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CORRESPONDENCE
Year : 2013  |  Volume : 138  |  Issue : 6  |  Page : 1025-1026

Triple-disk assay for phenotypic detection of predominant Carbapenemases


P. D. Hinduja National Hospital & Medical Research Centre Lalita Girdhar building (S1 Building) 5th Floor, Microbiology Department Veer Savarkar Marg, Mahim Mumbai 400 016, India

Date of Web Publication11-Feb-2014

Correspondence Address:
Camilla Rodrigues
P. D. Hinduja National Hospital & Medical Research Centre Lalita Girdhar building (S1 Building) 5th Floor, Microbiology Department Veer Savarkar Marg, Mahim Mumbai 400 016
India
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Source of Support: None, Conflict of Interest: None


PMID: 24521653

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How to cite this article:
Pillai P, Vadwai V, Deshpande P, Panchal M, Shetty A, Soman R, Rodrigues C. Triple-disk assay for phenotypic detection of predominant Carbapenemases. Indian J Med Res 2013;138:1025-6

How to cite this URL:
Pillai P, Vadwai V, Deshpande P, Panchal M, Shetty A, Soman R, Rodrigues C. Triple-disk assay for phenotypic detection of predominant Carbapenemases. Indian J Med Res [serial online] 2013 [cited 2019 Dec 8];138:1025-6. Available from: http://www.ijmr.org.in/text.asp?2013/138/6/1025/126917

Sir,

Carbapenems form an integral part of treatment regimen for serious and multi drug resistant Gram-negative bacterial infections. However, there are reports on increasing prevalence of carbapenem resistance in clinical isolates of Enterobacteriaceae mainly due to the production of metallo-β-carbapenemases (MBL),[1] Klebsiella pneumonia carbapenemase (KPC) [2] and ampC β-lactamases (AmpC)[3] . Thus, there arises an urgent need for establishment of a sensitive phenotypic assay that can facilitate simultaneous detection of MBL, KPC and AmpC. Recent studies have reported the use of β-lactum inhibitors coupled with meropenem disks for simple and accurate identification of carbapenemase producing organisms; for example, 3-aminophenylboronic acid (APBA), dipicolinic acid (DPA), and simultaneous use of APBA and cloxacillin (CLX) for detection of KPC, MBL and AmpC with porin loss respectively [4] . Thus, the purpose of this study was to determine the most predominant carbapenemase using the triple-disk assay in carbapenem resistant clinical isolates of Enterobacteriaceae.

A total of 19 consecutive meropenem resistant clinical isolates received in the Microbiology Department of P.D. Hinduja National Hospital and Research Centre, Mumbai, India, from March-July, 2010 were considered for this analysis. Meropenem resistance was determined using disk diffusion method as per the Clinical and Laboratory Standards Institute (CLSI) guidelines [5] . These resistant isolates were further evaluated for detection of the carbapenemases using the triple-disk assay [4] : a bacterial lawn was prepared using 0.5 McFarland inoculum on Muellar-Hinton agar plates. Four disks were placed on each plate: meropenem (10 μg, Rosco Diagnostica A/S, Taastrup, Denmark), meropenem (10 μg) + APBA (600 μg), meropenem (10 μg) + DPA (1000 μg) and meropenem (10 μg) + CLX (750 μg). An increase of ±5 mm in zone diameter around disks containing β-lactamase inhibitors, as compared with the disk with meropenem alone, was considered to be a positive result for APBA, DPA and CLX.

The 19 meropenem resistant isolates represented four different bacterial populations i.e. K. pneumoniae (68.4%, n=13), Escherichia coli (15.7%, n=3), Citrobacter species (10.5%, n=2) and Enterobacter species (5.2%, n=1). The triple-disk assay revealed 94.7% (n=18) organisms to be MBL producers, of which one isolate also coproduced AmpC; and one isolate was reported negative for production of cabapenemases suggesting the existence of an alternative mechanism responsible for conferring resistance. All 18 (100%) MBL producing isolates were molecularly proven to be positive for the presence of bla NDM-1 gene (data not shown). This triple-disk assay was found to be useful in detecting carbapenemases in Enterobacteriaceae, with MBL being the most predominant mechanism of resistance. Similar findings have been reported in an another study, wherein almost 100 per cent sensitivity and specificity have been reported on the use of triple-disk assay for detection of MBL and KPC [4] . More importantly, different carbapenemases produced are also known to cause variable levels of resistance to carbapenems and also other non-β-lactum drugs, hence this would facilitate initiation of a further optimized treatment regimen[6] .

In conclusion, triple-disk assay could be considered as a simple phenotypic assay for identification of carbapenemases.


   Acknowledgment Top


Authors thank National Health and Education Society, P. D. Hinduja National Hospital and Medical Research Centre for financial support.

 
   References Top

1.Kumarasamy KK, Toleman MA, Walsh TR, Bagaria J, Butt F, Balakrishnan R, et al. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. Lancet Infect Dis 2010; 10 : 597-602.  Back to cited text no. 1
    
2.Nordmann P, Cuzon G, Naas T. The real threat of Klebsiella pneumonia carbapenemase-producing bacteria. Lancet Infect Dis 2009; 9 : 228-36.   Back to cited text no. 2
    
3.Sinha M, Srinivasa H. Mechanisms of resistance to carbapenems in meropenem-resistant Acinetobacter isolates from clinical samples. Indian J Med Microbiol 2007; 25 : 121-5.  Back to cited text no. 3
    
4.Giske CG, Gezelius L, Samuelsen O, Warner M, Sundsfjord A, Woodford N. A sensitive and specific phenotypic assay for detection of metallo-â-lactamases and KPC in Klebsiella pneumoniae with the use of meropenem disks supplemented with aminophenylboronic acid, dipicolinic acid and cloxacillin. Clin Microbiol Infect 2011; 17 : 552-6.  Back to cited text no. 4
    
5.Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing: 21 st Informational Supplement. M100-S21. Wayne, PA, USA: CLSI; 2011.  Back to cited text no. 5
    
6.Tsakris A, Poulou A, Pournaras S, Voulgari E, Vrioni G, Themeli-Digalaki K, et al. A simple phenotypic method for the differentiation of metallo-â-lactamases and class A KPC carbapenemases in Enterobacteriaceae clinical isolates. J Antimicrob Chemother 2010; 65 : 1664-71.  Back to cited text no. 6
    




 

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