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<!DOCTYPE html> <html prefix='og: http://ogp.me/ns#'> <head> <link as='font' crossorigin='anonymous' href='https://public.cureus.com/fonts/inter/Inter-Bold.woff2' rel='preload' type='font/woff2'> <link as='font' crossorigin='anonymous' href='https://public.cureus.com/fonts/roboto-slab-v24-latin-regular.woff2' rel='preload' type='font/woff2'> <link as='font' crossorigin='anonymous' href='https://public.cureus.com/fonts/inter/Inter-Regular.woff2' rel='preload' type='font/woff2'> <link as='font' crossorigin='anonymous' href='https://public.cureus.com/fonts/inter/Inter-SemiBold.woff2' rel='preload' type='font/woff2'> <meta charset='utf-8'> <meta content='zjkqdnefb408s8r553whzqbqpwzt4h' name='facebook-domain-verification'> <script src='https://scripts.webcontentassessor.com/scripts/6644f6ec6410f12d38d14e10b9fd8b26e52181f9a3967852a941195459957aa4' type='application/javascript'></script>  <script> window.dataLayer = window.dataLayer || []; </script> <style> .async-hide { opacity: 0 !important} </style> <link rel="stylesheet" media="all" href="https://assets.cureus.com/packs/application-602998cf-1.css" /> <link rel="stylesheet" media="all" href="https://assets.cureus.com/packs/application-602998cf-2.css" /> <link rel="stylesheet" media="all" href="https://assets.cureus.com/packs/application-602998cf-3.css" /> <link rel="stylesheet" media="all" href="https://assets.cureus.com/packs/application-602998cf-4.css" /> <link rel="stylesheet" media="all" href="https://assets.cureus.com/packs/application-602998cf-5.css" /> <link rel="stylesheet" media="screen" href="https://assets.cureus.com/packs/css/ie_application-89da44eb.css" />  <script>(function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start': new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0], j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src= 'https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f); })(window,document,'script','dataLayer','GTM-5L5TP48');</script> <meta data-hubspot-id='pe46589883'> <script src='https://lngtd.com/cureus.js'></script> <script src='https://d3js.org/d3.v4.js'></script> <script src='https://d3js.org/d3-scale-chromatic.v1.min.js'></script> <script src='https://d3js.org/d3-geo-projection.v2.min.js'></script> <script src='https://cdnjs.cloudflare.com/ajax/libs/d3-tip/0.7.1/d3-tip.min.js'></script> <script src='https://cdnjs.cloudflare.com/ajax/libs/d3-legend/2.13.0/d3-legend.js'></script> <title>Modified Carbapenem Inactivation Method and Ethylenediaminetetraacetic Acid (EDTA)-Carbapenem Inactivation Method for Detection of Carbapenemase-Producing Enterobacterales and Pseudomonas aeruginosa | Cureus</title> <meta name="csrf-param" content="authenticity_token" /> <meta name="csrf-token" content="yz64YoftYwnZ/hqPbnvj4Ccr/ODyOcZ0ssZIjRJQOji/MWK4R4W9BtrXydWsMKmp4rXieizAMfB80jcLTEtl7Q==" /> <meta site='Cureus'> <meta content='width=device-width, initial-scale=1.0' name='viewport'> <meta content='text/html;charset=utf-8' http-equiv='Content-Type'> <meta content='Introduction: The rising incidence of carbapenem resistance in Enterobacterales and Pseudomonas aeruginosa is a concern. Since carbapenemase production is the primary resistance mechanism, detecting and identifying the genes responsible for it is crucial to effectively monitor its spread. Objective: This study aims to detect positivity for the modified carbapenem inactivation method (mCIM) and ethylenediaminetetraacetic acid (EDTA)-carbapenem inactivation method (eCIM) for the detection of carbapenemase-producing Enterobacterales and Pseudomonas aeruginosa. Methods: Methods: A cross-sectional study was carried out at a tertiary care hospital, including 250 clinical isolates of Enterobacterales and Pseudomonas aeruginosa. These isolates exhibited resistance to at least one of the carbapenems as determined by the VITEK AST 2 System (bioMérieux, USA). The isolates were subjected to mCIM testing, and those that tested positive were further tested using eCIM. The results were interpreted in accordance with the guidelines provided by the Clinical and Laboratory Standards Institute (CLSI) 2023. Results: Out of the total 250 carbapenem-resistant Enterobacterales and Pseudomonas aeruginosa isolates, 151 (60.4%) were Klebsiella pneumonia, 44 (17.6%) were Escherichia coli, 10 (4.0%) were Enterobacter cloacae, 6 (2.4%) were Providencia spp., 4 (1.6%) were Serratia marcescens, 4 (1.6%) were Proteus mirabilis and 31 (12.4%) were Pseudomonas aeruginosa. Positivity for the mCIM was observed in 96% (240 out of 250) of the isolates. Of the mCIM-positive isolates, 234 (97.5%) also tested positive for eCIM, indicating metallo-β-Lactamase (MLB) production. A statistically significant association was found between both mCIM and eCIM positivity and the degree of resistance to carbapenem (p&lt;0.05). Conclusion: This study shows that the inexpensive method, a combination of mCIM and eCIM assists in differentiating between serine carbapenemase producers and MLB producers, thereby guiding the selection of appropriate therapy and useful in infection control in resource-limited settings.' name='description'> <meta content='403691619670159' property='fb:pages'> <link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="citation_journal_title" content="Cureus" /><meta name="citation_title" content="Modified Carbapenem Inactivation Method and Ethylenediaminetetraacetic Acid (EDTA)-Carbapenem Inactivation Method for Detection of Carbapenemase-Producing Enterobacterales and Pseudomonas aeruginosa" /><meta name="citation_publication_date" content="2024/06/27" /><meta name="citation_date" content="2024/06/27" /><meta name="citation_issue" content="6" /><meta name="citation_volume" content="16" /><meta name="citation_doi" content="10.7759/cureus.63340" /><meta name="citation_fulltext_html_url" content="https://www.cureus.com/articles/258514-modified-carbapenem-inactivation-method-and-ethylenediaminetetraacetic-acid-edta-carbapenem-inactivation-method-for-detection-of-carbapenemase-producing-enterobacterales-and-pseudomonas-aeruginosa" /><meta name="citation_author" content="Gaurav Verma" /><meta name="citation_author" content="Nipa Singh" /><meta name="citation_author" content="Shradha Smriti" /><meta name="citation_author" content="Subhra Snigdha Panda" /><meta name="citation_author" content="Dipti Pattnaik" /><meta name="citation_author" content="Sukanta Tripathy" /><meta name="citation_author" content="Ashok K. Praharaj" /><meta name="citation_author" content="A. Raj Kumar Patro" /><meta name="DC.Publisher" content="Cureus" /><meta name="DC.Title" content="Modified Carbapenem Inactivation Method and Ethylenediaminetetraacetic Acid (EDTA)-Carbapenem Inactivation Method for Detection of Carbapenemase-Producing Enterobacterales and Pseudomonas aeruginosa" /><meta name="DC.Date" content="2024-06-27" /><meta name="DC.Identifier" content="10.7759/cureus.63340" /><meta name="DC.Language" content="en" /><meta name="DC.Contributor" content="Gaurav Verma" /><meta name="DC.Contributor" content="Nipa Singh" /><meta name="DC.Contributor" content="Shradha Smriti" /><meta name="DC.Contributor" content="Subhra Snigdha Panda" /><meta name="DC.Contributor" content="Dipti Pattnaik" /><meta name="DC.Contributor" content="Sukanta Tripathy" /><meta name="DC.Contributor" content="Ashok K. Praharaj" /><meta name="DC.Contributor" content="A. Raj Kumar Patro" /><meta name="prism.issn" content="2168-8184" /><meta name="prism.publicationName" content="Cureus" /><meta name="prism.publicationDate" content="2024/06/27" /><meta name="prism.url" content="https://www.cureus.com/articles/258514-modified-carbapenem-inactivation-method-and-ethylenediaminetetraacetic-acid-edta-carbapenem-inactivation-method-for-detection-of-carbapenemase-producing-enterobacterales-and-pseudomonas-aeruginosa" /><meta name="prism.doi" content="10.7759/cureus.63340" /><meta name="prism.volume" content="16" /> <meta property="og:title" content="Modified Carbapenem Inactivation Method and Ethylenediaminetetraacetic Acid (EDTA)-Carbapenem Inactivation Method for Detection of Carbapenemase-Producing Enterobacterales and Pseudomonas aeruginosa" /><meta property="og:type" content="article" /><meta property="og:image" content="https://assets.cureus.com/uploads/figure/file/1053849/article_river_385b7f5020b311ef9c36235e5dde3803-Figure-2-revised.png" /><meta property="og:description" content="Introduction: The rising incidence of carbapenem resistance in Enterobacterales and Pseudomonas aeruginosa is a concern. Since carbapenemase production is the primary resistance mechanism, detecting and identifying the genes responsible for it is crucial to effectively monitor its spread. Objective: This study aims to detect positivity for the modified carbapenem inactivation method (mCIM) and ethylenediaminetetraacetic acid (EDTA)-carbapenem inactivation method (eCIM) for the detection of carbapenemase-producing Enterobacterales and Pseudomonas aeruginosa. Methods: Methods: A cross-sectional study was carried out at a tertiary care hospital, including 250 clinical isolates of Enterobacterales and Pseudomonas aeruginosa. These isolates exhibited resistance to at least one of the carbapenems as determined by the VITEK AST 2 System (bioMérieux, USA). The isolates were subjected to mCIM testing, and those that tested positive were further tested using eCIM. The results were interpreted in accordance with the guidelines provided by the Clinical and Laboratory Standards Institute (CLSI) 2023. Results: Out of the total 250 carbapenem-resistant Enterobacterales and Pseudomonas aeruginosa isolates, 151 (60.4%) were Klebsiella pneumonia, 44 (17.6%) were Escherichia coli, 10 (4.0%) were Enterobacter cloacae, 6 (2.4%) were Providencia spp., 4 (1.6%) were Serratia marcescens, 4 (1.6%) were Proteus mirabilis and 31 (12.4%) were Pseudomonas aeruginosa. Positivity for the mCIM was observed in 96% (240 out of 250) of the isolates. Of the mCIM-positive isolates, 234 (97.5%) also tested positive for eCIM, indicating metallo-β-Lactamase (MLB) production. A statistically significant association was found between both mCIM and eCIM positivity and the degree of resistance to carbapenem (p&lt;0.05). Conclusion: This study shows that the inexpensive