Comparison of carbapenem MIC for NDM-producing Enterobacterales by different AST methods.

IF 3.7 Q2 INFECTIOUS DISEASES JAC-Antimicrobial Resistance Pub Date : 2024-04-06 eCollection Date: 2024-04-01 DOI:10.1093/jacamr/dlae028
Alfred Lok Hang Lee, Eddie Chi Man Leung, Viola Chi Ying Chow
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Abstract

Introduction: This study compared the performance of MIC test strip (ETEST), automated AST card (Vitek 2) and broth microdilution (BMD) in determining carbapenem susceptibility and MIC values of NDM-producing Enterobacterales.

Methods: NDM-producing Enterobacterales recovered from clinical specimens were included. The presence of blaNDM was confirmed by PCR. Identification of bacterial isolates was done by MALDI-TOF. Phenotypic susceptibility to three carbapenems (ertapenem, imipenem and meropenem) was tested by BMD, ETEST and Vitek 2. MIC values were interpreted in accordance with CLSI M100 (2022 edition). Using BMD as the reference standard, the essential agreement (EA), categorical agreement (CA), very major error (VME) and major error (ME) rates were evaluated.

Results: Forty-seven NDM-producing Enterobacterales isolates were included, 44 of which were Escherichia coli. The EA of Vitek 2 was 97.9% for ertapenem, 25.5% for meropenem and 42.6% for imipenem. Using Vitek 2, there were 0% VMEs across all three carbapenems tested. The EA of ETEST was 53.2% for ertapenem, 55.3% for imipenem and 36.2% for meropenem. The rates of VMEs for ETEST were high too (ertapenem 8.5%, meropenem 36.2%, imipenem 26.1%). The MIC values obtained from Vitek 2 were consistently higher than those from BMD, while MICs from ETEST were consistently lower than those from BMD.

Conclusions: The VME rate for ETEST was unacceptably high when BMD was used as the standard for comparison. Vitek 2 had acceptable EA and CA for ertapenem when BMD was used as the standard for comparison. For meropenem and imipenem, neither of the methods (ETEST, Vitek 2) showed acceptable EA and CA when compared with BMD.

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用不同的 AST 方法比较产 NDM 肠杆菌的碳青霉烯 MIC。
简介:本研究比较了 MIC 试纸(ETEST)、自动 AST 卡(Vitek 2)和肉汤微量稀释法(BMD)在确定产 NDM 肠杆菌的碳青霉烯类药物敏感性和 MIC 值方面的性能:方法:纳入从临床标本中回收的产NDM肠杆菌。通过 PCR 确认是否存在 blaNDM。细菌分离物的鉴定采用 MALDI-TOF。用 BMD、ETEST 和 Vitek 2 检测对三种碳青霉烯类(厄他培南、亚胺培南和美罗培南)的表型敏感性。MIC 值根据 CLSI M100(2022 年版)进行解释。以 BMD 为参考标准,评估了基本一致率(EA)、分类一致率(CA)、极重大误差率(VME)和重大误差率(ME):结果:47 株产 NDM 的肠杆菌属分离物被纳入其中,其中 44 株为大肠埃希菌。使用 Vitek 2,厄他培南的 EA 为 97.9%,美罗培南的 EA 为 25.5%,亚胺培南的 EA 为 42.6%。使用 Vitek 2 测试的所有三种碳青霉烯类药物的 VME 均为 0%。厄他培南的 ETEST EA 为 53.2%,亚胺培南为 55.3%,美罗培南为 36.2%。ETEST 的 VME 率也很高(厄他培南 8.5%、美罗培南 36.2%、亚胺培南 26.1%)。Vitek 2得出的MIC值始终高于BMD得出的MIC值,而ETEST得出的MIC值始终低于BMD得出的MIC值:结论:以 BMD 作为比较标准时,ETEST 的 VME 率高得令人无法接受。以 BMD 作为比较标准时,Vitek 2 对厄他培南的 EA 和 CA 均可接受。对于美罗培南和亚胺培南,与 BMD 相比,两种方法(ETEST 和 Vitek 2)都没有显示出可接受的 EA 和 CA。
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CiteScore
5.30
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审稿时长
16 weeks
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