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High Stringency Evaluation of the Automated BD Phoenix™ CPO Detect and RAPIDEC® CARBA NP Tests for Detection and Classification of Carbapenemases.

High Stringency Evaluation of the Automated BD Phoenix™ CPO Detect and RAPIDEC® CARBA NP Tests for Detection and Classification of Carbapenemases.
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Thomson G, Turner D, Brasso W, Kircher S, Guillet T, Thomson K,


Thomson G, Turner D, Brasso W, Kircher S, Guillet T, Thomson K, (click to view)

Thomson G, Turner D, Brasso W, Kircher S, Guillet T, Thomson K,

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Journal of clinical microbiology 2017 10 04() pii JCM.01215-17
Abstract

There is an urgent need for rapid, accurate detection and classification of carbapenemases. The current study evaluated the automated BD Phoenix™ CPO Detect and the manual bioMérieux RAPIDEC® CARBA NP for meeting these needs. Both tests were challenged with 294 Enterobacteriaceae, Pseudomonas aeruginosa and Acinetobacter baumannii chosen to provide extreme diagnostic difficulty. Carbapenemases such as KPC, NMC-A, IMI, SME, NDM, SPM, IMP, VIM, OXA-23, 40, 48, 58, 72, 181, and 232 were produced by 243 isolates and 51 carbapenemase-negative isolates included porin mutants and producers of ESBLs, AmpCs, K1, and broad spectrum β-lactamases. Both tests exhibited high sensitivity of carbapenemase detection (> 97%). Due to the highly challenging carbapenemase-negative isolates, specificities were lower than typical of evaluations involving mostly routine clinical isolates. BD Phoenix™ CPO Detect was 68.6% specific and RAPIDEC® CARBA NP was 60.8% to 78.4% specific depending on how borderline results were interpreted. Only BD Phoenix™ CPO Detect classified carbapenemases. It correctly classified 85.0% of class A, 72.4% of class B, and 88.6% of class D carbapenemases. Importantly with respect to empirical therapy with new β-lactamase inhibitor combinations such as ceftazidime/avibactam, no class B carbapenemases were misclassified as class A carbapenemases. Both tests offer advantages. Used alone, without initial susceptibility tests, RAPIDEC® CARBA NP can provide positive results for some isolates after only 10 to 30 minutes incubation. BD Phoenix™ CPO Detect provides novel advantages such as automated carbapenemase detection, inclusion in susceptibility panels to eliminate delays and subjectivity in initiating carbapenemase tests, and classification of most carbapenemases.

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