit KPC/MBL and OXA-48 Confirm Kit REVISION: DBV0034J DATE OF ISSUE: 09.02.2017 LANGUAGE: English FOR IN VITRO DIAGNOSTIC
More informationAbstract. Introduction. Editor: R. Canton
ORIGINAL ARTICLE BACTERIOLOGY A simple, robust and rapid approach to detect carbapenemases in Gram-negative isolates by MALDI-TOF mass spectrometry: validation with triple quadripole tandem mass spectrometry,
More informationEmergence of non-kpc carbapenemases: NDM and more
Emergence of non-kpc carbapenemases: NDM and more --- David Livermore Health Protection Agency, UK The first acquired carbapenemase to be recognised in gram-negative bacteria was IMP-1, a metallo-type,
More informationDetection of carbapenemases in Enterobacteriaceae: a challenge for diagnostic microbiological laboratories
REVIEW 10.1111/1469-0691.12678 Detection of carbapenemases in Enterobacteriaceae: a challenge for diagnostic microbiological laboratories J. Hrabak, E. Chudackova and C. C. Papagiannitsis Department of
More informationDetection of NDM-1, VIM-1, KPC, OXA-48, and OXA-162 carbapenemases by MALDI- TOF mass spectrometry
JCM Accepts, published online ahead of print on 2 May 2012 J. Clin. Microbiol. doi:10.1128/jcm.01002-12 Copyright 2012, American Society for Microbiology. All Rights Reserved. 1 2 3 4 5 6 7 8 9 10 11 12
More informationRapid identification of emerging resistance in Gram negatives. Prof. Patrice Nordmann
Rapid identification of emerging resistance in Gram negatives Prof. Patrice Nordmann Emerging Resistance threats, CDC USA-2013 Enterobacteriaceae producing extendedspectrum β-lactamases (ESBL) Multi-resistant
More informationSpread of carbapenems resistant Enterobacteriaceae in South Africa; report from National Antimicrobial Resistance Reference Laboratory
Spread of carbapenems resistant Enterobacteriaceae in South Africa; report from National Antimicrobial Resistance Reference Laboratory Olga Perovic*, Ashika Singh-Moodley, Samantha Iyaloo 5 th November
More informationORIGINAL ARTICLE. Julie Creighton and Clare Tibbs. Canterbury Health Laboratories, Christchurch
ORIGINAL ARTICLE Evaluation of the MAST indirect carbapenemase test and comparison with a modified carbapenem inactivation method for the detection of carbapenemase enzymes in Gram-negative bacteria Julie
More informationPhenotypic Detection Methods of Carbapenemase Production in Enterobacteriaceae
ISSN: 2319-7706 Volume 4 Number 6 (2015) pp. 547-552 http://www.ijcmas.com Original Research Article Phenotypic Detection Methods of Carbapenemase Production in Enterobacteriaceae Sathya Pandurangan 1,
More informationRapid detection of carbapenemase-producing Pseudomonas spp.
JCM Accepts, published online ahead of print on 12 September 2012 J. Clin. Microbiol. doi:10.1128/jcm.01597-12 Copyright 2012, American Society for Microbiology. All Rights Reserved. 1 Rapid detection
More informationRevised AAC Short Form format. Comparison of two phenotypic algorithms to detect carbapenemaseproducing
AAC Accepted Manuscript Posted Online 12 June 2017 Antimicrob. Agents Chemother. doi:10.1128/aac.00796-17 Copyright 2017 American Society for Microbiology. All Rights Reserved. 1 2 3 4 5 Revised AAC-00796-17
More informationNew Mechanisms of Antimicrobial Resistance and Methods for Carbapenemase Detection
New Mechanisms of Antimicrobial Resistance and Methods for Carbapenemase Detection Stephen G. Jenkins, PhD, F(AAM), D(ABMM) Professor of Pathology and Laboratory Medicine Professor of Pathology in Medicine
More informationDetecting CRE. what does one need to do?
