• Foodborne diseases
• Salmonella
• Salmonella infections
• Salmonella typhi

• Adolescent
• Adult
• Child
• Humans
• Ampicillin/therapeutic use
• Anti-Bacterial Agents/pharmacology
• Anti-Bacterial Agents/therapeutic use
• Bacteremia/drug therapy
• Bacteremia/epidemiology
• Bacteremia/microbiology
• Cohort Studies
• Diarrhea/microbiology
• Hospitals, University
• Salmonella
• Salmonella Infections/drug therapy
• Salmonella Infections/epidemiology
• Salmonella Infections/microbiology
• South America
• Retrospective Studies

• Fundación Valle de Lili

• Djibouti
• Gram-negative bacilli
• carbapenem resistance

• 10-IHU-03 Méditerranée Infection Foundation

• Antibiotic resistance
• CPE
• CPGNB
• CRE
• Magnetic digital microfluidics
• Microfluidics

The rapid and accurate diagnostic methods to identify carbapenemase-producing organisms (CPO) is of great importance for controlling the CPO infection. Herein, we have developed a microfluidic chip-based technique to detect CPO and assessed its clinical value in detecting CPO directly from blood cultures (BCs). The detection performance of the microfluidic chip-based LAMP amplification method was analyzed retrospectively on a collection of 192 isolates including molecularly characterized 108 CPO and 84 non-CPO and prospectively on a collection of 133 positive BCs with or without CPO suspicion, respectively. In the retrospective study, the microfluidic chip-based LAMP amplification method exhibited 87.5% accuracy (95% CI [82.0–91.5]), 97.7% sensitivity (95% CI [91.2–99.6]), 78.8% specificity (95% CI [69.5–86.0]), 79.6% positive predictive value (PPV) (95% CI [70.6–86.5]) and 97.6% negative predictive value (NPV) (95% CI [90.9–99.6]). Among the 192 isolates, 22 (11.5%) false-positives (FP) and 2 (1.0%) false negatives (FN) were observed. In the prospective study, the 133 routine isolates of positive BCs including 18 meropenem-resistant CPO and 115 non-CPO were assessed, and 4 FP were observed in non-CPO and CPO, respectively. The current method showed a total detection performance of 94.0% accuracy (95% CI [88.4–97.1]), 100.0% sensitivity (95% CI [73.2–100.0]), 93.2% specificity (95% CI [86.7–96.8]), 63.6% PPV (95% CI [40.8–82.0]) and 100.0% NPV (95% CI [95.8–100.0]). In summary, the microfluidic chip-based LAMP amplification method is reliable for the rapid screening and detection of CPO with high accuracy, sensitivity, and specificity, and could easily be implemented in clinical microbiology laboratories.

IMPORTANCE Rapid and accurate identification of CPO may reduce the genetic exchanges among bacteria and prevent further dissemination of carbapenemases to non-CPO. The current method had designed microfluidic chip-based LAMP amplification method for multiplex detection of carbapenemase genes and evaluated the detection performance of the newly method. The current method can rapidly screen and detect CPO with high accuracy, sensitivity, and specificity, and could easily be implemented in clinical microbiology laboratories, as this will reduce the carbapenem resistance issues worldwide.

• blood cultures
• carbapenemase-producing organisms
• clinical bacteria isolates
• detection performance
• loop-mediated isothermal amplification
• microfluidic chips

The dissemination of antimicrobial-resistance is a major global threat affecting both human and animal health. Carbapenems are human use β-lactams of last resort; thus. the dissemination of carbapenemase-producing (CP) bacteria creates severe limitations for the treatment of multidrug-resistant bacteria in hospitalized patients. Even though carbapenems are not routinely used in veterinary medicine, reports of infection or colonization by carbapenemase-producing Enterobacterales in companion animals are being reported. NDM-5 and OXA-48-like carbapenemases are among the most frequently reported in companion animals. Like in humans, Escherichia coli and Klebsiella pneumoniae are the most represented CP Enterobacterales found in companion animals, alongside with Acinetobacter baumannii. Considering that the detection of carbapenemase-producing Enterobacterales presents several difficulties, misdiagnosis of CP bacteria in companion animals may lead to important animal and public-health consequences. It is of the upmost importance to ensure an adequate monitoring and detection of CP bacteria in veterinary microbiology in order to safeguard animal health and minimise its dissemination to humans and the environment. This review encompasses an overview of the carbapenemase detection methods currently available, aiming to guide veterinary microbiologists on the best practices to improve its detection for clinical or research purposes.

