title: A simple phenotypic method for the differentiation of metallo-beta-lactamases and class A KPC carbapenemases in Enterobacteriaceae clinical isolates.
abstract: BACKGROUND
  The increasing frequency of class A KPC enzymes and class B metallo-beta-lactamases (MBLs) among Enterobacteriaceae as well as their possible co-production makes their early differentiation urgent.
  
  
  METHODS
  A simple phenotypic algorithm employing three combined-disc tests consisting of meropenem alone and with phenylboronic acid (PBA), EDTA, or both PBA and EDTA was designed for the differentiation of KPC and MBL enzymes. Augmentation of the zone of inhibition by >or=5 mm was considered a positive combined-disc test result. A total of 141 genotypically confirmed carbapenemase-positive Enterobacteriaceae clinical isolates (63 KPC producers, 47 MBL producers, and 31 KPC and MBL producers) with various carbapenem MICs were examined. For comparison, 84 genotypically confirmed carbapenemase-negative Enterobacteriaceae clinical isolates [39 extended-spectrum beta-lactamase (ESBL) producers, 22 AmpC producers, and 23 ESBL and AmpC producers] were also tested.
  
  
  RESULTS
  The phenotypic algorithm was able to differentiate MBL from KPC producers as well as to detect the possible co-production of both carbapenemases (positive result only with the combined-disc test using meropenem alone and with both PBA and EDTA). The method detected all KPC or MBL producers (sensitivity 100%) as well as 30 of the KPC and MBL producers (sensitivity 96.8%). All three combined-disc tests were negative for non-carbapenemase-producing isolates, except two ESBL and AmpC producers that gave positive combined-disc tests using meropenem alone and with PBA and both PBA and EDTA (specificity for KPC detection 98.8%).
  
  
  CONCLUSIONS
  This phenotypic method is very helpful to detect carbapenemase production and provides a simple algorithm for the differentiation of KPC and MBL enzymes, especially in regions where KPC- and MBL-possessing Enterobacteriaceae are highly prevalent.
authors.affiliation: Department of Microbiology, Medical School, University of Athens, Athens, Greece. atsakris@med.uoa.gr
authors.forename: Athanassios
authors.initials: A
authors.lastname: Tsakris
authors.forename: Aggeliki
authors.initials: A
authors.lastname: Poulou
authors.forename: Spyros
authors.initials: S
authors.lastname: Pournaras
authors.forename: Evangelia
authors.initials: E
authors.lastname: Voulgari
authors.forename: Georgia
authors.initials: G
authors.lastname: Vrioni
authors.forename: Katerina
authors.initials: K
authors.lastname: Themeli-Digalaki
authors.forename: Dimitra
authors.initials: D
authors.lastname: Petropoulou
authors.forename: Danai
authors.initials: D
authors.lastname: Sofianou
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D004755:Enterobacteriaceae / Q000201:enzymology* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000382:microbiology*; D006801:Humans; D008826:Microbial Sensitivity Tests; D012680:Sensitivity and Specificity; D001618:beta-Lactamases / Q000096:biosynthesis* / Q000145:classification*; D047090:beta-Lactams / Q000494:pharmacology*
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D001618:beta-Lactamases