4.7 Article

A comparative study between real-time PCR and loop-mediated isothermal amplification to detect carbapenemase and/or ESBL genes in Enterobacteriaceae directly from bronchoalveolar lavage fluid samples

Journal

JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY
Volume 75, Issue 6, Pages 1453-1457

Publisher

OXFORD UNIV PRESS
DOI: 10.1093/jac/dkaa031

Keywords

-

Funding

  1. Ajut a la Recerca 'Clinic-LaPedrera' [PEP: HB-16-JF-VG-C]
  2. Departament de Universitats, Recerca i Societat de la Informacio de la Generalitat de Catalunya [2014SGR0653]
  3. Plan Nacional de I + D+i 2013-2016, Instituto de Salud Carlos III
  4. Subdireccion General de Redes y Centros de Investigacion Cooperativa, Ministerio de Economia y Competitividad
  5. Spanish Network for Research in Infectious Diseases (REIPI) [RD16/0016/0010]
  6. 2017 call for Strategic Action on Health [PI17/01932, PI17/01468]
  7. European Development Regional Fund A way to achieve Europe' and operative programme Intelligent Growth 2014-2020
  8. Innovative Medicines Initiative [115620]
  9. Department of Health, Generalitat de Catalunya [SLT002/16/00349]

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Objectives: To evaluate and compare the efficacy of real-time PCR (Xpert Carba-R) and loop-mediated isothermal amplification (Eazyplex (R) SuperBug CRE) for detecting carbapenemase carriage in Enterobacteriaceae directly from bronchoalveolar lavage (BAL). Methods: Negative BAL samples were spiked with 21 well-characterized carbapenemase-producing Enterobacteriaceae strains to a final concentration of 10(2)-10(4) cfu/mL. Xpert Carba-R (Cepheid, Sunnyvale, CA, USA), which detects five targets (bla(KPC), bla(NDM), bla(VIM), bla(OXA-48) and bla(IMP-1)), and the Eazyplex (R) SuperBug CRE system (Amplex-Diagnostics GmbH, Germany), which detects seven genes (bla(KPC), bla(NDM), bla(VIM), bla(OXA-48), bla(OXA-181), bla(CTXM-1) and bla(CTXM-9)), were evaluated for the detection of these genes directly from BAL samples. Results: Xpert Carba-R showed 100% agreement with carbapenemase characterization by PCR and sequencing for all final bacteria concentrations. Eazyplex (R) SuperBug CRE showed 100%, 80% and 27% agreement with PCR and sequencing when testing 10(4), 10(3) and 10(2) cfu/mL, respectively. False negative results for Eazyplex (R) SuperBug CRE matched the highest cycle threshold values for Xpert Carba-R. Hands-on time for both assays was about 15 min, but Eazyplex (R) SuperBug CRE results were available within 30 min, whereas Xpert Carba-R took around 50 min. Conclusions: We here describe the successful use of two commercial diagnostic tests, Xpert Carba-R and Eazyplex (R) SuperBug CRE, to detect bacterial carbapenem resistance genes directly in lower respiratory tract samples. Our results could be used as proof-of-concept data for validation of these tests for this indication.

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