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During bone tumor resection, many cases require medial malleolar osteotomy to achieve adequate access to the operative field. Various osteotomy methods have been developed to address this issue, including oblique, transverse, reverse V-shape, and step-cut osteotomies.However, medial malleolar osteotomy has several drawbacks, such as the excessive disruption of the joint surface, unstable screw fixation when fixing the medial malleolus, and iatrogenic medial ankle joint arthritis due to articular displacement during the reduction of the osteotomy site. In addition, there is a possibility of injury to the posterior tibial artery, tibial nerve, or posterior tibialis tendon if the osteotomy range is too aggressive. Therefore, the authors propose a new osteotomy method, which has shown promising clinical results, namely, partial posterior medial malleolar osteotomy. This method minimizes articular involvement and provides adequate access to the operative field during talar body bone tumor resection.
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Objectives@#Our study aimed to present the distinctive correlates of formal thought disorder in patients with schizophrenia, using the Clinical Language Disorder Rating Scale (CLANG). @*Methods@#We compared clinical characteristics between schizophrenia patients with (n = 84) and without (n = 82) formal thought disorder. Psychometric scales including the CLANG, the Brief Psychiatric Rating Scale (BPRS), the Young Mania Rating Scale (YMRS), the Calgery Depression Scale for Schizophrenia (CDSS) and the Word Fluency Test (WFT) were used. @*Results@#After adjusting the effects of age, sex and total scores on the BPRS, YMRS and WFT, the subjects with disorganized speech presented significantly higher score on the abnormal syntax (p = 0.009), lack of semantic association (p = 0.005), discourse failure (p < 0.0001), pragmatics disorder (p = 0.001), dysarthria (p < 0.0001), and paraphasic error (p = 0.005) items than those without formal thought disorder. With defining the mentioned item scores as covariates, binary logistic regression model predicted that discourse failure (adjusted odds ratio [aOR] = 5.88, p < 0.0001) and pragmatics disorder (aOR = 2.17, p = 0.04) were distinctive correlates of formal thought disorder in patients with schizophrenia. @*Conclusions@#This study conducted Clinician Rated Dimensions of Psychosis Symptom Severity (CRDPSS) and CLANG scales on 166 hospitalized schizophrenia patients to explore the sub-items of the CLANG scale independently related to formal thought disorders in schizophrenia patients. Discourse failure and pragmatics disorder might be used as the distinctive indexes for formal thought disorder in patients with schizophrenia.
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The application of whole genome sequencing on SARS-CoV-2 viral genome is essential for our understanding of the molecular epidemiology and spread of viruses in the community. The portable whole genome sequencer MinION (Oxford Nanopore Technologies, ONT, UK) could be feasibly used in a clinical microbiology laboratory without the need of vast resources or stringent operating conditions. We used the MinION sequencer to analyze the viral genome sequence of one SARS-CoV-2 strain. In June 2020, nasopharyngeal specimen from one patient was subjected to whole-genome analysis using the nCoV-2019 sequencing protocol v2 of ARTIC using the MinION sequencer. The ONT MinKNOW software, RAMPART tool, and Genome Workbench were used. We identified 11 nucleotide variants using the Wuhan-Hu-1 isolate (NC_045512.2) as the reference sequence. There were six nucleotide variants (T265I, F924, Y3884L, P4715L, L5462, and Q6804L) in the ORF1ab region, one variant (D614G) in the S gene, one variant (Q57H) in ORF3a, one variant (P302) in the N gene, and two variants in each the 5′-UTR and 3′-UTR. In this prolonged coronavirus disease 2019 (COVID-19) pandemic season, the MinION system that operates an amplicon-based whole-genome sequencing protocol could be a rapid and reliable sequencer without the need of cumbersome viral cultivation.
