1887

Abstract

Rapid and reliable detection of carbapenemase-producing (CPE) from surveillance cultures is critical in supporting a good infection control programme. We implemented a new algorithm for CPE detection incorporating the NG Test CARBA 5 in January 2019.

Our goals were to compare turnaround time (TAT), costs and staff requirements between the old and new algorithm, and to evaluate the performance of the CARBA 5 test directly on colonies grown on CARBA Smart agar.

We analysed and compared the TAT of CPE surveillance cultures processed using the old and new CPE screening algorithm. The total actual reagent costs and staff requirements for the new CPE algorithm were compared with the estimated costs and staff requirements of the old CPE algorithm.

Of 197 isolates included in the evaluation of the new algorithm, 64 were positive for carbapenemases by both CARBA 5 and Xpert Carba-R assay. Of the 133 that were negative, two were found to harbour NDM and IMI genotypes. Significant improvements in TAT were achieved with 88.7 % of cultures with CPE, reported on the same day as growth was observed on CARBA Smart agar compared to none in the old algorithm. The new algorithm incurred lower costs and, based on our workload, the new algorithm is estimated to save 28.9 man-hours annually.

CARBA 5 performs well on colonies growing on CARBA Smart agar and significant improvements in TAT can be achieved without incurring additional costs or staff requirements.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.001132
2020-01-10
2020-01-27
Loading full text...

Full text loading...