Antimicrobial resistance in Gram-negative bacteria is one of the greatest threats to global health. New antibacterial strategies are urgently needed, and the development of antibiotic adjuvants that either neutralize resistance proteins or compromise the integrity of the cell envelope is of ever-growing interest. Most available adjuvants are only effective against specific resistance proteins. Here, we demonstrate that disruption of cell envelope protein homeostasis simultaneously compromises several classes of resistance determinants. In particular, we find that impairing DsbA-mediated disulfide bond formation incapacitates diverse β-lactamases and destabilizes mobile colistin resistance enzymes. Furthermore, we show that chemical inhibition of DsbA sensitizes multidrug-resistant clinical isolates to existing antibiotics and that the absence of DsbA, in combination with antibiotic treatment, substantially increases the survival of Galleria mellonella larvae infected with multidrug-resistant Pseudomonas aeruginosa. This work lays the foundation for the development of novel antibiotic adjuvants that function as broad-acting resistance breakers.

Antibiotics, like penicillin, are the foundation of modern medicine, but bacteria are evolving to resist their effects. Some of the most harmful pathogens belong to a group called the 'Gram-negative bacteria', which have an outer layer – called the cell envelope – that acts as a drug barrier. This envelope contains antibiotic resistance proteins that can deactivate or repel antibiotics or even pump them out of the cell once they get in. One way to tackle antibiotic resistance could be to stop these proteins from working.

Proteins are long chains of building blocks called amino acids that fold into specific shapes. In order for a protein to perform its role correctly, it must fold in the right way. In bacteria, a protein called DsbA helps other proteins fold correctly by holding them in place and inserting links called disulfide bonds. It was unclear whether DsbA plays a role in the folding of antibiotic resistance proteins, but if it did, it might open up new ways to treat antibiotic resistant infections.

To find out more, Furniss, Kaderabkova et al. collected the genes that code for several antibiotic resistance proteins and put them into Escherichia coli bacteria, which made the bacteria resistant to antibiotics. Furniss, Kaderabkova et al. then stopped the modified E. coli from making DsbA, which led to the antibiotic resistance proteins becoming unstable and breaking down because they could not fold correctly.

Further experiments showed that blocking DsbA with a chemical inhibitor in other pathogenic species of Gram-negative bacteria made these bacteria more sensitive to antibiotics that they would normally resist. To demonstrate that using this approach could work to stop infections by these bacteria, Furniss, Kaderabkova et al. used Gram-negative bacteria that produced antibiotic resistance proteins but could not make DsbA to infect insect larvae. The larvae were then treated with antibiotics, which increased their survival rate, indicating that blocking DsbA may be a good approach to tackling antibiotic resistant bacteria.

According to the World Health Organization, developing new treatments against Gram-negative bacteria is of critical importance, but the discovery of new drugs has ground to a halt. One way around this is to develop ways to make existing drugs work better. Making drugs that block DsbA could offer a way to treat resistant infections using existing antibiotics in the future.