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Background@#Staphylococcus aureus is a common colonizer of the nasal vestibule and is found in approximately 20%–30% of healthy adults, while Staphylococcus epidermidis appears to be the most frequent colonizer in all regions of the upper respiratory tract. Esp, aserine protease of S. epidermidis, was reported to inhibit S.aureus colonization. This study was performed to examine the nasal colonization of S. aureus and S. epidermidis and the presence of esp determinants. @*Methods@#Nasal swab specimens from 54 patients were cultured on blood agar plates (BAP) and selective media for S. aureus (S. aureus ID, bioMerieux, France) for the isolation of S.aureus and S. epidermidis. After 48 hours of incubation of with BAP, three or four colonies suspected of being coagulase-negative staphylococci (CNS) were identified by MALDI-TOF MS (Bruker, Germany). Polymerase chain reaction (PCR) for esp was performed on all CNS isolates identified as S. epidermidis. @*Results@#Forty-three S. epidermidis strains were isolated from 18 (33.3%) of the 54 patients.Nine (50.0%) of the 18 patients carried S. aureus, while the other nine did not. Of the 36 S. epidermidis non-carriers, 13 (36.1%) were colonized by S. aureus. All S. epidermidis strains were confirmed by PCR to have esp determinants. @*Conclusion@#S. epidermidis colonization did not affect S. aureus colonization in the nasal cavity. All S. epidermidis strains harbored the esp gene. We could not find any differences in the nasal colonization rates of S. aureus according to the presence of esp-positive S. epidermidis. Further research on the characterization of S. epidermidis in Korea is needed to understand the association between S. epidermidis and S. aureus colonization.
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Background@#Staphylococcus aureus is a common colonizer of the nasal vestibule and is found in approximately 20%–30% of healthy adults, while Staphylococcus epidermidis appears to be the most frequent colonizer in all regions of the upper respiratory tract. Esp, aserine protease of S. epidermidis, was reported to inhibit S.aureus colonization. This study was performed to examine the nasal colonization of S. aureus and S. epidermidis and the presence of esp determinants. @*Methods@#Nasal swab specimens from 54 patients were cultured on blood agar plates (BAP) and selective media for S. aureus (S. aureus ID, bioMerieux, France) for the isolation of S.aureus and S. epidermidis. After 48 hours of incubation of with BAP, three or four colonies suspected of being coagulase-negative staphylococci (CNS) were identified by MALDI-TOF MS (Bruker, Germany). Polymerase chain reaction (PCR) for esp was performed on all CNS isolates identified as S. epidermidis. @*Results@#Forty-three S. epidermidis strains were isolated from 18 (33.3%) of the 54 patients.Nine (50.0%) of the 18 patients carried S. aureus, while the other nine did not. Of the 36 S. epidermidis non-carriers, 13 (36.1%) were colonized by S. aureus. All S. epidermidis strains were confirmed by PCR to have esp determinants. @*Conclusion@#S. epidermidis colonization did not affect S. aureus colonization in the nasal cavity. All S. epidermidis strains harbored the esp gene. We could not find any differences in the nasal colonization rates of S. aureus according to the presence of esp-positive S. epidermidis. Further research on the characterization of S. epidermidis in Korea is needed to understand the association between S. epidermidis and S. aureus colonization.
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Background@#In this study, we aim to examine the effects of pre-analytical factors such as specimen type (serum or plasma), collection and storage conditions, and time, on the results of chemiluminescence immunoassay. @*Methods@#Blood samples were collected from 10 individuals and aliquoted into two sets of K3-ethylenediaminetetraacetic acid (EDTA) and serumseparating tubes (SST) each, for plasma and serum collection, respectively.For all the samples, one set of tubes was centrifuged within 1 hour and other set was centrifuged after 4 hours, followed by cell separation.Chemiluminescence assay was performed for adrenocorticotropic hormone (ACTH), parathyroid hormone (PTH), osteocalcin, C-telopeptide, and insulin at 0, 6, 24, and 48 hours after centrifugation; all the samples were assayed in duplicate. The samples were stored at 4℃ before the assay. @*Results@#The results obtained showed that the levels detected in plasmas were more consistent and stable as compared to serum. After a 6-hour storage at 4℃, a significant decrease was observed in the levels of ACTH and osteocalcin in plasma and serum; whereas, PTH and C-telopeptide levels were stable in plasma but decreased significantly in serum. Insulin levels in serum showed a decrease after a 6-hour storage while the levels in plasma were found to be stable until 24-hour storage. Serum samples separated after 4 hours showed a significant decrease in all hormone levels, while C-telopeptide and insulin levels were stable in plasma samples separated after 4 hours. @*Conclusions@#The results were found to be more stable in plasma samples from K3-EDTA tubes as compared to serum samples from SST in the measurement of unstable biological analytes. These results suggest that K3-EDTA tubes are preferable in the specimen collection for assaying biological analytes.
