Evaluation of expert rules for carbapenemase class identification in Enterobacterales isolates using the VITEK2 susceptibility testing platform.

IF 5.4 2区 医学 Q1 MICROBIOLOGY
Michaela J Eickhoff, Abigail P Brown, Carol E Muenks, Megan L Porter, Murad Ali, Iftikhar Uddin, Tahir Hussain, Melanie L Yarbrough, Rebekah E Dumm
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引用次数: 0

Abstract

Prompt identification of enzyme class in carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE) has critical implications for informing appropriate patient treatment, infection prevention, and public health. This study evaluates the performance of prototype bioMérieux Advanced Reporting Tool (bioART) expert rules to rapidly identify Klebsiella pneumoniae carbapenemase (KPC), metallo-β-lactamase (MBL), and OXA-48-like carbapenemase enzymes in CP-CRE. The bioART rules are designed for use with routine cards on the VITEK2 automated antimicrobial susceptibility testing (AST) platform. Results provided by the bioART rules should be interpreted in combination with the instrument Advanced Expert System (AES) to comprehensively evaluate phenotypic resistance phenotypes. Two hundred clinical isolates with varied β-lactam resistance profiles were enrolled, with 196 ultimately analyzed, including 115 CP-CREs. The AES alone detected CP-CRE isolates with a sensitivity of 83% and a specificity of 85%. The combined AES and bioART rules detected CP-CRE with a sensitivity of 96% and a specificity of 83%. Prediction of carbapenemase classes by the bioART rules was analyzed for a subset of 158 isolates, including only the species for which the rules have claimed indications. MBL, KPC, and OXA-48-like enzymes were detected with sensitivities of 97%, 76%, and 47%, respectively. Notably, sensitivity was 90% for single OXA-48-like producers, whereas OXA-48-like enzymes in dual New Delhi metallo-β-lactamase (NDM)/OXA-48-like-producing isolates were undetectable using phenotypic susceptibility patterns, and isolates were reported only as producing NDM enzymes. Overall, laboratories incorporating these tools into carbapenemase screening workflows may consider their utility in prompting confirmatory carbapenemase testing, guiding modifications to AST reporting, and/or prompting additional susceptibility testing.

Importance: Carbapenem-resistant bacteria are a major public health concern due to their ability to spread in healthcare settings and cause infections that are difficult to treat with first-line antibiotics. Identification of the enzyme classes responsible for carbapenem resistance plays a crucial role in ensuring that patients receive effective treatments and controlling the spread of these bacteria. In this study, we evaluated the performance of a new approach to identify carbapenemase enzymes without additional hands-on testing. The method is designed for use with the VITEK2 automated susceptibility testing platform to recognize patterns of resistance to antibiotics and make predictions about the possible resistance mechanisms.

VITEK2药敏试验平台对肠杆菌碳青霉烯酶类鉴定专家规则的评价
在产碳青霉烯酶的耐碳青霉烯肠杆菌(CP-CRE)中及时鉴定酶类对告知适当的患者治疗、感染预防和公共卫生具有重要意义。本研究评估了原型biomacrieux高级报告工具(bioART)专家规则快速鉴定肺炎克雷伯菌碳青霉烯酶(KPC)、金属β-内酰胺酶(MBL)和oxa -48样碳青霉烯酶的性能。bioART规则设计用于VITEK2自动抗菌药物敏感性试验(AST)平台上的常规卡片。生物抗逆转录病毒规则提供的结果应结合仪器高级专家系统(AES)进行解释,以综合评估表型抗性表型。纳入了200株具有不同β-内酰胺耐药谱的临床分离株,最终分析了196株,其中包括115株cp - cre。单独AES检测CP-CRE分离株的灵敏度为83%,特异性为85%。AES和bioART联合检测CP-CRE的灵敏度为96%,特异性为83%。对158株分离物的生物art规则预测碳青霉烯酶分类进行了分析,仅包括规则已声明适应症的物种。检测MBL、KPC和oxa -48样酶的灵敏度分别为97%、76%和47%。值得注意的是,单个oxa -48样产生物的敏感性为90%,而双重新德里金属β-内酰胺酶(NDM)/ oxa -48样产生物的oxa -48样酶使用表型敏感性模式无法检测到,并且分离物仅报道为产生NDM酶。总的来说,将这些工具纳入碳青霉烯酶筛选工作流程的实验室可能会考虑它们在提示确确性碳青霉烯酶测试、指导修改AST报告和/或提示额外的敏感性测试方面的效用。重要性:碳青霉烯耐药细菌是一个主要的公共卫生问题,因为它们能够在卫生保健环境中传播,并引起难以用一线抗生素治疗的感染。鉴定导致碳青霉烯耐药的酶类在确保患者接受有效治疗和控制这些细菌的传播方面起着至关重要的作用。在这项研究中,我们评估了鉴定碳青霉烯酶的新方法的性能,而无需额外的动手测试。该方法可与VITEK2自动药敏试验平台配合使用,识别抗生素耐药模式并预测可能的耐药机制。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Clinical Microbiology
Journal of Clinical Microbiology 医学-微生物学
CiteScore
17.10
自引率
4.30%
发文量
347
审稿时长
3 months
期刊介绍: The Journal of Clinical Microbiology® disseminates the latest research concerning the laboratory diagnosis of human and animal infections, along with the laboratory's role in epidemiology and the management of infectious diseases.
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