Comparison of Standard Carba NP and Modified CarbaNP for detection of carpapenemase-producing Enterobacteriaceae
Keywords:
CRE, blaIMP-14a, blaKPC, blaNDM, blaOXA48-like, Carba NPAbstract
Carbapenemase is an enzyme found in many bacteria especially in Enterobacteriaceae which stands for carbapenemresistant Enterobacteriace (CRE). Once mechanism of CRE is containing the resistant genes e.g. blaIMP-14a, blaKPC, blaNDM, blaOXA48-like. Most of regional and provincial hospital can not identify the resistant genes. They must be referring organisms to university hospital or National Institute of health of Thailand (NIH) to confirm the resistant genes that take too much times. Many hospitals can detect CRE by disk diffusion susceptibility testing (Imipenem meropenem and ertapenem)or by Modified Hodge Test, The Imipenem- EDTA combination disk, however these techniques can not cover every resistant genes, take a time and some methods show
false-positive. Carba NP is the method recommended by CLSI which can cover more resistant genes than the described methods above and save time as well as high specificity.
This study aims to modified the standard carba NP method to reduce processing time and using Imipenem/cilastatin which already have in the hospital instead of Imipenem monohydrate that is expensive. About 6 miligrams of Imipenem/cilastatin in modified Carba NP can detect CRE (Standard carba NP used 3 miligrams of Imipenem/monohydrate)
Modified Carba NP can reduce the processing time from 35-40 minutes to 2-3 minutes. The positive color of standard Carba NP revealed more yellow than the modified carba NP.
Modified Carba NP can be one option for region or general hospital in Thailand to do for initial detection carbapenemresistant that useful for the clinician and infectious team to rapid management and proper control spreading resistant organisms in affordability way.
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