Evaluation of the commercial combined disk test and minimum inhibitory concentration (MIC) determination for detection of carbapenemase producers among Gram-negative bacilli isolated in a region with high prevalence of blaOXA-48 and blaNDM

Zoya Hojabri, Maedeh Arab, Narges Darabi, Naim Sadat Kia, Bruno S Lopes (Corresponding Author), Omid Pajand (Corresponding Author)

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Abstract

Carbapenem-resistant Gram-negative bacilli (GNB) are a concern in the Middle East and worldwide. Simple screening methods have been sought to detect carbapenemase producers to determine appropriate therapeutic measures and implement infection control interventions. In this study, we evaluated the efficiency of agar disc diffusion, commercial combined disc test (Rosco), and carbapenem MIC determination in comparison to molecular detection of carbapenemase genes among 82 carbapenem non-susceptible Enterobacteriaceae (CNSE) and 37 Acinetobacter/Pseudomonas isolates. The blaOXA-48, blaNDM, blaNDM/OXA-48, and blaIMP were detected in 68 out of 82 CNSE isolates. All of the Acinetobacter baumannii isolates were positive for the blaOXA-51 (n = 23), of those some were positive for blaOXA-48 (n = 13) and blaNDM (n = 3). Sensitivities and specificities of combined disc test for detection of blaNDM and blaOXA-48 carrying Enterobacteriaceae isolates were 92.5% and 100%, and 58.5% and 100%, respectively, while those for Acinetobacter/Pseudomonas isolates were 100%, 81.8% and 96.2%, 89%, respectively. While carbapenem MIC values had excellent concordance with phenotypic combined disc test for detection of blaOXA-48 producers (area under curve > 90%), only ertapenem MIC's could precisely detect blaOXA-48 PCR-positive Enterobacteriaceae isolates (AUC 70%, sensitivity 70%, specificity 50%). The phenotypic commercial test showed excellent sensitivity for detection of blaNDM producers, but had poor sensitivity for blaOXA-48-producing Enterobacteriaceae. Ertapenem MIC values had low sensitivity and specificity for detection of the blaOXA-48-carrying Enterobacteriaceae. This is the first report of A. baumannii isolates co-harbored the blaOXA-48/blaNDM carbapenemases from Iran.

Original languageEnglish
Pages (from-to)81-89
Number of pages9
JournalInternational microbiology
Volume22
Issue number1
Early online date30 Aug 2018
DOIs
Publication statusPublished - Mar 2019

Fingerprint

Microbial Sensitivity Tests
Enterobacteriaceae
Carbapenems
Bacillus
Acinetobacter baumannii
Acinetobacter
Pseudomonas
Sensitivity and Specificity
Area Under Curve
Middle East
Infection Control
Iran
Agar
carbapenemase
Polymerase Chain Reaction
Genes

Keywords

  • Acinetobacter
  • Enterobacteriaceae
  • NDM
  • OXA-48
  • Carbapenemase
  • Rosco
  • MIC

Cite this

@article{cee0e7f839824663983893768e19f87c,
title = "Evaluation of the commercial combined disk test and minimum inhibitory concentration (MIC) determination for detection of carbapenemase producers among Gram-negative bacilli isolated in a region with high prevalence of blaOXA-48 and blaNDM",
abstract = "Carbapenem-resistant Gram-negative bacilli (GNB) are a concern in the Middle East and worldwide. Simple screening methods have been sought to detect carbapenemase producers to determine appropriate therapeutic measures and implement infection control interventions. In this study, we evaluated the efficiency of agar disc diffusion, commercial combined disc test (Rosco), and carbapenem MIC determination in comparison to molecular detection of carbapenemase genes among 82 carbapenem non-susceptible Enterobacteriaceae (CNSE) and 37 Acinetobacter/Pseudomonas isolates. The blaOXA-48, blaNDM, blaNDM/OXA-48, and blaIMP were detected in 68 out of 82 CNSE isolates. All of the Acinetobacter baumannii isolates were positive for the blaOXA-51 (n = 23), of those some were positive for blaOXA-48 (n = 13) and blaNDM (n = 3). Sensitivities and specificities of combined disc test for detection of blaNDM and blaOXA-48 carrying Enterobacteriaceae isolates were 92.5{\%} and 100{\%}, and 58.5{\%} and 100{\%}, respectively, while those for Acinetobacter/Pseudomonas isolates were 100{\%}, 81.8{\%} and 96.2{\%}, 89{\%}, respectively. While carbapenem MIC values had excellent concordance with phenotypic combined disc test for detection of blaOXA-48 producers (area under curve > 90{\%}), only ertapenem MIC's could precisely detect blaOXA-48 PCR-positive Enterobacteriaceae isolates (AUC 70{\%}, sensitivity 70{\%}, specificity 50{\%}). The phenotypic commercial test showed excellent sensitivity for detection of blaNDM producers, but had poor sensitivity for blaOXA-48-producing Enterobacteriaceae. Ertapenem MIC values had low sensitivity and specificity for detection of the blaOXA-48-carrying Enterobacteriaceae. This is the first report of A. baumannii isolates co-harbored the blaOXA-48/blaNDM carbapenemases from Iran.",
keywords = "Acinetobacter, Enterobacteriaceae, NDM, OXA-48, Carbapenemase, Rosco, MIC",
author = "Zoya Hojabri and Maedeh Arab and Narges Darabi and Kia, {Naim Sadat} and Lopes, {Bruno S} and Omid Pajand",
note = "Acknowledgments: We would like to thank the “Deputy of Research” of Semnan University of Medical Sciences for their cooperation and for providing facilities to this work. Funding: This work was supported fully by Semnan University of Medical Sciences (grant nos.730 and 919). This is a report of a database from research projects entitled “Investigation of the prevalence, antimicrobial susceptibility testing and carbapenemase production among Enterobacteriaceae and Pseudomonas aeruginosa isolates recovered from clinical specimens collected from Semnan hospitals and the effect of driving factors” and “Determination of Minimum Inhibitory Concentration (MIC) of Ertapenem in carbapenem non-susceptible isolates of Enterobacteriaceae recovered from hospitalized patients” registered in Semnan University of Medical Sciences, Semnan, Iran.",
year = "2019",
month = "3",
doi = "10.1007/s10123-018-0030-1",
language = "English",
volume = "22",
pages = "81--89",
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T1 - Evaluation of the commercial combined disk test and minimum inhibitory concentration (MIC) determination for detection of carbapenemase producers among Gram-negative bacilli isolated in a region with high prevalence of blaOXA-48 and blaNDM

