1887

Abstract

The aims of the study were to compare four different agar plate methods in the identification of carbapenemase-producing Klebsiella pneumoniae (CP-Kp) from rectal samples and to assess the role of phenotypic methodologies in the identification of carbapenemase type from clinical K. pneumoniae isolates. Two chromogenic agars (Brilliance CRE and CHROMagar KPC) were compared to MacConkey agar plates with ertapenem (ERT) or imipenem (IMP) disks for the identification of CP-Kp from 912 rectal swabs. CP-Kp was detected in 329 samples by either agar methodology (299 K. pneumoniae carbapenemase positive, 27 Verona integron-encoded metallo-β-lactamase positive and 3 K. pneumoniae carbapenemase and Verona integron-encodedmetallo-β-lactamase positive). Sensitivity of Brilliance CRE, CHROMagar KPC and MacConkey agar plus IMP or ERT disk (inhibition zone <25 mm) was 96.8, 99.2, 67.2 and 81.8 %, while specificity was 90.9, 78.2, 98.1 and 97.9 %, respectively. Synergy meropenem-disk tests with EDTA or phenylboronic acid were used in order to detect the carbapenemase type as compared to PCR results (bla VIM, bla KPC and bla NDM) from 2515 isolates with reduced susceptibility to any of the Etest-examined carbapenems (ERT, IMP or meropenem). Metallo-β-lactamase MP/MPI Etest was applied in 616 isolates. Sensitivity was 98.4, 90.9 and 82.2 % for phenylboronic acid synergy test, EDTA synergy test and metallo-β-lactamase Etest, respectively, while their specificity was high (>97.5 %). Phenotypic methodologies can provide reliable results for the identification of carbapenemase production among K. pneumoniae isolates. Chromogenic agars can be applied in high-risk patients as part of surveillance and infection control programs.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.000318
2016-09-01
2019-10-17
Loading full text...

Full text loading...

/deliver/fulltext/jmm/65/9/954.html?itemId=/content/journal/jmm/10.1099/jmm.0.000318&mimeType=html&fmt=ahah

References

  1. Adler A. , Navon-Venezia S. , Moran-Gilad J. , Marcos E. , Schwartz D. , Carmeli Y. . ( 2011;). Laboratory and clinical evaluation of screening agar plates for detection of carbapenem-resistant Enterobacteriaceae from surveillance rectal swabs. . J Clin Microbiol 49: 2239–2242. [CrossRef] [PubMed]
    [Google Scholar]
  2. Cohen Stuart J. , Voets G. , Rottier W. , Voskuil S. , Scharringa J. , Van Dijk K. , Fluit A. C. , Leverstein-Van Hall M. . ( 2013;). Evaluation of the Oxoid Brilliance™ CRE Agar for the detection of carbapenemase-producing Enterobacteriaceae . . Eur J Clin Microbiol Infect Dis 32: 1445–1449. [CrossRef] [PubMed]
    [Google Scholar]
  3. Daikos G. L. , Petrikkos P. , Psichogiou M. , Kosmidis C. , Vryonis E. , Skoutelis A. , Georgousi K. , Tzouvelekis L. S. , Tassios P. T. et al. ( 2009;). Prospective observational study of the impact of VIM-1 metallo-beta-lactamase on the outcome of patients with Klebsiella pneumoniae bloodstream infections. . Antimicrob Agents Chemother 53: 1868–1873. [CrossRef] [PubMed]
    [Google Scholar]
  4. Day K. M. , Ali S. , Mirza I. A. , Sidjabat H. E. , Silvey A. , Lanyon C. V. , Cummings S. P. , Abbasi S. A. , Raza M. W. et al. ( 2013;). Prevalence and molecular characterization of Enterobacteriaceae producing NDM-1 carbapenemase at a military hospital in Pakistan and evaluation of two chromogenic media. . Diagn Microbiol Infect Dis 75: 187–191. [CrossRef] [PubMed]
    [Google Scholar]
  5. European Centre for Disease Prevention and Control (ECDC) ( 2013;). Carbapenemase-Producing Bacteria in Europe: Interim Results From the European Survey on Carbapenemase-Producing Enterobacteriaceae (EuSCAPE) Project. Stockholm, Sweden:: ECDC;.
