Carbapenem resistance in Klebsiella pneumoniae not detected by automated susceptibility testing

Emerg Infect Dis. 2006 Aug;12(8):1209-13. doi: 10.3201/eid1208.060291.

Abstract

Detecting beta-lactamase-mediated carbapenem resistance among Klebsiella pneumoniae isolates and other Enterobacteriaceae is an emerging problem. In this study, 15 blaKPC-positive Klebsiella pneumoniae that showed discrepant results for imipenem and meropenem from 4 New York City hospitals were characterized by isoelectric focusing; broth microdilution (BMD); disk diffusion (DD); and MicroScan, Phoenix, Sensititre, VITEK, and VITEK 2 automated systems. All 15 isolates were either intermediate or resistant to imipenem and meropenem by BMD; 1 was susceptible to imipenem by DD. MicroScan and Phoenix reported 1 (6.7%) and 2 (13.3%) isolates, respectively, as imipenem susceptible. VITEK and VITEK 2 reported 10 (67%) and 5 (33%) isolates, respectively, as imipenem susceptible. By Sensititre, 13 (87%) isolates were susceptible to imipenem, and 12 (80%) were susceptible to meropenem. The VITEK 2 Advanced Expert System changed 2 imipenem MIC results from >16 ?g/mL to <2 ?g/mL but kept the interpretation as resistant. The recognition of carbapenem-resistant K. pneumoniae continues to challenge automated susceptibility systems.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / pharmacology*
  • Automation
  • Carbapenems / pharmacology*
  • Drug Resistance, Bacterial*
  • Humans
  • Imipenem / pharmacology
  • Klebsiella pneumoniae / drug effects*
  • Meropenem
  • Microbial Sensitivity Tests / instrumentation
  • Microbial Sensitivity Tests / methods
  • Reference Standards
  • Thienamycins / pharmacology

Substances

  • Anti-Bacterial Agents
  • Carbapenems
  • Thienamycins
  • Imipenem
  • Meropenem