method, a combination of mCIM and eCIM assists in differentiating between serine carbapenemase producers and MLB producers, thereby guiding the selection of appropriate therapy and useful in infection control in resource-limited settings." /><meta property="og:url" content="https://www.cureus.com/articles/258514-modified-carbapenem-inactivation-method-and-ethylenediaminetetraacetic-acid-edta-carbapenem-inactivation-method-for-detection-of-carbapenemase-producing-enterobacterales-and-pseudomonas-aeruginosa" /> <meta property="twitter:card" content="summary" /><meta property="twitter:site" content="cureusinc" /><meta property="twitter:title" content="Modified Carbapenem Inactivation Method and Ethylenediaminetetraacetic Acid (EDTA)-Carbapenem Inactivation Method for Detection of Carbapenemase-Producing Enterobacterales and Pseudomonas aeruginosa" /><meta property="twitter:description" content="Introduction: The rising incidence of carbapenem resistance in Enterobacterales and Pseudomonas aeruginosa is a concern. Since carbapenemase production is the primary resistance mechanism, detec..." /><meta property="twitter:image:src" content="https://assets.cureus.com/uploads/figure/file/1053849/article_river_385b7f5020b311ef9c36235e5dde3803-Figure-2-revised.png" /> <meta content='Gaurav Verma' name='citation_author'> <meta content='Nipa Singh' name='citation_author'> <meta content='Shradha Smriti' name='citation_author'> <meta content='Subhra Snigdha Panda' name='citation_author'> <meta content='Dipti Pattnaik' name='citation_author'> <meta content='Sukanta Tripathy' name='citation_author'> <meta content='Ashok K. Praharaj' name='citation_author'> <meta content='A. Raj Kumar Patro' name='citation_author'> <meta content='2024/06/27' name='publication_date'> <meta content='https://assets.cureus.com/uploads/original_article/pdf/258514/20240728-1126561-xxq9jt.pdf' name='citation_pdf_url'>    <script> !function(f,b,e,v,n,t,s) {if(f.fbq)return;n=f.fbq=function(){n.callMethod? n.callMethod.apply(n,arguments):n.queue.push(arguments)}; if(!f._fbq)f._fbq=n;n.push=n;n.loaded=!0;n.version='2.0'; n.queue=[];t=b.createElement(e);t.async=!0; t.src=v;s=b.getElementsByTagName(e)[0]; s.parentNode.insertBefore(t,s)}(window, document,'script', 'https://connect.facebook.net/en_US/fbevents.js'); fbq('init', '1476487503126175'); fbq('track', 'PageView'); </script> <noscript> <img height="1" width="1" style="display:none" src="https://www.facebook.com/tr?id=1476487503126175&ev=PageView&noscript=1" /> </noscript>  <script> !function(e,t,n,s,u,a){e.twq||(s=e.twq=function(){s.exe?s.exe.apply(s,arguments):s.queue.push(arguments); 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href="/channels/bvdu"><img src="https://assets.cureus.com/uploads/channel/logo/187/channel_logo_BVDU_logo.png" /> <span>Bharati Vidyapeeth (Deemed to be University), Pune</span> </a></li> <li class='channels'> <a class="light-blue-hover" href="/channels/blde"><img src="https://assets.cureus.com/uploads/channel/logo/175/channel_logo_BLDE_DU_LOGO_PNG.png" /> <span>BLDE (Deemed to be University)</span> </a></li> <li class='channels'> <a class="light-blue-hover" href="/channels/caro-acro"><img src="https://assets.cureus.com/uploads/channel/logo/5/channel_logo_CARO_logo_400__1_.jpg" /> <span>Canadian Association of Radiation Oncology</span> </a></li> <li class='channels'> <a class="light-blue-hover" href="/channels/crnn"><img src="https://assets.cureus.com/uploads/channel/logo/34/channel_logo_1549570407-Screen_Shot_2019-02-07_at_3.13.26_PM.png" /> <span>Contemporary Reviews in Neurology and Neurosurgery</span> </a></li> <li class='channels'> <a class="light-blue-hover" 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Patel College of Osteopathic Medicine (KPCOM)</span> </a></li> <li class='channels'> <a class="light-blue-hover" href="/channels/eisenhowerh"><img src="https://assets.cureus.com/uploads/channel/logo/186/channel_logo_image.png" /> <span>Eisenhower Health</span> </a></li> <li class='channels'> <a class="light-blue-hover" href="/channels/flagship"><img src="https://assets.cureus.com/uploads/channel/logo/113/channel_logo_channel_logo_1587670935-channel_logo_flagship.png" /> <span>FLAGSHIP: Medical Scholarly Proceedings</span> </a></li> <li class='channels'> <a class="light-blue-hover" href="/channels/fau-flagship"><img src="https://assets.cureus.com/uploads/channel/logo/114/channel_logo_1587732682-FuHGBKUC_400x400.jpg" /> <span>Florida Atlantic University</span> </a></li> <li class='channels'> <a class="light-blue-hover" href="/channels/fiu-flagship"><img src="https://assets.cureus.com/uploads/channel/logo/115/channel_logo_1588264234-KSTnUYCw_400x400.png" /> <span>Florida International University</span> </a></li> <li class='channels'> <a class="light-blue-hover" href="/channels/fsu-flagship"><img src="https://assets.cureus.com/uploads/channel/logo/126/channel_logo_unnamed-2.png" /> <span>Florida State University</span> </a></li> <li class='channels'> <a class="light-blue-hover" href="/channels/ppf"><img src="https://assets.cureus.com/uploads/channel/logo/128/channel_logo_Logo-FPP.png" /> <span>Fondazione Paolo Procacci</span> </a></li> <li class='channels'> <a class="light-blue-hover" href="/channels/gemsh"><img src="https://assets.cureus.com/uploads/channel/logo/180/channel_logo_CHANNEL_LOGO.png" /> <span>Great Eastern Medical School and Hospital</span> </a></li> <li class='channels'> <a class="light-blue-hover" href="/channels/gwha"><img src="https://assets.cureus.com/uploads/channel/logo/164/channel_logo_FSkUzpdPTgSOuzt-4aT6aA.jpg" /> <span>Great Western Hospital Academy</span> </a></li> <li class='channels'> <a class="light-blue-hover" href="/channels/huim"><img 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src="https://public.cureus.com/new-nav-bar/specialties-tab/forensic_medicine.png" /> <span>Forensic Medicine</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/gastroenterology"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/gastroenterology.png" /> <span>Gastroenterology</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/general_surgery"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/general_surgery.png" /> <span>General Surgery</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/genetics"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/genetics.png" /> <span>Genetics</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/geriatrics"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/geriatrics.png" /> <span>Geriatrics</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/healthcare_technology"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/healthcare_technology.png" /> <span>Healthcare Technology</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/health_policy"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/health_policy.png" /> <span>Health Policy</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/hematology"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/hematology.png" /> <span>Hematology</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/hiv_aids"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/hiv_aids.png" /> <span>HIV / AIDS</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/infectious_disease"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/infectious_disease.png" /> <span>Infectious Disease</span> </a></div> <div class='large-4 columns'> <a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/integrative_complementary_medicine"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/integrative_complementary_medicine.png" /> <span>Integrative / Complementary Medicine</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/internal_medicine"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/internal_medicine.png" /> <span>Internal Medicine</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/medical_education"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/medical_education.png" /> <span>Medical Education</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/medical_physics"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/medical_physics.png" /> <span>Medical Physics</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/medical_simulation"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/medical_simulation.png" /> <span>Medical Simulation</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/nephrology"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/nephrology.png" /> <span>Nephrology</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/neurology"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/neurology.png" /> <span>Neurology</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/neurosurgery"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/neurosurgery.png" /> <span>Neurosurgery</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/nuclear_medicine"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/nuclear_medicine.png" /> <span>Nuclear Medicine</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/nutrition"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/nutrition.png" /> <span>Nutrition</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/obstetrics_gynecology"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/obstetrics_gynecology.png" /> <span>Obstetrics / Gynecology</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/occupational_health"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/occupational_health.png" /> <span>Occupational Health</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/oncology"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/oncology.png" /> <span>Oncology</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/ophthalmology"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/ophthalmology.png" /> <span>Ophthalmology</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/oral_medicine"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/oral_medicine.png" /> <span>Oral Medicine</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/orthopedics"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/orthopedics.png" /> <span>Orthopedics</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/osteopathic_medicine"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/osteopathic_medicine.png" /> <span>Osteopathic