Comparison of the Three Phenotypic Methods to Detect Biofilm Production in Coagulase Negative Staphylococci

Coagulase Negative Staphylococci species (CoNS) have been recognized as etiological agents in wide variety of infections, patients with implants and devices. CoNS has the ability to produce biofilm which is responsible for resistance to host defense mechanisms and to the antibiotics. Hence this study was undertaken to study biofilm production by the isolated species of CoNS by three different phenotypic methods and compare these methods for biofilm production.METHODSIn this cross-sectional study, 200 CoNS isolates from clinically significant samples were identified up to species level by conventional phenotypic methods. Biofilm production was detected by Tissue Culture Plate method (TCP), Standard Tube method (ST) and Congo Red Agar Plate method (CRA). Biofilm production in test strains were compared with reference strains.RESULTSOut of 200 CoNS isolates, 122 were positive by TCP method, 106 by ST method & 67 by CRA method for biofilm production. Considering TCP method as gold standard, sensitivity, specificity, PPV and NPV of ST & CRA method were found to be 86.06%, 98.71%, 99.05%, 81.91% and 54.09%, 98.71%, 98.50% and 57.89% respectively. Analysis of Kappa agreement between TCP and ST method showed good agreement while between TCP & CRA, moderate agreement. Comparison of ST and CRA method with TCP by Pearson correlation coefficient test showed strong association between ST and TCP method (p= 0.006) & poor association between TCP and CRA method. (p<0.01).CONCLUSIONSBiofilm production by TCP method was higher compared to the other methods. ST method is comparable to TCP but CRA alone cannot be considered for biofilm detection in CoNS. ST method can be used in routine as it gives reliable results with good sensitivity & specificity and is easy to perform.

Evaluation of Six Phenotypic Methods for the Detection of Carbapenemases in Gram-Negative Bacteria With Characterized Resistance Mechanisms

BACKGROUND: We compared the performance of the modified Hodge test (MHT), Triton Hodge test (THT), Carba NP test (CNPt), simplified Carba NP test (CNPt-direct), blue-Carba NP test (BCT), and carbapenem inactivation method (CIM) for rapid and accurate carbapenemase detection. METHODS: The methods were evaluated by using 256 gram-negative isolates, including 197 Enterobacteriaceae (79 Enterobacter spp., 74 Klebsiella spp., 33 Escherichia coli, 10 Citrobacter spp., and 1 Serratia marcescens), 51 Acinetobacter baumannii, and 8 Pseudomonas aeruginosa strains. The collection included 117 non-carbapenemase, 18 Klebsiella pneumoniae carbapenemases (KPC) producers, 46 New Delhi metallo-β-lactamases (NDM) producers, 11 imipenemases (IMP) producers, and 51 oxacillinases (OXA) producers, and 13 strains harboring two different carbapenemase genes. RESULTS: The specificity of the THT (91.5%) was significantly lower than other methods, each of which had 100% specificity (P0.999). Because of improved detection of NDM carriers, THT showed significantly higher sensitivity than the MHT (84.9% vs 75.5%, P<0.001). However, poor performances in detecting OXA still influenced the sensitivities of the CNPt (66.2%) and BCT (82.0%), as well as the MHT and THT. CONCLUSIONS: CNPt-direct and CIM demonstrated the best performance for the efficient detection of carbapenemase among the six evaluated methods. Except the MHT and THT, the detection of carbapenemase-producing Enterobacteriaceae by all the other methods was acceptable, when the OXA-type carbapenemase was not prevalent.

Molecular characterization of Enterobacteriaceae resistant to carbapenem antimicrobials / Caracterização molecular de enterobactérias resistentes aos carbapenêmicos

ABSTRACT The present study aimed to genotypically and phenotypically characterize clinical isolates of carbapenem-resistant Enterobacteriaceae collected from inpatients at the University Hospital of Santa Maria, during seven months. Among the clinical isolates subjected to the modified Hodge test (MHT), 62.5% were positive, indicating possible production of carbapenemase. Polymerase chain reaction (PCR) demonstrated that blaKPC was the most frequently found gene (31%), followed by blaIMP (12.5%). Combined use of the methods is needed to identify carbapenem resistance in enterobacteria to prevent their spread and control the infections caused by these organisms.

