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Peer-reviewedCC BY 4.0Journal of Clinical Microbiology

Performance of seven carbapenemase detection assays in Pseudomonas aeruginosa across different epidemiological settings: a multicenter cross-sectional study

  • Lukas Schaffarczyk1,2
  • Rebekka Laufenberg3
  • Timo J. B. van Eldijk1
  • Niels Pfennigwerth4
  • Sören Gatermann4
  • Axel Hamprecht1,2,5,6
6 affiliations
  1. 1Department of Medical Microbiology and Virology, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
  2. 2Institute of Medical Microbiology and Virology, Klinikum Oldenburg, Oldenburg, Germany
  3. 3SYNLAB MVZ Leverkusen GmbH, Leverkusen, Germany
  4. 4Department of Medical Microbiology, Ruhr-University Bochum, German National Reference Center for Multidrug-resistant Gram-negative Bacteria, Bochum, Germany
  5. 5Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, University Hospital, Cologne, Germany
  6. 6German Center for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
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Abstract

The detection of carbapenemases in Pseudomonas aeruginosa remains challenging due to a great variety of other resistance mechanisms, and most laboratories, therefore, do not test for them. This study aimed to comparatively evaluate seven phenotypic carbapenemase detection assays across three epidemiological settings. A total of 320 P. aeruginosa isolates from three German centers with varying carbapenemase prevalences (5.8%–51.4%), including 113 carbapenemase-producing isolates carrying VIM-2 (n = 58), NDM-1 (n = 19), and GIM-1 (n = 16), underwent whole-genome sequencing as reference to assess seven phenotypic carbapenemase-detection tests: modified- and modified-zinc-supplemented carbapenem inactivation method (mCIM and mzCIM), simplified carbapenem inactivation method (sCIM), Carba NP, imipenem–cloxacillin test (IC-4000), and two imipenem–EDTA disk assays. Of all confirmation assays, mzCIM and sCIM showed the best overall performance for carbapenemase detection (sensitivity/specificity: 100%/94.2% and 99.1%/92.8%), followed by mCIM (93.8%/96.1%). Carba NP achieved the highest specificity (99.0%), but the lowest sensitivity (85.8%). EDTA-based assays and IC-4000 were highly sensitive (96.5%–100%) but less specific (79.7%–87.0%). Negative predictive values were consistently high (≥98%–100%) across all assays and prevalence settings, whereas positive predictive values varied (72.5%–98.0%). Both mzCIM and sCIM exhibited robust performance for carbapenemase detection in P. aeruginosa, representing the most suitable approach across diverse epidemiological settings. Their high negative predictive values indicate that these assays are particularly effective for ruling out carbapenemase production. Furthermore, both assays are cost-effective, simple to perform, and can be readily implemented in any routine microbiology laboratory.

IMPORTANCE: This study provides comparative diagnostic accuracy data for seven phenotypic carbapenemase detection assays in Pseudomonas aeruginosa (PA) across different prevalence settings. Modified-zinc-supplemented carbapenem inactivation method (mzCIM) and simplified carbapenem inactivation method (sCIM) are the most robust screening tools and show that local carbapenemase-producing P. aeruginosa (CP-PA) prevalence substantially influences the utility of all evaluated assays.

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Cite

BibTeXRIS
BibTeX
@article{schaffarczyk2026performance,
  title = {{Performance of seven carbapenemase detection assays in Pseudomonas aeruginosa across different epidemiological settings: a multicenter cross-sectional study}},
  author = {Lukas Schaffarczyk and Rebekka Laufenberg and Timo J. B. van Eldijk and Niels Pfennigwerth and Sören Gatermann and Axel Hamprecht},
  journal = {Journal of Clinical Microbiology},
  year = {2026},
  month = sep,
  doi = {10.1128/jcm.00714-26},
  url = {https://doi.org/10.1128/jcm.00714-26},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Performance of seven carbapenemase detection assays in Pseudomonas aeruginosa across different epidemiological settings: a multicenter cross-sectional study
AU  - Lukas Schaffarczyk
AU  - Rebekka Laufenberg
AU  - Timo J. B. van Eldijk
AU  - Niels Pfennigwerth
AU  - Sören Gatermann
AU  - Axel Hamprecht
PY  - 2026
DA  - 2026/09/17
JO  - Journal of Clinical Microbiology
DO  - 10.1128/jcm.00714-26
UR  - https://doi.org/10.1128/jcm.00714-26
AB  - The detection of carbapenemases in Pseudomonas aeruginosa remains challenging due to a great variety of other resistance mechanisms, and most laboratories, therefore, do not test for them. This study aimed to comparatively evaluate seven phenotypic carbapenemase detection assays across three epidemiological settings. A total of 320 P. aeruginosa isolates from three German centers with varying carbapenemase prevalences (5.8%–51.4%), including 113 carbapenemase-producing isolates carrying VIM-2 (n = 58), NDM-1 (n = 19), and GIM-1 (n = 16), underwent whole-genome sequencing as reference to assess seven phenotypic carbapenemase-detection tests: modified- and modified-zinc-supplemented carbapenem inactivation method (mCIM and mzCIM), simplified carbapenem inactivation method (sCIM), Carba NP, imipenem–cloxacillin test (IC-4000), and two imipenem–EDTA disk assays. Of all confirmation assays, mzCIM and sCIM showed the best overall performance for carbapenemase detection (sensitivity/specificity: 100%/94.2% and 99.1%/92.8%), followed by mCIM (93.8%/96.1%). Carba NP achieved the highest specificity (99.0%), but the lowest sensitivity (85.8%). EDTA-based assays and IC-4000 were highly sensitive (96.5%–100%) but less specific (79.7%–87.0%). Negative predictive values were consistently high (≥98%–100%) across all assays and prevalence settings, whereas positive predictive values varied (72.5%–98.0%). Both mzCIM and sCIM exhibited robust performance for carbapenemase detection in P. aeruginosa, representing the most suitable approach across diverse epidemiological settings. Their high negative predictive values indicate that these assays are particularly effective for ruling out carbapenemase production. Furthermore, both assays are cost-effective, simple to perform, and can be readily implemented in any routine microbiology laboratory.  IMPORTANCE: This study provides comparative diagnostic accuracy data for seven phenotypic carbapenemase detection assays in Pseudomonas aeruginosa (PA) across different prevalence settings. Modified-zinc-supplemented carbapenem inactivation method (mzCIM) and simplified carbapenem inactivation method (sCIM) are the most robust screening tools and show that local carbapenemase-producing P. aeruginosa (CP-PA) prevalence substantially influences the utility of all evaluated assays.
SN  - 0095-1137
SN  - 1098-660X
ER  -