Rapid Detection of Carbapenemase Production in Enterobacteriaceae by Use of a Modified Paper Strip Carba NP Method

Abstract

Rapid and accurate detection of carbapenemase-producing Enterobacteriaceae (CPE) is important for preventing their spread in health care settings. We compared the performance of the Carba NP (CNP) test using the CLSI tube method with that using a modified paper strip method for the detection of carbapenemases in 390 Enterobacteriaceae isolates. The isolates were identified by Hong Kong's carbapenem-resistant Enterobacteriaceae surveillance program in 2016 and comprised 213 CPE and 177 carbapenemase-negative Enterobacteriaceae isolates. Molecular genotype was used as the reference. The test results were read at different time points for the CLSI method (1 min, 5 min, 1 h, and 2 h) and strip method (1 min and 5 min). The strip CNP and CLSI CNP tests correctly detect carbapenemase production in 93% and 93% of KPC producers, 100% and 38% of IMI producers, 94% and 85% of IMP producers, 98% and 90% of NDM producers, and 29% and 12% of OXA producers, respectively. Overall, the strip method has superior sensitivity to the CLSI method (86% versus 75%, respectively; P < 0.001, McNemar test). The specificity of both methods was 100%. By the CLSI method, 27%, 14%, 29%, and 6% of the CPE isolates were positive at 1 min, 5 min, 1 h, and 2 h, respectively. In contrast, by the strip method, 76% of the CPE isolates were positive at 1 min, and an additional 10% were positive at 5 min. In conclusion, the Carba NP test by use of the modified strip method has a higher sensitivity and a shorter assay time than that those by use of the CLSI tube method.

Keywords: carbapenem resistance; carbapenemases; prevalence; rapid tests.

FIG 1

Modified strip Carba NP test. (A) Setup of the test strips in a petri dish. (B) Examples of test strip results: positive (yellow), weak positive (light yellow), and negative (red or red-orange).

FIG 2

Time to positive results for 213 CPE by the CLSI CNP and strip CNP tests after stratification by type of carbapenemases. Results for the CLSI CNP tests were read at 1 min, 5 min, 1 h, and 2 h. Results for the strip CNP tests were read at 1 min and 5 min.