Improved Phenotype-Based Definition for Identifying Carbapenemase Producers among Carbapenem-Resistant Enterobacteriaceae
Improved Phenotype-Based Definition for Identifying Carbapenemase Producers among Carbapenem-Resistant Enterobacteriaceae
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DOI：
10.3201/eid2109.150198
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发表时间：
2015-09-01
影响因子：
11.8
通讯作者：
Kallen, Alexander J.
中科院分区：
文献类型：
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作者：
Chea, Nora;Bulens, Sandra N.;Kallen, Alexander J.
预防产碳青霉烯酶、耐碳青霉烯类肠杆菌科（CP-CRE）的传播是公共卫生的优先事项。一个基于表型的定义，可靠地识别CP-CRE，同时最大限度地减少非CP-CRE的错误分类，可以帮助预防工作。为了评估可能的定义，我们评价了在美国新发感染项目中心经过检测并被认为对>= 1种碳青霉烯不敏感的肠细菌分离株。我们确定了符合（假阳性）非CP分离株和不符合（假阴性）我们研究期间使用的疾病控制和预防中心CRE定义的CP分离株的数量：30%（94/312）的CRE具有碳青霉烯酶基因，21%（14/67）的肺炎克雷伯菌产碳青霉烯酶克雷伯菌分离株被错误分类为非CP。一个新的定义需要耐1碳青霉烯很少错过CP菌株，但55%的结果是假阳性;增加修改霍奇测试的定义减少假阳性到12%。应考虑将该定义用于产碳青霉烯酶CRE的监测和预防。
Preventing transmission of carbapenemase-producing, carbapenem-resistant Enterobacteriaceae (CP-CRE) is a public health priority. A phenotype-based definition that reliably identifies CP-CRE while minimizing misclassification of non CP-CRE could help prevention efforts. To assess possible definitions, we evaluated enterobacterial isolates that had been tested and deemed nonsusceptible to >= 1 carbapenem at US Emerging Infections Program sites. We determined the number of non-CP isolates that met (false positives) and CP isolates that did not meet (false negatives) the Centers for Disease Control and Prevention CRE definition in use during our study: 30% (94/312) of CRE had carbapenemase genes, and 21% (14/67) of Klebsiella pneumoniae carbapenemase producing Klebsiella isolates had been misclassified as non-CP. A new definition requiring resistance to 1 carbapenem rarely missed CP strains, but 55% of results were false positive; adding the modified Hodge test to the definition decreased false positives to 12%. This definition should be considered for use in carbapenemase-producing CRE surveillance and prevention.