Evaluation of clinical efficacy of three phenotypic tests for screening carbapenemase-producing <i>Klebsiella pneumoniae</i>_West China Medical Journal

Authors：

WANG Qun ¹ , YE Meiyi ¹ , SUN Yang ¹ , CHEN Tao ² , WANG Fang ³ , WANG Fangfang ⁴ , HUANG Chunhua ⁵ ,  LIN Lei ¹

1. Department of Clinical Laboratory, People’s Hospital of Dayi County, Dayi, Sichuan 611330, P. R. China;
2. Department of Clinical Laboratory, Xindu District People’s Hospital, Chengdu, Sichuan 610500, P. R. China;
3. Department of Clinical Laboratory, TCM Hospital of Sichuan Province, Chengdu, Sichuan 610032, P. R. China;
4. Department of Clinical Laboratory, Pengzhou People’s Hospital, Pengzhou, Sichuan 611930, P. R. China;
5. Department of Clinical Laboratory, Sichuan Tianfu New Area People’s Hospital, Chengdu, Sichuan 611330, P. R. China;

Corresponding?author：

LIN Lei, Email: 1498296455@qq.com

Keywords：

Carbapenemase; Klebsiella pneumoniae; modified Hodge test; modified carbapenem inactivation method; EDTA-carbapenem inactivation method

DOI：

10.7507/1002-0179.202301113

Video：

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Objective To compare the screening ability of modified Hodge test (MHT), modified carbapenem inactivation method (mCIM) and EDTA-carbapenem inactivation method (eCIM) for drug resistance phenotype of carbapenemase-producing Klebsiella pneumoniae. Methods Carbapenem resistant Klebsiella pneumoniae (CRKP) strains clinically isolated from 5 hospitals in Chengdu between January 2019 and December 2021 were collected, and the carbapenem sensitive Klebsiella pneumoniae (CSKP) strains isolated in the same period were randomly collected. Polymerase chain reaction (PCR) -amplified carbapenem resistance gene as the gold standard, the consistencies between the results of the three phenotypic tests and the results of genetic testing were compared. Results A total of 160 CRKP strains and 120 CSKP strains were isolated. Among the 160 CRKP strains, carbapenem resistance genes were detected in 156 strains, including 105 strains of bla_KPC-2, 41 strains of bla_NDM-1, 8 strains of bla_KPC-19, 1 strain of bla_IMP-1, and 1 strain carrying both bla_KPC-2 and bla_NDM-1. None of the 120 CSKP drug resistance genes were detected. The sensitivity and specificity of carbapenem screening for MHT and mCIM were 73.08% (114/156), 96.67% (116/120), 97.44% (152/156) and 98.33% (118/120), respectively. The sensitivity and specificity of eCIM for screening metalloenzymes were 95.35% (41/43) and 100% (120/120), respectively. Conclusions The sensitivity of MHT to detect carbapenemase is lower than that of the other two methods, and it is easy to produce false negatives when it is used to detect metalloenzymes. The mCIM has high sensitivity and is consistent with the PCR genetic test results. The combined detection of mCIM and eCIM can screen carbapenemases more effectively and distinguish the types of carbapenemases.

Citation： WANG Qun, YE Meiyi, SUN Yang, CHEN Tao, WANG Fang, WANG Fangfang, HUANG Chunhua, LIN Lei. Evaluation of clinical efficacy of three phenotypic tests for screening carbapenemase-producing Klebsiella pneumoniae. West China Medical Journal, 2023, 38(8): 1148-1153. doi: 10.7507/1002-0179.202301113 Copy