• E. coli
• infectious disease
• microbiology

Colistin is a polymyxin antibiotic of last resort for the treatment of infections caused by multi-drug-resistant Gram-negative bacteria. By targeting lipopolysaccharide (LPS), the antibiotic disrupts both the outer and cytoplasmic membranes, leading to bacterial death and lysis. Colistin resistance in Escherichia coli occurs via mutations in the chromosome or the acquisition of mobilized colistin-resistance (mcr) genes. Both these colistin-resistance mechanisms result in chemical modifications to the LPS, with positively charged moieties added at the cytoplasmic membrane before the LPS is transported to the outer membrane. We have previously shown that MCR-1-mediated LPS modification protects the cytoplasmic but not the outer membrane from damage caused by colistin, enabling bacterial survival. However, it remains unclear whether this observation extends to colistin resistance conferred by other mcr genes, or resistance due to chromosomal mutations. Using a panel of clinical E. coli that had acquired mcr −1, –1.5, −2, –3, −3.2 or −5, or had acquired polymyxin resistance independently of mcr genes, we found that almost all isolates were susceptible to colistin-mediated permeabilization of the outer, but not cytoplasmic, membrane. Furthermore, we showed that permeabilization of the outer membrane of colistin-resistant isolates by the polymyxin is in turn sufficient to sensitize bacteria to the antibiotic rifampicin, which normally cannot cross the LPS monolayer. These findings demonstrate that colistin resistance in these E. coli isolates is due to protection of the cytoplasmic but not outer membrane from colistin-mediated damage, regardless of the mechanism of resistance.

• E. coli
• MCR
• colistin
• lipopolysaccharide
• polymyxin
• resistance

• CPE
• ESBL
• carbapenemase
• detection methods
• multidrug resistance
• preanalytical parameters

• CRE
• Carbapenemase
• Carbapenemase-producing
• Enterobacterales
• KPC

• CR-hvKP
• Klebsiella pneumoniae
• antibiotics
• carbapenem resistance
• hypervirulence
• lower-middle-income countries
• neonatal sepsis
• treatment

• AST
• Blood
• LAMP
• MALDI-TOF
• PCR
• Rapid
• Sequencing
• T2MR

• Antimicrobial resistance
• ESBL; GenePOC Carba/Revogene Carba C Assay
• GeneXpert
• MALDI-TOF
• beta-lactamase
• carbapenemase
• in vitro diagnostic
• multi-drug resistant bacteria
• point-of-care
• real-time PCR
• whole genome sequencing

• AmpC β-lactamase
• Direct blood culture method
• Extended-spectrum-β-lactamase
• Fluorogenic probe
• Phenol red assay

• A. baumannii
• Carba NP
• carbapenemases
• tracheal aspirates

• blood culture
• blood-modified carbapenem inactivation method (Blood-mCIM)
• bloodstream infection
• carbapenemase
• carbapenemase-producing Enterobacteriaceae (CPE)
• modified carbapenem inactivation method (mCIM)
• phenotypic detection

• carbapenemase-producing Enterobacteriaceae
• direct
• fluorogenic assay
• fluorogenic probe
• positive blood culture

• CIM test
• ESBL detection
• blood culture
• carbapenemase detection

• Anti-Bacterial Agents/pharmacology
• Bacterial Proteins/biosynthesis
• Bacterial Proteins/genetics
• Carbapenem-Resistant Enterobacteriaceae/classification
• Carbapenem-Resistant Enterobacteriaceae/drug effects
• Carbapenem-Resistant Enterobacteriaceae/genetics
• Carbapenem-Resistant Enterobacteriaceae/isolation & purification
• Enterobacteriaceae Infections/diagnosis
• Enterobacteriaceae Infections/microbiology
• Humans
• Microbial Sensitivity Tests
• Reproducibility of Results
• beta-Lactam Resistance
• beta-Lactamases/biosynthesis
• beta-Lactamases/genetics

• Department of Sciences of Public Health and Pediatrics

Early identification of infections caused by carbapenemase-producing Enterobacterales (CPE) can help to optimize patient treatment and improve outcome. In this study, protocols for rapid detection of carbapenemase production directly from positive blood cultures were developed applying a concentration and hemolysis step before a test for carbapenemase production was performed.