Medicine</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/otolaryngology"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/otolaryngology.png" /> <span>Otolaryngology</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/pain_management"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/pain_management.png" /> <span>Pain Management</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/palliative_care"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/palliative_care.png" /> <span>Palliative Care</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/pathology"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/pathology.png" /> <span>Pathology</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/pediatrics"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/pediatrics.png" /> <span>Pediatrics</span> </a></div> <div class='large-4 columns'> <a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/pediatric_surgery"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/pediatric_surgery.png" /> <span>Pediatric Surgery</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/pharmacology"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/pharmacology.png" /> <span>Pharmacology</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/physical_medicine_rehabilitation"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/physical_medicine_rehabilitation.png" /> <span>Physical Medicine & Rehabilitation</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/plastic_surgery"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/plastic_surgery.png" /> <span>Plastic Surgery</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/podiatry"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/podiatry.png" /> <span>Podiatry</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/preventive_medicine"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/preventive_medicine.png" /> <span>Preventive Medicine</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/psychiatry"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/psychiatry.png" /> <span>Psychiatry</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/psychology"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/psychology.png" /> <span>Psychology</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/health_public"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/health_public.png" /> <span>Public Health</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/pulmonology"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/pulmonology.png" /> <span>Pulmonology</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/quality_improvement"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/quality_improvement.png" /> <span>Quality Improvement</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/radiation_oncology"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/radiation_oncology.png" /> <span>Radiation Oncology</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/radiology"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/radiology.png" /> <span>Radiology</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/rheumatology"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/rheumatology.png" /> <span>Rheumatology</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/sports_medicine"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/sports_medicine.png" /> <span>Sports Medicine</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/substance_use_and_addiction"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/substance_use_and_addiction.png" /> <span>Substance Use and Addiction</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/therapeutics"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/therapeutics.png" /> <span>Therapeutics</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/transplantation"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/transplantation.png" /> <span>Transplantation</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/trauma"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/trauma.png" /> <span>Trauma</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/urology"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/urology.png" /> <span>Urology</span> </a><a target="_blank" class="large-12 columns grid-item specialty-card light-blue-hover" href="/miscellaneous"><img class="specialty-icon" src="https://public.cureus.com/new-nav-bar/specialties-tab/miscellaneous.png" /> <span>Miscellaneous</span> </a></div> </div> </div> </div> </li> <li class='nav-item hoverable'> <a class="nav-item-name" href="/about_publishing">Resources</a> <div class='row nav-item-dropdown small-collapse authors-and-reviewers'> <div class='large-3 small-3 columns left-side'> <div class='inner-container'> <h4 class='dropdown-headers'>About Publishing</h4> <div class='dropdown-paragraph authors-about-publishing'> <p>Why publish in Cureus? Click below to find out.</p> </div> <div class='button-container authors-and-reviewers'> <a class="learn-more-button light-blue-hover" href="/about_publishing"><img src="https://public.cureus.com/new-nav-bar/arrow-right-blue.png" /> <h6>Learn more</h6> </a></div> </div> </div> <div class='large-9 small-9 columns right-side'> <h4 class='dropdown-headers'>For Authors & Reviewers</h4> <div class='dropdown-grid'> <div class='row'> <div class='large-4 columns grid-item light-blue-hover last'> <a href="/author_guide"><img src="https://public.cureus.com/new-nav-bar/author-guide.png" /> <span>Author Guide</span> </a></div> <div class='large-4 columns grid-item light-blue-hover'> <a href="/media_guide"><img src="https://public.cureus.com/new-nav-bar/media-guide.png" /> <span>Media Guide</span> </a></div> <div class='large-4 columns grid-item light-blue-hover'> <a href="/promotion_guide"><img src="https://public.cureus.com/new-nav-bar/sharing.png" /> <span>Article Sharing Guide</span> </a></div> </div> <div class='row'> <div class='large-4 columns grid-item light-blue-hover'> <a href="/reviewer_guide"><img src="https://public.cureus.com/new-nav-bar/reviewer-guide.png" /> <span>Reviewer Guide</span> </a></div> <div class='large-4 columns grid-item light-blue-hover'> <a href="/honors"><img src="https://public.cureus.com/new-nav-bar/cureus-honors.png" /> <span>Cureus Honors</span> </a></div> <div class='large-4 columns grid-item light-blue-hover last'> <a href="/siq"><img src="https://public.cureus.com/new-nav-bar/shield.png" /> <span>SIQ</span> </a></div> </div> <div class='row'> <div class='large-4 columns grid-item light-blue-hover'> <a href="/guest_editor_guide"><img src="https://public.cureus.com/new-nav-bar/guest-editor-guide.png" /> <span>Guest Editor Guide</span> </a></div> <div class='large-4 columns grid-item light-blue-hover'> <a href="/article_promotion"><img src="https://public.cureus.com/new-nav-bar/tag.png" /> <span>Article Promotion</span> </a></div> <div class='large-4 columns grid-item light-blue-hover'> <a href="/cureus_editing_services"><img src="https://public.cureus.com/new-nav-bar/preferred-editing-service.png" /> <span>Author Fees (Preferred Editing)</span> </a></div> </div> <div class='row'> <div class='large-4 columns grid-item light-blue-hover'> <a href="/academic_channels_guide"><img src="https://public.cureus.com/channel_guide.png" /> <span>Academic Channels Guide</span> </a></div> <div class='large-4 columns grid-item light-blue-hover last'> <a href="/about_collections"><img src="https://public.cureus.com/new-nav-bar/partnerships/about_advertising.png" /> <span>About Collections</span> </a></div> </div> </div> </div> </div> </li> <li class='nav-item hoverable'> <a class="nav-item-name" href="/channels">Channels</a> <div class='row nav-item-dropdown small-collapse channels'> <div class='large-3 small-3 columns left-side'> <div class='inner-container'> <div class='dropdown-section'> <h4 class='dropdown-headers'>About Channels</h4> <div class='dropdown-paragraph'> <p>Unlock discounted publishing that highlights your organization and the peer-reviewed research and clinical experiences it produces.</p> </div> <div class='button-container channels'> <a class="learn-more-button light-blue-hover channels" href="/channels"><h6>Learn more</h6> <img src="https://public.cureus.com/new-nav-bar/arrow-right-blue.png" /> </a></div> </div> <div class='dropdown-section'> <h4 class='dropdown-headers'>Academic Channels Guide</h4> <div class='dropdown-paragraph'> <p>Find out how channels are organized and operated, including details on the roles and responsibilities of channel editors.</p> </div> <div class='button-container channels'> <a class="learn-more-button light-blue-hover channels" href="/academic_channels_guide"><h6>Learn more</h6> <img src="https://public.cureus.com/new-nav-bar/arrow-right-blue.png" /> </a></div> </div> </div> </div> <div class='large-9 small-9 columns right-side'> <div class='grid-header'> <h4 class='dropdown-headers channels'> Channels </h4> <a class="dropdown-header-anchor-text channels" href="/channels/all">More <img class="orange-arrow" src="https://public.cureus.com/new-nav-bar/orange-arrow-right.png" /> </a></div> <div class='dropdown-grid row small-collapse'> <div class='large-6 columns'> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/acoscardsurg"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/75/channel_logo_1563472685-ACOS_cardiothoracic_logo.png" /> <span>ACOS Cardiothoracic and Vascular Surgery</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/acosgensurg"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/74/channel_logo_1563472913-ACOS_gen_surg_logo.png" /> <span>ACOS General Surgery</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/aons"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/32/channel_logo_1550341068-AONS_gold_logo_edited_021619.png" /> <span>ACOS Neurological Surgery</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/acosplasurg"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/76/channel_logo_1563302199-PLATIClogo_color.jpg" /> <span>ACOS Plastic and Reconstructive Surgery</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/acosursurg"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/77/channel_logo_1563473310-ACOS_urol_logo.png" /> <span>ACOS