5 th ICAN Conference, Harare 4 th November 2014 Room 2: 10:30-12:00 Detecting CRE (Carbapenem-resistant Enterobacteriaceae) what does one need to do? Dr Nizam Damani Associate Medical Director Infection
More informationIn Vitro Activity of Ceftazidime-Avibactam Against Isolates. in a Phase 3 Open-label Clinical Trial for Complicated
AAC Accepted Manuscript Posted Online 21 November 2016 Antimicrob. Agents Chemother. doi:10.1128/aac.01820-16 Copyright 2016, American Society for Microbiology. All Rights Reserved. 1 2 3 4 5 6 7 8 9 10
More informationDetection of SPM-1-producing Pseudomonas aeruginosa and CHDL-producing. Acinetobacter baumannii using Liquid Chromatography Mass Spectrometry
JCM Accepts, published online ahead of print on 24 October 2012 J. Clin. Microbiol. doi:10.1128/jcm.02365-12 Copyright 2012, American Society for Microbiology. All Rights Reserved. [Brief Report] Carvalhaes
More informationKPC around the world Maria Virginia Villegas, MD, MSC
KPC around the world Maria Virginia Villegas, MD, MSC Scientific Director Bacterial Resistance and Nosocomial Infections Research Area International Center for Medical Research and Training, CIDEIM, Cali,
More informationSurveillance of antimicrobial susceptibility of Enterobacteriaceae pathogens isolated from intensive care units and surgical units in Russia
Feb. 2016 THE JAPANESE JOURNAL OF ANTIBIOTICS 69 1 41 41 Surveillance of antimicrobial susceptibility of Enterobacteriaceae pathogens isolated from intensive care units and surgical units in Russia IRINA
More informationSSRG International Journal of Medical Science (SSRG-IJMS) volume 2 Issue 4 April 2015
Utilization of MacConkeyMeropenem screening Agar for the Detection of Carbapenem Resistanant Enterobacteriaceae in a tertiary care hospital Sanjeev Kumar 1, Anamika Vyas 2, S.K.Mehra 3 1,3 Department of
More informationChapter 2. Detection of ESBL producing Enterobacteriaceae
Chapter 2 Detection of ESBL producing Enterobacteriaceae Chapter 1 22 Chapter 2.1 Laboratory detection of extended-spectrum β-lactamase-producing Enterobacteriaceae: evaluation of two screening agar plates
More informationβ CARBA Test Rapid detection of carbapenemase-producing Enterobacteriaceae strains Contents 1. INTENDED USE
β CARBA Test 25 68260 Rapid detection of carbapenemase-producing Enterobacteriaceae strains 881159 2015/05 Contents 1. INTENDED USE 2. SUMMARY AND EXPLANATION OF THE TEST 3. PRINCIPLE OF THE PROCEDURE
More informationMultidrug-resistant organisms are a major public health
Improved Phenotype-Based Definition for Identifying Carbapenemase Producers among Carbapenem-Resistant Enterobacteriaceae Nora Chea, Sandra N. Bulens, Thiphasone Kongphet-Tran, Ruth Lynfield, Kristin M.
