title: A sensitive and specific phenotypic assay for detection of metallo-β-lactamases and KPC in Klebsiella pneumoniae with the use of meropenem disks supplemented with aminophenylboronic acid, dipicolinic acid and cloxacillin.
abstract: Enterobacteriaceae producing carbapenemases, such as KPC or metallo-β-lactamases (MBLs), have emerged on several continents. Phenotypic tests are urgently needed for their rapid and accurate detection. A novel carbapenemase detection test, comprising a meropenem disk, and meropenem disks supplemented with 730 μg of EDTA, 1000 μg of dipicolinic acid (DPA), 600 μg of aminophenylboronic acid (APBA), or 750 μg of cloxacillin, was evaluated against Klebsiella pneumoniae isolates with KPC (n = 34), VIM (n = 21), IMP (n = 4) or OXA-48 (n = 9) carbapenemases, and carbapenem-resistant Enterobacteriaceae with porin loss in combination with an extended-spectrum β-lactamase (ESBL) (n = 9) or AmpC hyperproduction (n = 5). Commercially available diagnostics tablets from Rosco containing meropenem and the same inhibitors as described above (except EDTA) were also evaluated. An increased meropenem inhibition zone was sought in the presence of each added β-lactamase inhibitor. APBA had excellent sensitivity for detecting K. pneumoniae with KPC enzymes. Isolates with combined AmpC hyperproduction and porin loss were also positive in the APBA test but, unlike KPC producers, showed cloxacillin synergy. Both DPA and EDTA had excellent sensitivity for detection of MBL-producing K. pneumoniae. However, EDTA showed poor specificity, with positive results noted for 1/9 ESBL-producing isolates, for 4/34 KPC-producing isolates, and for 4/9 OXA-48-producing isolates, whereas all of these were negative when DPA was used. The in-house test distinguished accurately between several different mechanisms mediating reduced susceptibility to carbapenems in Enterobacteriaceae. The commercial combination tablets from Rosco performed similarly to the in-house test, with the exception of one false-positive MBL result and one false-positive KPC result among the OXA-48 producers.
authors.affiliation: Clinical Microbiology, MTC, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. christian.giske@karolinska.se
authors.forename: C G
authors.initials: CG
authors.lastname: Giske
authors.forename: L
authors.initials: L
authors.lastname: Gezelius
authors.forename: Ø
authors.initials: Ø
authors.lastname: Samuelsen
authors.forename: M
authors.initials: M
authors.lastname: Warner
authors.forename: A
authors.initials: A
authors.lastname: Sundsfjord
authors.forename: N
authors.initials: N
authors.lastname: Woodford
mesh_terms: D000900:Anti-Bacterial Agents / Q000378:metabolism / Q000494:pharmacology*; D001897:Boronic Acids / Q000378:metabolism / Q000494:pharmacology*; D003023:Cloxacillin / Q000378:metabolism / Q000494:pharmacology*; D004755:Enterobacteriaceae / Q000201:enzymology* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000382:microbiology; D006801:Humans; D000077731:Meropenem; D008826:Microbial Sensitivity Tests; D010848:Picolinic Acids / Q000378:metabolism / Q000494:pharmacology*; D012680:Sensitivity and Specificity; D013845:Thienamycins / Q000378:metabolism / Q000494:pharmacology*; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001897:Boronic Acids; D010848:Picolinic Acids; D013845:Thienamycins; C028592:3-aminobenzeneboronic acid; D001618:beta-Lactamases; D000077731:Meropenem; D003023:Cloxacillin; C004860:dipicolinic acid