Urological Surgery</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/acom"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/125/channel_logo_Picture1.jpg" /> <span>Alabama College of Osteopathic Medicine Research</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/redcross"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/123/channel_logo_american-red-cross-logo-vector.png" /> <span>American Red Cross Scientific Advisory Council</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/avv"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/177/channel_logo_AVVP_logo.png" /> <span>Amrita Vishwa Vidyapeetham Healthcare Campus</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/astromedica"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/166/channel_logo_astromedica-logo_400x400.jpg" /> <span>AstroMedica: Advances in Transportation Medicine, Flight, Spaceflight, and Microgravity</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/atarif"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/189/channel_logo_Logo__2_.png" /> <span>ATARI Frontiers</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/baylorcm"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/169/channel_logo_Baylor_Christus_logo.png" /> <span>Baylor College of Medicine at Christus Children’s </span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/bswasmcgme"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/185/channel_logo_Channel_logo.png" /> <span>Baylor Scott & White All Saints Medical Center Graduate Medical Education</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/bsw-neuro"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/119/channel_logo_1595010280-BSW_logo.png" /> <span>Baylor Scott & White Medical Center Department of Neurosurgery</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/bvdu"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/187/channel_logo_BVDU_logo.png" /> <span>Bharati Vidyapeeth (Deemed to be University), Pune</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/blde"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/175/channel_logo_BLDE_DU_LOGO_PNG.png" /> <span>BLDE (Deemed to be University)</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/caro-acro"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/5/channel_logo_CARO_logo_400__1_.jpg" /> <span>Canadian Association of Radiation Oncology</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/crnn"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/34/channel_logo_1549570407-Screen_Shot_2019-02-07_at_3.13.26_PM.png" /> <span>Contemporary Reviews in Neurology and Neurosurgery</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/curie"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/162/channel_logo_Untitled_design-2.png" /> <span>Contemporary Updates: Radiotherapy Innovation & Evidence (CURiE)</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/dalhousie-em"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/21/channel_logo_Screen_Shot_2022-09-29_at_7.07.50_PM.png" /> <span>Dalhousie Emergency Medicine</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/dpudypatil"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/168/channel_logo_3.jpg" /> <span>Dr. D Y Patil Medical College, Hospital and Research Centre, Dr. D Y Patil Vidyapeeth (Deemed to be University), Pune</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/nsumd-flagship"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/130/channel_logo_1610476628-NSUFlorida-KPCOM-Stacked-BlueGray_480px.png" /> <span>Dr. Kiran C. Patel College of Allopathic Medicine (NSUMD)</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/nsu-flagship"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/127/channel_logo_1610476628-NSUFlorida-KPCOM-Stacked-BlueGray_480px.png" /> <span>Dr. Kiran C. Patel College of Osteopathic Medicine (KPCOM)</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/eisenhowerh"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/186/channel_logo_image.png" /> <span>Eisenhower Health</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/flagship"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/113/channel_logo_channel_logo_1587670935-channel_logo_flagship.png" /> <span>FLAGSHIP: Medical Scholarly Proceedings</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/fau-flagship"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/114/channel_logo_1587732682-FuHGBKUC_400x400.jpg" /> <span>Florida Atlantic University</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/fiu-flagship"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/115/channel_logo_1588264234-KSTnUYCw_400x400.png" /> <span>Florida International University</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/fsu-flagship"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/126/channel_logo_unnamed-2.png" /> <span>Florida State University</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/ppf"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/128/channel_logo_Logo-FPP.png" /> <span>Fondazione Paolo Procacci</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/gemsh"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/180/channel_logo_CHANNEL_LOGO.png" /> <span>Great Eastern Medical School and Hospital</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/gwha"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/164/channel_logo_FSkUzpdPTgSOuzt-4aT6aA.jpg" /> <span>Great Western Hospital Academy</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/huim"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/145/channel_logo_Howard_Logo_for_Cureus_Channel.png" /> <span>Howard University Internal Medicine</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/ilcor"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/120/channel_logo_1600102064-logo-white.c9ba0b95.png" /> <span>International Liaison Committee on Resuscitation</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/ipss"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/4/channel_logo_1458062764-ipss-channel-logo-400x400.png" /> <span>International Pediatric Simulation Society</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/jrss"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/78/channel_logo_1569267141-LOGO_JRSS.png" /> <span>Japan Radiosurgery Society</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/karnavatiuni"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/173/channel_logo_IMG_3596.jpg" /> <span>Karnavati School of Dentistry, Karnavati University (KU)</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/kimsac"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/184/channel_logo_Logo_Image_1-1.png" /> <span>KIMSAC - Kalinga Institute of Medical Sciences Academic Channel</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/kvv"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/174/channel_logo_Channel_logo.jpg" /> <span>Krishna Vishwa Vidyapeeth (Deemed to be University), Karad.</span> </a></div> </div> <div class='large-6 columns'> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/lecom-flagship"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/116/channel_logo_1589819040-download.png" /> <span>Lake Erie College of Osteopathic Medicine (LECOM)</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/lucom"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/135/channel_logo_LUCOM-Channel-Seal.jpg" /> <span>Liberty Medicine Research Channel</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/lsuhsfma"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/161/channel_logo_LSUHS_Vert_Gold-White.png" /> <span>LSUHS Family Medicine Alexandria</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/mrdc"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/179/channel_logo_unnamed.jpg" /> <span>Manav Rachna Dental College</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/uacomtuc"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/194/channel_logo_Arizona_Wildcats_logo.svg.png" /> <span>MedCats do Research: The University of Arizona College of Medicine - Tucson</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/medsocdel"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/136/channel_logo_MSD_CHANNEL_LOGO_-_Final.png" /> <span>Medical Society of Delaware Academic Channel</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/med-peds"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/112/channel_logo_MPAC_square-transparent.png" /> <span>Med-Peds Academic Channel</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/srmist"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/178/channel_logo_SRMIST-logo-400x400_FINAL_.jpg" /> <span>MHS-SRMIST</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/michr"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/170/channel_logo_MICHR-vertical-white_cureus.png" /> <span>Michigan Institute for Clinical & Health Research (MICHR)</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/mwazcom"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/192/channel_logo_Logo.jpg" /> <span>Midwestern University, Arizona College of Osteopathic Medicine</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/military-medicine"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/29/channel_logo_1526494683-logo.png" /> <span>Military Medical Simulation</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/mme"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/133/channel_logo_MMElogo-page-0.jpg" /> <span>Modern Medical Educator</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/nbspr"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/70/channel_logo_circlelogo.png" /> <span>NB Social Pediatrics Research</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/nema"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/129/channel_logo_NEMAgroup.png" /> <span>NEMA Research Group</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/nriims"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/183/channel_logo_Nriims_hero_image.jpg" /> <span>NRI Institute of Medical Sciences</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/ocom"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/171/channel_logo_OCOM_logo.jpg" /> <span>Orlando College of Osteopathic