title: Phenotypic detection of carbapenem-susceptible metallo-beta-lactamase-producing gram-negative bacilli in the clinical laboratory.
abstract: Rapid detection of metallo-beta-lactamase (MBL)-producing gram-negative pathogens is critical to prevent their widespread dissemination. Thus far, no standardized phenotypic method is available, and previously reported techniques have poor sensitivity for detecting carbapenem-susceptible MBL-carrying isolates, an increasingly described phenomenon. We developed a phenotypic detection method using both a double-disk synergy test and a combined-disk test with imipenem and 292 microg EDTA on one agar plate. Genotypic confirmation was used for validation. Of the 134 clinical isolates, 84 were confirmed to carry an MBL. Of these, 51 (61%) were susceptible to at least one carbapenem, and 22 (26%) were isolated from blood. The phenotypic method correctly differentiated all MBL-producing isolates (sensitivity, 100%). Fifty-one of the 52 MBL-negative isolates were correctly differentiated (specificity, 98%). This study reports the validation of a simple and accurate MBL detection method that can be easily incorporated into the daily routine of a clinical laboratory. Early detection of MBL-carrying organisms, including those with susceptibility to carbapenems, is of paramount clinical importance, as it allows rapid initiation of strict infection control practices as well as therapeutic guidance for confirmed infection.
authors.affiliation: Microbiology Unit, Alfred Pathology Service, Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia.
authors.forename: Clare
authors.initials: C
authors.lastname: Franklin
authors.forename: Lisa
authors.initials: L
authors.lastname: Liolios
authors.forename: Anton Y
authors.initials: AY
authors.lastname: Peleg
mesh_terms: D000150:Acinetobacter / Q000187:drug effects; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001431:Bacteriological Techniques; D015780:Carbapenems / Q000494:pharmacology*; D003470:Culture Media; D004755:Enterobacteriaceae / Q000187:drug effects; D006090:Gram-Negative Bacteria / Q000145:classification* / Q000187:drug effects* / Q000254:growth & development; D016905:Gram-Negative Bacterial Infections / Q000382:microbiology*; D006801:Humans; D007753:Laboratories; D008826:Microbial Sensitivity Tests / Q000295:instrumentation / Q000379:methods; D010641:Phenotype; D016133:Polymerase Chain Reaction; D011549:Pseudomonas / Q000187:drug effects; D012680:Sensitivity and Specificity; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D003470:Culture Media; D001618:beta-Lactamases