scholarly journals Comparative Evaluation of Four Phenotypic Methods for Detection of Class A and B Carbapenemase-Producing Enterobacteriaceae in China

2018 ◽  
Vol 56 (8) ◽  
Author(s):  
Menglan Zhou ◽  
Danchen Wang ◽  
Timothy Kudinha ◽  
Qiwen Yang ◽  
Shuying Yu ◽  
...  
Keyword(s):  
Predictive Value ◽  
Comparative Evaluation ◽  
Detection Sensitivity ◽  
Detection Methods ◽  
Content Type ◽  
Class A ◽  
Carbapenem Resistant ◽  
Class B ◽  
Phenotypic Methods ◽  
Sensitivity Specificity

ABSTRACT The objective of this study was to evaluate the performance of four phenotypic methods in the detection of carbapenemase-producing Enterobacteriaceae (CPE) in China. We evaluated the performance of four carbapenemase detection methods, the modified Hodge test (MHT), the Carba NP test, the meropenem hydrolysis assay (MHA) with 1- and 2-h incubation, and the modified carbapenem inactivation method (mCIM) with meropenem, imipenem, and ertapenem, on 342 carbapenem-resistant Enterobacteriaceae isolates (CRE) in China. PCR was used as the gold standard. The 2-h-incubation MHA performed the best in carbapenemase detection (overall sensitivity, specificity, positive predictive value, and negative predictive value all 100%). Second was the Carba NP test, with a sensitivity of 99.6%. The 1-h-incubation MHA performed poorly in Klebsiella pneumoniae carbapenemase (KPC) detection (sensitivity, 71.3%). For mCIM, the best performance was observed with the meropenem disk. The MHT exhibited the worst performance, with a specificity of 88.8%. All assays except 1-h-incubation MHA, which failed to identify 68 KPC-2s, had a sensitivity of >98% in the detection of 172 KPCs. Likewise, all assays had a sensitivity of >95% in the detection of 70 class B carbapenemases, except for MHT (82.9%). The 2-h-incubation MHA significantly improved the accuracy in CPE detection compared with that for 1-h incubation and performed the best in the detection of class A and B carbapenemases. Our findings suggest that the MHA is the most practical assay for carbapenemase detection. For those who cannot afford the associated equipment, both the Carba NP test and mCIM are good alternatives with regard to the practical requirements of time and cost.

scholarly journals Evaluation of Carbapenemase Screening and Confirmation Tests with Enterobacteriaceae and Development of a Practical Diagnostic Algorithm

2014 ◽  
Vol 53 (1) ◽  
pp. 95-104 ◽  
Author(s):  
Florian P. Maurer ◽  
Claudio Castelberg ◽  
Chantal Quiblier ◽  
Guido V. Bloemberg ◽  
Michael Hombach
Keyword(s):  
Sensitivity And Specificity ◽  
Predictive Value ◽  
Diagnostic Algorithm ◽  
Negative Control Group ◽  
Negative Control ◽  
Control Group ◽  
Content Type ◽  
Class B ◽  
Mueller Hinton Agar ◽  
Sensitivity Specificity

Reliable identification of carbapenemase-producing members of the familyEnterobacteriaceaeis necessary to limit their spread. This study aimed to develop a diagnostic flow chart using phenotypic screening and confirmation tests that is suitable for implementation in different types of clinical laboratories. A total of 334 clinicalEnterobacteriaceaeisolates genetically characterized with respect to carbapenemase, extended-spectrum β-lactamase (ESBL), and AmpC genes were analyzed. A total of 142/334 isolates (42.2%) were suspected of carbapenemase production, i.e., intermediate or resistant to ertapenem (ETP) and/or meropenem (MEM) and/or imipenem (IPM) according to EUCAST clinical breakpoints (CBPs). A group of 193/334 isolates (57.8%) showing susceptibility to ETP, MEM, and IPM was considered the negative-control group in this study. CLSI and EUCAST carbapenem CBPs and the new EUCAST MEM screening cutoff were evaluated as screening parameters. ETP, MEM, and IPM with or without aminophenylboronic acid (APBA) or EDTA combined-disk tests (CDTs) and the Carba NP-II test were evaluated as confirmation assays. EUCAST temocillin cutoffs were evaluated for OXA-48 detection. The EUCAST MEM screening cutoff (<25 mm) showed a sensitivity of 100%. The ETP APBA CDT on Mueller-Hinton agar containing cloxacillin (MH-CLX) displayed 100% sensitivity and specificity for class A carbapenemase confirmation. ETP and MEM EDTA CDTs showed 100% sensitivity and specificity for class B carbapenemases. Temocillin zone diameters/MIC testing on MH-CLX was highly specific for OXA-48 producers. The overall sensitivity, specificity, positive predictive value, and negative predictive value of the Carba NP-II test were 78.9, 100, 100, and 98.7%, respectively. Combining the EUCAST MEM carbapenemase screening cutoff (<25 mm), ETP (or MEM), APBA, and EDTA CDTs, and temocillin disk diffusion on MH-CLX promises excellent performance for carbapenemase detection.