    [Google Scholar]
  6. European Committee on Antimicrobial Susceptibility Testing (EUCAST) ( 2012;). EUCAST guidelines for detection of resistance mechanisms and specific resistances of clinical and/or epidemiological importance. . http://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Consultation/EUCAST_guidelines_detection_of_resistance_mechanisms_121222.pdf 10 May 2016.
  7. European Committee on Antimicrobial Susceptibility Testing (EUCAST) ( 2016;). Breakpoint tables for interpretation of MICs and zone diameters. Version 6.0. . http://www.eucast.org. 10 May 2016.
  8. Galani I. , Rekatsina P. D. , Hatzaki D. , Plachouras D. , Souli M. , Giamarellou H. . ( 2008;). Evaluation of different laboratory tests for the detection of metallo-beta-lactamase production in Enterobacteriaceae . . J Antimicrob Chemother 61: 548–553. [CrossRef] [PubMed]
    [Google Scholar]
  9. Giakkoupi P. , Pappa O. , Polemis M. , Vatopoulos A. C. , Miriagou V. , Zioga A. , Papagiannitsis C. C. , Tzouvelekis L. S. . ( 2009;). Emerging Klebsiella pneumoniae isolates coproducing KPC-2 and VIM-1 carbapenemases. . Antimicrob Agents Chemother 53: 4048–4050. [CrossRef] [PubMed]
    [Google Scholar]
  10. Girlich D. , Halimi D. , Zambardi G. , Nordmann P. . ( 2013;). Evaluation of Etest® strips for detection of KPC and metallo-carbapenemases in Enterobacteriaceae . . Diagn Microbiol Infect Dis 77: 200–201. [CrossRef] [PubMed]
    [Google Scholar]
  11. Giske C. G. , Gezelius L. , Samuelsen Ø. , Warner M. , Sundsfjord A. , Woodford N. . ( 2011;). A sensitive and specific phenotypic assay for detection of metallo-β-lactamases and KPC in Klebsiella pneumoniae with the use of meropenem disks supplemented with aminophenylboronic acid, dipicolinic acid and cloxacillin. . Clin Microbiol Infect 17: 552–556. [CrossRef] [PubMed]
    [Google Scholar]
  12. Lolans K. , Calvert K. , Won S. , Clark J. , Hayden M. K. . ( 2010;). Direct ertapenem disk screening method for identification of KPC-producing Klebsiella pneumoniae and Escherichia coli in surveillance swab specimens. . J Clin Microbiol 48: 836–841. [CrossRef] [PubMed]
    [Google Scholar]
  13. Martínez D. , Marcano D. , Rodulfo H. , Salgado N. , Cuaical N. , Rodriguez L. , Caña L. , Medina B. , Guzman M. , De Donato M. . ( 2015;). KPC and VIM producing Enterobacter cloacae strain from a hospital in northeastern Venezuela. . Invest Clin 56: 182–187.[PubMed]
    [Google Scholar]
  14. McGettigan S. E. , Andreacchio K. , Edelstein P. H. . ( 2009;). Specificity of ertapenem susceptibility screening for detection of Klebsiella pneumoniae carbapenemases. . J Clin Microbiol 47: 785–786. [CrossRef] [PubMed]
    [Google Scholar]
  15. Miriagou V. , Tzelepi E. , Kotsakis S. D. , Daikos G. L. , Bou Casals J. , Tzouvelekis L. S. . ( 2013;). Combined disc methods for the detection of KPC- and/or VIM-positive Klebsiella pneumoniae: improving reliability for the double carbapenemase producers. . Clin Microbiol Infect 19: E412415. [CrossRef] [PubMed]
    [Google Scholar]
