Cargando…

Evaluation of the NG-Test CARBA 5 Lateral Flow Assay with an IMP-27-Producing Morganella morganii and Other Morganellaceae

An isolate of Morganella morganii (MMOR1) that tested susceptible to 3(rd)/4(th)-generation cephalosporins and intermediate to meropenem was characterized as positive for NDM and IMP carbapenemases by NG-Test CARBA 5. Our objective was to further investigate this result, given the inconsistent susce...

Descripción completa

Detalles Bibliográficos
Autores principales: Tarlton, Nicole J., Wallace, Meghan A., Potter, Robert F., Zhang, Kailun, Dantas, Gautam, Dubberke, Erik R., Burnham, Carey-Ann D., Yarbrough, Melanie L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Society for Microbiology 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10269506/
https://www.ncbi.nlm.nih.gov/pubmed/37199652
http://dx.doi.org/10.1128/spectrum.00793-23
_version_ 1785059184480354304
author Tarlton, Nicole J.
Wallace, Meghan A.
Potter, Robert F.
Zhang, Kailun
Dantas, Gautam
Dubberke, Erik R.
Burnham, Carey-Ann D.
Yarbrough, Melanie L.
author_facet Tarlton, Nicole J.
Wallace, Meghan A.
Potter, Robert F.
Zhang, Kailun
Dantas, Gautam
Dubberke, Erik R.
Burnham, Carey-Ann D.
Yarbrough, Melanie L.
author_sort Tarlton, Nicole J.
collection PubMed
description An isolate of Morganella morganii (MMOR1) that tested susceptible to 3(rd)/4(th)-generation cephalosporins and intermediate to meropenem was characterized as positive for NDM and IMP carbapenemases by NG-Test CARBA 5. Our objective was to further investigate this result, given the inconsistent susceptibility profile and unusual epidemiological profile for our region. The MMOR1 isolate was retested for antimicrobial susceptibilities and characterized for carbapenemase production. MMOR1 tested susceptible to ceftazidime, ceftriaxone, cefepime, aztreonam, and ertapenem, and intermediate to meropenem and imipenem. The isolate tested positive by carbapenem inactivation method (CIM) and CIM+EDTA (eCIM) testing, indicating metallo-β-lactamase production. The isolate tested negative for all carbapenemase genes on Xpert Carba-R, but positive for IMP on repeat testing of NG-Test CARBA 5. Whole-genome sequencing revealed MMOR1 contained bla(IMP-27), but no other carbapenemase genes. Additional testing with NG-Test CARBA 5 revealed a false-positive NDM band when the assay was overloaded with test inoculum. Supplementary isolates were tested with an overloaded inoculum (n = 6 M. morganii; n = 1 P. mirabilis; n = 1 IMP-27-producing P. rettgeri; n = 1 IMP-1-producing E. coli; n = 1 K. pneumoniae), and two non-carbapenemase-producing carbapenem non-susceptible M. morganii also generated a false-positive NDM band; though, this was not universal among this species. A dual IMP+/NDM+ M. morganii is an unusual result that should prompt additional investigation, especially in nonendemic regions and when the susceptibility profile is incompatible. IMP-27 is not detected by Xpert Carba-R but is variably detected by NG-Test CARBA 5. The microorganism inoculum used for NG-Test CARBA 5 must be carefully controlled for accurate results. IMPORTANCE The detection of carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE) is an important function of the clinical microbiology laboratory, where positive identifications have immediate implications for infection control and surveillance strategies in the inpatient setting and can inform appropriate selection of therapy among the various novel anti-CP-CRE agents. NG-Test CARBA 5 is a relatively new lateral flow assay used for detection of carbapenemases in CP-CRE. Here, we describe the characterization of a Morganella morganii isolate that generated a false-positive NDM carbapenemase detection by this assay, and perform bacterial test inoculum experiments with additional isolates to further investigate a cause of false-positive results using the NG-Test CARBA 5. While a lateral flow assay like the NG-Test CARBA 5 is a very desirable test format for clinical laboratories, there are pitfalls to avoid when performing this test and interpreting results, including recognizing an overloaded test assay, which could lead to false-positive results.
format Online
Article
Text
id pubmed-10269506
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher American Society for Microbiology
record_format MEDLINE/PubMed