Early identification of infections caused by carbapenemase-producing Enterobacterales (CPE) can help to optimize patient treatment and improve outcome. In this study, protocols for rapid detection of carbapenemase production directly from positive blood cultures were developed applying a concentration and hemolysis step before a test for carbapenemase production was performed. Four different methods (three modified colorimetric assays [β-Carba, bcCarba NP, and NeoRapid Carb] and a variation of the carbapenem inactivation method [CIM] test with blood cultures [bcCIM]) were assessed on blood cultures spiked with 185 different molecularly characterized Enterobacterales isolates. The challenge collection included 81 carbapenemase-negative isolates and 104 CPEs (OXA-48 [n = 25], NDM [n = 20], KPC [n = 18], VIM [n = 25], GIM [n = 5], OXA-48-like [n = 9], and OXA-48-like plus NDM [n = 2]). The sensitivity/specificity was 99.0%/95.1% for bcCarba NP, 99.0%/91.4% for NeoRapid Carb, 100%/95.1% for β-Carba and 100%/100% for bcCIM. Weakly hydrolyzing carbapenemases (e.g., OXA-48-like) were also well detected by the assays. The time to result was 20 to 45 min for β-Carba, 2 to 3 h for bcCarba NP, 2.5 to 2 h for NeoRapid Carb, and 18 to 24 h for bcCIM. In conclusion, all assays demonstrated good detection of CPE. The protocols can be easily implemented in any clinical microbiology laboratory and could help to optimize therapy early in bloodstream infections by CPE.

• CIM
• CPE
• Carba NP
• KPC
• NDM
• OXA-48
• VIM
• blood stream infection
• carbapenemase
• colorimetric
• β-Carba

The rapid detection of carbapenemase allows implementation of infection control measures and adaptation of antibiotic therapy. We evaluated the performances of the Xpert Carba-R V2^® assay for the direct detection and identification of carbapenemase on positive blood cultures. We focused our evaluation on its detection capacity and on the risks of interference due to the patient’s blood. Isolates of several variants of OXA-48-like (n=10), KPC (n=10), NDM (n=11), VIM (n=7), IMP-1 (n=1) carbapenemases and 14 non carbapenemase-producing Enterobacteriaceae were tested. For each isolate (n=53), an aerobic vial was seeded, and incubated in Bactec Fx (Becton Dickinson^®) automate. When positive, the Xpert^® Carba-R-V2 assay was assessed for carbapenemase detection using 40 µl aliquot. Reproducibility tests were performed on a subset of 23 isolates using aerobic and anaerobic vials. Longer incubation time was also evaluated on 6 isolates. A complementary prospective study in real-time testing of patient-derived clinical samples on 20 additional positive blood vials with Gram negative bacilli on direct examination was performed. Perfect sensitivity and specificity (100%) were observed regardless of the carbapenemase type, the blood vials used and the time of incubation. Xpert^® Carba-R-V2 assay is suitable for the rapid detection of the main carbapenemase genes directly on positive blood vials. Its performances and rapid time analysis allow its use in routine to guide therapeutic choices and to implement infection control measures.

• GeneXpert
• antibiotic therapy
• carbapenemase
• infection control measures
• positive blood culture
• rapid detection

• Gram-negative bacteria
• MALDI-TOF MS
• carbapenemase detection
• hydrolysis assay
• performances
• positive blood cultures

• bacteremia diagnosis
• blood culture
• clinical bacteriology
• laboratory medicine practices
• low-resource settings (LRS)

• IMP
• KPC
• NDM
• OXA-48-like
• VIM
• immunochromatography
• rapid diagnostic
• septicemia

The extended-spectrum beta-lactamase (ESBL) and carbapenemase producing gram-negative bacteria among the members of Enterobacteriaceae are of major health concern globally. The present study was carried out to determine proportion and genetic characterization of ESBL and carbapenemase producing Klebsiella pneumoniae strains isolated from intensive care units of a tertiary care hospital.