More informationGlobal Epidemiology of Carbapenem- Resistant Enterobacteriaceae (CRE)
Global Epidemiology of Carbapenem- Resistant Enterobacteriaceae (CRE) Mitchell J. Schwaber, MD MSc Director, National Center for Infection Control Ministry of Health State of Israel November 27, 2012 1
More informationA new diagnostic microarray (Check-KPC ESBL) for detection and. identification of extended-spectrum beta-lactamases in highly resistant
JCM Accepts, published online ahead of print on 8 June 2011 J. Clin. Microbiol. doi:10.1128/jcm.02087-10 Copyright 2011, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights
More informationStandardisation of testing for Carbapenemase Producing Organisms (CPO) in Scotland
Standardisation of testing for Carbapenemase Producing Organisms (CPO) in Scotland Version 1.0 7 June 2017 Revision Date June 2018 Scottish Microbiology and Virology Network (SMVN) SMVN Standardisation
More informationExpert rules in antimicrobial susceptibility testing: State of the art
Expert rules in antimicrobial susceptibility testing: State of the art ESCMID Postgraduate Education Course Antimicrobial Susceptibility Testing and Surveillance: from Laboratory to Clinic Hospital Universitario
More informationMulticenter study of the prevalence and the resistance mechanisms of carbapenem-resistant Enterobacteriaceae (CPE) in Belgium in
Multicenter study of the prevalence and the resistance mechanisms of carbapenem-resistant Enterobacteriaceae (CPE) in Belgium in 2011-2012 Study conducted by: 1. National Reference Center (NRC) for ESBL-producing
More informationST11 KPC-2 Klebsiella pneumoniae detected in Taiwan
AAC Accepts, published online ahead of print on 30 January 2012 Antimicrob. Agents Chemother. doi:10.1128/aac.05576-11 Copyright 2012, American Society for Microbiology. All Rights Reserved. 1 2 3 4 5
More informationCarbapenems and Enterobacteriaceae
Title Carbapenems and Enterobacteriaceae Presenter s details NHLS Dr Khine Swe Swe/Han FC Path ( Micro), SA MMed( micro), SA DTMH(Wits univ),sa PDIC(Stellen univ)sa MB,BS(Yangon),Myanmar Pathologist,Consultant/Lecturer,
More informationCARBAPENEM RESISTANCE From diagnosis to outbreak management
CARBAPENEM RESISTANCE From diagnosis to outbreak management TABLE OF CONTENTS INTRODUCTION 1 2 3 4 5 6 7 CARBAPENEM RESISTANCE p. 2 EPIDEMIOLOGY p. 6 CLINICAL ASPECTS p. 11 TREATMENT p. 12 DIAGNOSIS p.
More informationCarbapenem-resistant Escherichia coli and Klebsiella pneumoniae in Taiwan
Carbapenem-resistant Escherichia coli and Klebsiella pneumoniae in Taiwan An Infection Control Emergency Speaker: L Kristopher Siu Principal Investigator Division of Infectious Diseases National Institute
More informationPrevalence of Extended Spectrum -Lactamases In E.coli and Klebsiella spp. in a Tertiary Care Hospital
ISSN: 2319-7706 Volume 3 Number 10 (2014) pp. 474-478 http://www.ijcmas.com Original Research Article Prevalence of Extended Spectrum -Lactamases In E.coli and Klebsiella spp. in a Tertiary Care Hospital
More informationAAC Accepts, published online ahead of print on 13 October 2008 Antimicrob. Agents Chemother. doi: /aac
AAC Accepts, published online ahead of print on 13 October 2008 Antimicrob. Agents Chemother. doi:10.1128/aac.00931-08 Copyright 2008, American Society for Microbiology and/or the Listed Authors/Institutions.
More informationNature and Science 2017;15(10)
Evaluation of Substrate Profile Test for Detection of Metallobetalactamses among Imipenem Resistant Clinical Isolates of Gram Negative Bacteria Tarek El-said El-Banna, Fatma Ibrahim Sonboland Eslam Shaaban
More information(Plasmid mediated) Carbapenemases. Timothy R. Walsh, Cardiff University, Wales
(Plasmid mediated) Carbapenemases Timothy R. Walsh, Cardiff University, Wales What is a carbapenemase? How much carbapenem do they need to breakdown before they are called a carbapenemase? ESBL-enzymes
