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Comparative Study
. 2016 Dec 28;55(1):134-144.
doi: 10.1128/JCM.01524-16. Print 2017 Jan.

Informing Antibiotic Treatment Decisions: Evaluating Rapid Molecular Diagnostics To Identify Susceptibility and Resistance to Carbapenems against Acinetobacter spp. in PRIMERS III

Scott R Evans  1 , Andrea M Hujer  2   3 , Hongyu Jiang  4 , Carol B Hill  5 , Kristine M Hujer  2   3 , Jose R Mediavilla  6 , Claudia Manca  6 , Thuy Tien T Tran  4 , T Nicholas Domitrovic  2   3 , Paul G Higgins  7   8 , Harald Seifert  7   8 , Barry N Kreiswirth  6 , Robin Patel  9 , Michael R Jacobs  10 , Liang Chen  6 , Rangarajan Sampath  11 , Thomas Hall  11 , Christine Marzan  11 , Vance G Fowler Jr  5   12 , Henry F Chambers  13 , Robert A Bonomo  14   3   15
Affiliations
Comparative Study

Informing Antibiotic Treatment Decisions: Evaluating Rapid Molecular Diagnostics To Identify Susceptibility and Resistance to Carbapenems against Acinetobacter spp. in PRIMERS III

Scott R Evans et al. J Clin Microbiol. .

Erratum in

Abstract

The widespread dissemination of carbapenem-resistant Acinetobacter spp. has created significant therapeutic challenges. At present, rapid molecular diagnostics (RMDs) that can identify this phenotype are not commercially available. Two RMD platforms, PCR combined with electrospray ionization mass spectrometry (PCR/ESI-MS) and molecular beacons (MB), for detecting genes conferring resistance/susceptibility to carbapenems in Acinetobacter spp. were evaluated. An archived collection of 200 clinical Acinetobacter sp. isolates was tested. Predictive values for susceptibility and resistance were estimated as a function of susceptibility prevalence and were based on the absence or presence of beta-lactamase (bla) NDM, VIM, IMP, KPC, and OXA carbapenemase genes (e.g., blaOXA-23, blaOXA-24/40, and blaOXA-58 found in this study) against the reference standard of MIC determinations. According to the interpretation of MICs, 49% (n = 98) of the isolates were carbapenem resistant (as defined by either resistance or intermediate resistance to imipenem). The susceptibility sensitivities (95% confidence interval [CI]) for imipenem were 82% (74%, 89%) and 92% (85%, 97%) for PCR/ESI-MS and MB, respectively. Resistance sensitivities (95% CI) for imipenem were 95% (88%, 98%) and 88% (80%, 94%) for PCR/ESI-MS and MB, respectively. PRIMERS III establishes that RMDs can discriminate between carbapenem resistance and susceptibility in Acinetobacter spp. In the context of a known prevalence of resistance, SPVs and RPVs can inform clinicians regarding the best choice for empiric antimicrobial therapy against this multidrug-resistant pathogen.

Keywords: Acinetobacter; beta-lactams; carbapenemases.

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Figures

FIG 1
FIG 1
Distribution of Acinetobacter sp. carbapenem MICs versus target (gene) identification for PCR/ESI-MS and MB platforms. All gene targets were examined; only identified targets are presented. Abbreviations: I/R, intermediate/resistant; R, resistant.
FIG 2
FIG 2
Estimates of the susceptibility and resistance sensitivities displayed using discrimination summary plots. Results are presented with 95% confidence intervals for PCR/ESI-MS and MB.
FIG 3
FIG 3
Susceptibility predictive value (SPV) and resistance predictive value (RPV) plots with 95% confidence bands by drug and platform.
See this image and copyright information in PMC

References

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