AU - Hojabri, Zoya

AU - Arab, Maedeh

AU - Darabi, Narges

AU - Kia, Naim Sadat

AU - Lopes, Bruno S

AU - Pajand, Omid

N1 - Acknowledgments: We would like to thank the “Deputy of Research” of Semnan University of Medical Sciences for their cooperation and for providing facilities to this work. Funding: This work was supported fully by Semnan University of Medical Sciences (grant nos.730 and 919). This is a report of a database from research projects entitled “Investigation of the prevalence, antimicrobial susceptibility testing and carbapenemase production among Enterobacteriaceae and Pseudomonas aeruginosa isolates recovered from clinical specimens collected from Semnan hospitals and the effect of driving factors” and “Determination of Minimum Inhibitory Concentration (MIC) of Ertapenem in carbapenem non-susceptible isolates of Enterobacteriaceae recovered from hospitalized patients” registered in Semnan University of Medical Sciences, Semnan, Iran.

PY - 2019/3

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N2 - Carbapenem-resistant Gram-negative bacilli (GNB) are a concern in the Middle East and worldwide. Simple screening methods have been sought to detect carbapenemase producers to determine appropriate therapeutic measures and implement infection control interventions. In this study, we evaluated the efficiency of agar disc diffusion, commercial combined disc test (Rosco), and carbapenem MIC determination in comparison to molecular detection of carbapenemase genes among 82 carbapenem non-susceptible Enterobacteriaceae (CNSE) and 37 Acinetobacter/Pseudomonas isolates. The blaOXA-48, blaNDM, blaNDM/OXA-48, and blaIMP were detected in 68 out of 82 CNSE isolates. All of the Acinetobacter baumannii isolates were positive for the blaOXA-51 (n = 23), of those some were positive for blaOXA-48 (n = 13) and blaNDM (n = 3). Sensitivities and specificities of combined disc test for detection of blaNDM and blaOXA-48 carrying Enterobacteriaceae isolates were 92.5% and 100%, and 58.5% and 100%, respectively, while those for Acinetobacter/Pseudomonas isolates were 100%, 81.8% and 96.2%, 89%, respectively. While carbapenem MIC values had excellent concordance with phenotypic combined disc test for detection of blaOXA-48 producers (area under curve > 90%), only ertapenem MIC's could precisely detect blaOXA-48 PCR-positive Enterobacteriaceae isolates (AUC 70%, sensitivity 70%, specificity 50%). The phenotypic commercial test showed excellent sensitivity for detection of blaNDM producers, but had poor sensitivity for blaOXA-48-producing Enterobacteriaceae. Ertapenem MIC values had low sensitivity and specificity for detection of the blaOXA-48-carrying Enterobacteriaceae. This is the first report of A. baumannii isolates co-harbored the blaOXA-48/blaNDM carbapenemases from Iran.

AB - Carbapenem-resistant Gram-negative bacilli (GNB) are a concern in the Middle East and worldwide. Simple screening methods have been sought to detect carbapenemase producers to determine appropriate therapeutic measures and implement infection control interventions. In this study, we evaluated the efficiency of agar disc diffusion, commercial combined disc test (Rosco), and carbapenem MIC determination in comparison to molecular detection of carbapenemase genes among 82 carbapenem non-susceptible Enterobacteriaceae (CNSE) and 37 Acinetobacter/Pseudomonas isolates. The blaOXA-48, blaNDM, blaNDM/OXA-48, and blaIMP were detected in 68 out of 82 CNSE isolates. All of the Acinetobacter baumannii isolates were positive for the blaOXA-51 (n = 23), of those some were positive for blaOXA-48 (n = 13) and blaNDM (n = 3). Sensitivities and specificities of combined disc test for detection of blaNDM and blaOXA-48 carrying Enterobacteriaceae isolates were 92.5% and 100%, and 58.5% and 100%, respectively, while those for Acinetobacter/Pseudomonas isolates were 100%, 81.8% and 96.2%, 89%, respectively. While carbapenem MIC values had excellent concordance with phenotypic combined disc test for detection of blaOXA-48 producers (area under curve > 90%), only ertapenem MIC's could precisely detect blaOXA-48 PCR-positive Enterobacteriaceae isolates (AUC 70%, sensitivity 70%, specificity 50%). The phenotypic commercial test showed excellent sensitivity for detection of blaNDM producers, but had poor sensitivity for blaOXA-48-producing Enterobacteriaceae. Ertapenem MIC values had low sensitivity and specificity for detection of the blaOXA-48-carrying Enterobacteriaceae. This is the first report of A. baumannii isolates co-harbored the blaOXA-48/blaNDM carbapenemases from Iran.

KW - Acinetobacter

KW - Enterobacteriaceae

KW - NDM

KW - OXA-48

KW - Carbapenemase

KW - Rosco

KW - MIC

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