  16. Moran Gilad J. , Carmeli Y. , Schwartz D. , Navon-Venezia S. . ( 2011;). Laboratory evaluation of the CHROMagar KPC medium for identification of carbapenem-nonsusceptible Enterobacteriaceae . . Diagn Microbiol Infect Dis 70: 565–567. [CrossRef] [PubMed]
    [Google Scholar]
  17. Nordmann P. , Poirel L. . ( 2013;). Strategies for identification of carbapenemase-producing Enterobacteriaceae . . J Antimicrob Chemother 68: 487–489. [CrossRef] [PubMed]
    [Google Scholar]
  18. Nordmann P. , Poirel L. , Carrër A. , Toleman M. A. , Walsh T. R. . ( 2011;). How to detect NDM-1 producers. . J Clin Microbiol 49: 718–721. [CrossRef] [PubMed]
    [Google Scholar]
  19. Nordmann P. , Girlich D. , Poirel L. . ( 2012;). Detection of carbapenemase producers in Enterobacteriaceae by use of a novel screening medium. . J Clin Microbiol 50: 2761–2766. [CrossRef] [PubMed]
    [Google Scholar]
  20. Papadimitriou-Olivgeris M. , Marangos M. , Christofidou M. , Fligou F. , Bartzavali C. , Panteli E. S. , Vamvakopoulou S. , Filos K. S. , Anastassiou E. D. . ( 2014;). Risk factors for infection and predictors of mortality among patients with KPC-producing Klebsiella pneumoniae bloodstream infections in the intensive care unit. . Scand J Infect Dis 46: 642–648. [CrossRef] [PubMed]
    [Google Scholar]
  21. Papadimitriou-Olivgeris M. , Spiliopoulou I. , Christofidou M. , Logothetis D. , Manolopoulou P. , Dodou V. , Fligou F. , Marangos M. , Anastassiou E. D. . ( 2015;). Co-colonization by multidrug-resistant bacteria in two Greek intensive care units. . Eur J Clin Microbiol Infect Dis 34: 1947–1955. [CrossRef] [PubMed]
    [Google Scholar]
  22. Petropoulou D. , Tzanetou K. , Syriopoulou V. P. , Daikos G. L. , Ganteris G. , Malamou-Lada E. . ( 2006;). Evaluation of imipenem/imipenem+EDTA disk method for detection of metallo-β-lactamase-producing Klebsiella pneumoniae isolated from blood cultures. . Microb Drug Resist 12: 39–43. [CrossRef] [PubMed]
    [Google Scholar]
  23. Queenan A. M. , Bush K. . ( 2007;). Carbapenemases: the versatile beta-lactamases. . Clin Microbiol Re 20: 440–458. table of contents.[CrossRef]
    [Google Scholar]
  24. Singh K. , Mangold K. A. , Wyant K. , Schora D. M. , Voss B. , Kaul K. L. , Hayden M. K. , Chundi V. , Peterson L. R. . ( 2012;). Rectal screening for Klebsiella pneumoniae carbapenemases: comparison of real-time PCR and culture using two selective screening agar plates. . J Clin Microbiol 50: 2596–2600. [CrossRef] [PubMed]
    [Google Scholar]
  25. Spyropoulou A. , Papadimitriou-Olivgeris M. , Bartzavali C. , Vamvakopoulou S. , Marangos M. , Spiliopoulou I. , Anastassiou E. D. , Christofidou M. . ( 2015;). A ten-year surveillance study of carbapenemase-producing Klebsiella pneumoniae in a tertiary care Greek university hospital: predominance of KPC- over VIM- or NDM-producing isolates. . J Med Microbiol 65: 240–246. [CrossRef] [PubMed]
    [Google Scholar]