scholarly journals Genetic Diversity, Biochemical Properties, and Detection Methods of Minor Carbapenemases in Enterobacterales

2021 ◽  
Vol 7 ◽  
Author(s):  
Rémy A. Bonnin ◽  
Agnès B. Jousset ◽  
Cécile Emeraud ◽  
Saoussen Oueslati ◽  
Laurent Dortet ◽  
...  
Keyword(s):  
Genetic Diversity ◽  
Multidrug Resistant ◽  
Biochemical Properties ◽  
Amino Acid Sequences ◽  
Detection Methods ◽  
Gram Negative ◽  
Class A ◽  
Class D ◽  
Class B ◽  
Encoding Genes

Gram-negative bacteria, especially Enterobacterales, have emerged as major players in antimicrobial resistance worldwide. Resistance may affect all major classes of anti-gram-negative agents, becoming multidrug resistant or even pan-drug resistant. Currently, β-lactamase-mediated resistance does not spare even the most powerful β-lactams (carbapenems), whose activity is challenged by carbapenemases. The dissemination of carbapenemases-encoding genes among Enterobacterales is a matter of concern, given the importance of carbapenems to treat nosocomial infections. Based on their amino acid sequences, carbapenemases are grouped into three major classes. Classes A and D use an active-site serine to catalyze hydrolysis, while class B (MBLs) require one or two zinc ions for their activity. The most important and clinically relevant carbapenemases are KPC, IMP/VIM/NDM, and OXA-48. However, several carbapenemases belonging to the different classes are less frequently detected. They correspond to class A (SME-, Nmc-A/IMI-, SFC-, GES-, BIC-like…), to class B (GIM, TMB, LMB…), class C (CMY-10 and ACT-28), and to class D (OXA-372). This review will address the genetic diversity, biochemical properties, and detection methods of minor acquired carbapenemases in Enterobacterales.

scholarly journals 2175. Rapid Detection of Carbapenemase Producing Organisms Directly from Blood Cultures Positive for Gram-Negative Bacilli

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S738-S738
Author(s):  
William Stokes ◽  
Johann Pitout ◽  
Lorraine Campbell ◽  
Deirdre Church ◽  
Dan Gregson
Keyword(s):  
Predictive Value ◽  
Rapid Detection ◽  
Blood Cultures ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
Direct Testing ◽  
Appropriate Treatment ◽  
Risk Patients ◽  
Health Zone ◽  
Sensitivity Specificity

