Comparison of Different Phenotypic Tests versus PCR in the Detection of Carbapenemase-Producing Pseudomonas aeruginosa Isolates in Hamadan, Iran

Beig, Masoumeh; Taheri, Mohammad; Arabestani, Mohammad Reza

doi:10.1155/2021/5582615

Cited by 6 publications

(4 citation statements)

References 29 publications

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“…They demonstrated that CIM methods can be used for fast and accurate identification of carbapenemase enzymes. Additionally, this method is suitable to use in medical microbiology laboratories (19). In 2017, Malkoçoğlu et al indicated carbapenemase production was shown in only three of 84 isolates, and noted that the carbapenem resistance in other strains could be due to another mechanism, for example, porin alterations, and efflux pumps (20).…”

Section: Discussionmentioning

confidence: 99%

Investigation of Carbapenemase Production Among Carbapenem-Resistant Pseudomonas aeruginosa Isolates

Darweesh,

Şay Coşkun

2024

Harran Üniversitesi Tıp Fakültesi Dergisi

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Background: Pseudomonas aeruginosa is an opportunist organism that causes potentially life threatening nosocomial infections, particularly in immunocompromised patients. Carbapenems are regarded to be the last line of treatment against severe infections caused by multi drug resistant P. aeruginosa isolates. isolates. Production of the carbapenemase enzyme is the primary mechanism of carbapenem resistance and has become a serious health concern worldwide as these enzymes are highly transferable and limit therapeutic alternatives. Rapid detection of carbapenemase production is important for prompt planning the treatment of car-bapenemase-producing isolates and preventing the spread of these strains. This study aimed to investigate carbapenemase produc-tion in carbapenem resistant Pseudomonas aeruginosa isolates by the Carbapenem inactivation method. Materials and Methods: In this retrospective study a total of 172 Pseudomonas aeruginosa isolates were obtained from different samples sent from various clinics to Tokat Gaziosmanpaşa University Research and Application Hospital Microbiology Laboratory between 2016-2019 and were evaluated. Of the 172 isolates, 51 (29.7%) were found to be carbapenem- resistant and included in this investigation. Identification and antibiotic susceptibility tests of the isolates were performed with the Vitek 2 (Biomerieux, France) automated system. Carbapenem sensitivities were also determined by the disc diffusion method. Carbapenemase production in isolates was investigated by the Carbapenem inactivation method. Results: These samples were sent from clinical units, such as neurology (n =10), general surgery (n =8), internal medicine (n =7), and pediatric (n =6). The isolates were identified from wounds (n = 17), sputum (n = 15), blood (n = 11), urine (n = 5), and cerebrospinal fluid (n = 3) samples. Of all the carbapenem –resistant samples 32 (62.8%) were obtained from male, and 19 (37.3%) from female patients. Of the 51 carbapenem resistant isolates, 38 (74.5%) were found to be resistant to both imipenem and meropenem. Eight (15.7%) isolates were found to be resistant to imipenem only, and five (9.8%) isolates were resistant to meropenem. Carbapenemase production was detected in 31 (60.8%) isolates by using using the Carbapenem inactivation method. The antibiotic resistance rates of the carbapenem-resistant isolates were as follows: piperacillin-tazobactam 65%, amikacin 6.8%, gentamicin 15.2%, ceftazidime 34.6%, cefepime 38.3%, ciprofloxacin 26.7%, levofloxacin 24.2%. Conclusions: Rapid identification of carbapenemase enzymes among carbapenem resistant Pseudomonas aeruginosa isolates using phenotypic and genotypic approaches is important to control the transmission of infection caused by carbapenem-resistant isolates and to control the morbidity and mortality associated with them. In this study, the carbapenem inactivation test was seen as a method that can be preferred in the laboratory in terms of its easy and fast application in the detection of carbapenemase production. Key Words: Pseudomonas aeruginosa, Carbapenem inactivation method, Antimicrobial resistance

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Section: Discussionmentioning

confidence: 99%

Investigation of Carbapenemase Production Among Carbapenem-Resistant Pseudomonas aeruginosa Isolates

Darweesh,

Şay Coşkun

2024

Harran Üniversitesi Tıp Fakültesi Dergisi

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“…The mCIM test, which is supposed to prove the presence of any carbapenemase type (without differentiating them), lead to negative results for all our tested strains. As the test was performed according to the recommendations [ 27 , 57 , 58 ], we can only assume that the negative results are due to the low-level production of carbapenemase enzymes, even if the genetic background is present in most of the isolates (carbapenemase genes). Thus, the activity of mex efflux pump may play a more important role in bacterial antibiotic resistance.…”

Section: Discussionmentioning

confidence: 99%

“…The mCIM test is described to be a rapid and reliable way to detect carbapenemase-producing bacteria and can be used in clinical laboratories. However, it should be used in conjunction with other laboratory tests and clinical information to make a definitive diagnosis [ 26 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

