The combined-disk boronic acid test as an accurate strategy for the detection of KPC carbapenemase in Central America

  • Julio Zúñiga Gorgas Memorial Institute for Health Studies, Panama City, Panama
  • Gerardo Cruz Complejo Hospitalario Dr. Arnulfo Arias Madrid, Panama City, Panama
  • Carlos Pérez Complejo Hospitalario Dr. Arnulfo Arias Madrid, Panama City, Panama
  • LCRSP Microbiology Group Laboratorio Central de Referencia en Salud Pública, Gorgas Memorial Institute for Health Studies, Panama City, Panama
  • Musharaf Tarajia Instituto de Investigaciones Científicas y Servicios de Alta Tecnología, Ciudad del Saber, Panama
Keywords: carbapenemase, disease outbreaks, drug resistance, polymerase chain reaction, public health

Abstract

Introduction: Carbapenemase-producing Klebsiella pneumoniae (KPC) outbreaks may cause a huge economical burden on developing countries. Furthermore, KPC can be challenging to detect. We describe the laboratory strategy for the detection of KPC from 2011 to 2013 in a tertiary care hospital in Central America with approximately 1,000 beds.

Methodology: A retrospective analysis of a clinical laboratory database was done to determine the pragmatic application of the combined-disk boronic acid test during a KPC outbreak in Panama. A total of 1,026 Klebsiella pneumoniae isolates were found, of which 133 were positive for KPC. The strategy during two phases was described according to the test employed as a confirmatory test for KPC. After the K. pneumoniae isolates were detected by the VITEK 2 system, blaKPC polymerase chain reaction (PCR) and the combined-disk boronic acid test were employed as a confirmatory test during phase one. The combined-disk boronic acid test was employed as a confirmatory test for KPC during phase two.

Results: The sensitivity, specificity, positive predictive value, and negative predictive value of the boronic acid test were 100%, 97%, 91%, and 100%, respectively, when blaKPC PCR was employed as a confirmatory test during the start of the outbreak. Afterwards, modified VITEK 2 system parameters resulted in 116 suspicious KPC samples and the boronic acid test confirmed 102 isolates.

Conclusions: The use of an automated bacterial identification system and the boronic acid test for the detection of KPC was an effective and low-cost strategy for a clinical laboratory in Panama during an outbreak.

Author Biographies

LCRSP Microbiology Group, Laboratorio Central de Referencia en Salud Pública, Gorgas Memorial Institute for Health Studies, Panama City, Panama
Microbiology Department
Musharaf Tarajia, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología, Ciudad del Saber, Panama
Centro de Biología Celular y Molecular de Enfermedades
Published
2016-03-31
How to Cite
1.
Zúñiga J, Cruz G, Pérez C, Microbiology Group L, Tarajia M (2016) The combined-disk boronic acid test as an accurate strategy for the detection of KPC carbapenemase in Central America. J Infect Dev Ctries 10:298-303. doi: 10.3855/jidc.7213
Section
Brief Original Articles