Abstract Background The rapid detection of carbapenemase-producing organisms (CPOs) directly from blood cultures (BC) positive for Gram-negative bacilli (GNB) may accelerate the appropriate treatment of at-risk patients. Our objective was to evaluate the performance of two commercial assays in the rapid detection of CPOs directly from BC positive for GNB. Methods BC positive for GNB, taken from patients within the Calgary Health Zone over a 3 month period, were tested for the presence of CPOs with βCARBA® and NG-Test® CARBA 5. A subset of sterile BC samples was seeded with multi-drug-resistant (MDR) GNB. BC were incubated using the Bact-Alert™ system. Positive BC from clinical and seeded samples was tested directly with βCARBA and CARBA 5 from BC pellets processed for direct testing using an ammonium chloride lysis and wash method. Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) were calculated with 95% confidence intervals for binomial proportions. Results 65 samples were tested (30 clinical, 35 seeded). Seeded samples included 1 GES, 4 IMP, 6 KPC, 1 co-producing KPC and NDM, 9 OXA, 4 VIM, 5 NDM, and 5 non-CPO carbapenem-resistant organisms. βCARBA had a sensitivity, specificity, NPV and PPV of 100% (88.4% - 100%), 65.7% (47.8–80.9%), 100%, and 71.4% (61.3%–79.8%), respectively. CARBA 5 had a sensitivity, specificity, NPV and PPV of 90.0% (73.5%–97.9%), 100% (90.0%–100%), 92.1% (80.0%–97.2%), and 100%. When excluding GES, which is known not to be detected by CARBA 5, sensitivity and NPV increased to 93.1% (77.2%–99.2%) and 93.1% (78.0%–98.1%), respectively. False negatives for βCARBA occurred with 1 VIM-1 and IMP-14. Conclusion This study demonstrates that the detection of CPOs directly from positive BC can be accurately achieved. βCARBA had excellent sensitivity but suffered from poor specificity. CARBA 5 had good sensitivity and specificity but is unable to detect certain CPOs. Testing positive BC directly using βCARBA and/or CARBA 5 may be useful in rapidly detecting CPOs. Results of direct testing from the CARBA5 assay would quickly identify patients amenable to treatment with avibactam combination compounds. Disclosures All authors: No reported disclosures.

scholarly journals Nacubactam Enhances Meropenem Activity against Carbapenem-Resistant Klebsiella pneumoniae Producing KPC

2019 ◽  
Vol 63 (8) ◽  
Author(s):  
Melissa D. Barnes ◽  
Magdalena A. Taracila ◽  
Caryn E. Good ◽  
Saralee Bajaksouzian ◽  
Laura J. Rojas ◽  
...  
Keyword(s):  
Molecular Modeling ◽  
Klebsiella Pneumoniae ◽  
The United States ◽  
Alternative Mechanism ◽  
Enhancer Activity ◽  
Content Type ◽  
Class A ◽  
Carbapenem Resistant ◽  
Biochemical Analyses ◽  
Molecular Modeling And Docking

ABSTRACT Carbapenem-resistant Enterobacteriaceae (CRE) are resistant to most antibiotics, making CRE infections extremely difficult to treat with available agents. Klebsiella pneumoniae carbapenemases (KPC-2 and KPC-3) are predominant carbapenemases in CRE in the United States. Nacubactam is a bridged diazabicyclooctane (DBO) β-lactamase inhibitor that inactivates class A and C β-lactamases and exhibits intrinsic antibiotic and β-lactam “enhancer” activity against Enterobacteriaceae. In this study, we examined a collection of meropenem-resistant K. pneumoniae isolates carrying blaKPC-2 or blaKPC-3; meropenem-nacubactam restored susceptibility. Upon testing isogenic Escherichia coli strains producing KPC-2 variants with single-residue substitutions at important Ambler class A positions (K73, S130, R164, E166, N170, D179, K234, E276, etc.), the K234R variant increased the meropenem-nacubactam MIC compared to that for the strain producing KPC-2, without increasing the meropenem MIC. Correspondingly, nacubactam inhibited KPC-2 (apparent Ki [Ki app] = 31 ± 3 μM) more efficiently than the K234R variant (Ki app = 270 ± 27 μM) and displayed a faster acylation rate (k2/K), which was 5,815 ± 582 M−1 s−1 for KPC-2 versus 247 ± 25 M−1 s−1 for the K234R variant. Unlike avibactam, timed mass spectrometry revealed an intact sulfate on nacubactam and a novel peak (+337 Da) with the K234R variant. Molecular modeling of the K234R variant showed significant catalytic residue (i.e., S70, K73, and S130) rearrangements that likely interfere with nacubactam binding and acylation. Nacubactam’s aminoethoxy tail formed unproductive interactions with the K234R variant’s active site. Molecular modeling and docking observations were consistent with the results of biochemical analyses. Overall, the meropenem-nacubactam combination is effective against carbapenem-resistant K. pneumoniae. Moreover, our data suggest that β-lactamase inhibition by nacubactam proceeds through an alternative mechanism compared to that for avibactam.

scholarly journals Carbapenemase Detection among Carbapenem-Resistant Glucose-Nonfermenting Gram-Negative Bacilli