A total of 250 non-duplicate K. pneumoniae isolates were recovered from various clinical specimens from our intensive care units from May 2014 to May 2015. Antibiotic susceptibility testing was performed as recommended by Clinical and Laboratory Standard Institute. Phenotypic identification of ESBL and carbapenemase producing isolates were confirmed by the double-disk synergy test, modified Hodge test, imipenem and imipenem-EDTA combined test, respectively. Molecular characterization of β-lactamase genes were performed by polymerase chain reaction.

Out of 250 Klebsiella pneumonaie, 84% isolates were ESBL producers, 66% were carbapenem resistant based on their reduced susceptibility to imipenem, meropenem and ertapenem. Among these 165 carbapenem resistant isolates, 9.7% were positive for bla_NDM-1 and these isolates were also found to be positive for one or more bla genes. Co-carriage of AmpC in ESBL and carbapenem resistant isolates were 7.8% and 3.6%, respectively and were negative for bla_KPC genes.

The study indicated the prevalence of ESBLs and bla_NDM-1, with additional bla genes and AmpC among the K. pneumoniae isolates in our intensive care units. NDM-1 producing Enterobacteriaceae is a growing health care problem. Detection of the prevalence of antibacterial resistance pattern helps towards improved antibiotic policy and empirical antibiotic treatment.

Beena HB, Shenoy SM, et al. Molecular Characterization of Extended Spectrum β-lactamase and Carbapenemase Producing Klebsiella pneumoniae from a Tertiary Care Hospital. Indian J of Crit Care Med 2019;23(2):61-66.

• AmpC
• Carbapenemase
• Extended spectrum β-lactamase
• Metallo β-lactamase

• Blood culture
• Blue-Carba
• Carba-NP
• Carbapenemases
• KPC

• Bacterial Proteins/genetics
• Bacterial Proteins/metabolism
• Blood Culture/methods
• Enterobacteriaceae/classification
• Enterobacteriaceae/genetics
• Enterobacteriaceae/isolation & purification
• Enterobacteriaceae Infections/blood
• Enterobacteriaceae Infections/diagnosis
• Enterobacteriaceae Infections/microbiology
• Humans
• Polymerase Chain Reaction
• Sensitivity and Specificity
• Workflow
• beta-Lactamases/genetics
• beta-Lactamases/metabolism

Carbapenemase producing Enterobacteriaceae (CPE) are becoming a global healthcare concern. Current laboratory methods for the detection of CPE include screening followed by confirmatory phenotypic and genotypic tests. These processes would generally take ≥72 hours, which could negatively impact patient care and Infection Control practices. To this end, we developed a protocol for rapid resistance testing (RRT) to detect hydrolysis in a panel of beta lactam antibiotics consisting of ampicillin, cefazolin, cefotaxime and imipenem, using liquid chromatography tandem mass spectrometry. Ninety—nine beta lactamase producing Enterobacteriaceae isolates were used to evaluate the RRT method, 54 isolates were CPE and 45 isolates were Class A or AmpC beta lactamase producing Enterobacteriaceae but not carbapenemase producers. We also tested 10 E.coli isolates that were susceptible to ampicillin, cefazolin, cefotaxime and imipenem. Receiver Operating Characteristic (ROC) Curves analysis showed that imipenem had a sensitivity and a specificity of 100% for crabapenemase detection at hydrolysis cut off values that are greater than 50% and less than or equal to 80%. The RRT protocol can be conducted in a time frame of less than 2 hours. This preliminary study shows that the rapid resistance testing protocol might have utility for the rapid detection of CPE. Additional work with a greater number and variety of beta- lactamase producing Enterobacteriaceae isolates is required to validate these preliminary findings.