Medicine</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/psuneuro"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/16/channel_logo_IMG_0914.JPG" /> <span>Penn State Neurosurgery</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/ucladom"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/182/channel_logo_UCLA-Health_Logo_Stacked_RGB.png" /> <span>Proceedings of the UCLA Department of Medicine</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/shsucom"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/195/channel_logo_SHSU-COM_Square_Logo.png" /> <span>Sam Houston State University College of Osteopathic Medicine</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/sbh"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/142/channel_logo_SBH-IM-Logo-Pantone-072_White.png" /> <span>SBH Health System</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/scr"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/137/channel_logo_Academic_Channel_Logo.png" /> <span>Sinai Chicago Research</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/su-neurosurgery"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/8/channel_logo_1459446720-stanford-medicine-channel-logo-600x600.png" /> <span>Stanford Neurosurgery</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/suims"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/188/channel_logo_Channel_Logo.jpg.jpeg" /> <span>Subbaiah Research Institute</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/sdhsu"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/176/channel_logo_Rezised_logo_400x400.jpg" /> <span>SUNY Downstate Health Sciences University</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/tawam"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/172/channel_logo_Tawan_logo.jpeg" /> <span>Tawam Oncology</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/ttuhsc"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/154/channel_logo_TTUHSC_logo_400x400.png" /> <span>Texas Tech University Health Sciences Center El Paso</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/fmsr"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/117/channel_logo_1593455763-fmsrp_logo.jpg" /> <span>The Florida Medical Student Research Publications</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/therss"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/14/channel_logo_RSS_Spark_400x2.png" /> <span>the Radiosurgery Society</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/tmu"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/191/channel_logo_SoM-LI-profile-400x400.png" /> <span>Toronto Metropolitan University School of Medicine: Health Insights</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/sbcvl"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/72/channel_logo_1562007282-Logo_image-_sbcvl_VERT.jpg" /> <span>UCSF Surgical Neuroanatomy Collection</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/uf-flagship"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/134/channel_logo_UF-jax.jpg" /> <span>University of Florida College of Medicine – Jacksonville</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/jax-neuro"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/35/channel_logo_1553024316-4cepMG_U_400x400.png" /> <span>University of Florida-Jacksonville Neurosurgery</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/ulneuro"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/27/channel_logo_1525976670-logo.png" /> <span>University of Louisville Neurosurgery</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/usf-flagship"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/121/channel_logo_1597339004-usf_logo_final.png" /> <span>University of South Florida</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/utmba"><img class="grid-channel-icon" src="https://assets.cureus.com/uploads/channel/logo/190/channel_logo_302701215_556920986231403_8743524727628504148_n.png" /> <span>UTMB Anesthesiology</span> </a></div> <div class='large-12 columns grid-item'> <a class="light-blue-hover dropdown-channel-card" href="/channels/utrgv"><img class="grid-channel-icon" 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class='site-wrap' id='root'> <div class='container' id='container'> <div id='main'> <div id='content'> <div data-react-class="ArticleShow/Main" data-react-props="{"metricsPaths":{"reads":"https://api.cureus.com/api/v1/articles/258514/reads","world_map":"https://api.cureus.com/api/v1/articles/258514/viewer_map_data","us_map":"https://api.cureus.com/api/v1/articles/258514/us_viewer_map_data","chart_data":"https://api.cureus.com/api/v1/articles/258514/chart_data","headers":{"AUTHORIZATION":"Token token=\"b379181d6af37391f0853c8c53934b7ed504a045c54bd4ff51009df69c32b0b9edea5654921cacb81c8998d4799685de6220df0704dc6ccabbf3bf29a7f33d3d\""}},"article":{"id":258514,"siq":"-","title":"Modified Carbapenem Inactivation Method and Ethylenediaminetetraacetic Acid (EDTA)-Carbapenem Inactivation Method for Detection of Carbapenemase-Producing Enterobacterales and Pseudomonas aeruginosa","abstract":"\u003cp\u003eIntroduction: The rising incidence of carbapenem resistance in Enterobacterales and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e is a concern. Since carbapenemase production is the primary resistance mechanism, detecting and identifying the genes responsible for it is crucial to effectively monitor its spread.\u003c/p\u003e\r\n\r\n\u003cp\u003eObjective: This study aims to detect positivity for the modified carbapenem inactivation method (mCIM) and ethylenediaminetetraacetic acid (EDTA)-carbapenem inactivation method (eCIM) for the detection of carbapenemase-producing Enterobacterales and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e.\u003c/p\u003e\r\n\r\n\u003cp\u003eMethods: Methods: A cross-sectional study was carried out at a tertiary care hospital, including 250 clinical isolates of Enterobacterales and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e. These isolates exhibited resistance to at least one of the carbapenems as determined by the VITEK AST 2 System (bioMérieux, USA). The isolates were subjected to mCIM testing, and those that tested positive were further tested using eCIM. The results were interpreted in accordance with the guidelines provided by the Clinical and Laboratory Standards Institute (CLSI) 2023.\u003c/p\u003e\r\n\r\n\u003cp\u003eResults: Out of the total 250 carbapenem-resistant Enterobacterales and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e isolates, 151 (60.4%) were \u003cem\u003eKlebsiella pneumonia, \u003c/em\u003e44 (17.6%) were \u003cem\u003eEscherichia coli,\u003c/em\u003e 10 (4.0%) were \u003cem\u003eEnterobacter cloacae\u003c/em\u003e, 6 (2.4%) were \u003cem\u003eProvidencia spp\u003c/em\u003e., 4 (1.6%) were \u003cem\u003eSerratia marcescens\u003c/em\u003e, 4 (1.6%) were \u003cem\u003eProteus mirabilis\u003c/em\u003e and 31 (12.4%) were \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e. Positivity for the mCIM was observed in 96% (240 out of 250) of the isolates. Of the mCIM-positive isolates, 234 (97.5%) also tested positive for eCIM, indicating metallo-β-Lactamase (MLB) production. A statistically significant association was found between both mCIM and eCIM positivity and the degree of resistance to carbapenem (p\u0026lt;0.05)\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e\r\n\r\n\u003cp\u003eConclusion: This study shows that the inexpensive method, a combination of mCIM and eCIM assists in differentiating between serine carbapenemase producers and MLB producers, thereby guiding the selection of appropriate therapy and useful in infection control in resource-limited settings.\u003c/p\u003e","categories":[{"id":12,"name":"Medical Education"},{"id":42,"name":"Infectious Disease"},{"id":56,"name":"Healthcare Technology"}],"channel_id":null,"published_at":"2024-06-27T23:12:40.943-07:00","first_month":false,"doi":"10.7759/cureus.63340","keywords":["carbapenem-resistant","ecim","mcim","metallo-β-lactamase","phenotypic test","serine-beta lactamase"],"pdf_email_already_submitted":false,"pdf_link":"/articles/258514-modified-carbapenem-inactivation-method-and-ethylenediaminetetraacetic-acid-edta-carbapenem-inactivation-method-for-detection-of-carbapenemase-producing-enterobacterales-and-pseudomonas-aeruginosa.pdf","long_citation":"Verma G, Singh N, Smriti S, et al. (June 27, 2024) Modified Carbapenem Inactivation Method and Ethylenediaminetetraacetic Acid (EDTA)-Carbapenem Inactivation Method for Detection of Carbapenemase-Producing Enterobacterales and Pseudomonas aeruginosa. Cureus 16(6): e63340. doi:10.7759/cureus.63340","path":"https://www.cureus.com/articles/258514-modified-carbapenem-inactivation-method-and-ethylenediaminetetraacetic-acid-edta-carbapenem-inactivation-method-for-detection-of-carbapenemase-producing-enterobacterales-and-pseudomonas-aeruginosa","boostable_path":"/articles/258514-modified-carbapenem-inactivation-method-and-ethylenediaminetetraacetic-acid-edta-carbapenem-inactivation-method-for-detection-of-carbapenemase-producing-enterobacterales-and-pseudomonas-aeruginosa/payments/social_boost"},"hasAttachments":true,"articleHtml":{"article":{"id":329437,"public_view_id":63511,"tab_type":"article","html":"\u003cdiv class='new-article-content-wrap'\u003e\n\u003cdiv class='new-article-content-section'\u003e\n\u003cdiv class='article-content-body article-tab' itemprop='description'\u003e\n\u003ch3 class='reg' id='abstract'\u003eAbstract\u003c/h3\u003e\n\u003cp\u003eIntroduction: The rising incidence of carbapenem resistance in Enterobacterales and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e is a concern. Since carbapenemase production is the primary resistance mechanism, detecting and identifying the genes responsible for it is crucial to effectively monitor its spread.\u003c/p\u003e\r\n\r\n\u003cp\u003eObjective: This study aims to detect positivity for the modified carbapenem inactivation method (mCIM) and ethylenediaminetetraacetic acid (EDTA)-carbapenem inactivation method (eCIM) for the detection of carbapenemase-producing Enterobacterales and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e.