More informationAcademic Perspective in. David Livermore Prof of Medical Microbiology, UEA Lead on Antibiotic resistance PHE
Academic Perspective in Emerging No, we can t Issues treat of carbapenemase Resistance and ESBL in Gram-ve producers Bacteria based on MIC David Livermore Prof of Medical Microbiology, UEA Lead on Antibiotic
More informationThe Public Health Benefit of CRE Colonization Testing
The Public Health Benefit of CRE Colonization Testing Allison C Brown, PhD MPH Team Lead, AR Capacities and Special Studies Division of Healthcare Quality Promotion CDC Carbapenem Resistance Serious threat
More informationPublic Health Surveillance for Multi Drug Resistant Organisms in Orange County
Public Health Surveillance for Multi Drug Resistant Organisms in Orange County Matt Zahn, MD Medical Director Epidemiology and Assessment Orange County Public Health Antimicrobial Mechanisms of Action
More informationDevelopment of a phenotypic method for fecal carriage detection of OXA-48-producing
JCM Accepts, published online ahead of print on 11 May 2011 J. Clin. Microbiol. doi:10.1128/jcm.00055-11 Copyright 2011, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights
More informationCAT Critically Appraised Topic
CAT Critically Appraised Topic Part I: Evaluation of Three Different Agar Media for Rapid Detection of Extended- Spectrum β-lactamase Producing Enterobacteriaceae from Clinical Screening Samples. Part
More informationHigh Stringency Evaluation of the Automated BD Phoenix CPO Detect and. Running Title: Phenotypic Carbapenemase Detection and Classification
JCM Accepted Manuscript Posted Online 4 October 2017 J. Clin. Microbiol. doi:10.1128/jcm.01215-17 Copyright 2017 Thomson et al. This is an open-access article distributed under the terms of the Creative
More informationAbstract. a Jann-Tay Wang 1, Un-In Wu 2, Tsai-Ling Yang Lauderdale 3, Mei-Chen Chen 3, Shu-Ying Li 4, Le-Yin Hsu 5, Shan-Chwen Chang 1,6 *
RESEARCH ARTICLE Carbapenem-Nonsusceptible Enterobacteriaceae in Taiwan Jann-Tay Wang 1, Un-In Wu 2, Tsai-Ling Yang Lauderdale 3, Mei-Chen Chen 3, Shu-Ying Li 4, Le-Yin Hsu 5, Shan-Chwen Chang 1,6 * 1
More informationCARBAPENEM RESISTANCE FROM DIAGNOSIS TO OUTBREAK MANAGEMENT
CARBAPENEM RESISTANCE FROM DIAGNOSIS TO OUTBREAK MANAGEMENT INTRODUCTION TABLE OF CONTENTS CARBAPENEM RESISTANCE 2 EPIDEMIOLOGY 6 CLINICAL ASPECTS 11 TREATMENT 12 DIAGNOSIS 14 SCREENING 20 INFECTION CONTROL
More informationHelen Heffernan and Rosemary Woodhouse Antibiotic Reference Laboratory, Institute of Environmental Science and Research Limited (ESR); July 2014.
Annual survey of extended-spectrum -lactamase (ESBL)-producing Enterobacteriaceae, 2013 Helen Heffernan and Rosemary Woodhouse Antibiotic Reference Laboratory, Institute of Environmental Science and Research
More informationAbstract. Introduction. Methods. Editor: R. Canton
ORIGINAL ARTICLE BACTERIOLOGY High rate of faecal carriage of extended-spectrum b-lactamase and OXA-48 carbapenemase-producing Enterobacteriaceae at a University hospital in Morocco D. Girlich 1, N. Bouihat
More informationToolkit for the Management of Carbapenemase Producing Organisms (CPO)
Toolkit for the Management of Carbapenemase Producing Organisms (CPO) Prepared by: Provincial Infection Control Network of British Columbia (PICNet) September 2014 V1.1 Feb 2015 Provincial Infection Control
More informationJMSCR Vol 05 Issue 03 Page March 2017
www.jmscr.igmpublication.org Impact Factor 5.84 Index Copernicus Value: 83.27 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v5i3.131 Carba NP Test as a Rapid Diagnostic Tool
More informationCOMMENTARY. Extended-Spectrum- -Lactamase, AmpC, and Carbapenemase Issues. Kenneth S. Thomson*
JOURNAL OF CLINICAL MICROBIOLOGY, Apr. 2010, p. 1019 1025 Vol. 48, No. 4 0095-1137/10/$12.00 doi:10.1128/jcm.00219-10 Copyright 2010, American Society for Microbiology. All Rights Reserved. COMMENTARY