• Anti-Bacterial Agents/metabolism
• Anti-Bacterial Agents/pharmacology
• Anti-Bacterial Agents/therapeutic use
• Bacterial Proteins/isolation & purification
• Bacterial Proteins/metabolism
• Carbapenem-Resistant Enterobacteriaceae/drug effects
• Carbapenem-Resistant Enterobacteriaceae/isolation & purification
• Carbapenem-Resistant Enterobacteriaceae/metabolism
• Carbapenems/metabolism
• Carbapenems/pharmacology
• Carbapenems/therapeutic use
• Cephalosporins/metabolism
• Cephalosporins/pharmacology
• Cephalosporins/therapeutic use
• Chromatography, High Pressure Liquid/instrumentation
• Chromatography, High Pressure Liquid/methods
• Enterobacteriaceae Infections/drug therapy
• Enterobacteriaceae Infections/microbiology
• Escherichia coli/drug effects
• Escherichia coli/metabolism
• Humans
• Hydrolysis
• Microbial Sensitivity Tests/instrumentation
• Microbial Sensitivity Tests/methods
• Tandem Mass Spectrometry/instrumentation
• Tandem Mass Spectrometry/methods
• Time Factors
• beta-Lactam Resistance
• beta-Lactamases/isolation & purification
• beta-Lactamases/metabolism

• Blood stream infection
• Carba NP
• Carbapenemase
• NDM
• OXA-48

• Anti-Bacterial Agents/pharmacology
• Bacterial Proteins/analysis
• Bacterial Proteins/metabolism
• Bacteriological Techniques
• Blood Culture
• Carbapenem-Resistant Enterobacteriaceae/drug effects
• Carbapenem-Resistant Enterobacteriaceae/enzymology
• Colorimetry
• Enterobacteriaceae/enzymology
• Enzyme Assays/methods
• Humans
• Microbial Sensitivity Tests
• Reagent Kits, Diagnostic
• Sensitivity and Specificity
• Time Factors
• beta-Lactamases/analysis
• beta-Lactamases/metabolism

Bloodstream infections caused by carbapenemase-producing Enterobacteriaceae (CPE) are associated with treatment failure and increased mortality. Detection of CPE from blood cultures (BC) by standard methods takes 16–72 hours, which can delay the initiation of appropriate antimicrobial therapy and compromise patient outcome. In the present study, we developed and evaluated a new method for the rapid detection of carbapenemases directly from positive BC using a new multiplex immunochromatographic test (ICT). The new ICT was assessed using 170 molecularly characterized Enterobacteriaceae clinical isolates including 126 CPE (OXA-48-like (N = 79), KPC (N = 18) and NDM (N = 29)). After spiking with bacteria and incubation in a BC system, blood from positive BC bottles was hemolyzed, bacteria concentrated by centrifugation and lysed. The lysate was transferred to the RESIST-3 O.K.N. ICT (Coris BioConcept, Gembloux, Belgium), which detects OXA-48-like, KPC and NDM carbapenemases. The final results of the ICT were read when they became positive, at the latest after 15 min. All CPE isolates (126/126) were correctly detected with the new protocol (100% sensitivity, 100% specificity). There was perfect concordance between ICT results and molecular characterization. Total time to result was 20–45 min.

Conclusions: This proof-of-principle study demonstrates that with the newly developed method, OXA-48-like, KPC and NDM carbapenemases can be reliably detected directly from positive BC bottles. The new method is more rapid than other currently available assays and can be performed in any routine microbiology laboratory. This can help to rapidly identify patients with CPE BSI and optimize the management of patients with these difficult-to-treat infections. Further studies are needed to assess the performance of the ICT in routine diagnostics.

• Bacterial Proteins/metabolism
• Blood Culture/methods
• Enterobacteriaceae/drug effects
• Enterobacteriaceae/enzymology
• Enterobacteriaceae/isolation & purification
• Humans
• Immunoassay/methods
• Sensitivity and Specificity
• Time Factors
• Zinc/pharmacology
• beta-Lactamases/metabolism

