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

Abstract Objectives Infections caused by carbapenem-resistant Enterobacteriaceae (CRE) are major public health threats, and the most important mechanism of resistance to carbapenems in CRE is the production of cabarpenemases. Early identification of carbapenemase-producing Enterobacteriaceae (CPE) leads to improved clinical outcomes. This systematic review was to assess the accuracy and applicability of the modified Hodge’s test (MHT), carbapenemase Nordmann-Poirel test (Carba NP), modified carbapenem inactivation method (mCIM) and matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF-MS) for CPE detection. Methods The meta-analysis included pooled sensitivity, specificity, diagnostic odds ratio, summary receiver operating characteristic curve, and area under the curve. Results 67 studies were included for the analysis. The pooled sensitivities of MHT, Carba NP, mCIM and MALDI-TOF MS were 92% (95% CI: 87%-95%), 97% (95% CI: 94%-98%), 99% (95% CI: 99%-100%), and 99% (95% CI: 96%-100%), respectively; the pooled specificities were 93% (95% CI: 86%-97%), 100% (95% CI: 99%-100%), 99% (95% CI: 96%-100%), and 99% (95% CI: 96%-100%), respectively; the pooled diagnostic odds ratios were 98.156 (95% CI: 48.175-199.995), 1277.710 (95%CI: 751.391-2172.692), 3597.352 (95% CI: 1287.575-10000), and 1781.360 (95% CI: 651.827-4868.228), respectively; the pooled AUC values of the SROC were 0.97, 1, 1, and 1, respectively. Conclusions Carba NP, mCIM and MALDI-TOF MS all demonstrated high accuracies in CPE detection, while MHT was not recommended due to some clear drawbacks. We recommended the selection of carbapenemase detection tests in the order of mCIM, Carba NP and MALDI-TOF MS according to their simplicities, costs and the equipments and skills involved.