2017 ◽  
Vol 55 (9) ◽  
pp. 2858-2864 ◽  
Author(s):  
Patricia J. Simner ◽  
Belita N. A. Opene ◽  
Krizia K. Chambers ◽  
Matthew E. Naumann ◽  
Karen C. Carroll ◽  
...  
Keyword(s):  
Method Comparison ◽  
Comparison Study ◽  
Gram Negative ◽  
Content Type ◽  
Carbapenem Resistant ◽  
Class D ◽  
Class B ◽  
Synergy Test ◽  
Method Comparison Study ◽  
Phenotypic Tests

ABSTRACT Accurate detection of carbapenemase-producing glucose-nonfermenting Gram-negative bacilli (CPNFs), including Pseudomonas aeruginosa and Acinetobacter baumannii , is necessary to prevent their dissemination within health care settings. We performed a method comparison study of 11 phenotypic carbapenemase detection assays to evaluate their accuracy for the detection of CPNFs. A total of 96 carbapenem-resistant glucose-nonfermenting isolates were included, of which 29% produced carbapenemases. All CPNFs were molecularly characterized to identify β-lactamase genes. A total of 86% of the carbapenemase-producing P. aeruginosa isolates produced class B carbapenemases. Several assays performed with a sensitivity of >90% for the detection of carbapenemase-producing P. aeruginosa , including all rapid chromogenic assays and the modified carbapenem inactivation method. Most included assays, with the exception of the Manual Blue Carba assay, the Modified Carba NP assay, the boronic acid synergy test, and the metallo-β-lactamase Etest, had specificities of >90% for detecting carbapenemase-producing P. aeruginosa . Class D carbapenemases were the most prevalent carbapenemases among the carbapenemase-producing A. baumannii strains, with 60% of the carbapenemase-producing A. baumannii isolates producing acquired OXA-type carbapenemases. Although several assays achieved >90% specificity in identifying carbapenemase-producing A. baumannii , no assays achieved a sensitivity of greater than 90%. Our findings suggest that the available phenotypic tests generally appear to have excellent sensitivity and specificity for detecting carbapenemase-producing P. aeruginosa isolates. However, further modifications to existing assays or novel assays may be necessary to accurately detect carbapenemase-producing A. baumannii .

scholarly journals Characterization of CIA-1, an Ambler Class A Extended-Spectrum β-Lactamase from Chryseobacterium indologenes

2011 ◽  
Vol 56 (1) ◽  
pp. 588-590 ◽  
Author(s):  
Takehisa Matsumoto ◽  
Mika Nagata ◽  
Nau Ishimine ◽  
Kenji Kawasaki ◽  
Kazuyoshi Yamauchi ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Reference Strain ◽  
Content Type ◽  
Chryseobacterium Indologenes ◽  
Esbl Gene ◽  
Class A ◽  
Extended Spectrum ◽  
Class B ◽  
Lactamase Gene

ABSTRACTAn Ambler class A β-lactamase gene,blaCIA-1, was cloned from the reference strainChryseobacterium indologenesATCC 29897 and expressed inEscherichia coliBL21. TheblaCIA-1gene encodes a novel extended-spectrum β-lactamase (ESBL) that shared 68% and 60% identities with the CGA-1 and CME-1 β-lactamases, respectively.blaCIA-1-like genes were detected from clinical isolates. In addition to the metallo-β-lactamase IND of Ambler class B,C. indologeneshas a class A ESBL gene,blaCIA-1, located on the chromosome.

scholarly journals Detection of Clostridium difficile in Feces of Asymptomatic Patients Admitted to the Hospital

2016 ◽  
Vol 55 (2) ◽  
pp. 403-411 ◽  
Author(s):  
Elisabeth M. Terveer ◽  
Monique J. T. Crobach ◽  
Ingrid M. J. G. Sanders ◽  
Margreet C. Vos ◽  
Cees M. Verduin ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Predictive Value ◽  
Health Care Facilities ◽  
Nucleic Acid Amplification ◽  
Content Type ◽  
Asymptomatic Patients ◽  
Toxigenic Culture ◽  
Stool Samples ◽  
Sensitivity Specificity ◽  
Low Prevalence