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Background@#Two methods of counting cells in body fluids were compared;manual counting using a Neubauer chamber, and automated cell countingusing an XN-350 hematology analyzer. @*Methods@#Cells from 32 body fluid samples were counted by manualexamination and by an automated analyzer. Total cells (TC), white bloodcells (WBC), red blood cells (RBC), polymorphonuclear leukocytes (PMN),mononuclear leukocytes (MN), neutrophils, lymphocytes, monocytes, andeosinophils were each counted by both methods. The results were comparedusing the Pearson correlation test, Bland-Altman regression analysis, andPassing-Bablok regression analysis. @*Results@#The two methods showed very strong correlation in TC, WBC,RBC, PMN, and MN counts, strong correlation in % neutrophils, and %lymphocytes, and weak correlation in % monocytes and % eosinophils.Using Bland-Altman regression analysis, the mean biases for TC, WBC, andRBC were -270, -257.4, and -1,256.09, respectively, and 0.15 for PMN andMN. Research parameters were compared as well: mean biases were -1.31,-2.46, -5.16, and -3.58 for % neutrophils, % monocytes, % lymphocytes,and % eosinophils, respectively. Passing-Bablok regression equationswere y=1.039x+20, y=1.037x+19, y=1.259x+0.0, y=0.983x+1.541, andy=0.983x+0.125 for TC, WBC, RBC, PMN, and MN, respectively. The equationswere y=0.955x+2.194 for % neutrophils, y=0.965x+1.184 for % monocytes,y=1.003x+0.161 for % lymphocytes, and y=x+0.75 for % eosinophils. @*Conclusions@#WBC differential count results performed by an automatedhematology analyzer generally show good correlation with our referencemethod, Neubauer chamber counting.
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Background@#Carbapenem-resistant Acinetobacter baumannii (CRAB) has emerged as an important nosocomial pathogen.The purpose of this study was to determine the effective methods for performing surveillance cultures of CRAB. @*Methods@#Nasal and rectal swabs were obtained concurrently from hospitalized intensive care unit patients colonized with CRAB. All the samples were inoculated in CHROMagar Acinetobacter medium with CR102 (CHROMagar), MacConkey agar medium supplemented with 5 µg/mL imipenem (MCA-IPM), and triptic soy broth medium supplemented with 5 µg/ mL imipenem (TSB-IPM). CRAB detection rates for each sample were compared. @*Results@#The CRAB detection rate in either one of the nasal or rectal swabs from the 37 patients tested were 89.2% (33/37) with the use of CHROMagar, 78.4% (29/37) with the use of MCA-IMP, and 86.5% (32/37) with the use of TSB-IMP. @*Conclusion@#We determined that concurrent use of both nasal and rectal swabs and CHROMagar could be an effective method for CRAB surveillance cultures.
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There is an urgent need for accurate and rapid diagnostic assays capable of identifying carbapenemase-producing Enterobacteriaceae (CPE). We assessed the performance of the RESIST-4 O.K.N.V. (OKNV) assay (Coris BioConcept, Gembloux, Belgium) for the identification of oxacillinase (OXA)-48-like-, Klebsiella pneumoniae carbapenemase (KPC)-, New Delhi metallo-β-lactamase (NDM)-, and Verona integron-encoded metallo-β-lactamase (VIM)-producing Enterobacteriaceae grown on sheep blood agar (SBA) and the CHROMagar KPC medium. Sixty-five carbapenem-resistant Enterobacteriaceae (CRE) isolates with characterized carbapenemase content were used to evaluate the OKNV assay. The assay correctly identified all 30 isolates that produced one of the four targeted carbapenemase families. Additionally, it correctly identified 15 isolates that co-produced KPC and NDM, VIM and NDM or OXA-48-like and NDM, but failed to identify an NDM-1 and OXA-232 co-producing Klebsiella pneumoniae isolate. All 16 non-carbapenemase-producing CRE and four CPE isolates exhibited negative results, and no cross-reaction was observed. Overall, the sensitivity and specificity of the assay were 97.8% and 100%, respectively. The OKNV assay is an accurate and rapid assay for identifying OXA-48-like, KPC, NDM, and VIM carbapenemases produced by Enterobacteriaceae isolates cultured on both SBA and the CHROMagar KPC media in the clinical microbiology laboratory.
