Suriya R Vijay, Kv Leela, Feliciana J Han, R Aishwarya
Microbiology, SRM (Sri Ramaswamy Memorial) Medical College Hospital and Research Centre, SRM Institute of Science and Technology, Kattankulathur, IND.
Cureus. 2024 Aug 20;16(8):e67322. doi: 10.7759/cureus.67322. eCollection 2024 Aug.
Carbapenem-resistant Enterobacterales, particularly those that produce carbapenemases, pose a significant public health concern due to very limited treatment options. The timely identification of carbapenemase-producing Enterobacterales (CPE) is essential for putting in place efficient infection control measures and selecting appropriate antimicrobial therapies, thereby improving the clinical outcome of the patient. The purpose of this systematic review is to compare the diagnostic accuracy and practicality between two phenotypic tests, namely the modified carbapenem inactivation method (mCIM) and carbapenemase Nordmann-Poirel (Carba NP) test, in detecting carbapenemase production by Enterobacterales and thereby aiding the clinician in making a decision to choose an appropriate test for their phenotypic detection. This systematic review involved combining sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, diagnostic odds ratio with 95% confidence interval (CIs), Forest plot for sensitivity and specificity, and plotting suitable summary receiver operating characteristic curve with the area under the curve. Of the 20 studies included in this review, the overall effect sizes of Carba NP and mCIM with 95% CIs were as follows: sensitivity, 91% (86-96%) and 97% (95-99%); specificity, 93% (88-97%) and 97% (93-100%); PPV, 97% and 98%; NPV, 79% and 90%; accuracy, 93% and 97%; diagnostic odds ratio, 1487.8879 and 8527.5541; and AUC, 0.85 and 1, respectively. In conclusion, the mCIM method showed superior sensitivity (97%), specificity (97%), and accuracy compared to the Carba NP test in detecting carbapenemase production, even though both these methods had a few technical limitations. The Carba NP test is rapid, affordable, and dependable, whereas mCIM is more accurate and cost-effective but time-consuming. We propose that both tests can be reliably used for screening of carbapenemase production in Enterobacterales, as endorsed by the Clinical and Laboratory Standards Institute even in resource-limited clinical laboratories, in the order of prioritizing the mCIM method first and then followed by the Carba NP test when situation demands expedited results.
耐碳青霉烯类肠杆菌科细菌，尤其是那些产生碳青霉烯酶的细菌，由于治疗选择非常有限，对公共卫生构成了重大威胁。及时鉴定产碳青霉烯酶的肠杆菌科细菌（CPE）对于实施有效的感染控制措施和选择合适的抗菌治疗至关重要，从而改善患者的临床结局。本系统评价的目的是比较两种表型试验，即改良碳青霉烯灭活法（mCIM）和碳青霉烯酶诺德曼-普雷尔试验（Carba NP试验）在检测肠杆菌科细菌碳青霉烯酶产生方面的诊断准确性和实用性，从而帮助临床医生决定选择合适的试验进行表型检测。本系统评价涉及将敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）、准确性、诊断比值比及其95%置信区间（CIs）、敏感性和特异性的森林图以及绘制合适的汇总受试者工作特征曲线及其曲线下面积相结合。在本评价纳入的20项研究中，Carba NP试验和mCIM试验的总体效应量及95% CIs如下：敏感性分别为91%（86%-96%）和97%（95%-99%）；特异性分别为93%（88%-97%）和97%（93%-100%）；PPV分别为97%和98%；NPV分别为79%和90%；准确性分别为93%和97%；诊断比值比分别为1487.8879和8527.5541；曲线下面积（AUC）分别为0.85和1。总之，在检测碳青霉烯酶产生方面，mCIM方法在敏感性（97%）、特异性（97%）和准确性方面均优于Carba NP试验，尽管这两种方法都有一些技术局限性。Carba NP试验快速、经济且可靠，而mCIM更准确且具有成本效益，但耗时较长。我们建议，正如临床和实验室标准协会所认可的那样，即使在资源有限的临床实验室中，这两种试验都可可靠地用于筛查肠杆菌科细菌中的碳青霉烯酶产生情况，优先顺序为首先采用mCIM方法，然后在情况需要快速获得结果时采用Carba NP试验。
