Clinical laboratory detection of carbapenem-resistant and carbapenemase-producing<i>Enterobacteriaceae</i>

Miller, Samuel D.; Humphries, Romney M.

doi:10.1080/14787210.2016.1206815

Cited by 37 publications

(38 citation statements)

References 70 publications

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“…Real-time PCR amplification of known resistance genes has also been shown to be clinically effective in screening for Methicillin-resistant Staphylococcus aureus , with low false negative and false positive rates between 0.0% to 7.3% and 0.0% to 5.4% respectively [16]. Additionally, rapid molecular assays are available for carbapenem-resistant Enterobacteriaceae and have been shown to detect most resistance genes without yielding false positives [17]. …”

Section: Discussionmentioning

confidence: 99%

Wild-Type Gyrase A Genotype of Neisseria gonorrhoeae Predicts In Vitro Susceptibility to Ciprofloxacin: A Systematic Review of the Literature and Meta-Analysis

Allan‐Blitz¹,

Wang²,

Klausner³

2017

Sexual Trans Dis

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Multidrug-resistant Neisseria gonorrhoeae infections have been declared one of the top three urgent threats to public health. Approaches to combat resistance include targeted therapy with antibiotics previously thought to be ineffective, made possible by rapid molecular assays to predict susceptibility. Previous studies have associated the gyrase A (gyrA) gene of Neisseria gonorrhoeae with in vitro resistance to ciprofloxacin. We conducted a systematic review of studies comparing Neisseria gonorrhoeae gyrA genotype results with conventional antimicrobial susceptibility test results. We identified 31 studies meeting inclusion criteria, among which seven different loci for mutations in the gyrA gene were identified, from sixteen countries between the years of 1996 and 2016. We then performed a meta-analysis among those studies stratifying by use of real-time PCR or non-real-time PCR technique, and compared the summary receiver operating characteristic curves (sROC) between the two PCR methods. Among studies using real-time PCR the pooled estimate of sensitivity and specificity of gyrA genotype results for the prediction of Neisseria gonorrhoeae susceptibility to ciprofloxacin were 98.2% (95% CI 96.5%-99.1%) and 98.6% (95% CI 97.0%-99.3%), respectively. The sROCs for studies using real-time PCR techniques were well separated from those using non-real-time PCR techniques, with only slight overlap in the confidence intervals, suggesting that real-time PCR techniques were a more accurate approach. GyrA genotype testing is a novel approach to combating the emergence of multi drug-resistant Neisseria gonorrhoeae, and is a sensitive and specific method to predict in vitro ciprofloxacin susceptibility.

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Section: Discussionmentioning

confidence: 99%

Wild-Type Gyrase A Genotype of Neisseria gonorrhoeae Predicts In Vitro Susceptibility to Ciprofloxacin: A Systematic Review of the Literature and Meta-Analysis

Allan‐Blitz¹,

Wang²,

Klausner³

2017

Sexual Trans Dis

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“…However, this was most effective for isolates of K. pneumoniae and Escherichia coli, whereas 26% of Enterobacter species isolates demonstrated false-positive MHT results (18). The MHT is also associated with false-negative results for NDM-producing CRE (6). While at the time, the MHT was the only CLSIendorsed carbapenemase test that was readily performed by clinical laboratories, the CLSI voted in January 2017 to retire the MHT as a confirmatory test for CP-CRE and will remove this procedure in the 28th edition of the M100S standard, leaving laboratories with few practical options for testing CP-CRE.…”

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confidence: 97%

“…However, such interventions critically depend on accurate and rapid identification of patients colonized or infected by CRE through laboratory testing. Unfortunately, detection of CRE, let alone CP-CRE, remains a challenge for most clinical microbiology laboratories in the United States (6). For instance, updated carbapenem breakpoints for the Enterobacteriaceae published by the Clinical and Laboratory Standards Institute (CLSI) in 2010 have been incompletely adopted by clinical laboratories (15,16), because not all manufacturers of antimicrobial susceptibility test (AST) systems have obtained U.S. Food and Drug Administration (FDA) clearance for these new breakpoints.…”

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confidence: 99%

“…Subsequent studies in this region documented that nearly 1 in 3 residents of long-term acute care facilities were colonized with KPC-producing CRE (5). CRE harboring other carbapenem-hydrolyzing enzymes, such as NDM, VIM, IMP, or the OXA-48 type, common in other areas of the world (6), are also spreading in the United States (7-9). The introduction of isolates expressing these carbapenemases to a single institution by a patient traveling from an area of endemicity can lead to rapid spread, as occurred in our own institution when an OXA-232-producing K. pneumoniae strain was introduced to our facility by a colonized patient, leading to transmission of CRE to 14 patients via reprocessed duodenoscopes (10).…”