Subject(s)
Humans , Agar , Enterobacteriaceae , Klebsiella pneumoniae , Sensitivity and Specificity , SheepABSTRACT
Viral respiratory infections are one of the most common infections worldwide. It is important to detect the virus early and precisely. In this study, we evaluated the limit of detection (LoD) and usefulness of the Real-Q RV Detection kit (BioSewoom, Seoul, Korea). We measured the LoD of the Real-Q RV Detection kit using 10 strains of standard viruses. We then compared the detection results by the Allplex Respiratory Panel Assay kit (Seegene, Seoul, Korea) using 123 clinical specimens. The discrepant results were confirmed by sequencing. Among the 10 standard viruses, the LoD of human rhinovirus (HRV) was the lowest and that of parainfluenza virus 2 and 3 was relatively high as detected by Real-Q RV Detection kit. Agreements of the two kits ranged from 95.9% to 100%. Three specimens detected negative by the Allplex Respiratory Panel kit were detected as adenovirus (AdV) by the Real-Q RV Detection kit and were confirmed by sequencing. Similarly, a specimen detected negative by the Allplex Respiratory Panel kit was detected as HRV by the Real-Q RV Detection kit and was confirmed by sequencing. A specimen detected as human enterovirus by the Allplex Respiratory Panel kit was detected as HRV by the Real-Q RV Detection kit and was confirmed by sequencing. Real-Q RV Detection kit showed good diagnostic performance and can be useful for detecting major viruses that cause respiratory infections.
Subject(s)
Humans , Adenoviridae , Enterovirus , Limit of Detection , Paramyxoviridae Infections , Respiratory Tract Infections , Rhinovirus , SeoulABSTRACT
Nearly one third of the world's population have active or latent tuberculosis, resulting in 1.5 million deaths annually. Tuberculosis involving the peripheral nerve is difficult to detect. Sural nerve tuberculoma is an extremely rare case of tuberculous involvement of the peripheral nerve that has attracted the attention of physicians. This paper reports a patient with sural nerve tuberculoma. A 58-year-old female patient presented with a palpable mass on the posterolateral calf with progressive tingling sensation on the distal area. The patient had no history of trauma and it was unclear whether the patient had any contact with individuals with active tuberculosis. The histopathologic findings revealed a granuloma-like lesion with caseous necrosis that was compatible with tuberculoma.
Subject(s)
Female , Humans , Middle Aged , Latent Tuberculosis , Necrosis , Peripheral Nerves , Sensation , Sural Nerve , Tuberculoma , TuberculosisABSTRACT
BACKGROUND: Diarrhea has been the second leading cause of death among children under the age of five, and the rapid and accurate pathogen diagnosis in patients with diarrhea is crucial for reducing morbidity and mortality. A newly developed one-step multiplex real-time PCR assay, the Allplex GI-Virus Assay, was evaluated for its ability to detect six diarrhea-causing viruses (rotavirus, norovirus genogroup I (GI) and genogroup II (GII), enteric adenovirus, astrovirus, and sapovirus) in stool samples. METHODS: The performance of the Allplex assay was compared with those of another multiplex PCR assay (Seeplex Diarrhea-V Ace Detection) and genotyping by sequencing, using 446 stool samples from patients with acute gastroenteritis. RESULTS: The overall agreement rates between the results of the Allplex and Seeplex assays were 98.7% for rotavirus, 99.1% for norovirus GI, 93.3% for norovirus GII, 98.0% for adenovirus, and 99.6% for astrovirus. The overall agreement rates between the Allplex assay and genotyping were 99.1% for rotavirus, 99.1% for norovirus GI, 98.7% for norovirus GII, 89.7% for adenovirus, 98.2% for astrovirus, and 99.8% for sapovirus. In addition, eight rotavirus genotypes, three norovirus GI genotypes, four norovirus GII genotypes, eight adenovirus genotypes, two astrovirus genotypes, and two sapovirus genotypes were detected. CONCLUSIONS: The Allplex assay showed high agreement with Seeplex and genotyping results, and was able to additionally detect sapoviruses. The Allplex assay could be useful in identifying viral gastrointestinal infections in patients with acute gastroenteritis symptoms.
