Jornal de Agentes Antimicrobianos

The Efficacy of the MicroScan^®Walkaway System in Reporting Carbapenemase-Producing Enterobacteriaceae in Patients with Bacteremia, South Africa

Abstract

Mohlabeng R, Shuping L, Perovic O and Singh-Moodley A

Background: The emergence of Carbapenemase-producing Enterobacteriaceae (CPE) is a major public health problem worldwide. As Carbapenemase-production has emerged, treatment of infections has become more difficult leading to high mortality. Real time detection of the presence of these enzymes by in vitro susceptibility testing of these organisms is urgently needed to provide effective treatment and appropriate implementation of infection and prevention control measures. Automated phenotypic systems are widely used in clinical microbiology laboratories for bacterial identification and antimicrobial susceptibility testing. However, critical evaluation is needed to determine the accuracy of these systems.
Objective: Our study was set out to evaluate whether the MicroScan® Walkaway system is a reliable method for predicting CPE in patients with a Carbapenem-resistant Enterobacteriaceae (CRE) infections. Methods: This was a cross-sectional study of CRE isolates from July 2015 to July 2016 received as part of an active CRE surveillance programme. Bacterial identification and antimicrobial susceptibility testing for Carbapenems were performed using the MALDI-ToF and MicroScan® Walkaway system, respectively. Genotypic testing was performed using the LightMix® modular Carbapenemase kits in a multiplex real-time PCR assay to confirm the presence of Carbapenemase genes.
Results: During the study period, there were 219 CRE tested. Out of 219 CRE cases, Carbapenemase genes were detected in 173 (78.9%). The most prevalent gene was blaNDM (38.8%; n=85), followed by blaOXA-48 and variants (32.8%; n=72), blaVIM (6.9%; n=15) and blaGES (0.5%; n=1). The MicroScan® Walkaway system had the highest sensitivity with ertapenem (86.7%). Sensitivities for all other Carbapenems were similar, but below 65%. The positive predictive value for ertapenem was 78.9% and >80% for imipenem (86.2%), meropenem (81.3%) and doripenem (83.7%). Overall, testing for all Carbapenems had a sensitivity of 89%, positive predictive value of 79% and specificity of 10.9%, amongst them imipenem having the highest specificity at 60.9%.
Conclusion: The MicroScan® Walkaway system is sensitive, but lacks specificity. However, it shows to be an efficient diagnostic adjunct to the LightMix® modular multiplex real-time PCR assay for predicting CPE in a patient with a CRE infection depending on the Carbapenem used.