Comparison of the performance of three variations of the Carbapenem Inactivation Method (CIM, modified CIM [mCIM] and in-house method (iCIM)) for the detection of carbapenemase-producing Enterobacterales and non-fermenters

Abstract

Objective: The objective of this study was to compare the performance of an in-house CIM (iCIM) modification with the CIM and mCIM for the detection of carbapenemase production in 149 well characterised isolates (70 carbapenemase producers and 79 non-carbapenemase producers). Methods: Isolates were tested using the CIM, mCIM and iCIM procedures. The gold standard was genotypic characterisation by PCR. Results: For Acinetobacter baumannii, the sensitivity was low (10%) for the mCIM, 70% for the CIM but was 100% for the iCIM, with a specificity of 100% for all three. For Enterobacterales, the sensitivity of all three tests was 100% for Ambler class A and B β-lactamases, while the iCIM also had a sensitivity of 100% for class D β lactamases. The sensitivity in Enterobacterales was highest for the iCIM at 100% (CIM 98.2%, mCIM 96.2%). The specificity was 100% for the mCIM and 98% for the CIM and iCIM. For Pseudomonas aeruginosa, the sensitivity of the CIM (100%) was higher than the iCIM (85.7%) and the mCIM (71.4%). iCIM exhibited excellent sensitivity (100%) and specificity (98%) for carbapenemase detection in Enterobacterales and was able to detect two OXA-232 producers that the mCIM did not detect and an OXA-181 producer that the CIM did not detect. Conclusions: In conclusion, iCIM performed better than the CIM and mCIM for carbapenemase detection in A. baumannii and Enterobacterales, however the CIM achieved the highest sensitivity for carbapenemase detection in P. aeruginosa suggesting that different CIM variations should be utilised depending on the organism type.

Keywords

• Carbapenemase
• Phenotypic testing
• CIM test
• Antimicrobial resistance