Prospective evaluation of an easy and reliable work flow for the screening of OXA-48-producing Klebsiella pneumoniae in endemic settings.
Algorithm
Carbapenemase
Enterobacterales
OXA-48
Temocillin
Journal
The Journal of hospital infection
ISSN: 1532-2939
Titre abrégé: J Hosp Infect
Pays: England
ID NLM: 8007166
Informations de publication
Date de publication:
Aug 2020
Aug 2020
Historique:
received:
18
03
2020
accepted:
27
04
2020
pubmed:
7
5
2020
medline:
8
6
2021
entrez:
7
5
2020
Statut:
ppublish
Résumé
Carbapenemase-producing Enterobacterales (CPE) represent a serious threat to public health. Clinical microbiology laboratories (CMLs) need effective protocols for screening and confirmation of CPE. To prospectively evaluate an algorithm for the screening of carbapenemase-producing Klebsiella pneumoniae in an OXA-48 endemic hospital. The algorithm was based on a disc diffusion assay using ertapenem and temocillin, which also served as a purity check for routine automated antimicrobial susceptibility testing. All isolates with minimal inhibitory concentrations >0.5 mg/L or zone inhibition diameters <25 mm for ertapenem (Criterion 1) and <12 mm for temocillin (Criterion 2) were tested sequentially by an OXA-48 lateral flow immunochromatographic assay and a multiplex polymerase chain reaction targeting VIM, KPC and OXA-48. If neither test was positive, the modified Hodge test or CARBA NP test was used. Over 2 years, 2487 K. pneumoniae were assessed by the algorithm proposed, and 378 (15.20%) met both criteria. Of these, 98.68% (373/378) were either confirmed as OXA-48 producers or originated from patients with a previous CPE isolate that maintained the same resistance phenotype over time. The remaining three K. pneumoniae were VIM producers. Only two of the 378 isolates (0.53%) did not produce carbapenemase, despite meeting Criteria 1 and 2. The algorithm described combined the most sensitive carbapenem for CPE detection with a cut-off for temocillin that was highly specific for detection of OXA-48. It is reliable and easy to apply in routine CML work flow, allowing rapid detection of CPE isolates and hence prompt implementation of infection control measures and targeted antimicrobial regimens.
Sections du résumé
BACKGROUND
BACKGROUND
Carbapenemase-producing Enterobacterales (CPE) represent a serious threat to public health. Clinical microbiology laboratories (CMLs) need effective protocols for screening and confirmation of CPE.
AIM
OBJECTIVE
To prospectively evaluate an algorithm for the screening of carbapenemase-producing Klebsiella pneumoniae in an OXA-48 endemic hospital.
METHODS
METHODS
The algorithm was based on a disc diffusion assay using ertapenem and temocillin, which also served as a purity check for routine automated antimicrobial susceptibility testing. All isolates with minimal inhibitory concentrations >0.5 mg/L or zone inhibition diameters <25 mm for ertapenem (Criterion 1) and <12 mm for temocillin (Criterion 2) were tested sequentially by an OXA-48 lateral flow immunochromatographic assay and a multiplex polymerase chain reaction targeting VIM, KPC and OXA-48. If neither test was positive, the modified Hodge test or CARBA NP test was used.
FINDINGS
RESULTS
Over 2 years, 2487 K. pneumoniae were assessed by the algorithm proposed, and 378 (15.20%) met both criteria. Of these, 98.68% (373/378) were either confirmed as OXA-48 producers or originated from patients with a previous CPE isolate that maintained the same resistance phenotype over time. The remaining three K. pneumoniae were VIM producers. Only two of the 378 isolates (0.53%) did not produce carbapenemase, despite meeting Criteria 1 and 2.
CONCLUSION
CONCLUSIONS
The algorithm described combined the most sensitive carbapenem for CPE detection with a cut-off for temocillin that was highly specific for detection of OXA-48. It is reliable and easy to apply in routine CML work flow, allowing rapid detection of CPE isolates and hence prompt implementation of infection control measures and targeted antimicrobial regimens.
Identifiants
pubmed: 32371082
pii: S0195-6701(20)30229-2
doi: 10.1016/j.jhin.2020.04.044
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
beta-Lactamases
EC 3.5.2.6
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
659-662Informations de copyright
Copyright © 2020 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.