Subject(s)
Child , Humans , Adenoviridae , Cause of Death , Diagnosis , Diarrhea , Gastroenteritis , Genotype , Mortality , Multiplex Polymerase Chain Reaction , Norovirus , Real-Time Polymerase Chain Reaction , Rotavirus , SapovirusABSTRACT
BACKGROUND: Different age groups may have different reference intervals. However, the currently used reference interval for complete blood count (CBC) in clinical laboratories is based on results from healthy adults between 20 and 50 years of age. In this study, we aimed to establish reference intervals for 16 CBC parameters in Korean healthy elderly individuals. METHODS: A total of 3,359 healthy adults were selected from 4,253 adults (aged ≥20 years) who underwent regular health check-ups, based on a medical examination by interview. The reference intervals for CBC in two groups (aged <60 and ≥60 years), and the partitioning of reference intervals between the two age groups were established. RESULTS: Most CBC parameters showed no significant differences in reference intervals between the two age groups. Among the men, platelet distribution width (PDW) was the only parameter that required a separate reference interval between the two age groups. Among the women, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW), and eosinophil % required separate reference intervals between the two age groups. CONCLUSIONS: The reference intervals for most CBC parameters were not significantly different between the two age groups. Except for PDW in men and MCV, MCHC, RDW, and eosinophil % in women, reference intervals for CBC parameters in individuals younger than 60 years of age could also be applied to those that are 60 years of age or older.
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Adult , Aged , Female , Humans , Male , Blood Cell Count , Blood Cells , Blood Platelets , Eosinophils , Erythrocyte IndicesABSTRACT
The aim of this study was to evaluate the influence of balance on the spatiotemporal features, lower-limb kinematics, and center of mass (COM) of the non-faller elderly during walking. In this study, 20 healthy elderly women (age, 76.2 ± 5.6 years; height, 150.1 ± 3.2 cm; weight, 55.8 ± 9.0 kg) were enrolled. Based on the Berg balance scale (BBS), the elderly were classified into two groups: poor balance (PB; BBS scores 0.05). The ROM of the mediolateral COM was greater in PB than in GB. Hip transversal movements in the two groups were different. The impairment of the lateral balance function might contribute to an increase in the incidence of fall events in the elderly with poor balance.
Subject(s)
Adult , Aged , Female , Humans , Biomechanical Phenomena , Gait , Hip , Incidence , Range of Motion, Articular , WalkingABSTRACT
Moxibustion is a traditional Oriental medicine therapy that treats the symptoms of a disease with thermal stimulation. However, it is difficult to control the strength of the thermal or chemical stimulus generated by the various types and amounts of moxa and to prevent energy loss through the skin. To overcome these problems, we previously developed a method to efficiently provide RF thermal stimulation to subcutaneous tissue. In this paper, we propose a finite element model (FEM) to predict temperature distributions in subcutaneous tissue after radio-frequency thermal stimulation. To evaluate the performance of the developed FEM, temperature distributions were obtained from the FEM, and in vivo experiments were conducted using the RF stimulation system at subcutaneous tissue depths of 5 and 10 mm in the femoral region of a rabbit model. High correlation coefficients between simulated and actual temperature distributions—0.98 at 5 mm and 0.99 at 10 mm—were obtained, despite some slight errors in the temperature distribution at each depth. These results demonstrate that the FEM described here can be used to determine thermal stimulation profiles produced by RF stimulation of subcutaneous tissue.
Subject(s)
Finite Element Analysis , Medicine, East Asian Traditional , Methods , Moxibustion , Skin , Subcutaneous TissueABSTRACT
Platelet distribution width (PDW) is an index for platelet size variation. In this study, we analysed the correlation between PDW values obtained using two different hematology analysers that employ different measurement methods. Complete blood cell parameters including PDW for 153 healthy individuals were measured using both, ADVIA 2120i (Simens AG, Germany) and XN-3000 (Sysmex, Japan). The PDW values measured using the two hematology analysers showed a moderate correlation (r=0.661, P0.900, P<0.001). PDW obtained using XN-3000 showed a strong correlation with mean platelet volume, whereas PDW obtained using ADVIA 2120i did not. The reference values in this group were 40.0%–64.2% in ADVIA 2120i and 9.0–16.0 fL in XN-3000. In conclusion, PDW values obtained using ADVIA 2120i and XN-3000 are not interchangeable. In laboratories equipped with more than one hematology analyser, a particular analyser should be used consistently for monitoring a particular patient.
