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Multicenter, Prospective Validation of a Phenotypic Algorithm to Guide Carbapenemase Testing in Carbapenem-Resistant Pseudomonas aeruginosa Using the ERACE-PA Global Surveillance Program

Fecha de publicación: Fecha Ahead of Print:

Autores organización

Autores

  • Gill CM
  • Aktaþ E
  • Alfouzan W
  • Bourassa L
  • Brink A
  • Burnham C.-A.D.
  • Canton R
  • Carmeli Y
  • Falcone M
  • Kiffer C
  • Marchese A
  • Martinez O
  • Pournaras S
  • Satlin MJ
  • Seifert H
  • Thabit AK
  • Thomson KS
  • Nicolau DP

Grupos de investigación

Resumen

Background: Carbapenemase-producing, carbapenem-resistant Pseudomonas aeruginosa (CP-CRPA) is a global challenge. However, detection efforts can be laborious because numerous mechanisms produce carbapenem resistance. A minimum inhibitory concentration-based algorithm (imipenem- or meropenem-resistant plus ceftazidime-nonsusceptible plus cefepime-nonsusceptible) was proposed to identify the isolates most likely to harbor a carbapenemase; however, prospective validation in geographies displaying genotypic diversity and varied carbapenemase prevalence is warranted. Methods: CRPA isolates were collected during the Enhancing Rational Antimicrobials for P. aeruginosa (ERACE-PA) global surveillance program from 17 sites in 12 countries. Isolates underwent susceptibility testing following local standards to ceftazidime, cefepime, and ceftolozane/tazobactam. Isolates underwent initial phenotypic carbapenemase screening followed by molecular testing if positive. The primary algorithm criteria were applied, and results were compared with phenotypic carbapenemase results to assess the performance of the algorithm. A secondary criterion, the algorithm criterion or imipenem- or meropenem-resistant plus ceftolozane/tazobactam-nonsusceptible, was assessed. Results: A total of 807 CRPA were assessed, and 464 isolates met the algorithm criteria described above. Overall, testing was reduced by 43% compared with testing all CRPA. Carbapenemase-positive isolates missed by the algorithm were largely driven by Guiana extended spectrum (GES). Addition of the criterion of imipenem- or meropenem-resistant plus ceftolozane/tazobactam-nonsusceptible decreased the number of CP-CRPA missed by the algorithm (21 vs 40 isolates, respectively), reducing number of isolates tested by 39%. Conclusions: Application of the initial algorithm (imipenem- or meropenem-resistant plus ceftazidime-nonsusceptible plus cefepime-nonsusceptible) performed well in a global cohort, with 33% phenotypically carbapenemase-positive isolates. The addition of imipenem- or meropenem-resistant plus ceftolozane/tazobactam-nonsusceptible reduced the number of phenotypically carbapenemase-positive isolates missed and may be useful in areas with a prominence of GES. © 2021 The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

© The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

Datos de la publicación

ISSN/ISSNe:
2328-8957, 2328-8957

Open Forum Infectious Diseases  Oxford University Press

Tipo:
Article
Páginas:
-
Enlace a otro recurso:
www.scopus.com

Citas Recibidas en Web of Science: 2

Citas Recibidas en Scopus: 9

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Keywords

  • carbapenem; carbapenemase; cefepime; ceftazidime; ceftolozane plus tazobactam; imipenem; meropenem; antibiotic sensitivity; Article; bacterium isolate; broth dilution; carbapenem resistant Pseudomonas aeruginosa; disk diffusion; genotype; minimum inhibitory concentration; nonhuman; phenotype; polymerase chain reaction; prevalence; sensitivity and specificity; skim milk; whole genome sequencing

Campos de estudio

Proyectos asociados

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Investigador Principal: MARIA VIRGINIA VILLEGAS BOTERO

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Caracterización Molecular de Aislamientos Resistentes a Ceftazidime Avibactam en Enterobacterales y Pseudomonas aeruginosa recolectados en cinco Países de América Latina. Molecular mechanisms leading to ceftazidime-avibactam resistance in Enterobacterales and Pseudomonas aeruginosa collected from five Latin American countries

Investigador Principal: MARIA VIRGINIA VILLEGAS BOTERO

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