\u003c/p\u003e\r\n\r\n\u003cp\u003eMethods: Methods: A cross-sectional study was carried out at a tertiary care hospital, including 250 clinical isolates of Enterobacterales and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e. These isolates exhibited resistance to at least one of the carbapenems as determined by the VITEK AST 2 System (bioMérieux, USA). The isolates were subjected to mCIM testing, and those that tested positive were further tested using eCIM. The results were interpreted in accordance with the guidelines provided by the Clinical and Laboratory Standards Institute (CLSI) 2023.\u003c/p\u003e\r\n\r\n\u003cp\u003eResults: Out of the total 250 carbapenem-resistant Enterobacterales and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e isolates, 151 (60.4%) were \u003cem\u003eKlebsiella pneumonia, \u003c/em\u003e44 (17.6%) were \u003cem\u003eEscherichia coli,\u003c/em\u003e 10 (4.0%) were \u003cem\u003eEnterobacter cloacae\u003c/em\u003e, 6 (2.4%) were \u003cem\u003eProvidencia spp\u003c/em\u003e., 4 (1.6%) were \u003cem\u003eSerratia marcescens\u003c/em\u003e, 4 (1.6%) were \u003cem\u003eProteus mirabilis\u003c/em\u003e and 31 (12.4%) were \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e. Positivity for the mCIM was observed in 96% (240 out of 250) of the isolates. Of the mCIM-positive isolates, 234 (97.5%) also tested positive for eCIM, indicating metallo-β-Lactamase (MLB) production. A statistically significant association was found between both mCIM and eCIM positivity and the degree of resistance to carbapenem (p\u0026lt;0.05)\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e\r\n\r\n\u003cp\u003eConclusion: This study shows that the inexpensive method, a combination of mCIM and eCIM assists in differentiating between serine carbapenemase producers and MLB producers, thereby guiding the selection of appropriate therapy and useful in infection control in resource-limited settings.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\n\u003cdiv class='new-article-content-section'\u003e\n\u003cdiv class='article-content-body article-tab'\u003e\n\u003ch3 class='reg' id='introduction'\u003eIntroduction\u003c/h3\u003e\n\u003cp\u003eAntibiotic-resistant bacteria are emerging as a significant public health issue worldwide, leading to recurring patient infections. These drug-resistant microorganisms cause infections in hospitalized patients, limiting the available treatment options and resulting in higher infection and mortality rates \u003ca class=\"content-anchor refs-anchor\" href=\"javascript:void(0)\"\u003e[1]\u003c/a\u003e. Identifying these drug-resistant organisms promptly is essential to ensure patients receive timely and effective treatment \u003ca class=\"content-anchor refs-anchor\" href=\"javascript:void(0)\"\u003e[2]\u003c/a\u003e.\u003c/p\u003e\r\n\r\n\u003cp\u003eCarbapenems, including meropenem, imipenem, ertapenem, and doripenem, are effective in treating multi-drug-resistant (MDR) infections. However, the incidence of carbapenem resistance (CR) has increased over the last few decades. CR is commonly observed in Enterobacterales such as \u003cem\u003eEscherichia coli \u003c/em\u003eand \u003cem\u003eKlebsiella pneumonia\u003c/em\u003e, as well as in \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e and Acinetobacter spp. \u003ca class=\"content-anchor refs-anchor\" href=\"javascript:void(0)\"\u003e[3,4]\u003c/a\u003e.\u003c/p\u003e\r\n\r\n\u003cp\u003eAccording to the Centers for Disease Control and Prevention (Atlanta, Georgia, USA), a carbapenem-resistant organism is an organism that is resistant to one or more carbapenem antibiotics or produces the carbapenemase enzyme \u003ca class=\"content-anchor refs-anchor\" href=\"javascript:void(0)\"\u003e[5]\u003c/a\u003e. The development of carbapenem resistance is associated with the production of carbapenem-hydrolyzing β-lactamases and due to the production of extended-spectrum beta-lactamases (ESBL). \u003c/p\u003e\r\n\r\n\u003cp\u003eMolecular methods are considered the gold standard for detecting carbapenemase enzyme production. However, these methods can be expensive and are typically available only in larger facilities. To make detection more cost-effective, several phenotypic assays have been developed. These include the Combined Disk Test (CDT), modified Hodge Test (MHT), Double Disk Synergy Test (DDST), modified carbapenem inactivation method (mCIM), ethylenediaminetetraacetic acid (EDTA)-carbapenem inactivation method (eCIM), and Carba NP test. The MHT was the first phenotypic test recommended by the Clinical and Laboratory Standards Institute (CLSI) in 2009 for detecting carbapenemase production with good sensitivity and specificity. According to current Clinical and Laboratory Standards Institute guidelines, carbapenemase production detection is performed using three phenotypic tests: mCIM, eCIM, and Carba \u003ca class=\"content-anchor refs-anchor\" href=\"javascript:void(0)\"\u003e[6]\u003c/a\u003e. The mCIM and eCIM tests could differentiate between serine beta-lactamases and metallo-beta-lactamases, which is useful in selecting therapeutic interventions and infection control.\u003c/p\u003e\r\n\r\n\u003cp\u003eThis study aims to detect carbapenemase production in Enterobacterales and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e using a combination of the mCIM and eCIM phenotypic methods. A part of this study was presented at MICROCON 2023 National Conference, Indian Association of Medical Microbiologists, held between 23rd and 26th November 2023, at the Scientific Convocation Center, King George's Medical University, Lucknow, India.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class='article-content-body article-tab'\u003e\n\u003ch3 class='reg' id='materials_and_methods'\u003eMaterials \u0026 Methods\u003c/h3\u003e\n\u003cp\u003eThis cross-sectional study was conducted from May 2023 to September 2023 in the Department of Microbiology at the Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India. The study included isolates obtained from various clinical specimens (urine, blood, body fluids, pus, and sputum) routinely received in the microbiology department. A total of 250 clinical isolates were included in the study, comprising Enterobacterales (219 out of 250) and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e (31 out of 250). These isolates were resistant to at least one of the carbapenems, as per the Clinical and Laboratory Standards Institute (CLSI) guidelines. The study was approved by the Institutional Ethics Committee (reference no. KIIT/KIMS/IEC/1344/2023). Some of the clinical isolates of Enterobacterales and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e were not resistant to carbapenems and such isolates were excluded from the study.\u003c/p\u003e\r\n\r\n\u003ch4\u003eProcedure\u003c/h4\u003e\r\n\r\n\u003cp\u003ePrimary isolates were stored in tryptic soya broth to prevent changes in bacterial properties. The identification and antibiotic sensitivity tests of these clinical isolates were conducted in a microbiology laboratory. These isolates were found to be resistant to at least one of the carbapenems (meropenem, imipenem, or ertapenem), as determined by the VITEK AST 2 System (bioMérieux, USA) using Antimicrobial Susceptibility Testing (AST) panels 405 and 406.\u003c/p\u003e\r\n\r\n\u003cp\u003eModified carbapenem inactivation method (mCIM): mCIM was performed to detect the production of the carbapenemase enzyme in Enterobacterales and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e \u003ca class=\"content-anchor refs-anchor\" href=\"javascript:void(0)\"\u003e[6]\u003c/a\u003e. EDTA-carbapenem inactivation method (eCIM): When the mCIM test yielded a positive result, the eCIM was then conducted to distinguish between the metallo-β-lactamase (MBL) and serine-β-Lactamase enzymes \u003ca class=\"content-anchor refs-anchor\" href=\"javascript:void(0)\"\u003e[6]\u003c/a\u003e.\u003c/p\u003e\r\n\r\n\u003cp\u003eModified carbapenem inactivation method in conjugation with the EDTA-carbapenem inactivation method: The mCIM and eCIM methods were employed to detect CPE, following the CLSI-2023 guidelines. For each strain under test, two tubes, each containing 2 mL of Trypticase Soy Broth (TSB), were used concurrently. One tube was supplemented with 20 µL of 0.5 M EDTA (Sigma), while the other tube was kept EDTA-free. A fresh colony from the strain under test was transferred to each tube using a 1 µL inoculating loop. A 10-mg meropenem disk (HiMedia, India) was then incubated with the bacterial suspension from the tested strain for 2-4 hours at 35°C. Following this, meropenem disks from both tubes were placed on Mueller Hinton agar plates, which were then inoculated with the \u003cem\u003eE. coli \u003c/em\u003eATCC 25922 indicator strain. The mCIM was considered to have yielded a positive result when the diameter of the inhibition zone was between 6 and 15 mm, or between 16 and 18 mm but with small colonies present within the inhibitory zone. Interpretation of eCIM results should be undertaken only when the mCIM result indicates the presence of a carbapenemase. If the zone diameter for eCIM exceeds that of mCIM by 5 mm, it suggests a potential production of metallo-carbapenemase. \u003cem\u003eE. coli\u003c/em\u003e ATCC 25922 was used as a quality control measure.\u003c/p\u003e\r\n\r\n\u003cp\u003eAccording to the data provided by CLSI, the mCIM's sensitivity and specificity are greater than 99% for Enterobacterales and range from 97-100% for \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e. In contrast, the eCIM method demonstrates sensitivity and specificity greater than 95% and 92%, respectively, for Enterobacterales. In this study, we conducted mCIM on all 250 isolates and performed eCIM on those isolates that tested positive for mCIM.\u003c/p\u003e\r\n\r\n\u003ch4\u003eStatistical analysis\u003c/h4\u003e\r\n\r\n\u003cp\u003eThe statistical analysis was conducted using GraphPad Prism software (version 10) (GraphPad Software, Boston, MA). The association between the carbapenem results, as determined by Vitek MIC, mCIM, and eCIM, was compared using a 2x2 Fisher’s exact test. A p-value of less than 0.05 was considered statistically significant.