Subject(s)
Humans , Blood Cells , Blood Platelets , Erythrocyte Indices , Erythrocytes , Hematology , Leukocytes , Mean Platelet Volume , Platelet Count , Reference ValuesABSTRACT
PURPOSE: This study aimed to examine the accuracy of rapid influenza diagnostic tests (RIDT) in children with an influenza-like illness and to evaluate factors associated with greater accuracy. METHODS: Pediatric patients, who visited Hallym University Sacred Heart Hospital with an influenza-like illness between June 2011 and May 2016, were enrolled in this study. We tested 798 samples using a real-time polymerase chain reaction (PCR) for respiratory viruses and compared the results with rapid influenza tests. RESULTS: In comparison with the results of the multiplex PCR, the positive agreement rates of RIDT for influenza A and B virus were 75.7% and 60.0%, respectively. The performance of RIDT varied according to days after fever onset. The positive agreement rates of RIDT for influenza A and B tests, performed within 4 days of fever onset, were 77.6% and 73.2%, but the rates for tests performed more than 5 days after fever onset were 66.7% and 21.4%, respectively. CONCLUSIONS: The RIDT is a quick and simple aid to diagnosis, but is less sensitive than the labeled sensitivity. Moreover, test performance varied according to days after fever onset. Test specimens for RIDT should be collected as soon as possible after the onset of symptoms (less than 4 days).
Subject(s)
Child , Humans , Diagnosis , Diagnostic Tests, Routine , Fever , Heart , Herpesvirus 1, Cercopithecine , Chromatography, Affinity , Influenza, Human , Multiplex Polymerase Chain Reaction , Orthomyxoviridae , Polymerase Chain Reaction , Real-Time Polymerase Chain Reaction , SeasonsABSTRACT
BACKGROUND: The accurate and rapid identification of the causative viruses is important for the timely diagnosis and management of respiratory infections. Multiplex molecular diagnostic techniques have been widely adopted to detect respiratory viruses. We compared the results of a newly upgraded, multiplex, molecular bead-based respiratory viral panel (RVP) assay with the results of Anyplex II RV16 detection kit and AdvanSure RV real-time RT-PCR assay. METHODS: We tested 254 respiratory specimens and cultured viral strains using the Luminex xTAG RVP Fast v2 assay (Luminex Molecular Diagnostics, Canada) and Anyplex II RV16 detection kit and compared the results. Specimens showing discordant results between the two assays were tested with a AdvanSure RV real-time RT-PCR assay. RESULTS: Of the 254 respiratory specimens, there was total agreement in the results between the xTAG RVP Fast v2 assay and the other real-time PCR assay in 94.1–100% of the specimens. The agreement levels were relatively low (94.1–97.6%) for specimens of adenovirus, coronavirus NL63, and parainfluenza type 3. In comparison to the other assay, the xTAG RVP Fast v2 assay detected a higher number of parainfluenza type 3 (4 cases) and metapneumovirus (9 cases). CONCLUSIONS: The xTAG RVP Fast v2 assay showed comparable capabilities compared with the other assays; it will be useful for identifying respiratory viral infections in patients with respiratory symptoms. Clinicians should be aware of the characteristics of the assays they use, since different assays show different detectability for each virus.
Subject(s)
Humans , Adenoviridae , Coronavirus , Diagnosis , Metapneumovirus , Molecular Diagnostic Techniques , Paramyxoviridae Infections , Pathology, Molecular , Real-Time Polymerase Chain Reaction , Respiratory Tract InfectionsABSTRACT
BACKGROUND: We evaluated the carbapenem inactivation method (CIM) compared with the modified Hodge test (MHT) for the detection of carbapenemase-producing Gram-negative bacilli. METHODS: A total of 61 isolates of carbapenemase-producing Enterobacteriaceae (CPE: 14 KPC, 7 GES-5, 8 NDM-1, 9 VIM-2, 9 IMP-1, and 14 OXA-48-like), 34 isolates of metallo-β-lactamase (MBL)-producing Pseudomonas spp. (14 VIM-2 and 20 IMP-6), and 70 carbapenem-nonsusceptible carbapenemase-negative isolates were included. The CIM and MHT were performed for all of the isolates. To perform the CIM, a meropenem disk was incubated with a suspension of the isolate to be tested and then on Mueller-Hinton agar with the Escherichia coli ATCC 29522 strains. The absence of an inhibition zone indicates presence of a carbapenemase. The presence of a clearing zone indicates lack of a carbapenemase. RESULTS: The total sensitivity and specificity of CIM (96% sensitivity and 100% specificity) in carbapenem-nonsusceptible Enterobacteriaceae and Pseudomonas spp. were better than those of the MHT (77% sensitivity and 94% specificity). The interpretation of CIM results was easy, with no or 20 mm inhibition zones indicating negative carbapenemase activity. CONCLUSION: The CIM had excellent sensitivity and specificity for detection of CPE and MBL-producing Pseudomonas spp., and a positive result was easily determined, unlike the MHT.