Accuracy and applicability of different phenotypic methods for carbapenemase detection in Enterobacteriaceae: A systematic review and meta-analysis

Objectives: Carbapenem-resistant Enterobacteriaceae (CRE) are a major public-health threat. The most important mechanism of carbapenem resistance in CRE is carbapenemase production. Early identi fication of carbapenemase-producing Enterobacteriaceae (CPE) leads to improved clinical outcomes. This systematic review aimed to assess the accuracy and applicability of the modi fied Hodge test (MHT), the carbapenemase Nordmann-Poirel (Carba NP) test, the modi fied carbapenem inactivation method (mCIM) and matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF/MS) for CPE detection. Methods: The meta-analysis included pooled sensitivity, speci ficity, diagnostic odds ratio, and summary receiver operating characteristic (SROC) curve and area under the curve (AUC). Results: A total of 67 studies were included in the analysis. Pooled effect sizes (95% con fidence interval) of the MHT, Carba NP, mCIM and MALDI-TOF/MS, respectively, were as follows: sensitivity, 92% (87-95%), 97% (94-98%), 99% (99-10 0%) and 99% (96-100%); speci ficity, 93% (86-97%), 100% (99-10 0%), 99% (96-10 0%) and 99% (96-10 0%); diagnostic odds ratio, 98.156 (48.175-199.995), 1277.710 (751.391-2172.692), 3597.352 (1287.575-10000) and 1781.360 (651.827-4868.228); and AUC, 0.97, 1, 1 and 1. Conclusion: Carba NP, mCIM and MALDI-TOF/MS all demonstrated high accuracy in CPE detection, whereas the MHT is not recommended owing to some clear drawbacks. We recommend the selection of carbapenemase detection tests in the order of mCIM, Carba NP and MALDI-TOF/MS according to their simplicity, cost, and equipment and skills involved. (C) 2019 International Society for Antimicrobial Chemotherapy. Published by Elsevier Ltd.