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Abstract：
BACKGROUND: We aimed to compare the performance of carbapenemase classification in carbapenem-resistant Klebsiella pneumoniae (CRKP) obtained using the BD Phoenix CPO Detect panel (CPO panel) and Cepheid Xpert Carba-R assays. We analyzed 55 CRKP strains from clinical specimens collected between November 2020 and November 2022. The CPO panel was used to detect both antibiotic susceptibility and phenotypic carbapenemase classes, while Xpert Carba-R was employed to identify KPC, NDM, VIM, OXA-48, and IMP genes. Due to the limited availability of molecular kits, we arbitrarily selected 55 isolates, identified as carbapenemase-producing according to the CPO panel and with meropenem minimum inhibitory concentration values > 8 mg/L.
RESULTS: According to the Xpert Carba-R assay, 16 of the 55 isolates (29.1%) were categorised as Ambler Class A (11 of which matched CPO panel Class A identification); three isolates (5.5%) were identified as Class B and 27 isolates (49.1%) as Class D (in both cases consistent with CPO panel B and D classifications). A further eight isolates (14.5%) exhibited multiple carbapenemase enzymes and were designated as dual-carbapenemase producers, while one isolate (1.8%) was identified as a non-carbapenemase-producer. The CPO panel demonstrated positive and negative percent agreements of 100% and 85.7% for Ambler Class A, 100% and 100% for Class B, and 96.4% and 100% for Class D carbapenemase detection, respectively.
CONCLUSIONS: While the CPO panel\'s phenotypic performance was satisfactory in detecting Class B and D carbapenemases, additional confirmatory testing may be necessary for Class A carbapenemases as part of routine laboratory procedures.
RESULTS: According to the Xpert Carba-R assay, 16 of the 55 isolates (29.1%) were categorised as Ambler Class A (11 of which matched CPO panel Class A identification); three isolates (5.5%) were identified as Class B and 27 isolates (49.1%) as Class D (in both cases consistent with CPO panel B and D classifications). A further eight isolates (14.5%) exhibited multiple carbapenemase enzymes and were designated as dual-carbapenemase producers, while one isolate (1.8%) was identified as a non-carbapenemase-producer. The CPO panel demonstrated positive and negative percent agreements of 100% and 85.7% for Ambler Class A, 100% and 100% for Class B, and 96.4% and 100% for Class D carbapenemase detection, respectively.
CONCLUSIONS: While the CPO panel\'s phenotypic performance was satisfactory in detecting Class B and D carbapenemases, additional confirmatory testing may be necessary for Class A carbapenemases as part of routine laboratory procedures.
摘要：
背景：我们旨在比较使用BDPhoenixCPO检测面板（CPO面板）和CepheidXpertCarba-R测定获得的耐碳青霉烯类肺炎克雷伯菌（CRKP）的碳青霉烯酶分类性能。我们分析了2020年11月至2022年11月收集的临床标本中的55株CRKP菌株。CPO小组用于检测抗生素敏感性和表型碳青霉烯酶类别，而XpertCarba-R被用来鉴定KPC，NDM,VIM,OXA-48和IMP基因。由于分子试剂盒的可用性有限，我们任意选择了55个分离株，根据CPO面板鉴定为产生碳青霉烯酶，并且美罗培南的最小抑制浓度值>8mg/L。
结果：根据XpertCarba-R分析，55个分离株中的16个（29.1％）被归类为AmblerA类（其中11个与CPOA类鉴定相匹配）；3个分离株（5.5％）被鉴定为B类，27个分离株（49.1％）被鉴定为D类（在两种情况下都与CPOB和D类分类一致）。另外8个分离株（14.5％）表现出多种碳青霉烯酶，并被指定为双碳青霉烯酶生产者，而一个分离物（1.8％）被鉴定为非碳青霉烯酶生产者。CPO小组显示，AmblerA类的正面和负面百分比协议分别为100％和85.7％，100%和100%对于B类,D类碳青霉烯酶检测为96.4%和100%，分别。
结论：虽然CPO小组的表型性能在检测B类和D类碳青霉烯酶方面令人满意，作为常规实验室程序的一部分,可能需要对A类碳青霉烯酶进行额外的验证性测试.
结果：根据XpertCarba-R分析，55个分离株中的16个（29.1％）被归类为AmblerA类（其中11个与CPOA类鉴定相匹配）；3个分离株（5.5％）被鉴定为B类，27个分离株（49.1％）被鉴定为D类（在两种情况下都与CPOB和D类分类一致）。另外8个分离株（14.5％）表现出多种碳青霉烯酶，并被指定为双碳青霉烯酶生产者，而一个分离物（1.8％）被鉴定为非碳青霉烯酶生产者。CPO小组显示，AmblerA类的正面和负面百分比协议分别为100％和85.7％，100%和100%对于B类,D类碳青霉烯酶检测为96.4%和100%，分别。
结论：虽然CPO小组的表型性能在检测B类和D类碳青霉烯酶方面令人满意，作为常规实验室程序的一部分,可能需要对A类碳青霉烯酶进行额外的验证性测试.
