The purpose of this investigation was to compare the performance and cost of the Carba NP test with the Rapid CARB Screen Kit in detecting the presence of carbapenemase in Enterobacteriaceae and Pseudomonas aeruginosa. Ninety-two Enterobacteriaceae and 19 P. aeruginosa strains were used in this study. Multiplex polymerase chain reaction (PCR) was performed to determine whether these microorganisms harboured bla VIM, bla IMP, bla NDM, bla KPC and bla OXA-48. The Carba NP test and Rapid CARB Screen Kit were used on the strains according to the standardised protocols. The sensitivity, specificity and positive and negative predictive values of the tests were calculated. The cost of performing one test was also calculated. Forty-five Enterobacteriaceae and six P. aeruginosa were found to harbour carbapenemase-encoding genes. The Carba NP test had sensitivities of 91.1 % and 100 % for Enterobacteriaceae and P. aeruginosa, respectively. The Rapid CARB Screen Kit had sensitivities of 73.3 % and 66.7 % for Enterobacteriaceae and P. aeruginosa, respectively. The specificity of both tests was 100 %. The approximated price for performing one Carba NP test was 0.31 Euros and for CARB Screen Kit, it was 1.25 Euros. The Carba NP test performed better than the Rapid CARB Screen Kit in detecting carbapenemase production in Enterobacteriaceae and P. aeruginosa. The cost to perform both tests is reasonable.

Objectives: To determine the point prevalence of carbapenem-non-susceptible Enterobacteriaceae (CNSE) and carbapenemase-producing Enterobacteriaceae (CPE) isolates among hospitalized patients in Belgium.Methods: Twenty-four hospital-based laboratories prospectively collected 200 non-duplicated Enterobacteriaceae isolates from clinical specimens of hospitalized patients over a 2 month period. All isolates were screened locally for decreased susceptibility to carbapenem drugs using a disc diffusion method according to CLSI interpretative criteria. CNSE strains were referred centrally for confirmation of carbapenemase by phenotypic and molecular testing.Results: From February to April 2012, 158 of the 4564 screened Enterobacteriaceae isolates were categorized as non-susceptible to carbapenems, resulting in a point prevalence of CNSE of 3.5% (95% CI: 2.9% -4.2%; range per centre: 0.5% -8.5%). Of the 125 referred CNSE isolates, 11 Klebsiella pneumoniae isolates [OXA-48 (n¼ 7), KPC type (n¼ 3) and NDM type (n¼ 1)], 1 OXA-48-positive Escherichia coli isolate and 1 KPC-positive Klebsiella oxytoca isolate were detected in eight hospitals. None of the 72 carbapenem-non-susceptible Enterobacter spp. isolates were confirmed as CPE. The minimal estimated point prevalence of CPE isolates was 0.28% (13/ 4564; 95% CI: 0.13% -0.44%) overall (range per centre: 0%-1.5%).Conclusions: Despite the overall low prevalence of CNSE found in this study, the detection of CPE isolates in one-third of the participating centres raises concerns and highly suggests the spread and establishment of CPE in Belgian hospitals.

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We reported a woman with urinary-tract infection caused by OXA-48 producing Klebsiella pneumoniae. Using molecular techniques, we showed that she might acquire this bacterium from another family member who lived in the same house. The two isolates, although different by pulsed-field gel electrophoresis and multilocus sequence typing, carried blaOXA-48 in a similar IncL/M plasmid. This case report shows that community spreading of carbapenemase producing Enterobacteriaceae occurs in the low endemic area not only in nosocomial setting but also in the community.