1.	Wang M, Earley M, Chen L, et al. Clinical outcomes and bacterial characteristics of carbapenem-resistant Klebsiella pneumoniae complex among patients from different global regions (CRACKLE-2): a prospective, multicentre, cohort study. Lancet Infect Dis, 2022, 22(3): 401-412.
2.	Calfee DP. Recent advances in the understanding and management of Klebsiella pneumoniae. F1000Res, 2017, 6: 1760.
3.	Bowers JR, Kitchel B, Driebe EM, et al. Genomic analysis of the emergence and rapid global dissemination of the clonal group 258 Klebsiella pneumoniae pandemic. PLoS One, 2015, 10(7): e0133727.
4.	CLSI. Performance standards for antimicrobial susceptibility testing. 31sted. CLSI supplement M100. Wayne, PA: Clinical and Laboratory Standards Institute, 2021.
5.	Liu C, Liu L, Jin MM, et al. Molecular epidemiology and risk factors of carbapenem-resistant Klebsiella pneumoniae bloodstream infections in Wuhan, China. Curr Med Sci, 2022, 42(1): 68-76.
6.	MacKenzie FM, Forbes KJ, Dorai-John T, et al. Emergence of a carbapenem-resistant Klebsiella pneumoniae. Lancet, 1997, 350(9080): 783.
7.	曹蕾, 李小月, 羅慶禮, 等. CIM, mCIM 和 MHT 篩選腸桿菌科細菌產碳青霉烯酶的方法評價. 現代檢驗醫學雜志, 2020, 35(1): 67-70.
8.	胡付品, 郭燕, 朱德妹, 等. 2019 年 CHINET 三級醫院細菌耐藥監測. 中國感染與化療雜志, 2020, 20(3): 233-243.
9.	王群. 耐碳青霉烯肺炎克雷伯菌的分子特征研究. 成都: 成都中醫藥大學, 2019.
10.	張欣, 喻華, 黃湘寧, 等. 四川省細菌耐藥監測網 2014 年細菌耐藥監測數據分析. 中國抗生素雜志, 2016, 41(8): 624-631.
11.	黃湘寧, 殷琳, 張欣, 等. 2017 年四川省細菌耐藥監測報告. 中國抗生素雜志, 2018, 43(9): 1143-1150.
12.	余佳佳, 劉瑛, 俞靜, 等. 碳青霉烯類抗菌藥物滅活試驗篩查產碳青霉烯酶腸桿菌科細菌的效能評價. 檢驗醫學, 2017, 32(7): 628-632.
13.	Girlich D, Poirel L, Nordmann P. Value of the modified Hodge test for detection of emerging carbapenemases in Enterobacteriaceae. J Clin Microbiol, 2012, 50(2): 477-479.
14.	Seah C, Low DE, Patel SN, et al. Comparative evaluation of a chromogenic agar medium, the modified Hodge test, anda battery of meropenem-inhibitor discs for detection of carbapenemase activity in Enterobacteriaceae. J Clin Microbiol, 2011, 49(5): 1965-1969.
15.	Gelmez GA, Can B, Hasdemir U, et al. Evaluation of phenotypic tests for detection of carbapenemases: new modifications with new interpretation. J Infect Chemother, 2021, 27(2): 226-231.
16.	Pierce VM, Simner PJ, Lonsway DR, et al. Modified carbapenem inactivation method for phenotypic detection of carbapenemase production among Enterobacteriaceae. J Clin Microbiol, 2017, 55(8): 2321-2333.
17.	馬玉蘭, 宋文杰, 李繼紅, 等. mCIM 與 eCIM 篩選腸桿菌科細菌碳青霉烯酶的效果評價. 臨床檢驗雜志, 2018, 36(9): 650-654.
18.	Sfeir MM, Hayden JA, Fauntleroy KA, et al. EDTA-modified carbapenem inactivation method: a phenotypic method for detecting metallo-β-lactamase-producing Enterobacteriaceae. J Clin Microbiol, 2019, 57(5): e01757-18.

