Development and Application of a Pragmatic Algorithm to Guide Definitive Carbapenemase Testing to Identify Carbapenemase-Producing <i>Pseudomonas aeruginosa</i>
A minimum inhibitory concentration (MIC) derived algorithm, predictive of carbapenemase production, was developed using a challenge set (<i>n</i> = 92) of <i>Pseudomonas aeruginosa</i> (PA), including carbapenemase-producing (CP), cephalosporinase and/or efflux/porin mutation...
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-10-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/9/11/738 |
| _version_ | 1797549774228946944 |
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| author | Christian M. Gill Tomefa E. Asempa David P. Nicolau |
| author_facet | Christian M. Gill Tomefa E. Asempa David P. Nicolau |
| author_sort | Christian M. Gill |
| collection | DOAJ |
| description | A minimum inhibitory concentration (MIC) derived algorithm, predictive of carbapenemase production, was developed using a challenge set (<i>n</i> = 92) of <i>Pseudomonas aeruginosa</i> (PA), including carbapenemase-producing (CP), cephalosporinase and/or efflux/porin mutation, and wild-type isolates. Broth microdilution MICs to clinically relevant anti-pseudomonal agents were utilized. The algorithm was applied to 1209 clinical PA isolates from a US surveillance program. Confirmatory genotypic (Xpert<sup>®</sup> Carba-R assay) and phenotypic (mCIM/eCIM) testing for carbapenemases was conducted on algorithm-derived isolates. With the algorithm, carbapenem resistance alone resulted in poor specificity to identify CP-PA (54%) within the challenge set of isolates. Inclusion of cefepime, ceftazidime, and piperacillin/tazobactam non-susceptibility resulted in a specificity of 66%. Ceftolozane/tazobactam resistance further improved specificity (89%). Of the 1209 isolates, 116 met criteria (carbapenem-resistant and non-susceptibility to cefepime, ceftazidime, and piperacillin/tazobactam) for confirmatory testing. Carba-R and mCIM/eCIM identified five (all <i>bla</i><sub>VIM</sub>-positive) and seven carbapenemase-producing isolates, respectively. This MIC algorithm combined with genotypic/phenotypic carbapenemase testing is a pragmatic and streamlined approach to identify CP-PA. |
| first_indexed | 2024-03-10T15:19:13Z |
| format | Article |
| id | doaj.art-dbf52ef90c4c429c8071dc32ab441a53 |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-10T15:19:13Z |
| publishDate | 2020-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-dbf52ef90c4c429c8071dc32ab441a532023-11-20T18:38:38ZengMDPI AGAntibiotics2079-63822020-10-0191173810.3390/antibiotics9110738Development and Application of a Pragmatic Algorithm to Guide Definitive Carbapenemase Testing to Identify Carbapenemase-Producing <i>Pseudomonas aeruginosa</i>Christian M. Gill0Tomefa E. Asempa1David P. Nicolau2Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT 06102, USACenter for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT 06102, USACenter for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT 06102, USAA minimum inhibitory concentration (MIC) derived algorithm, predictive of carbapenemase production, was developed using a challenge set (<i>n</i> = 92) of <i>Pseudomonas aeruginosa</i> (PA), including carbapenemase-producing (CP), cephalosporinase and/or efflux/porin mutation, and wild-type isolates. Broth microdilution MICs to clinically relevant anti-pseudomonal agents were utilized. The algorithm was applied to 1209 clinical PA isolates from a US surveillance program. Confirmatory genotypic (Xpert<sup>®</sup> Carba-R assay) and phenotypic (mCIM/eCIM) testing for carbapenemases was conducted on algorithm-derived isolates. With the algorithm, carbapenem resistance alone resulted in poor specificity to identify CP-PA (54%) within the challenge set of isolates. Inclusion of cefepime, ceftazidime, and piperacillin/tazobactam non-susceptibility resulted in a specificity of 66%. Ceftolozane/tazobactam resistance further improved specificity (89%). Of the 1209 isolates, 116 met criteria (carbapenem-resistant and non-susceptibility to cefepime, ceftazidime, and piperacillin/tazobactam) for confirmatory testing. Carba-R and mCIM/eCIM identified five (all <i>bla</i><sub>VIM</sub>-positive) and seven carbapenemase-producing isolates, respectively. This MIC algorithm combined with genotypic/phenotypic carbapenemase testing is a pragmatic and streamlined approach to identify CP-PA.https://www.mdpi.com/2079-6382/9/11/738carbapenemases<i>Pseudomonas aeruginosa</i>molecular diagnosticssusceptibility testingphenotypic carbapenemase testingantimicrobial susceptibility testing |
| spellingShingle | Christian M. Gill Tomefa E. Asempa David P. Nicolau Development and Application of a Pragmatic Algorithm to Guide Definitive Carbapenemase Testing to Identify Carbapenemase-Producing <i>Pseudomonas aeruginosa</i> Antibiotics carbapenemases <i>Pseudomonas aeruginosa</i> molecular diagnostics susceptibility testing phenotypic carbapenemase testing antimicrobial susceptibility testing |
| title | Development and Application of a Pragmatic Algorithm to Guide Definitive Carbapenemase Testing to Identify Carbapenemase-Producing <i>Pseudomonas aeruginosa</i> |
| title_full | Development and Application of a Pragmatic Algorithm to Guide Definitive Carbapenemase Testing to Identify Carbapenemase-Producing <i>Pseudomonas aeruginosa</i> |
| title_fullStr | Development and Application of a Pragmatic Algorithm to Guide Definitive Carbapenemase Testing to Identify Carbapenemase-Producing <i>Pseudomonas aeruginosa</i> |
| title_full_unstemmed | Development and Application of a Pragmatic Algorithm to Guide Definitive Carbapenemase Testing to Identify Carbapenemase-Producing <i>Pseudomonas aeruginosa</i> |
| title_short | Development and Application of a Pragmatic Algorithm to Guide Definitive Carbapenemase Testing to Identify Carbapenemase-Producing <i>Pseudomonas aeruginosa</i> |
| title_sort | development and application of a pragmatic algorithm to guide definitive carbapenemase testing to identify carbapenemase producing i pseudomonas aeruginosa i |
| topic | carbapenemases <i>Pseudomonas aeruginosa</i> molecular diagnostics susceptibility testing phenotypic carbapenemase testing antimicrobial susceptibility testing |
| url | https://www.mdpi.com/2079-6382/9/11/738 |
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