Abstract
The purpose of this investigation was to compare several phenotypic methods, including combined disk tests (CDT) containing metallo-β-lactamase (MBL) inhibitors or cloxacillin, and the Carba NP test for the detection of carbapenemase-producing Pseudomonas aeruginosa (CPPA). A new CDT using imipenem (10 μg) ± cloxacillin 4,000 μg and the Carba NP test were evaluated to detect CPPA. In addition, four commercially available combined disks containing a carbapenem and ethylene-diamine-tetra-acetic acid (EDTA) or dipicolinic acid (DPA) as the inhibitor were tested in order to detect MBL-positive P. aeruginosa. All these phenotypic methods were evaluated on 188 imipenem non-susceptible P. aeruginosa (CPPA, n = 75) isolates divided into 26 well-characterized collection strains and 162 non-duplicate clinical isolates referred to the national reference laboratory in 2013. For the total of 188 isolates tested, CDT containing EDTA or DPA displayed high sensitivities (99 %) and specificities (95 %) for detecting MBL-producing isolates. CDT with cloxacillin showed a sensitivity and specificity of 97 %/96 % compared to 88 %/99 % for the Carba NP test in order to detect CPPA. For the 162 clinical isolates, CDT containing EDTA or DPA displayed a high negative predictive value (NPV) (99 %) for detecting MBL-producing isolates. CDT with cloxacillin showed an NPV of 98 %, compared to 95 % for the Carba NP test in order to detect CPPA. In our setting, CDT associating imipenem ± EDTA or ± DPA performed best for the detection of MBL-producing P. aeruginosa. Imipenem/imipenem–cloxacillin test yielded good NPV to exclude the presence of MBL in imipenem non-susceptible isolates.
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Acknowledgments
We thank our microbiologist colleagues for referring isolates to the national reference center and to Jose Bou Casals from Rosco Diagnostica for providing the meropenem ± DPA tablets. This study was supported in part by a research grant from the Fondation Mont-Godinne. The national reference center is partially supported by the Belgian Ministry of Social Affairs through a fund within the health insurance system.
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The authors declare that they have no conflict of interest.
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Heinrichs, A., Huang, T.D., Berhin, C. et al. Evaluation of several phenotypic methods for the detection of carbapenemase-producing Pseudomonas aeruginosa . Eur J Clin Microbiol Infect Dis 34, 1467–1474 (2015). https://doi.org/10.1007/s10096-015-2376-z
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DOI: https://doi.org/10.1007/s10096-015-2376-z