ABSTRACTRecent evidence shows that patients asymptomatically colonized withClostridium difficilemay contribute to the transmission ofC. difficilein health care facilities. Additionally, these patients may have a higher risk of developingC. difficileinfection. The aim of this study was to compare a commercially available PCR directed to both toxin A and B (artusC. difficileQS-RGQ kit CE; Qiagen), an enzyme-linked fluorescent assay to glutamate dehydrogenase (GDH ELFA) (Vidas, bioMérieux), and an in-house-developed PCR totcdB, with (toxigenic) culture ofC. difficileas the gold standard to detect asymptomatic colonization. Test performances were evaluated in a collection of 765 stool samples obtained from asymptomatic patients at admission to the hospital. TheC. difficileprevalence in this collection was 5.1%, and 3.1% contained toxigenicC. difficile. Compared toC. difficileculture, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of theC. difficileGDH ELFA were 87.2%, 91.2%, 34.7%, and 99.3%, respectively. Compared with results of toxigenic culture, the sensitivity, specificity, PPV, and NPV of the commercially available PCR and the in-house PCR were 95.8%, 93.4%, 31.9%, 99.9%, and 87.5%, 98.8%, 70%, and 99.6%, respectively. We conclude that in a low-prevalence setting of asymptomatically colonized patients, both GDH ELFA and a nucleic acid amplification test can be applied as a first screening test, as they both display a high NPV. However, the low PPV of the tests hinders the use of these assays as stand-alone tests.

Momentum phenomenon in the Chinese Class A and B share markets

2015 ◽  
Vol 7 (2) ◽  
pp. 116-133 ◽  
Author(s):  
Taufiq Choudhry ◽  
Yuan Wu
Keyword(s):  
Stock Market ◽  
Driving Forces ◽  
Chinese Stock Market ◽  
Market Segments ◽  
Content Type ◽  
Share Ownership ◽  
Comprehensive View ◽  
Class A ◽  
Class B ◽  
A Share

Purpose – The purpose of this paper is to investigate the momentum phenomenon in two market segments of the Chinese stock market – the Class A share market and Class B share market over time period spanning from January 1996 to December 2010. Design/methodology/approach – The authors largely follow Jegadeesh and Titman (1993) paper; the authors decompose the momentum returns following the procedure first proposed by Jegadeesh and Titman (1995). In addition, a liquidity factor (Pastor and Stambaugh, 2003) and a share ownership factor (Wang and Xu, 2004) are incorporated in the procedure to gauge the contribution of liquidity and the dynamics of share ownership towards the momentum returns, respectively in the two segments of the Chinese stock market. Findings – The authors find compelling evidence showing distinctively different momentum phenomena exist in the two market segments of the Chinese stock market. Specifically, the momentum phenomenon is more pronounced in the Chinese Class A share market compared to those found in the Chinese Class B share market. Through decomposing the momentum returns, the authors find evidence showing the dismal momentum returns observed in the Class B share market can be attributed to markedly weakened contributions of the liquidity factor and the share ownership factor. Research limitations/implications – Relatively short sample time horizon compared to the most of major financial markets such as USA and UK. The number of B shares has been rather limited. Practical implications – Subsequent to the opening of the Chinese Class B share market to domestic investors in 2001 and the opening of the Chinese Class A share market to qualified foreign institutional investors (QFII) in 2003, the empirical evidence found in this study provides a crucial reference point for domestic and foreign portfolio strategists in guiding them to form suitable portfolio strategies concerning investments in a nascent financial market such as the Chinese stock market, fraught with volatility and speculative trading behaviour. Social implications – It offers a comprehensive view of the momentum phenomenon in the Chinese Class A and B share markets over the sample period from January 1996 to December 2010. Second, the reasons behind the dichotomy of the momentum returns found in the two market segments were investigated through decomposing the momentum returns based on Jegdeesh and Titman’s (1995) method while incorporating three new explanatory factors – the liquidity factor, share ownership factor and the under reaction towards firm-specific news factor. Originality/value – A couple of extant papers have visited the topic before. yet this paper offers more comprehensive view on the existence of momentum premium in both Chinese Class A and B share markets and investigates the driving forces behind the subdued momentum returns observed in the B share market.

