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Strategies for identification of carbapenemase-producing Enterobacteriaceae.

The spread of carbapenem-hydrolysing β-lactamases in Enterobacteriaceae is becoming a major public health issue. These β-lactamases hydrolyse almost all β-lactams, are plasmid-encoded and are easily transferable among enterobacterial species. They are found in multidrug-resistant isolates. Detection of these isolates from infected specimens first relies on careful recognition of any decreased susceptibility to carbapenems. After this, rapid biochemical identification of carbapenemase producers using the novel Carba NP test should be performed. Subsequently, molecular techniques can be used to identify carbapenemase genes if necessary (epidemiology). Detection of carriers relies on a preliminary screening step, with stools or rectal swabs being screened on selective culture media such as SUPERCARBA medium, which posseses the broadest spectrum for detecting any type of carbapenemase producer.