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class='article-content-body article-tab'\u003e\n\u003ch3 class='reg' id='results'\u003eResults\u003c/h3\u003e\n\u003cp\u003eOut of the 250 isolates analyzed, 219 (87.6%) were classified as part of the Enterobacterales family, and 31 (12.4%) were identified as \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e isolates. The majority of carbapenem-resistant isolates (61.2%) were from males, accounting for 153 isolates, while 97 (38.8%) isolates were from females. Patients over 60 years of age made up 134 (53.6%) of the 250 cases. The most common source of isolates was urine, with 88 instances (35%) (Figure \u003ca class=\"content-anchor attachment-anchor\" data-anchor=\"figure-anchor-1053849\" href=\"javascript:void(0)\"\u003e\u003cem\u003e1\u003c/em\u003e\u003c/a\u003e). The majority of isolates were obtained from the ICU, accounting for 153 (61.2%), followed by in-patient wards with 101 (40.4%), and the OPD with 29 (11.6%).\u003c/p\u003e\r\n\r\n\r\n\r\n\r\n\r\n\u003cdiv class=\"article-attachment-wrap\" data-number=\"1\" id=\"figure-anchor-1053849\" style=\"page-break-inside: avoid;\"\u003e\n\u003cdiv class=\"attachment-container\"\u003e\n\u003ca class=\"mfp-image gallery-item\" data-thumbnail=\"https://assets.cureus.com/uploads/figure/file/1053849/large_thumbnail_385b7f5020b311ef9c36235e5dde3803-Figure-2-revised.png\" title=\"Sample-wise-distribution-of-carbapenem-resistant-isolates\" href=\"https://assets.cureus.com/uploads/figure/file/1053849/lightbox_385b7f5020b311ef9c36235e5dde3803-Figure-2-revised.png\"\u003e\u003cimg itemprop=\"image\" contenteditable=\"false\" alt=\"Sample-wise-distribution-of-carbapenem-resistant-isolates\" title=\"Sample-wise-distribution-of-carbapenem-resistant-isolates\" src=\"https://assets.cureus.com/uploads/figure/file/1053849/article_river_385b7f5020b311ef9c36235e5dde3803-Figure-2-revised.png\"\u003e\n\u003c/a\u003e\n\u003c/div\u003e\n\u003cdiv class=\"attachment-metadata\"\u003e\n\u003ch6 class=\"attachment-title\"\u003e\n\u003cspan\u003eFigure\u003c/span\u003e\n1:\nSample-wise distribution of carbapenem-resistant isolates\n\u003c/h6\u003e\n\u003cdiv class=\"attachment-caption\"\u003e\n\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class=\"fancy-bottom\"\u003e\u003c/div\u003e\n\u003c/div\u003e\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n\r\n\r\n\u003cp\u003eWe analyzed samples across seven categories. The most predominant carbapenem-resistant organism was \u003cem\u003eKlebsiella pneumonia\u003c/em\u003e, accounting for 151 (60.4%) of the cases, followed by \u003cem\u003eE. coli\u003c/em\u003e with 44 (17.6%) and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e with 31 (12.4%). Whereas 145 (96%) of \u003cem\u003eKlebsiella pneumonia\u003c/em\u003e, 41 (93%) of \u003cem\u003eE. coli\u003c/em\u003e, and 31 (100%) of \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e tested positive for mCIM, suggesting the presence of carbapenemase enzyme production in the isolates.\u003c/p\u003e\r\n\r\n\u003cp\u003eThe mCIM positivity among Enterobacterales ranges from 75% to 100%. Specifically, 145 (96%) of \u003cem\u003eKlebsiella pneumonia\u003c/em\u003e and 41 (93%) of \u003cem\u003eE. coli\u003c/em\u003e showed positive results in the mCIM test. Pseudomonas aeruginosa demonstrated a 31 (100%) positive result on the mCIM test (Figure \u003ca class=\"content-anchor attachment-anchor\" data-anchor=\"figure-anchor-1053852\" href=\"javascript:void(0)\"\u003e\u003cem\u003e2\u003c/em\u003e\u003c/a\u003e), suggesting that a significant proportion of carbapenem resistance is attributable to the production of the carbapenemase enzyme.\u003c/p\u003e\r\n\r\n\r\n\r\n\r\n\r\n\u003cdiv class=\"article-attachment-wrap\" data-number=\"2\" id=\"figure-anchor-1053852\" style=\"page-break-inside: avoid;\"\u003e\n\u003cdiv class=\"attachment-container\"\u003e\n\u003ca class=\"mfp-image gallery-item\" data-thumbnail=\"https://assets.cureus.com/uploads/figure/file/1053852/large_thumbnail_8ff297d020b311ef81d8f76277cd6528-Figure-1-revised.png\" title=\"mCIM-and-eCIM-test-setup\" href=\"https://assets.cureus.com/uploads/figure/file/1053852/lightbox_8ff297d020b311ef81d8f76277cd6528-Figure-1-revised.png\"\u003e\u003cimg itemprop=\"image\" contenteditable=\"false\" alt=\"mCIM-and-eCIM-test-setup\" title=\"mCIM-and-eCIM-test-setup\" src=\"https://assets.cureus.com/uploads/figure/file/1053852/article_river_8ff297d020b311ef81d8f76277cd6528-Figure-1-revised.png\"\u003e\n\u003c/a\u003e\n\u003c/div\u003e\n\u003cdiv class=\"attachment-metadata\"\u003e\n\u003ch6 class=\"attachment-title\"\u003e\n\u003cspan\u003eFigure\u003c/span\u003e\n2:\nmCIM and eCIM test setup\n\u003c/h6\u003e\n\u003cdiv class=\"attachment-caption\"\u003e\n\u003cp\u003e(A) Modified carbapenem inactivation method (mCIM) test: Isolate 1: Positive Control; Isolate 23, 24 \u0026amp; 25: Carbapenemase +ve. (B). Ethylenediaminetetraacetic acid (EDTA)-carbapenem inactivation method (eCIM) test: Isolate 14 \u0026amp; 20: Serine positive; Isolate 15 \u0026amp; 19: Metallo-β-lactamases (MBL) positive.\u003c/p\u003e\n\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class=\"fancy-bottom\"\u003e\u003c/div\u003e\n\u003c/div\u003e\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n\r\n\r\n\u003cp\u003eWe subjected all mCIM-positive isolates to the EDTA-carbapenem inactivation method (eCIM) test. Out of a total of 240 isolates, which included 219 (87.6%) Enterobacterales and 31 (12.4%) \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e, the eCIM test was positive for 142 (98%) of \u003cem\u003eKlebsiella pneumonia\u003c/em\u003e, 39 (95%) of \u003cem\u003eE. coli\u003c/em\u003e isolates, and 31 (100%) of \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e isolates. Consequently, 234 (93.6%) carbapenem-resistant Gram-negative bacilli (CRGNB) isolates were eCIM-positive, indicating that 234 (97.5%) were MBL producers and six (2.5%) were serine-β-lactamase producers.\u003c/p\u003e\r\n\r\n\u003cp\u003eThe distribution of carbapenemase in CRGNB varied from 91.4% to 100% across different samples. Among the three most common samples, carbapenemase production was most prevalent in urine samples 85 (96.6%), followed by respiratory secretions 56 (96.5%), and blood 32 (91.4%) (Table \u003ca class=\"content-anchor attachment-anchor\" data-anchor=\"table-anchor-1053856\" href=\"javascript:void(0)\"\u003e\u003cem\u003e1\u003c/em\u003e\u003c/a\u003e).\u003c/p\u003e\r\n\r\n\r\n\r\n\r\n\r\n\u003cdiv class=\"article-attachment-wrap table-attachment-wrap\" data-number=\"1\" id=\"table-anchor-1053856\"\u003e\n\u003cdiv class=\"table-container\" contenteditable=\"false\"\u003e\n\u003ctable\u003e\n\t\u003ctbody\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eSample\u003c/td\u003e\n\t\t\t\u003ctd\u003eNo. of CRGNB\u003c/td\u003e\n\t\t\t\u003ctd\u003eNo. of mCIM +ve isolates N (%)\u003c/td\u003e\n\t\t\t\u003ctd\u003eNo. of eCIM +ve isolates N (%)\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eUrine\u003c/td\u003e\n\t\t\t\u003ctd\u003e88\u003c/td\u003e\n\t\t\t\u003ctd\u003e85 (96.6)\u003c/td\u003e\n\t\t\t\u003ctd\u003e85 (96.5)\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eRespiratory secretions\u003c/td\u003e\n\t\t\t\u003ctd\u003e58\u003c/td\u003e\n\t\t\t\u003ctd\u003e56 (96.5)\u003c/td\u003e\n\t\t\t\u003ctd\u003e55 (94.8)\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eBlood \u003c/td\u003e\n\t\t\t\u003ctd\u003e35\u003c/td\u003e\n\t\t\t\u003ctd\u003e32 (91.4)\u003c/td\u003e\n\t\t\t\u003ctd\u003e32 (91.4)\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003ePus \u0026amp; wound swab\u003c/td\u003e\n\t\t\t\u003ctd\u003e28\u003c/td\u003e\n\t\t\t\u003ctd\u003e27 (96.4)\u003c/td\u003e\n\t\t\t\u003ctd\u003e25 (89.2)\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eTissue\u003c/td\u003e\n\t\t\t\u003ctd\u003e16\u003c/td\u003e\n\t\t\t\u003ctd\u003e16 (100)\u003c/td\u003e\n\t\t\t\u003ctd\u003e15 (93.7)\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eSwabs\u003c/td\u003e\n\t\t\t\u003ctd\u003e13\u003c/td\u003e\n\t\t\t\u003ctd\u003e13 (100)\u003c/td\u003e\n\t\t\t\u003ctd\u003e11 (84.6)\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eFluids\u003c/td\u003e\n\t\t\t\u003ctd\u003e12\u003c/td\u003e\n\t\t\t\u003ctd\u003e11 (91.6)\u003c/td\u003e\n\t\t\t\u003ctd\u003e11 (91.6)\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eTotal\u003c/td\u003e\n\t\t\t\u003ctd\u003e250\u003c/td\u003e\n\t\t\t\u003ctd\u003e240 (96.0)\u003c/td\u003e\n\t\t\t\u003ctd\u003e234 (93.6)\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"attachment-metadata\"\u003e\n\u003ch6 class=\"attachment-title\"\u003e\n\u003cspan\u003eTable\u003c/span\u003e\n1: Distribution of carbapenemase producer samples analysis (positivity to mCIM and eCIM)\n\u003c/h6\u003e\n\u003cdiv class=\"attachment-caption\"\u003e\n\u003cp\u003emCIM: Modified carbapenem inactivation method; eCIM: Ethylenediaminetetraacetic acid (EDTA)-carbapenem inactivation method; CRGNB: Carbapenem-resistant Gram-negative bacilli.\u003c/p\u003e\n\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class=\"fancy-bottom\"\u003e\u003c/div\u003e\n\u003c/div\u003e\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n\r\n\r\n\u003cp\u003eOut of the 250 isolates, 207 (82.8%) demonstrated resistance to all carbapenems tested using the automated VITEK AST 2 system. However, 24 (9.6%) isolates displayed either sensitivity or moderate susceptibility to one or more of the tested carbapenems. Notably, meropenem and imipenem were the drugs most frequently showing moderate susceptibility, with an MIC value of 2 µg/mL for 22 (9.4%) isolates (Table \u003ca class=\"content-anchor attachment-anchor\" data-anchor=\"table-anchor-1053857\" href=\"javascript:void(0)\"\u003e\u003cem\u003e2\u003c/em\u003e\u003c/a\u003e).