RESUMO Objetivou-se caracterizar fenotípica e genotipicamente isolados clínicos de enterobactérias resistentes aos carbapenêmicos (CRE) provenientes do Hospital Universitário de Santa Maria (RS). Entre os isolados clínicos submetidos ao teste modificado de Hodge (MHT), 62,5% apresentaram positividade, indicando possível produção de carbapenemase. A reação em cadeia da polimerase (PCR) demonstrou que o blaKPC foi o gene mais encontrado (31%), seguido de blaIMP (12,5%). O uso conjunto de distintas metodologias faz-se necessário para identificar a resistência aos carbapenêmicos produzida pelas enterobactérias, de modo a auxiliar o controle de infecção prevenindo a disseminação desses microrganismos.

Evaluación de diversos métodos fenotípicos para la detección de carbapenemasas KPC en Klebsiella pneumoniae / Evaluation of phenotypic methods for the detection of KPC carbapenemases in Klebsiella pneumoniae

Se investigó el desempeño de diversos métodos fenotípicos para la detección de carbapenemasas KPC en 44 aislamientos de Klebsiella pneumoniae con sensibilidad disminuida a los carbapenems, 30 productores y 14 no productores de KPC. Se determinó la sensibilidad a imipenem, meropenem y ertapenem por dilución en agar y difusión por discos. Se evaluaron los siguientes métodos fenotípicos: sinergia entre discos de carbapenems y discos con los inhibidores amoxicilina/ácido clavulánico (AMC ) y ácido aminofenilborónico (APB); inhibición por "discos combinados" (según una técnica de predifusión diseñada a tal fin en nuestro laboratorio), comparando el efecto de los carbapenems solos o asociados con los inhibidores mencionados; y el test de Hodge modificado, para el cual se propone una lectura cuantificada. El método de Hodge detectó todos los aislamientos KPC positivos con los tres carbapenems evaluados, mientras que fue negativo para todos los aislamientos KPC negativos con imipenem y meropenem, y produjo dos resultados falsos positivos con ertapenem. Cuantificando la lectura de este método se pudieron discriminar objetivamente los resultados verdaderos positivos (≥ 8 mm) de los falsos positivos (< 5 mm). Se observó sinergia entre carbapenems y APB con todos los aislamientos KPC positivos, aunque esto requirió ajustar la distancia entre discos. En los aislamientos KPC negativos no se observó sinergia entre carbapenems y APB. Empleando el método con discos combinados con imipenem o meropenem más APB se detectaron la mayoría de los aislamientos KPC positivos y no se observaron falsos positivos. Por el contrario, las combinaciones carbapenem más AMC no fueron sensibles ni específicas.

We evaluated phenotypic methods for the detection of KPC carbapenemases in 44 clinical isolates of K. pneumoniae having reduced susceptibility to carbapenems, 30 of which were KPC-positive and 14 KPC-negative. Both the agar dilution and disk diffusion methods were performed for imipenem, meropenem and ertapenem. The following phenotypic methods were assayed: the double disk synergy test, using boronic acid or clavulanic acid as inhibitors, "combined" disks of carbapenem plus inhibitor (boronic acid, clavulanic acid and both boronic plus clavulanic acid), by using a pre-diffusion technique and the modified Hodge test. The double disk diffusion test using boronic acid could detect all KPC-positive isolates, but adjustment of disk distance was necessary for achieving such performance. The simulation of combined disks by our pre-diffusion technique detected all KPCpositive strains for all 3 carbapenems when using boronic acid as inhibitor, clavulanic acid was less susceptible and specific as compared with boronic acid. The modified Hodge test using any carbapenem was clearly positive for all KPC-producing isolates. This test was negative for all KPC-negative strains when imipenem or meropenem were used, but 2/14 isolates yielded a weak positive result when using ertapenem. By measuring the enhanced growth of E. coli ATCC 25922 observed in this test, we could objectively discriminate true-positive (≥ 8 mm) from false-positive results (< 5 mm). Our results show that the use of phenotypic methods is effective for the rapid detection of KPC producers in K. pneumoniae isolates with reduced susceptibility to carbapenems.

Accuracy of phenotypic methicillin susceptibility methods in the detection of Staphylococcus aureus isolates carrying different SCCmec types

A total of 138 isolates, 118 methicillin-resistant Staphylococcus aureus (MRSA) isolates (staphylococcal cassette chromosome type II, 20 isolates, type III, 39 isolates and type IV, 59 isolates) and 20 methicillin-sensitive S. aureus isolates were evaluated by phenotypic methods: cefoxitin and oxacillin disk diffusion (DD), agar dilution (AD), latex agglutination (LA), oxacillin agar screening (OAS) and chromogenic agar detection. All methods showed 100 percent specificity, but only the DD tests presented 100 percent sensitivity. The sensitivity of the other tests ranged from 82.2 percent (OAS)-98.3 percent (AD). The LA test showed the second lowest sensitivity (86.4 percent). The DD test showed high accuracy in the detection of MRSA isolates, but there was low precision in the detection of type IV isolates by the other tests, indicating that the genotypic characteristics of the isolates should be considered.