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confidence: 99%

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Use of Ancillary Carbapenemase Tests To Improve Specificity of Phenotypic Definitions for Carbapenemase-Producing Enterobacteriaceae

2017

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Carbapenemase-producing Enterobacteriaceae (CPE) are a significant threat to public health. In 2015, CDC revised the surveillance definition for CPE to include all Enterobacteriaceae resistant to any carbapenem tested. However, this definition is associated with poor specificity. We evaluated the performance of this definition, compared to carbapenemase PCR, for a collection of 125 Enterobacteriaceae. We also investigated the impact of ancillary testing for carbapenemase of isolates that met the CDC CPE surveillance definition. The two ancillary tests evaluated were the Xpert Carba-R assay, a molecular test, and the carbapenem inactivation method (CIM). Two variables were evaluated for the CIM: suspension of organisms in double-distilled water (ddH 2 O) versus tryptic soy broth (TSB) to incubate disks, and incubation of plates for 6 h versus 18 to 20 h. The sensitivity and specificity of the Carba-R assay were 100% compared to the results of in-house PCR. The sensitivities of the CIM performed with TSB were 94.6% when read at 6 h and 97.7% when read at 18 to 20 h; the sensitivities with ddH 2 O were 88.0% when read at 6 h and 93.0% when incubated for 18 to 20 h. The specificity was 100% for all variables tested. Without ancillary testing, the sensitivity of the CDC definition was 98.9% for CPE, and the specificity was 6.1%. Testing isolates that screened positive by the CDC definition with the Xpert Carba-R did not change the sensitivity, and it improved the specificity to 100%. Similarly, the use of the CIM (TSB and 18 to 20 h of incubation) to confirm screen-positive isolates resulted in a sensitivity of 95.6% and specificity of 100%.KEYWORDS Carba-R, Enterobacteriaceae, carbapenamase, carbapenem inactivation method C arbapenem-resistant Enterobacteriaceae (CRE), particularly those that are resistant due to carbapenemase production, are a significant threat to public health. Infections caused by CRE are associated with a high attributable mortality (1), and U.S. surveillance data have demonstrated a steady increase in the burden of disease caused by CRE since 2000 (2). The U.S. CRE epidemic is driven, in part, by Klebsiella pneumoniae isolates of sequence type (ST) 258 that express the K. pneumoniae carbapenemase (KPC) (3). Transfer of patients colonized or infected with this organism between health care institutions is thought to have led to the dissemination of ST 258 K. pneumoniae across the country. One particularly well documented outbreak described by the Centers for Disease Control and Prevention Epicenter Program demonstrated that patient transfers between 26 health care facilities across four counties lead to the spread of KPCproducing CRE to 40 patients over a 1-year period (4). Subsequent studies in this region documented that nearly 1 in 3 residents of long-term acute care facilities were colonized with KPC-producing CRE (5). CRE harboring other carbapenem-hydrolyzing enzymes, such as NDM, VIM, IMP, or the OXA-48 type, common in other areas of the world (6), are also spreading in the Unite...

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“…), and these methods also have their own limitations. The interested reader is referred to the following excellent recent reviews for a more detailed description of carbapenemase detection methods (17,18).…”

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confidence: 99%

Is This the Carbapenemase Test We've Been Waiting for? A Multicenter Evaluation of the Modified Carbapenem Inactivation Method

Butler-Wu

Abbott

2017

J Clin Microbiol

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A plethora of phenotypic methods exist for the detection of carbapenemases; however, clinical laboratories have struggled for years with accurate, objective phenotypic detection of carbapenemase activity in Enterobacteriaceae. In this issue of the Journal of Clinical Microbiology, V. M. Pierce et al. (J Clin Microbiol 55: 2321-2333, https://doi.org/10.1128/JCM.00193-17) report on a multicenter evaluation of the modified carbapenem inactivation method (mCIM). The high sensitivity, specificity, reproducibility, and ease of interpretation associated with the mCIM for Enterobacteriaceae will likely lead to its adoption by clinical laboratories.

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Clinical laboratory detection of carbapenem-resistant and carbapenemase-producingEnterobacteriaceae

Cited by 37 publications

References 70 publications

Wild-Type Gyrase A Genotype of Neisseria gonorrhoeae Predicts In Vitro Susceptibility to Ciprofloxacin: A Systematic Review of the Literature and Meta-Analysis

Wild-Type Gyrase A Genotype of Neisseria gonorrhoeae Predicts In Vitro Susceptibility to Ciprofloxacin: A Systematic Review of the Literature and Meta-Analysis

Use of Ancillary Carbapenemase Tests To Improve Specificity of Phenotypic Definitions for Carbapenemase-Producing Enterobacteriaceae

Is This the Carbapenemase Test We've Been Waiting for? A Multicenter Evaluation of the Modified Carbapenem Inactivation Method

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