• Universität zu Köln

The global emergence of carbapenemases led to the need of developing new methods for their rapid detection. The aim of this study was to evaluate the performance of the rapid tests for carbapenemase-producing and non-producing Enterobacteriaceae. Carbapenem non-susceptible Enterobacteriaceae from a surveillance study submitted to a multiplex real time PCR for carbapenemase detection were included in this study. The isolates were subjected to the rapid phenotypic tests Carba NP, Blue-Carba and Carbapenem Inactivation Method (CIM). A total of 83 carbapenemase-producing (43) and non-producing (40) isolates were included in the study. The sensitivity/specificity were 62.7%/97.5%, 95.3%/100%, and 74.4%/97.5% for Carba NP, Blue-Carba and CIM, respectively. Both Carba NP and Blue-Carba presented their final results after 75 min of incubation; the final results for CIM were obtained only after 8 h. Failure to detect OXA-370 carbapenemase was the main problem for Carba NP and CIM assays. As the Blue-Carba presented the highest sensitivity, it can be considered the best screening test. Conversely, CIM might be the easiest to perform, as it does not require special reagents. The early detection of carbapenemases aids to establish infection control measures and prevent carbapenemases to spread reducing the risk of healthcare associated infections and therapeutic failure.

• Blue-Carba
• CIM
• Carba NP
• Carbapenemases
• Rapid tests

• blood culture
• carbapenemase
• colorimetric methods
• rapid test

• CHROMagar
• Carba NP test
• carbapenem-resistant Enterobacteriaceae
• modified Hodge test

• Blood cultures
• Disk diffusion
• Mueller-Hinton rapid-SIR
• Rapid antimicrobial susceptibility test

• Accelerate Pheno™ system
• Antimicrobial susceptibility testing
• Bacteremia
• Bloodstream infections
• Gram-negative bacteria
• Sepsis

• Enterobacteriaceae
• GES-5
• NDM-1
• carbapenemases
• plasmid-mediated resistance

• CIM
• Carba NP-direct
• carbapenemase
• β-CARBA

• carbapenemase
• carbapenemase detection tests
• carbapenem-producing organisms
• carbapenem-resistant enterobacteriaceae
• metallo-β-lactamase

• Anti-Bacterial Agents/therapeutic use
• Bacterial Proteins/genetics
• Bacterial Proteins/metabolism
• Carbapenem-Resistant Enterobacteriaceae/enzymology
• Carbapenem-Resistant Enterobacteriaceae/genetics
• Carbapenems/therapeutic use
• Enterobacteriaceae/enzymology
• Enterobacteriaceae/genetics
• Enterobacteriaceae Infections/epidemiology
• Enterobacteriaceae Infections/microbiology
• Enterobacteriaceae Infections/prevention & control
• Enterobacteriaceae Infections/therapy
• Global Health
• Humans
• Prevalence
• beta-Lactamases/genetics
• beta-Lactamases/metabolism

• CC999999 Intramural CDC HHS

• AST
• LAMP
• MALDI-TOF
• Microarray
• PCR
• Rapid
• Real time
• Sequencing

• Brazil
• Carbapenemases
• Enterobacteriaceae
• OXA-48
• OXA-48 K-SeT

• Blood culture
• Carbapenemases
• Detection
• Klebsiella pneumoniae
• MALDI-TOF MS

• Bacterial Proteins/analysis
• Bacterial Proteins/isolation & purification
• Bacterial Typing Techniques/methods
• Blood Culture/methods
• Cell Culture Techniques
• Cross Infection
• Enterobacteriaceae/enzymology
• Enterobacteriaceae/isolation & purification
• Ertapenem
• Humans
• Italy
• Klebsiella Infections/diagnosis
• Klebsiella pneumoniae/drug effects
• Klebsiella pneumoniae/enzymology
• Klebsiella pneumoniae/isolation & purification
• Laboratories
• Proteomics
• Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization/economics
• Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization/methods
• Time Factors
• beta-Lactamases/analysis
• beta-Lactamases/isolation & purification
• beta-Lactams/pharmacology

• P42 ES004911 NIEHS NIH HHS

• Carbapenemases
• Gram-negative
• Identification method
• Molecular methods
• Phenotypic methods

• Carba NP test
• Carbapenemase gene expression
• Carbapenemase-producing Enterobacteriaceae
• IMP type metallo-β-lactamase