Uncovering the Resistance Mechanisms in Extended-Drug-Resistant Pseudomonas aeruginosa Clinical Isolates: Insights from Gene Expression and Phenotypic Tests

Coșeriu,

Mare,

Toma

et al. 2023

Microorganisms

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(1) Background: The purpose of the study was to describe the activity of mex efflux pumps in Multidrug-Resistant (MDR) clinical isolates of Pseudomonas aeruginosa and to compare the carbapenem-resistance identification tests with PCR; (2) Methods: Sixty MDR P. aeruginosa were analyzed for detection of carbapenemase by disk diffusion inhibitory method, carbapenem inactivation method and Modified Hodge Test. Endpoint PCR was used to detect 7 carbapenemase genes (blaKPC, blaOXA48-like, blaNDM, blaGES-2, blaSPM, blaIMP, blaVIM) and mcr-1 for colistin resistance. The expression of mexA, mexB, mexC, mexE and mexX genes corresponding to the four main efflux pumps was also evaluated; (3) Results: From the tested strains, 71.66% presented at least one carbapenemase gene, with blaGES-2 as the most occurring gene (63.3%). Compared with the PCR, the accuracy of phenotypic tests did not exceed 25% for P. aeruginosa. The efflux pump genes were present in all strains except one. In 85% of the isolates, an overactivity of mexA, mexB and mostly mexC was detected. Previous treatment with ceftriaxone increased the activity of mexC by more than 160 times; (4) Conclusions: In our MDR P. aeruginosa clinical isolates, the carbapenem resistance is not accurately detected by phenotypic tests, due to the overexpression of mex efflux pumps and in a lesser amount, due to carbapenemase production.

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“…This study documented that the mCIM test is the most sensitive test for the detection of CRE. 30 Beig et al 31 documented Carba NP and mCIM tests as highly sensitive and specific phenotypic tests for detection of CRE with 97% and 94% sensitivity compared to MHT with 67% sensitivity. 31 However, in the present study, both mCIM and Carba NP were highly sensitive in the detection of CRE.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Three Phenotypic Methods of Carbapenemase Enzyme Detection to Identify Carbapenem-resistant Enterobacterales

Khare¹,

Gopinathan²,

Leela³

et al. 2022

J. Pure Appl. Microbiol.

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The prevalence of multidrug-resistant gram-negative bacilli has increased worldwide. Critical care areas of most hospitals use carbapenem antibiotics for the empirical treatment of gram-negative bacterial (GNB) infections. In the last decade, there have been reports of the detection of carbapenem-resistant Enterobacterales (CRE). This rise in the spread of CRE presents a great challenge in the treatment of GNB infections and poses a serious threat to global health. To detect the burden of CRE and to characterize CRE, we used three phenotypic methods for the detection of carbapenemase enzymes. Using conventional aerobic bacterial culture methods, 150 Enterobacterales strains were isolated from various clinical samples. Identification of CRE was performed using multiple phenotypic detection methods, such as the Kirby Bauer disc diffusion method for meropenem (10 mcg) using the CLSI 2021 interpretation for meropenem, modified Hodge test (MHT), Carba NP test, and modified carbapenem inactivation method (mCIM) test. A total of 150 Enterobacterales strains were isolated over a period of 1 year. Among these, 66/150 (44%), 63/150 (43%), 64/150 (43%), and 65/150 (43%) were identified as CRE using the Kirby Bauer disc diffusion method, MHT, mCIM test, and Carba NP test, respectively. The sensitivity and specificity of MHT, mCIM, and Carba NP tests within 95% CI were 93.94%/100%, 96.97%/100%, and 98.48%/100%, respectively. The positive and negative predictive values of MHT, mCIM, and Carba NP tests were 100%/95.45%, 100%/97.67%, and 100%/98.82%, respectively. The accuracies of the MHT, mCIM, and Carba NP tests were 97.33%, 98.67%, and 99.33% respectively indicating a high burden of carbapenem resistance in Enterobacterales. Therefore, given the current statistics of carbapenem resistance, use of carbapenem as empiric treatment in the intensive care units of hospitals may not be beneficial. Identification of carbapenem resistance can help in the initiation of appropriate antimicrobial therapy. This study compares the accuracy and efficiency of Carba NP, mCIM, and MHT in detecting carbapenem-resistant Enterobacterales.

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Comparison of Different Phenotypic Tests versus PCR in the Detection of Carbapenemase-Producing Pseudomonas aeruginosa Isolates in Hamadan, Iran

Cited by 6 publications

References 29 publications

Investigation of Carbapenemase Production Among Carbapenem-Resistant Pseudomonas aeruginosa Isolates

Investigation of Carbapenemase Production Among Carbapenem-Resistant Pseudomonas aeruginosa Isolates

Uncovering the Resistance Mechanisms in Extended-Drug-Resistant Pseudomonas aeruginosa Clinical Isolates: Insights from Gene Expression and Phenotypic Tests

Comparison of Three Phenotypic Methods of Carbapenemase Enzyme Detection to Identify Carbapenem-resistant Enterobacterales

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