Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
J Clin Microbiol. 2021 May 19;59(6). doi: 10.1128/JCM.02874-20.
Detection of carbapenem-resistant (CRPA) with carbapenemase-producing (CP) genes is critical for preventing transmission. Our objective was to assess whether certain antimicrobial susceptibility testing (AST) profiles can efficiently identify CP-CRPA. We defined CRPA as with imipenem or meropenem MICs of ≥8 μg/ml; CP-CRPA was CRPA with CP genes (////). We assessed the sensitivity and specificity of AST profiles to detect CP-CRPA among CRPA isolates collected by CDC's Antibiotic Resistance Laboratory Network (AR Lab Network) and the Emerging Infections Program (EIP) during 2017 to 2019. Three percent (195/6,192) of AR Lab Network CRPA isolates were CP-CRPA. Among CRPA isolates, adding not susceptible (NS) to cefepime or ceftazidime to the definition had 91% sensitivity and 50% specificity for identifying CP-CRPA; adding NS to ceftolozane-tazobactam had 100% sensitivity and 86% specificity. Of 965 EIP CRPA isolates evaluated for CP genes, 7 were identified as CP-CRPA; 6 of the 7 were NS to cefepime and ceftazidime, and all 7 were NS to ceftolozane-tazobactam. Among 4,182 EIP isolates, clinical laboratory AST results were available for 96% of them for cefepime, 80% for ceftazidime, and 4% for ceftolozane-tazobactam. The number of CRPA isolates needed to test (NNT) to identify one CP-CRPA isolate decreased from 138 to 64 if the definition of NS to cefepime or ceftazidime was used and to 7 with NS to ceftolozane-tazobactam. Adding not susceptible to cefepime or ceftazidime to CRPA carbapenemase testing criteria would reduce the NNT by half and can be implemented in most clinical laboratories; adding not susceptible to ceftolozane-tazobactam could be even more predictive once AST for this drug is more widely available.
检测产碳青霉烯酶（CP）的耐碳青霉烯肠杆菌科细菌（CRPA）对于防止传播至关重要。我们的目标是评估某些抗菌药物敏感性测试（AST）谱是否能够有效地识别 CP-CRPA。我们将 CRPA 定义为亚胺培南或美罗培南 MIC 为≥8μg/ml 的细菌；CP-CRPA 是产 CP 基因的 CRPA（////）。我们评估了 2017 年至 2019 年期间疾病预防控制中心的抗生素耐药性实验室网络（AR 实验室网络）和新发感染计划（EIP）收集的 CRPA 分离株中 AST 谱检测 CP-CRPA 的敏感性和特异性。AR 实验室网络 CRPA 分离株中有 3%（195/6192）为 CP-CRPA。在 CRPA 分离株中，将头孢吡肟或头孢他啶的不敏感（NS）添加到定义中，对 CP-CRPA 的检测具有 91%的敏感性和 50%的特异性；将 NS 添加到头孢洛扎他巴坦中，具有 100%的敏感性和 86%的特异性。在评估的 965 株 EIP CRPA 分离株中，有 7 株被鉴定为 CP-CRPA；这 7 株分离株对头孢吡肟和头孢他啶均为 NS，对头孢洛扎他巴坦均为 NS。在 4182 株 EIP 分离株中，有 96%的分离株可获得头孢吡肟、80%的分离株可获得头孢他啶和 4%的分离株可获得头孢洛扎他巴坦的临床实验室 AST 结果。如果将头孢吡肟或头孢他啶的不敏感（NS）添加到 CRPA 碳青霉烯酶检测标准中，那么鉴定一个 CP-CRPA 分离株所需的 CRPA 分离株数量（NNT）从 138 减少到 64，而如果添加 NS 到头孢洛扎他巴坦中，则 NNT 为 7。将头孢吡肟或头孢他啶的不敏感（NS）添加到 CRPA 碳青霉烯酶检测标准中，可以将 NNT 减半，并且可以在大多数临床实验室中实施；一旦头孢洛扎他巴坦的 AST 更为广泛可用，那么添加 NS 到头孢洛扎他巴坦中可能更具预测性。