Diferentes métodos fenotípicos para isolamento e identificação de espécies de Candida / Different phenotypic methods for isolation and identification of Candida species

C. albicans é o mais frequente agente responsável pela candidíase e está também associada a doençasimunossupressoras como, por exemplo, diabetes. Entretanto, outras espécies não-albicans como C.dubliniensis inicialmente associada com candidíase da orofaringe de pacientes infectados pelo vírus HIV,onde ainda é mais prevalente, tem sido reconhecida como causa de infecção em pacientes com câncer,com fibrose cística e pacientes com diversas patologias e diferentes graus de imunocomprometimento.Utilizando-se métodos fenotípicos para identificação de Candida spp. é possível discriminar rotineiramenteisolados orais em laboratórios de microbiologia. Um dos problemas que interferem na realização de identificaçãodas espécies do gênero Candida em estudos epidemiológicos mais amplos é a dificuldade da rápidaidentificação, a partir de meios de triagem de baixo custo. Dessa forma, alguns métodos fenotípicos sãoapresentados com o objetivo de contribuir na busca de testes alternativos que possam com segurança, seremaplicados às rotinas de laboratórios.

C. albicans is the frequent agent for the oral candidosis and it is also associated to immunosuppressivediseases as, for example, diabetes. However, other non-albicans species such as C. dubliniensis initiallyassociated with candidosis in orofaringe patients infected by the virus HIV, where is still more prevalent,it has been recognized as infection cause in patients with cancer, cystic fibrosis and patients with severalpathologies. Phenotypics methods for Candida spp. are easy-to-use procedures for routine discriminationof oral isolates in the clinical microbiology laboratory. One of the problems that interfere in the identificationaccomplishment of the species of Candida in more wide epidemic studies is the difficulty of the fast identification,starting from screen methods of low cost. In that way, some phenotypics methods are presented withthe objective of contributing in the search of alternative tests to be applied as routine in laboratories.

Detección fenotípica y molecular de resistencia a meticilina en S. aureus / Phenotypic and molecular detection of methicillin resistance in S. aureus

La detección de resistencia a meticilina es complicada debido a la heterogeneidad de su expresión fenotípica; dificultando su detección en el laboratorio, lo que ha conducido al desarrollo de varias técnicas para incrementar su expresión in vitro. A fin de evaluar cuatro técnicas para la detección de resistencia a meticilina: método de difusión del disco con oxacilina (OX, 1 ug) y cefoxitin (FOX, 30 ug); screening test, concentración inhibitoria mínima (CIM) y detección de PBP2a, utilizando la presencia del gen mecA como método de referencia, se procesaron 286 cepas de S. aureus. Se determinó la sensibilidad (SEN), especificidad (ESP), valor predictivo positivo (VPP), valor predictivo negativo (VPN) y eficiencia (EFC) de cada uno de los métodos. Se obtuvo un total de 50 cepas resistentes a oxacilina, PBP2a positivos (mecA positivos). La sensibilidad del disco de OX fue de 99.14 por ciento y la de FOX fue de 100 por ciento. La SEN, VPP, VPN y EFC de los otros métodos fue de 100 por ciento. Todas, a excepción del método de difusión del disco de OX (ESP de 99.14), resultaron 100 por ciento específicos.

Detecting methicillin resistance is complicated due to the heterogeneity of its phenotypic expression, making its detection difficult in the laboratory; this has led to the development of several techniques to increase its expression in vitro. Four techniques for detecting methicillin resistance were evaluated: the disk diffusion method with oxacillin (OX, 1 ug) and cephoxitin (FOX, 30 ug); the screening test, minimum inhibitory concentration (MIC) and detection of PBP2a, using the presence of mecA gen as a reference method; 286 strains of S. aureus, were processed. The sensibility (SEN), specificity (SPE), positive predictive value (PPV), negative predictive value (NPV) and efficiency (EFC) of each method were determined. A total of 50 oxacillin resistant, PBP2a positive (mecA positive) strains were obtained. Sensibility of the OX disk was 99.14 percent; and of the FOX disk was 100 percent. The SEN, PPV, NVP and EFC of the other methods were 100 percent. All the tests, except the OX disk diffusion method (99.14 percent of ESP), were 100 percent specific.