  26. Steinmann J. , Kaase M. , Gatermann S. , Popp W. , Steinmann E. , Damman M. , Paul A. , Saner F. , Buer J. , Rath P. . ( 2011;). Outbreak due to a Klebsiella pneumoniae strain harbouring KPC-2 and VIM-1 in a German university hospital, July 2010 to January 2011. . Euro Surveill 16: 19944.[PubMed]
    [Google Scholar]
  27. Tsakris A. , Poulou A. , Pournaras S. , Voulgari E. , Vrioni G. , Themeli-Digalaki K. , Petropoulou D. , Sofianou D. . ( 2010;). A simple phenotypic method for the differentiation of metallo-beta-lactamases and class A KPC carbapenemases in Enterobacteriaceae clinical isolates. . J Antimicrob Chemother 65: 1664–1671. [CrossRef] [PubMed]
    [Google Scholar]
  28. Tsakris A. , Themeli-Digalaki K. , Poulou A. , Vrioni G. , Voulgari E. , Koumaki V. , Agodi A. , Pournaras S. , Sofianou D. . ( 2011;). Comparative evaluation of combined-disk tests using different boronic acid compounds for detection of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae clinical isolates. . J Clin Microbiol 49: 2804–2809. [CrossRef] [PubMed]
    [Google Scholar]
  29. Tzouvelekis L. S. , Markogiannakis A. , Psichogiou M. , Tassios P. T. , Daikos G. L. . ( 2012;). Carbapenemases in Klebsiella pneumoniae and other Enterobacteriaceae: an evolving crisis of global dimensions. . Clin Microbiol Rev 25: 682–707. [CrossRef] [PubMed]
    [Google Scholar]
  30. Vading M. , Samuelsen Ø. , Haldorsen B. , Sundsfjord A. S. , Giske C. G. . ( 2011;). Comparison of disk diffusion, Etest and VITEK2 for detection of carbapenemase-producing Klebsiella pneumoniae with the EUCAST and CLSI breakpoint systems. . Clin Microbiol Infect 17: 668–674. [CrossRef] [PubMed]
    [Google Scholar]
  31. Vasoo S. , Lolans K. , Li H. , Prabaker K. , Hayden M. K. . ( 2014;). Comparison of the CHROMagar™ KPC, Remel Spectra™ CRE, and a direct ertapenem disk method for the detection of KPC-producing Enterobacteriaceae from perirectal swabs. . Diagn Microbiol Infect Dis 78: 356–359. [CrossRef] [PubMed]
    [Google Scholar]
  32. Viau R. , Frank K. M. , Jacobs M. R. , Wilson B. , Kaye K. , Donskey C. J. , Perez F. , Endimiani A. , Bonomo R. A. . ( 2016;). Intestinal carriage of carbapenemase-producing organisms: current status of surveillance methods. . Clin Microbiol Rev 29: 1–27. [CrossRef] [PubMed]
    [Google Scholar]
  33. Wang Y. , Cao W. , Zhu X. , Chen Z. , Li L. , Zhang B. , Wang B. , Tian L. , Wang F. et al. ( 2012;). Characterization of a novel Klebsiella pneumoniae sequence type 476 carrying both blaKPC-2 and blaIMP-4. . Eur J Clin Microbiol Infect Dis 31: 1867–1872. [CrossRef] [PubMed]
    [Google Scholar]
  34. Zioga A. , Miriagou V. , Tzelepi E. , Douzinas E. , Tsakiri M. , Legakis N. J. , Daikos G. L. , Tzouvelekis L. S. . ( 2010;). The ongoing challenge of acquired carbapenemases: a hospital outbreak of Klebsiella pneumoniae simultaneously producing VIM-1 and KPC-2. . Int J Antimicrob Agents 36: 190–191. [CrossRef] [PubMed]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.000318
Loading
/content/journal/jmm/10.1099/jmm.0.000318
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error