1. Wang M, Earley M, Chen L, et al. Clinical outcomes and bacterial characteristics of carbapenem-resistant Klebsiella pneumoniae complex among patients from different global regions (CRACKLE-2): a prospective, multicentre, cohort study. Lancet Infect Dis, 2022, 22(3): 401-412.
2. Calfee DP. Recent advances in the understanding and management of Klebsiella pneumoniae. F1000Res, 2017, 6: 1760.
3. Bowers JR, Kitchel B, Driebe EM, et al. Genomic analysis of the emergence and rapid global dissemination of the clonal group 258 Klebsiella pneumoniae pandemic. PLoS One, 2015, 10(7): e0133727.
4. CLSI. Performance standards for antimicrobial susceptibility testing. 31sted. CLSI supplement M100. Wayne, PA: Clinical and Laboratory Standards Institute, 2021.
5. Liu C, Liu L, Jin MM, et al. Molecular epidemiology and risk factors of carbapenem-resistant Klebsiella pneumoniae bloodstream infections in Wuhan, China. Curr Med Sci, 2022, 42(1): 68-76.
6. MacKenzie FM, Forbes KJ, Dorai-John T, et al. Emergence of a carbapenem-resistant Klebsiella pneumoniae. Lancet, 1997, 350(9080): 783.
7. 曹蕾, 李小月, 羅慶禮, 等. CIM, mCIM 和 MHT 篩選腸桿菌科細菌產碳青霉烯酶的方法評價. 現代檢驗醫學雜志, 2020, 35(1): 67-70.
8. 胡付品, 郭燕, 朱德妹, 等. 2019 年 CHINET 三級醫院細菌耐藥監測. 中國感染與化療雜志, 2020, 20(3): 233-243.
9. 王群. 耐碳青霉烯肺炎克雷伯菌的分子特征研究. 成都: 成都中醫藥大學, 2019.
10. 張欣, 喻華, 黃湘寧, 等. 四川省細菌耐藥監測網 2014 年細菌耐藥監測數據分析. 中國抗生素雜志, 2016, 41(8): 624-631.
11. 黃湘寧, 殷琳, 張欣, 等. 2017 年四川省細菌耐藥監測報告. 中國抗生素雜志, 2018, 43(9): 1143-1150.
12. 余佳佳, 劉瑛, 俞靜, 等. 碳青霉烯類抗菌藥物滅活試驗篩查產碳青霉烯酶腸桿菌科細菌的效能評價. 檢驗醫學, 2017, 32(7): 628-632.
13. Girlich D, Poirel L, Nordmann P. Value of the modified Hodge test for detection of emerging carbapenemases in Enterobacteriaceae. J Clin Microbiol, 2012, 50(2): 477-479.
14. Seah C, Low DE, Patel SN, et al. Comparative evaluation of a chromogenic agar medium, the modified Hodge test, anda battery of meropenem-inhibitor discs for detection of carbapenemase activity in Enterobacteriaceae. J Clin Microbiol, 2011, 49(5): 1965-1969.
15. Gelmez GA, Can B, Hasdemir U, et al. Evaluation of phenotypic tests for detection of carbapenemases: new modifications with new interpretation. J Infect Chemother, 2021, 27(2): 226-231.
16. Pierce VM, Simner PJ, Lonsway DR, et al. Modified carbapenem inactivation method for phenotypic detection of carbapenemase production among Enterobacteriaceae. J Clin Microbiol, 2017, 55(8): 2321-2333.
17. 馬玉蘭, 宋文杰, 李繼紅, 等. mCIM 與 eCIM 篩選腸桿菌科細菌碳青霉烯酶的效果評價. 臨床檢驗雜志, 2018, 36(9): 650-654.
18. Sfeir MM, Hayden JA, Fauntleroy KA, et al. EDTA-modified carbapenem inactivation method: a phenotypic method for detecting metallo-β-lactamase-producing Enterobacteriaceae. J Clin Microbiol, 2019, 57(5): e01757-18.

West China Medical Journal

Evaluation of clinical efficacy of three phenotypic tests for screening carbapenemase-producing Klebsiella pneumoniae

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