A Review of Phenotypic Carbapenemase Detection Methods

Yücel Duman; Altan Akıneden; Selçuk Türkel

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Fenotipik Karbapenemaz Tespit Yöntemlerinin İncelenmesi

Öz

Karbapenemler, Gram-negatif, Gram-pozitif ve anaerobik bakteriler tarafından kaynaklanan çoklu ilaç dirençli enfeksiyonların tedavisinde kullanılan geniş spektrumlu antibiyotiklerdir. Ancak, bu antibiyotikleri aşırı kullanımı, karbapenem dirençli bakterilerin (CRB) artışına yol açmış ve bu durum tedavi açısından önemli zorluklar yaratmıştır. Karbapenem direnci, öncelikle karbapenemleri hidrolize eden ve genellikle plazmidler tarafından kodlanan karbapenemaz enzimlerinin üretimiyle aracılık edilmektedir, bu da genetik materyalin yatay transferini kolaylaştırır. Karbapenemaz üreten organizmaların hızlı bir şekilde tespiti, etkili antimikrobiyal yönetim ve direnç yayılmasının önlenmesi için çok önemlidir. Karbapenemazları tespit etmek için fenotipik yöntemler arasında disk difüzyon, minimum inhibitör konsantrasyon (MIC) yöntemleri, gradyan difüzyon, otomatik sistemler ve kromojenik ortamlar bulunmaktadır. Carba NP testi ve immünokromatografik analizler gibi daha ileri teknikler, direnç profillerinin hızlı bir şekilde tanımlanmasını sağlarken, spektrofotometrik analizler enzimatik hidrolizi tespit eder. Yöntem seçimi, duyarlılık, özgüllük ve klinik bağlama bağlıdır. Erken ve doğru tespit, tedavinin zamanında ayarlanmasına olanak tanır, hasta sonuçlarını optimize eder ve geniş spektrumlu antibiyotikleri yanlış kullanımı sınırlayarak hastaların tedavi süreçlerini iyileştirir.

Anahtar Kelimeler

A Review of Phenotypic Carbapenemase Detection Methods

Abstract

Carbapenems are broad-spectrum antibiotics used to treat multidrug-resistant infections caused by Gram-negative, Gram-positive, and anaerobic bacteria. However, the overuse of these antibiotics has led to the rise of carbapenem-resistant bacteria (CRB), which present significant treatment challenges. Carbapenem resistance is primarily mediated by the production of carbapenemase enzymes, which hydrolyze carbapenems and are often encoded by plasmids, facilitating horizontal gene transfer. Rapid detection of carbapenemase-producing organisms is crucial for effective antimicrobial stewardship and preventing the spread of resistance. Phenotypic methods for detecting carbapenemases include disk diffusion, minimum inhibitory concentration (MIC) methods, gradient diffusion, automated systems, and chromogenic media. More advanced techniques, such as the Carba NP test and immunochromatographic assays, provide rapid identification of resistance profiles, while spectrophotometric analysis detects enzymatic hydrolysis. The choice of method depends on sensitivity, specificity, and clinical context. Early and accurate detection allows for timely adjustments to treatment, optimizing patient outcomes and limiting the misuse of broad-spectrum antibiotics.

Keywords

Supporting Institution

No financial or personal relationships with other individuals or organizations have influenced the content or interpretation of this work.

Project Number

yok

Ethical Statement

We hereby confirm that our manuscript entitled “A Review of Phenotypic Carbapenemase Detection Methods” is a narrative review article based entirely on previously published data and does not involve any human or animal subjects, experiments, or patient-identifiable information. Therefore, ethical approval was not required for this type of article.

Thanks

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