References

  1. World Health Organization Global Antimicrobial Resistance Surveillance System (GLASS) Report: Early Implementation 2016-2017 Geneva, Switzerland: World Health Organization; 2017
    [Google Scholar]
  2. Savard P, Perl TM. Combating the spread of carbapenemases in Enterobacteriaceae: a battle that infection prevention should not lose. Clin Microbiol Infect 2014;20:854–861 [CrossRef]
    [Google Scholar]
  3. Viau R, Frank KM, Jacobs MR, Wilson B, Kaye K et al. Intestinal carriage of carbapenemase-producing organisms: current status of surveillance methods. Clin Microbiol Rev 2016;29:1–27 [CrossRef]
    [Google Scholar]
  4. Hrabák J, Chudáčková E, Papagiannitsis CC. Detection of carbapenemases in Enterobacteriaceae: a challenge for diagnostic microbiological laboratories. Clin Microbiol Infect 2014;20:839–853 [CrossRef]
    [Google Scholar]
  5. van Dijk K, Voets GM, Scharringa J, Voskuil S, Fluit AC et al. A disc diffusion assay for detection of class A, B and OXA-48 carbapenemases in Enterobacteriaceae using phenyl boronic acid, dipicolinic acid and temocillin. Clin Microbiol Infect 2014;20:345–349 [CrossRef]
    [Google Scholar]
  6. Mancini S, Kieffer N, Poirel L, Nordmann P. Evaluation of the Rapidec Carba NP and β-CARBA® tests for rapid detection of carbapenemase-producing Enterobacteriaceae. Diagn Microbiol Infect Dis 2017;88:293–297 [CrossRef]
    [Google Scholar]
  7. Pierce VM, Simner PJ, Lonsway DR, Roe-Carpenter DE, Johnson JK et al. Modified carbapenem inactivation method for phenotypic detection of carbapenemase production among Enterobacteriaceae. J Clin Microbiol 2017;55:2321–2333 [CrossRef]
    [Google Scholar]
  8. Dortet L, Tandé D, de Briel D, Bernabeu S, Lasserre C et al. Maldi-Tof for the rapid detection of carbapenemase-producing Enterobacteriaceae: comparison of the commercialized MBT STAR-Carba IVD kit with two in-house MALDI-TOF techniques and the RAPIDEC Carba NP. J Antimicrob Chemother 2018;73:2352–2359 [CrossRef]
    [Google Scholar]
  9. Findlay J, Hopkins KL, Meunier D, Woodford N. Evaluation of three commercial assays for rapid detection of genes encoding clinically relevant carbapenemases in cultured bacteria. J Antimicrob Chemother 2015;70:1338–1342 [CrossRef]
    [Google Scholar]
  10. Tato M, Ruiz-Garbajosa P, Traczewski M, Dodgson A, McEwan A et al. Multisite evaluation of Cepheid Xpert Carba-R assay for detection of carbapenemase-producing organisms in rectal swabs. J Clin Microbiol 2016;54:1814–1819 [CrossRef]
    [Google Scholar]
  11. Glupczynski Y, Evrard S, Huang T-D, Bogaerts P. Evaluation of the RESIST-4 K-SeT assay, a multiplex immunochromatographic assay for the rapid detection of OXA-48-like, KPC, VIM and NDM carbapenemases. J Antimicrob Chemother 2019;74:1284–1287 [CrossRef]
    [Google Scholar]
  12. Boutal H, Vogel A, Bernabeu S, Devilliers K, Creton E et al. A multiplex lateral flow immunoassay for the rapid identification of NDM-, KPC-, IMP- and VIM-type and OXA-48-like carbapenemase-producing Enterobacteriaceae. J Antimicrob Chemother 2018;73:909–915 [CrossRef]
    [Google Scholar]
  13. Hopkins KL, Meunier D, Naas T, Volland H, Woodford N. Evaluation of the NG-Test carba 5 multiplex immunochromatographic assay for the detection of KPC, OXA-48-like, NDM, VIM and IMP carbapenemases. J Antimicrob Chemother 2018;73:3523–3526 [CrossRef]
    [Google Scholar]
  14. Kolenda C, Benoit R, Carricajo A, Bonnet R, Dauwalder O et al. Evaluation of the new multiple immunochromatographic O.K.N.V. K-SeT assay for rapid detection of OXA-48-like, KPC, NDM, and VIM carbapenemases. J Clin Microbiol 2018;56:e01247–18 [CrossRef]
    [Google Scholar]
  15. Marimuthu K, Venkatachalam I, Khong WX, Koh TH, Cherng BPZ et al. For the carbapenemase-producing Enterobacteriaceae in Singapore (CaPES) Study Group. Clinical and molecular epidemiology of carbapenem-resistant Enterobacteriaceae among adult inpatients in Singapore. Clin Infect Dis 2017;64:S68–75
    [Google Scholar]
  16. Maurer FP, Castelberg C, Quiblier C, Bloemberg GV, Hombach M. Evaluation of carbapenemase screening and confirmation tests with Enterobacteriaceae and development of a practical diagnostic algorithm. J Clin Microbiol 2015;53:95–104 [CrossRef]
    [Google Scholar]
  17. Robert J, Pantel A, Merens A, Meiller E, Lavigne JP. Nicolas-Chanoine MH and on behalf of ONERBA’s carbapenem resistance study group. Development of an algorithm for phenotypic screening of carbapenemase producing Enterobacteriaceae in the routine laboratory. BMC Infect Dis 2017;17:78
    [Google Scholar]
  18. Vanstone GL, Woodhead S, Roulston K, Sharma H, Wey E et al. Improving the detection of carbapenemase-producing organisms (CPO) in a low-prevalence setting: evaluation of four commercial methods and implementation of an algorithm of testing. J Med Microbiol 2018;67:208–214 [CrossRef]
    [Google Scholar]
  19. Baeza LL, Pfennigwerth N, Greissl C, Göttig S, Saleh A et al. Comparison of five methods for detection of carbapenemases in Enterobacterales with proposal of a new algorithm. Clin Microbiol Infect 2019;25:1286.e9–121286 [CrossRef]
    [Google Scholar]
  20. European Committee on Antimicrobial Susceptibility Testing, 2017 EUCAST guidelines for detection of resistance mechanisms and specific resistances of clinical and/or epidemiological importance. version 2.0. http://www.eucast.org
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.001132
Loading
/content/journal/jmm/10.1099/jmm.0.001132
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