International Microbiology

, Volume 22, Issue 1, pp 81–89 | Cite as

Evaluation of the commercial combined disk test and minimum inhibitory concentration (MIC) determination for detection of carbapenemase producers among Gram-negative bacilli isolated in a region with high prevalence of blaOXA-48 and blaNDM

  • Zoya Hojabri
  • Maedeh Arab
  • Narges Darabi
  • Naim Sadat Kia
  • Bruno S. LopesEmail author
  • Omid PajandEmail author
Original Article


Carbapenem-resistant Gram-negative bacilli (GNB) are a concern in the Middle East and worldwide. Simple screening methods have been sought to detect carbapenemase producers to determine appropriate therapeutic measures and implement infection control interventions. In this study, we evaluated the efficiency of agar disc diffusion, commercial combined disc test (Rosco), and carbapenem MIC determination in comparison to molecular detection of carbapenemase genes among 82 carbapenem non-susceptible Enterobacteriaceae (CNSE) and 37 Acinetobacter/Pseudomonas isolates. The blaOXA-48, blaNDM, blaNDM/OXA-48, and blaIMP were detected in 68 out of 82 CNSE isolates. All of the Acinetobacter baumannii isolates were positive for the blaOXA-51 (n = 23), of those some were positive for blaOXA-48 (n = 13) and blaNDM (n = 3). Sensitivities and specificities of combined disc test for detection of blaNDM and blaOXA-48 carrying Enterobacteriaceae isolates were 92.5% and 100%, and 58.5% and 100%, respectively, while those for Acinetobacter/Pseudomonas isolates were 100%, 81.8% and 96.2%, 89%, respectively. While carbapenem MIC values had excellent concordance with phenotypic combined disc test for detection of blaOXA-48 producers (area under curve > 90%), only ertapenem MIC’s could precisely detect blaOXA-48 PCR-positive Enterobacteriaceae isolates (AUC 70%, sensitivity 70%, specificity 50%). The phenotypic commercial test showed excellent sensitivity for detection of blaNDM producers, but had poor sensitivity for blaOXA-48-producing Enterobacteriaceae. Ertapenem MIC values had low sensitivity and specificity for detection of the blaOXA-48-carrying Enterobacteriaceae. This is the first report of A. baumannii isolates co-harbored the blaOXA-48/blaNDM carbapenemases from Iran.


Acinetobacter Enterobacteriaceae NDM OXA-48 Carbapenemase Rosco MIC 



We would like to thank the “Deputy of Research” of Semnan University of Medical Sciences for their cooperation and for providing facilities to this work.


This work was supported fully by Semnan University of Medical Sciences (grant nos.730 and 919). This is a report of a database from research projects entitled “Investigation of the prevalence, antimicrobial susceptibility testing and carbapenemase production among Enterobacteriaceae and Pseudomonas aeruginosa isolates recovered from clinical specimens collected from Semnan hospitals and the effect of driving factors” and “Determination of Minimum Inhibitory Concentration (MIC) of Ertapenem in carbapenem non-susceptible isolates of Enterobacteriaceae recovered from hospitalized patients” registered in Semnan University of Medical Sciences, Semnan, Iran.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The present study was approved by the Semnan University of Medical Sciences, Iran.

Informed consent

Written informed consent was not necessary for this study. Patient data were anonymous for the purposes of this analysis, and all confidential patients’ information was protected in accordance with the Iranian law.


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Microbiology Department, Faculty of MedicineSemnan University of Medical SciencesSemnanIran
  2. 2.Student Research Committee, Faculty of MedicineSemnan University of Medical SciencesSemnanIran
  3. 3.Social Health Determinants Research Center, Department of Community Medicine, Faculty of MedicineSemnan University of Medical SciencesSemnanIran
  4. 4.Department of Medical Microbiology, School of Medicine, Medical Sciences and NutritionUniversity of AberdeenAberdeenUK

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