Evaluation of methods for the detection of carbapenemases in Enterobacterales causing infections: a comparative study with Real-Time PCR in Cuba
Keywords:
Enterobacterales; carbapenemasas; métodos diagnósticos; resistencia antimicrobiana; CubaAbstract
Background: Carbapenemase-producing Enterobacterales are a public health problem due to their extreme drug resistance, high morbidity and mortality, and rapid spread. Early detection of these resistance mechanisms is critical for clinical and epidemiological control.
Objective: To evaluate the performance of two diagnostic methods available in Cuba the ROSCO combined disc test and Coris RESIST‑3 O.K.N. immunochromatography—for detecting metallo‑β‑lactamases, compared to real‑time PCR.
Methods: A retrospective cross-sectional observational study (2015–2018) was conducted at the Pedro Kourí Institute. One hundred carbapenem‑resistant Enterobacterales isolates from 11 hospitals across eight cuban provinces were analyzed by ROSCO, Coris RESIST‑3 O.K.N., and PCR for blaNDM, blaKPC, blaVIM, blaIMP. Sensitivity, specificity, positive and negative predictive values, and Cohen’s kappa index were calculated.
Results: Seventy-one isolates (71 %) harbored carbapenemase genes: blaNDM (100 %), blaKPC (12.7 %), and blaVIM (9.8 %), with 22.5 % co‑producers. The ROSCO method classified 100 % of the isolates as positive (carbapenemase producers) and showed 100 % sensitivity and specificity, with very good concordance (κ=1.00). Ninety-one percent of the isolates were positive using the RESIST-3 O.K.N. method, which had a sensitivity of 90.14 %, a specificity of 100 %, and very good concordance (κ=0.84). Both methods demonstrated a high positive predictive value (100 %).
Conclusions: The evaluated methods constitute useful alternatives for detecting carbapenemases in Cuban laboratories without access to PCR, optimizing surveillance and outbreak control. The predominance of NDM and the co-production of different genetic types underscore the need to strengthen microbiological and epidemiological surveillance to reduce the morbidity and mortality associated with this emergency.
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