spelling pubmed-102695062023-06-16 Evaluation of the NG-Test CARBA 5 Lateral Flow Assay with an IMP-27-Producing Morganella morganii and Other Morganellaceae Tarlton, Nicole J. Wallace, Meghan A. Potter, Robert F. Zhang, Kailun Dantas, Gautam Dubberke, Erik R. Burnham, Carey-Ann D. Yarbrough, Melanie L. Microbiol Spectr Research Article An isolate of Morganella morganii (MMOR1) that tested susceptible to 3(rd)/4(th)-generation cephalosporins and intermediate to meropenem was characterized as positive for NDM and IMP carbapenemases by NG-Test CARBA 5. Our objective was to further investigate this result, given the inconsistent susceptibility profile and unusual epidemiological profile for our region. The MMOR1 isolate was retested for antimicrobial susceptibilities and characterized for carbapenemase production. MMOR1 tested susceptible to ceftazidime, ceftriaxone, cefepime, aztreonam, and ertapenem, and intermediate to meropenem and imipenem. The isolate tested positive by carbapenem inactivation method (CIM) and CIM+EDTA (eCIM) testing, indicating metallo-β-lactamase production. The isolate tested negative for all carbapenemase genes on Xpert Carba-R, but positive for IMP on repeat testing of NG-Test CARBA 5. Whole-genome sequencing revealed MMOR1 contained bla(IMP-27), but no other carbapenemase genes. Additional testing with NG-Test CARBA 5 revealed a false-positive NDM band when the assay was overloaded with test inoculum. Supplementary isolates were tested with an overloaded inoculum (n = 6 M. morganii; n = 1 P. mirabilis; n = 1 IMP-27-producing P. rettgeri; n = 1 IMP-1-producing E. coli; n = 1 K. pneumoniae), and two non-carbapenemase-producing carbapenem non-susceptible M. morganii also generated a false-positive NDM band; though, this was not universal among this species. A dual IMP+/NDM+ M. morganii is an unusual result that should prompt additional investigation, especially in nonendemic regions and when the susceptibility profile is incompatible. IMP-27 is not detected by Xpert Carba-R but is variably detected by NG-Test CARBA 5. The microorganism inoculum used for NG-Test CARBA 5 must be carefully controlled for accurate results. IMPORTANCE The detection of carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE) is an important function of the clinical microbiology laboratory, where positive identifications have immediate implications for infection control and surveillance strategies in the inpatient setting and can inform appropriate selection of therapy among the various novel anti-CP-CRE agents. NG-Test CARBA 5 is a relatively new lateral flow assay used for detection of carbapenemases in CP-CRE. Here, we describe the characterization of a Morganella morganii isolate that generated a false-positive NDM carbapenemase detection by this assay, and perform bacterial test inoculum experiments with additional isolates to further investigate a cause of false-positive results using the NG-Test CARBA 5. While a lateral flow assay like the NG-Test CARBA 5 is a very desirable test format for clinical laboratories, there are pitfalls to avoid when performing this test and interpreting results, including recognizing an overloaded test assay, which could lead to false-positive results. American Society for Microbiology 2023-05-18 /pmc/articles/PMC10269506/ /pubmed/37199652 http://dx.doi.org/10.1128/spectrum.00793-23 Text en Copyright © 2023 Tarlton et al. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International license (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Research Article
Tarlton, Nicole J.
Wallace, Meghan A.
Potter, Robert F.
Zhang, Kailun
Dantas, Gautam
Dubberke, Erik R.
Burnham, Carey-Ann D.
Yarbrough, Melanie L.
Evaluation of the NG-Test CARBA 5 Lateral Flow Assay with an IMP-27-Producing Morganella morganii and Other Morganellaceae
title Evaluation of the NG-Test CARBA 5 Lateral Flow Assay with an IMP-27-Producing Morganella morganii and Other Morganellaceae
title_full Evaluation of the NG-Test CARBA 5 Lateral Flow Assay with an IMP-27-Producing Morganella morganii and Other Morganellaceae
title_fullStr Evaluation of the NG-Test CARBA 5 Lateral Flow Assay with an IMP-27-Producing Morganella morganii and Other Morganellaceae
title_full_unstemmed Evaluation of the NG-Test CARBA 5 Lateral Flow Assay with an IMP-27-Producing Morganella morganii and Other Morganellaceae
title_short Evaluation of the NG-Test CARBA 5 Lateral Flow Assay with an IMP-27-Producing Morganella morganii and Other Morganellaceae
title_sort evaluation of the ng-test carba 5 lateral flow assay with an imp-27-producing morganella morganii and other morganellaceae
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10269506/
https://www.ncbi.nlm.nih.gov/pubmed/37199652
http://dx.doi.org/10.1128/spectrum.00793-23
work_keys_str_mv AT tarltonnicolej evaluationofthengtestcarba5lateralflowassaywithanimp27producingmorganellamorganiiandothermorganellaceae
AT wallacemeghana evaluationofthengtestcarba5lateralflowassaywithanimp27producingmorganellamorganiiandothermorganellaceae
AT potterrobertf evaluationofthengtestcarba5lateralflowassaywithanimp27producingmorganellamorganiiandothermorganellaceae
AT zhangkailun evaluationofthengtestcarba5lateralflowassaywithanimp27producingmorganellamorganiiandothermorganellaceae
AT dantasgautam evaluationofthengtestcarba5lateralflowassaywithanimp27producingmorganellamorganiiandothermorganellaceae
AT dubberkeerikr evaluationofthengtestcarba5lateralflowassaywithanimp27producingmorganellamorganiiandothermorganellaceae
AT burnhamcareyannd evaluationofthengtestcarba5lateralflowassaywithanimp27producingmorganellamorganiiandothermorganellaceae
AT yarbroughmelaniel evaluationofthengtestcarba5lateralflowassaywithanimp27producingmorganellamorganiiandothermorganellaceae