Carbapenem-Resistant Non-Glucose-Fermenting Gram-Negative Bacilli: the Missing Piece to the Puzzle

Gniadek, Thomas J.; Carroll, Karen C.; Simner, Patricia J.

doi:10.1128/jcm.03264-15

Cited by 92 publications

(78 citation statements)

References 73 publications

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“…Increasing reports of CPNFs, dominated by Pseudomonas aeruginosa and Acinetobacter baumannii, are worrisome as many of these carbapenemase genes have demonstrated mobility across Gram-negative species, regardless of an organism's ability to ferment glucose (3). Lack of recognition and detection of CPNFs may further perpetuate the problem of carbapenem resistance among all Gram-negative organisms.…”

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Carbapenemase Detection among Carbapenem-Resistant Glucose-Nonfermenting Gram-Negative Bacilli

et al. 2017

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Accurate detection of carbapenemase-producing glucose-nonfermenting Gram-negative bacilli (CPNFs), including Pseudomonas aeruginosa and Acinetobacter baumannii, is necessary to prevent their dissemination within health care settings. We performed a method comparison study of 11 phenotypic carbapenemase detection assays to evaluate their accuracy for the detection of CPNFs. A total of 96 carbapenem-resistant glucose-nonfermenting isolates were included, of which 29% produced carbapenemases. All CPNFs were molecularly characterized to identify ␤-lactamase genes. A total of 86% of the carbapenemase-producing P. aeruginosa isolates produced class B carbapenemases. Several assays performed with a sensitivity of Ͼ90% for the detection of carbapenemase-producing P. aeruginosa, including all rapid chromogenic assays and the modified carbapenem inactivation method. Most included assays, with the exception of the Manual Blue Carba assay, the Modified Carba NP assay, the boronic acid synergy test, and the metallo-␤-lactamase Etest, had specificities of Ͼ90% for detecting carbapenemase-producing P. aeruginosa. Class D carbapenemases were the most prevalent carbapenemases among the carbapenemase-producing A. baumannii strains, with 60% of the carbapenemaseproducing A. baumannii isolates producing acquired OXA-type carbapenemases. Although several assays achieved Ͼ90% specificity in identifying carbapenemaseproducing A. baumannii, no assays achieved a sensitivity of greater than 90%. Our findings suggest that the available phenotypic tests generally appear to have excellent sensitivity and specificity for detecting carbapenemase-producing P. aeruginosa isolates. However, further modifications to existing assays or novel assays may be necessary to accurately detect carbapenemase-producing A. baumannii.

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Carbapenemase Detection among Carbapenem-Resistant Glucose-Nonfermenting Gram-Negative Bacilli

et al. 2017

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“…Additionally, the CDC designated multidrug-resistant (MDR) Pseudomonas aeruginosa and Acinetobacter baumannii as serious threats because they are resistant to nearly all available antibiotics, including carbapenems-declaring that they require urgent public health attention (1). Optimal screening methods for rapid detection of carbapenem-resistant organisms (CROs) have yet to be established (2). Currently described methods include broth enrichment, direct selective culture, chromogenic media, and detection of carbapenemase genes directly from rectal swabs (3)(4)(5)(6)(7)(8)(9).…”

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Evaluation of Multiple Methods for Detection of Gastrointestinal Colonization of Carbapenem-Resistant Organisms from Rectal Swabs

et al. 2016

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bRectal swabs from high-risk patients were screened for carbapenem-resistant organisms (CROs) using several methods. The direct MacConkey plate method was the most sensitive for CROs (95%), while chromID CARBA and the Check-Direct CPE screen assay were the most sensitive for the detection of carbapenemase-producing organisms (CPOs) (100%; all bla KPC ). All methods had a specificity of >90% for CROs, and for CPOs, the specificity ranged from 85 to 98%. Broth enrichment methods performed poorly compared to direct inoculation methods, negating the need for the broth enrichment step. In 2013, the U.S. Centers for Disease Control and Prevention (CDC) assigned the highest threat level to carbapenem-resistant Enterobacteriaceae (CRE). Additionally, the CDC designated multidrug-resistant (MDR) Pseudomonas aeruginosa and Acinetobacter baumannii as serious threats because they are resistant to nearly all available antibiotics, including carbapenems-declaring that they require urgent public health attention (1). Optimal screening methods for rapid detection of carbapenem-resistant organisms (CROs) have yet to be established (2). Currently described methods include broth enrichment, direct selective culture, chromogenic media, and detection of carbapenemase genes directly from rectal swabs (3-9). The objectives of this study were to (i) evaluate multiple methods for screening CROs from rectal swabs and (ii) to determine the prevalence of gastrointestinal colonization with CROs among high-risk inpatient populations.Two-hundred thirteen remnant vancomycin-resistant enterococcus (VRE) surveillance rectal ESwabs (Copan, Murrieta, CA) were collected in a non-outbreak setting from four distinct inpatient populations at The Johns Hopkins Hospital, Baltimore, MD. ESwabs were collected upon hospital unit admission and weekly thereafter until unit discharge. Consecutive rectal ESwabs were collected from medical and surgical intensive care units (MICUs and SICUs, respectively), an oncology ward, and an organ transplant ward over a 2-week period. The ESwabs were vortexed, and the remnant liquid Amies broth was aliquoted to cryovials and frozen at Ϫ70°C until further testing was performed. From each ESwab broth, five different methods for the detection of CRO were set up in parallel. The five methods included (i) the CDC broth enrichment method with ertapenem for selection (3), (ii) a modified CDC broth enrichment method using ertapenem and vancomycin for selection (3), (iii) a direct MacConkey plate with ertapenem disks (4, 6), (iv) a chromogenic chromID CARBA agar plate method (with the new reformulated medium; package insert version 20157 A-en-2013/02, reference no. 414012 [bioMérieux, Marcy l'Étoile, France]), and (v) the Check-Direct CPE screen assay for the BD MAX instrument (Check-Points, Wageningen, The Netherlands; Becton Dickinson, Sparks, MD). The ESwab broth was first vortexed for 5 s, 100 l of ESwab broth was inoculated into each of the medium types, and 25 l was inoculated into a DNA sample buffer tube (SBT) for the Check...

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“…1 However, the hazards posed by CP Pseudomonas aeruginosa and CP Acinetobacter baumannii have been underestimated. 2 The transmission of mobile genetic elements containing carbapenemase-encoding genes is not species specific. Early and accurate detection of CP P. aeruginosa and CP A. baumannii is necessary to prevent the propagation of carbapenemases across all gram-negative organisms in healthcare settings.…”

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confidence: 99%

Is There a Carbapenem MIC Cutoff Value That Distinguishes Carbapenemase-Producing and Non-Carbapenemase-Producing Carbapenem Non-Susceptible Pseudomonas and Acinetobacter Isolates?

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et al. 2017

Infect. Control Hosp. Epidemiol.

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Carbapenem-Resistant Non-Glucose-Fermenting Gram-Negative Bacilli: the Missing Piece to the Puzzle

Cited by 92 publications

References 73 publications

Carbapenemase Detection among Carbapenem-Resistant Glucose-Nonfermenting Gram-Negative Bacilli

Carbapenemase Detection among Carbapenem-Resistant Glucose-Nonfermenting Gram-Negative Bacilli

Evaluation of Multiple Methods for Detection of Gastrointestinal Colonization of Carbapenem-Resistant Organisms from Rectal Swabs

Is There a Carbapenem MIC Cutoff Value That Distinguishes Carbapenemase-Producing and Non-Carbapenemase-Producing Carbapenem Non-Susceptible Pseudomonas and Acinetobacter Isolates?

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