HB&L system for rapid phenotypic detection of clinical carbapenem-resistant Enterobacterales isolates. (September 2021)

• Record Type: Journal Article
• Authors: Wei, Ming; Wang, Peng; Wang, Shuai; Yang, Chunxia; Gu, Li
• Is Part Of: Journal of global antimicrobial resistance. Volume 26(2021)
• Page Start: 272
• Page End: 278
• Publication Date: 2021-09
• Subjects: HB&L system -- Carbapenem-resistant Enterobacterales -- Rapid phenotypic detection -- Time–kill curve -- Carbapenemase gene; Drug resistance -- Periodicals; Drug resistance -- Periodicals; Drug resistance; Periodicals; 616.9041
• DOI: 10.1016/j.jgar.2021.02.036
• Languages: English
• ISSNs: 2213-7165

Abstract

Highlights: PCR confirmed that 143/247 (52.2%) isolates were carbapenemase-producing Enterobacterales with only one carbapenemase gene. The HB&L system can detect not only carbapenemase-producing CRE (CP-CRE) but also non-CP-CRE isolates. After 4 h of culture, 139/149 (93.3%) CRE could be detected by the HB&L system. Accuracy of HB&L system was very high with 100% sensitivity and 96.0% specificity at only 6 h for detecting CRE isolates. Time–kill curves from HB&L system may suggest an effective treatment option for clinicians. ABSTRACT: Objectives: The prevalence of carbapenem-resistant Enterobacterales (CRE) has increased rapidly worldwide in the last two decades. CRE infection poses a huge challenge for today's clinical therapy. Rapid and accurate detection of clinical CRE isolates can avoid inappropriate antimicrobial treatment and reduce mortality. However, existing detection methods are either time consuming, expensive or inaccurate, making them unable to fully meet clinical demands. In this study, the HB&L system was designed to distinguish CRE from carbapenem-susceptible Enterobacterales (CSE), as it can accelerate the growth of bacteria, detect both carbapenemase-producing CRE (CP-CRE) and non-CP-CRE isolates in real time, and provide time–kill curves. Methods: The broth microdilution method and PCR and sequencing were used as the reference methods to identify CRE and carbapenemase-producing Enterobacterales (CPE) isolates, respectively. Three methods for detecting CRE isolates, including the Carba NP test, modified carbapenem inactivation method (mCIM) and HB&L system, were evaluated. Results: The accuracy of the HB&L system was extremely high with 100% sensitivity and 96.0% specificity at only 6 h of culture time for detecting CRE. Time–kill curves may provide information on effective treatment options for clinicians. This system is superior to the mCIM (20–24 h detection time; 90.6% sensitivity and 96.6% specificity) and Carba NP test (2 h detection time; 85.2% sensitivity and 98.4% specificity), which are only designed to detect CP-CRE. Conclusion: The HB&L system is promising for wide application for detection of clinical CRE in hospitals. Graphical Abstract: Image, graphical abstract