title: The combined-disk boronic acid test as an accurate strategy for the detection of KPC carbapenemase in Central America.
abstract: BACKGROUND
  Carbapenemase-producing Klebsiella pneumoniae (KPC) outbreaks may cause a huge economical burden on developing countries. Furthermore, KPC can be challenging to detect. We describe the laboratory strategy for the detection of KPC from 2011 to 2013 in a tertiary care hospital in Central America with approximately 1,000 beds.
  
  
  METHODS
  A retrospective analysis of a clinical laboratory database was done to determine the pragmatic application of the combined-disk boronic acid test during a KPC outbreak in Panama. A total of 1,026 Klebsiella pneumoniae isolates were found, of which 133 were positive for KPC. The strategy during two phases was described according to the test employed as a confirmatory test for KPC. After the K. pneumoniae isolates were detected by the VITEK 2 system, blaKPC polymerase chain reaction (PCR) and the combined-disk boronic acid test were employed as a confirmatory test during phase one. The combined-disk boronic acid test was employed as a confirmatory test for KPC during phase two.
  
  
  RESULTS
  The sensitivity, specificity, positive predictive value, and negative predictive value of the boronic acid test were 100%, 97%, 91%, and 100%, respectively, when blaKPC PCR was employed as a confirmatory test during the start of the outbreak. Afterwards, modified VITEK 2 system parameters resulted in 116 suspicious KPC samples and the boronic acid test confirmed 102 isolates.
  
  
  CONCLUSIONS
  The use of an automated bacterial identification system and the boronic acid test for the detection of KPC was an effective and low-cost strategy for a clinical laboratory in Panama during an outbreak.
authors.affiliation: Gorgas Memorial Institute for Health Studies, Panama City, Panama. juliozc22@gmail.com.
authors.forename: Julio
authors.initials: J
authors.lastname: Zúñiga
authors.forename: Gerardo
authors.initials: G
authors.lastname: Cruz
authors.forename: Carlos
authors.initials: C
authors.lastname: Pérez
authors.forename: Musharaf
authors.initials: M
authors.lastname: Tarajia
mesh_terms: D001426:Bacterial Proteins / Q000032:analysis*; D001897:Boronic Acids / Q000378:metabolism*; D052978:Disk Diffusion Antimicrobial Tests / Q000379:methods*; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000201:enzymology* / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D010176:Panama; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D001618:beta-Lactamases / Q000032:analysis*
chemical_list: D001426:Bacterial Proteins; D001897:Boronic Acids; D001618:beta-Lactamases; C063912:carbapenemase