Abstract
BackgroundThere is an unmet need for rapid detection of carbapenemase-producing Klebsiella pneumoniae (CPK) for patient care and infection control. The BD MAX™ CRE (automated PCR, Geneohm, Canada) test is the fully automated sample-to-result platform for detection of resistance genes, blaKPC, blaOXA-48 and blaNDM within 2 hours. It has been validated for using with colonies and rectal swab. We aimed to evaluate its performance for detection of carbapenemases genes directly from respiratory samples of the patients whom K. pneumoniae (KP) were identified.MethodsA total of 169 KP isolates and respiratory samples were collected from patients admitted to King Chulalongkorn Memorial Hospital, Bangkok, Thailand from June 2017 to December 2017. The automated PCR test was performed directly from respiratory specimens. The results were compared with in-house PCR for detection of carbapenemase genes performed on KP colonies isolated from respiratory specimens as our reference method. Patient and clinical characteristics between patients with CPK and non-CPK were also analyzed.ResultsThe prevalence of CPK was 10.6% (18/169 isolates). The automated PCR test had 91.12% accuracy, 66.7% sensitivity (95% CI, 40.9–86.6), 94.0% specificity (95% CI, 88.9–86.6), 57.1% positive predictive value (95% CI, 39.5–73.1) and 95.9% negative predictive value (95% CI, 92.48–97.85). Of 18 isolates, blaOXA-48 was the most common carbapenemase gene (17 isolates; 94.4%), followed by blaNDM-1 (7 isolates; 38.9%). A combination of blaOXA-48 and blaNDM-1 was detected in 6 isolates (33.3%). There were 7 (38.8%) colonizations and 11 (61.1%) infections. The significant risk factors for CPK included post-surgery (P = 0.04) and prior antibiotics exposure (P = 0.04). There was a trend toward higher mortality in patients with CPK albeit not significantly (33% vs. 24.5%, P = 0.41).ConclusionThe automated PCR test has an acceptable accuracy with fair sensitivity for the detection of carbapenemase genes. It is unique that OXA-48 and OXA-48/NDM-1 are the most common carbapenemases in our institute. This diagnostic test may be use for rapid diagnosis or infection control purposes. Exposure to antibiotics associated with colonization or infection with CPK. Patients with CPK had higher mortality.Disclosures All authors: No reported disclosures.
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