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

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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, 罗庆礼, 等. CIM, mCIM 和 MHT 筛选肠杆菌科细菌产碳青霉烯酶的方法评价. 现代检验医学杂志, 2020, 35(1): 67-70.
8.	胡付品, 郭燕, 朱德妹, 等. 2019 年 CHINET 三级医院细菌耐药监测. 中国感染与化疗杂志, 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: 成都中医药大学, 2019.
10.	张欣, 喻华, 黄湘宁, 等. 四川省细菌耐药监测网 2014 年细菌耐药监测数据分析. 中国抗生素杂志, 2016, 41(8): 624-631.
11.	黄湘宁, 殷琳, 张欣, 等. 2017 年四川省细菌耐药监测报告. 中国抗生素杂志, 2018, 43(9): 1143-1150.
12.	余佳佳, 刘瑛, 俞静, 等. 碳青霉烯类抗菌药物灭活试验筛查产碳青霉烯酶肠杆菌科细菌的效能评价. 检验医学, 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.	马玉兰, 宋文杰, 李继红, 等. mCIM 与 eCIM 筛选肠杆菌科细菌碳青霉烯酶的效果评价. 临床检验杂志, 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, 罗庆礼, 等. CIM, mCIM 和 MHT 筛选肠杆菌科细菌产碳青霉烯酶的方法评价. 现代检验医学杂志, 2020, 35(1): 67-70.
8. 胡付品, 郭燕, 朱德妹, 等. 2019 年 CHINET 三级医院细菌耐药监测. 中国感染与化疗杂志, 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: 成都中医药大学, 2019.
10. 张欣, 喻华, 黄湘宁, 等. 四川省细菌耐药监测网 2014 年细菌耐药监测数据分析. 中国抗生素杂志, 2016, 41(8): 624-631.
11. 黄湘宁, 殷琳, 张欣, 等. 2017 年四川省细菌耐药监测报告. 中国抗生素杂志, 2018, 43(9): 1143-1150.
12. 余佳佳, 刘瑛, 俞静, 等. 碳青霉烯类抗菌药物灭活试验筛查产碳青霉烯酶肠杆菌科细菌的效能评价. 检验医学, 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. 马玉兰, 宋文杰, 李继红, 等. mCIM 与 eCIM 筛选肠杆菌科细菌碳青霉烯酶的效果评价. 临床检验杂志, 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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