Tympanic membrane displacement testing in regular assessment of intracranial pressure in eight children with shunted hydrocephalus

1998 ◽  
Vol 88 (6) ◽  
pp. 983-995 ◽  
Author(s):  
Madan Samuel ◽  
David M. Burge ◽  
Robert J. Marchbanks
Keyword(s):  
Intracranial Pressure ◽  
Positive Predictive Value ◽  
Tympanic Membrane ◽  
Predictive Value ◽  
Comparative Evaluation ◽  
Icp Monitoring ◽  
Content Type ◽  
Accuracy And Repeatability ◽  
Fine Print ◽  
Membrane Displacement

Object. The authors assessed the accuracy and repeatability of the tympanic membrane displacement (TMD) test, an audiometric technique that is used to evaluate changes in intracranial pressure (ICP) in children with shunted hydrocephalus. Methods. A prospective comparative evaluation of 31 clinical episodes of shunt malfunction was made by using the serial TMD test and direct ICP measurement in eight children with shunted hydrocephalus between January 1995 and February 1996. The volume displacement of the tympanic membrane (Vm) on stapedial contraction was inward for raised ICP in 11 instances and ranged from −120 to −539 nl (mean −263.5 nl). This was confirmed by direct ICP monitoring, which showed values ranging from 20 to 30 mm Hg (mean 26 mm Hg). The TMD test measurement (Vm) in 18 instances of low ICP ranged from 263 to 717 nl (mean 431.3 nl); this was corroborated by direct ICP measurement, which ranged from 3 to 7 mm Hg (mean 4.2 mm Hg). The normal baseline Vm values obtained when patients were asymptomatic ranged from −98 to 197 nl (mean 110 nl). As a noninvasive diagnostic tool used in predicting changes in ICP, the TMD test had a sensitivity of 83% and specificity of 100%. The positive predictive value of the test was 100% and the negative predictive value was 29%. Conclusions. The TMD test can be used on a regular basis as a reproducible investigative tool in the assessment of ICP in children with shunted hydrocephalus, thereby reducing the need for invasive ICP monitoring. The equipment necessary to perform this testing is mobile. It will provide a useful serial guide to ICP abnormalities in children with shunted hydrocephalus.

scholarly journals Systematic comparison of three commercially available combination disc tests and zCIM for carbapenemase detection in Enterobacterales isolates

2021 ◽  
Author(s):  
Janko Sattler ◽  
Anne Brunke ◽  
Axel Hamprecht
Keyword(s):  
Infection Control ◽  
Patient Treatment ◽  
Diagnostic Strategy ◽  
Class A ◽  
Molecular Tests ◽  
Class D ◽  
Great Performance ◽  
Class B ◽  
Overall Performance ◽  
Sensitivity Specificity

Detection of carbapenemases in Enterobacterales is crucial for patient treatment and infection control. Among others, combination disk tests (CDT) with different inhibitors (e.g. EDTA) and variations of the carbapenem inactivation method (CIM) are recommended by EUCAST or CLSI and are used by many laboratories as they are relatively inexpensive. In this study, we compare three commercially available CDT, faropenem disc testing (FAR) and the zinc supplemented CIM test (zCIM) for detection of carbapenemase-producing Enterobacterales (CPE). Rosco KPC/MBL and OXA-48 Confirm Kit (ROS-CDT), Liofilchem KPC&MBL&OXA-48 disc kit (LIO-CDT), Mastdiscs Combi Carba plus (MAST-CDT), FAR and zCIM were challenged with 106 molecularly characterized CPE and 47 non-CPE. Sensitivity/specificity was 86% (CI 78-92%)/98% (CI 89-100%) for MAST-CDT and ROS-CDT, 96% (CI 91-99%)/87% (CI 74-95%) for LIO-CDT and 99% (CI 95-100%)/81% (CI 67-91%) for FAR compared to 98% (CI 93-100%)/100% (CI 92-100%) for zCIM. The CDT showed great performance differences depending on the carbapenemase class, with MAST-CDT and LIO-CDT best detecting class B, ROS-CDT class A and LIO-CDT class D carbapenemases. Conclusion : The overall performance of commercially available CDTs was good but varied greatly for different carbapenemases and between manufacturers, compared with FAR and zCIM which performed well for all carbapenemase types. For reliable carbapenemase detection CDT should preferably not be used as the sole test, but can be part of a diagnostic strategy when combined with other assays (e.g. CIM-based, immunochromatographic or molecular tests).

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