More informationARTICLE IN PRESS International Journal of Antimicrobial Agents xxx (2010) xxx xxx
International Journal of Antimicrobial Agents xxx (2010) xxx xxx Contents lists available at ScienceDirect International Journal of Antimicrobial Agents journal homepage: http://www.elsevier.com/locate/ijantimicag
More informationFernando Pasteran, Tania Mendez, Melina Rapoport, Leonor Guerriero, and Alejandra Corso*
JOURNAL OF CLINICAL MICROBIOLOGY, Apr. 2010, p. 1323 1332 Vol. 48, No. 4 0095-1137/10/$12.00 doi:10.1128/jcm.01771-09 Copyright 2010, American Society for Microbiology. All Rights Reserved. Controlling
More informationRisk factors for fecal carriage of carbapenemase producing Enterobacteriaceae among intensive care unit patients from a tertiary care center in India
Mittal et al. BMC Microbiology (2016) 16:138 DOI 10.1186/s12866-016-0763-y RESEARCH ARTICLE Risk factors for fecal carriage of carbapenemase producing Enterobacteriaceae among intensive care unit patients
More informationTHE INVASION BY CARBAPENEMASE-PRODUCING ENTEROBACTERIACEAE
ANKEM Derg 2012;26(Ek 2):31-35 THE INVASION BY CARBAPENEMASE-PRODUCING ENTEROBACTERIACEAE Patrice NORDMANN Service de Bactériologie-Virologie, Hôpital de Bicêtre, Le Kremlin-Bicêtre, South-Paris Medical
More informationClinical Microbiology Newsletter
Clinical Microbiology Newsletter $88 Vol. 30, No. 10 www.cmnewsletter.com May 15, 2008 Newer β-lactamases: Clinical and Laboratory Implications, Part I * Ellen Smith Moland, B.S.M.T., Soo-Young Kim, M.D.,
More informationCRO and CPE: Epidemiology and diagnostic tests
CRO and CPE: Epidemiology and diagnostic tests Scottish Microbiology and Virology Network Scientific Meeting 22 nd April 2016 Katie Hopkins PhD Clinical Scientist, Antimicrobial Resistance and Healthcare
More informationESCMID Online Lecture Library. by author
www.eucast.org EXPERT RULES IN ANTIMICROBIAL SUSCEPTIBILITY TESTING Dr. Rafael Cantón Hospital Universitario Ramón y Cajal SERVICIO DE MICROBIOLOGÍA Y PARASITOLOGÍA Departamento de Microbiología II Universidad
More informationLaboratory testing for carbapenems resistant Enterobacteriacae (CRE)
Laboratory testing for carbapenems resistant Enterobacteriacae (CRE) Olga Perovic, Principal Pathologist, Center for Opportunistic, Tropical and Hospital Infections, Senior lecturer WITS, 9 th March 2013
More informationResults and experience of BARN ESBL project. Marina Ivanova and project team Tallinn
Results and experience of BARN ESBL project Marina Ivanova and project team Tallinn 13.05.2013 Aim of the project Improvement of detection and surveillance of resistance caused by extended spectrum betalactamase
More informationUpdate on CLSI and EUCAST
Update on CLSI and EUCAST 1 Completed work» Cephalosporin breakpoints for Enterobacteriaceae ESBL screens MIC versus resistance mechanism» Carbapenem breakpoints for Enterobacteriaceae Modified Hodge Test»
More informationCeftazidime-Avibactam and Aztreonam an interesting strategy to Overcome β- Lactam Resistance Conferred by Metallo-β-Lactamases in Enterobacteriaceae
AAC Accepted Manuscript Posted Online 19 June 2017 Antimicrob. Agents Chemother. doi:10.1128/aac.01008-17 Copyright 2017 American Society for Microbiology. All Rights Reserved. 1 2 3 Ceftazidime-Avibactam
More informationComparision of Antibiotic Susceptibility Testing As Per CLSI and Eucast Guidelines for Gram Negative Bacilli
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 15, Issue 7 Ver. X (July. 2016), PP 01-05 www.iosrjournals.org Comparision of Antibiotic Susceptibility
More informationRevised AAC Version 2» New-Data Letter to the Editor ACCEPTED. Plasmid-Mediated Carbapenem-Hydrolyzing β-lactamase KPC-2 in
AAC Accepts, published online ahead of print on 3 December 2007 Antimicrob. Agents Chemother. doi:10.1128/aac.01180-07 Copyright 2007, American Society for Microbiology and/or the Listed Authors/Institutions.
More information