\u003c/p\u003e\r\n\r\n\r\n\r\n\r\n\r\n\u003cdiv class=\"article-attachment-wrap table-attachment-wrap\" data-number=\"2\" id=\"table-anchor-1053857\"\u003e\n\u003cdiv class=\"table-container\" contenteditable=\"false\"\u003e\n\u003ctable\u003e\n\t\u003ctbody\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eAntibiotic\u003c/td\u003e\n\t\t\t\u003ctd\u003eSusceptible N (%)\u003c/td\u003e\n\t\t\t\u003ctd\u003eModerately Susceptible N (%)\u003c/td\u003e\n\t\t\t\u003ctd\u003eResistant N (%)\u003c/td\u003e\n\t\t\t\u003ctd\u003eTotal\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eImipenem\u003c/td\u003e\n\t\t\t\u003ctd\u003e15 (6.0)\u003c/td\u003e\n\t\t\t\u003ctd\u003e9 (3.6)\u003c/td\u003e\n\t\t\t\u003ctd\u003e226 (90.4)\u003c/td\u003e\n\t\t\t\u003ctd\u003e250\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eMeropenem\u003c/td\u003e\n\t\t\t\u003ctd\u003e18 (7.2)\u003c/td\u003e\n\t\t\t\u003ctd\u003e12 (4.8)\u003c/td\u003e\n\t\t\t\u003ctd\u003e220 (88.0)\u003c/td\u003e\n\t\t\t\u003ctd\u003e250\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eErtapenem *\u003c/td\u003e\n\t\t\t\u003ctd\u003e3 (1.2)\u003c/td\u003e\n\t\t\t\u003ctd\u003e1 (0.4)\u003c/td\u003e\n\t\t\t\u003ctd\u003e207 (82.8)\u003c/td\u003e\n\t\t\t\u003ctd\u003e211*\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"attachment-metadata\"\u003e\n\u003ch6 class=\"attachment-title\"\u003e\n\u003cspan\u003eTable\u003c/span\u003e\n2: Carbapenem susceptibility test results (as per VITEK AST 2)\n\u003c/h6\u003e\n\u003cdiv class=\"attachment-caption\"\u003e\n\u003cp\u003eVITEK AST 2 System (bioMérieux, USA); AST: Antimicrobial susceptibility testing.\u003c/p\u003e\n\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class=\"fancy-bottom\"\u003e\u003c/div\u003e\n\u003c/div\u003e\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n\r\n\r\n\u003cp\u003eTable \u003ca class=\"content-anchor attachment-anchor\" data-anchor=\"table-anchor-1053860\" href=\"javascript:void(0)\"\u003e\u003cem\u003e3\u003c/em\u003e\u003c/a\u003e presents an analysis comparing the results from the VITEK AST 2 system and the mCIM test. A 2x2 Fisher’s exact test was performed to investigate the relationship between carbapenem susceptibility testing using the automated minimum inhibitory concentration (MIC) method and mCIM positivity. The analysis revealed a statistically significant correlation between the variables, with a p-value of 0.0027. It was observed that isolates showing resistance to all three carbapenems through MIC determination are more likely to be carbapenemase producers, compared to isolates that are sensitive or moderately sensitive to one or more carbapenems.\u003c/p\u003e\r\n\r\n\r\n\r\n\r\n\r\n\u003cdiv class=\"article-attachment-wrap table-attachment-wrap\" data-number=\"3\" id=\"table-anchor-1053860\"\u003e\n\u003cdiv class=\"table-container\" contenteditable=\"false\"\u003e\n\u003ctable\u003e\n\t\u003ctbody\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003e Variables\u003c/td\u003e\n\t\t\t\u003ctd\u003eIsolates sensitive or moderately sensitive to at least one of the carbapenem\u003c/td\u003e\n\t\t\t\u003ctd\u003e Isolates resistant to all carbapenem\u003c/td\u003e\n\t\t\t\u003ctd\u003e Total\u003c/td\u003e\n\t\t\t\u003ctd\u003e Chi-square\u003c/td\u003e\n\t\t\t\u003ctd\u003e p-value\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003emCIM +ve\u003c/td\u003e\n\t\t\t\u003ctd\u003e55\u003c/td\u003e\n\t\t\t\u003ctd\u003e185\u003c/td\u003e\n\t\t\t\u003ctd\u003e240\u003c/td\u003e\n\t\t\t\u003ctd\u003e \u003c/td\u003e\n\t\t\t\u003ctd\u003e \u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003emCIM-ve\u003c/td\u003e\n\t\t\t\u003ctd\u003e7\u003c/td\u003e\n\t\t\t\u003ctd\u003e3\u003c/td\u003e\n\t\t\t\u003ctd\u003e10\u003c/td\u003e\n\t\t\t\u003ctd\u003e11.413\u003c/td\u003e\n\t\t\t\u003ctd\u003e0.0027\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eTotal\u003c/td\u003e\n\t\t\t\u003ctd\u003e62\u003c/td\u003e\n\t\t\t\u003ctd\u003e188\u003c/td\u003e\n\t\t\t\u003ctd\u003e250\u003c/td\u003e\n\t\t\t\u003ctd\u003e \u003c/td\u003e\n\t\t\t\u003ctd\u003e \u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003e\u003cstrong\u003e Variables\u003c/strong\u003e\u003c/td\u003e\n\t\t\t\u003ctd\u003e\u003cstrong\u003eIsolates sensitive or moderately sensitive to at least one of the carbapenem\u003c/strong\u003e\u003c/td\u003e\n\t\t\t\u003ctd\u003e\u003cstrong\u003e Isolates resistant to all carbapenem\u003c/strong\u003e\u003c/td\u003e\n\t\t\t\u003ctd\u003e\u003cstrong\u003e Total\u003c/strong\u003e\u003c/td\u003e\n\t\t\t\u003ctd\u003e\u003cstrong\u003e Chi-square\u003c/strong\u003e\u003c/td\u003e\n\t\t\t\u003ctd\u003e\u003cstrong\u003e p-value\u003c/strong\u003e\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eeCIM +ve\u003c/td\u003e\n\t\t\t\u003ctd\u003e22\u003c/td\u003e\n\t\t\t\u003ctd\u003e212\u003c/td\u003e\n\t\t\t\u003ctd\u003e234\u003c/td\u003e\n\t\t\t\u003ctd\u003e \u003c/td\u003e\n\t\t\t\u003ctd\u003e \u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eeCIM-ve\u003c/td\u003e\n\t\t\t\u003ctd\u003e5\u003c/td\u003e\n\t\t\t\u003ctd\u003e1\u003c/td\u003e\n\t\t\t\u003ctd\u003e6\u003c/td\u003e\n\t\t\t\u003ctd\u003e32.0255\u003c/td\u003e\n\t\t\t\u003ctd\u003e0.0001\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eTotal\u003c/td\u003e\n\t\t\t\u003ctd\u003e27\u003c/td\u003e\n\t\t\t\u003ctd\u003e213\u003c/td\u003e\n\t\t\t\u003ctd\u003e240\u003c/td\u003e\n\t\t\t\u003ctd\u003e \u003c/td\u003e\n\t\t\t\u003ctd\u003e \u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"attachment-metadata\"\u003e\n\u003ch6 class=\"attachment-title\"\u003e\n\u003cspan\u003eTable\u003c/span\u003e\n3: Investigation of the pattern of susceptibility to carbapenems in relation to the positivity of mCIM and eCIM\n\u003c/h6\u003e\n\u003cdiv class=\"attachment-caption\"\u003e\n\u003cp\u003eThere is a statistically significant association of modified carbapenem inactivation method (mCIM) positivity with the degree of resistance to carbapenem p-value: 0.0027; There is a statistically significant association of ethylenediaminetetraacetic acid (EDTA)-carbapenem inactivation method (eCIM) positivity with the degree of resistance to carbapenem p-value: 0.0001.\u003c/p\u003e\n\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class=\"fancy-bottom\"\u003e\u003c/div\u003e\n\u003c/div\u003e\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n\r\n\r\n\u003cp\u003eOut of 240 mCIM-positive isolates, 234 (97.5%) were eCIM-positive, indicating the presence of metallo-β-lactamase genes (such as \u003cem\u003eNDM\u003c/em\u003e, \u003cem\u003eIMP\u003c/em\u003e, \u003cem\u003eVIM\u003c/em\u003e, \u003cem\u003eKPC\u003c/em\u003e, and \u003cem\u003eIMI\u003c/em\u003e). The remaining six isolates could be serine β-lactamases, or there might be a co-occurrence of serine β-lactamases with \u003cem\u003eMBL\u003c/em\u003e genes. Among the 234 eCIM-positive isolates, 22 (9.4%) were sensitive or moderately sensitive to at least one of the carbapenems.\u003c/p\u003e\r\n\r\n\u003cp\u003eThe analysis between mCIM and eCIM results is presented in Table \u003ca class=\"content-anchor attachment-anchor\" data-anchor=\"table-anchor-1053860\" href=\"javascript:void(0)\"\u003e\u003cem\u003e3\u003c/em\u003e\u003c/a\u003e. A 2x2 Fisher’s exact test was performed to examine the association between mCIM positivity and eCIM. The correlation between these variables showed statistical significance, with a p-value of 0.0001.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class='article-content-body article-tab'\u003e\n\u003ch3 class='reg' id='discussion'\u003eDiscussion\u003c/h3\u003e\n\u003cp\u003eCarbapenem, once a highly effective drug for treating Gram-negative infections, has become less effective in treating serious infections caused by Gram-negative bacteria. This is due to these organisms acquiring carbapenem resistance genes, primarily \u003cem\u003eNDM\u003c/em\u003e, \u003cem\u003eKPC\u003c/em\u003e, \u003cem\u003eOXA-48\u003c/em\u003e, \u003cem\u003eVIM\u003c/em\u003e, and \u003cem\u003eIMP\u003c/em\u003e. Carbapenem-hydrolyzing β-lactamases are divided into serine-β-lactamases Class A and Class D, which include blaKPC, blaIMI, blaOXA-48, blaOXA-181, blaOXA-23, blaOXA-40, and blaOXA-58. Metallo-β-lactamases of Class B include blaIMP, blaVIM, and blaNDM. In Western countries, the most widespread variety is blaKPC, followed by blaOXA. Previous studies have shown that the most common categories in the Asian subcontinent were MBL, namely blaNDM-1 and blaOXA-48 \u003ca class=\"content-anchor refs-anchor\" href=\"javascript:void(0)\"\u003e[7]\u003c/a\u003e.\u003c/p\u003e\r\n\r\n\u003cp\u003eIn our study, the majority of isolates were obtained from the ICU, accounting for 153 (61.2%), followed by in-patient wards with 101 (27.2%), and the OPD with 29 (11.6%). This distribution is similar to the findings of a study by Baskaran et al. \u003ca class=\"content-anchor refs-anchor\" href=\"javascript:void(0)\"\u003e[7]\u003c/a\u003e. Our study found that the prevalence of carbapenemase production among the carbapenem-resistant isolates screened by the VITEK AST 2 System was 96% (95% CI: 92.77-98.07). This was particularly true for metallo β-lactamases, with 96% mCIM positivity (i.e., 234 out of 240 were positive for EDTA-carbapenem inactivation method (eCIM). This is consistent with a study by Gallego et al., which showed that the prevalence of mCIM was between 96% and 98% \u003ca class=\"content-anchor refs-anchor\" href=\"javascript:void(0)\"\u003e[8]\u003c/a\u003e. A study in Lucknow by Rahman et al. recorded a 100% prevalence of \u003cem\u003eNDM\u003c/em\u003e genes in all the carbapenem-resistant Enterobacterales \u003ca class=\"content-anchor refs-anchor\" href=\"javascript:void(0)\"\u003e[9]\u003c/a\u003e. According to a study conducted by Roopashree et al., the mCIM method revealed a prevalence rate of 45.09% \u003ca class=\"content-anchor refs-anchor\" href=\"javascript:void(0)\"\u003e[10]\u003c/a\u003e.\u003c/p\u003e\r\n\r\n\u003cp\u003eResearch conducted in the Coimbatore region of Tamil Nadu revealed a prevalence rate of 73.33% between 2011 and 2015 and 82% in 2017 \u003ca class=\"content-anchor refs-anchor\" href=\"javascript:void(0)\"\u003e[11]\u003c/a\u003e. The majority of these studies focused on isolates from samples taken from patients with specific co-morbid conditions. Furthermore, a study by Gromski et al. found a higher prevalence of positive bile culture in patients who had not previously undergone biliary stent placement \u003ca class=\"content-anchor refs-anchor\" href=\"javascript:void(0)\"\u003e[12]\u003c/a\u003e. The results showed that 86.1% of patients without a prior biliary stent had positive bile cultures, compared to only 55% of patients in an earlier study who had a positive bile culture without a previous biliary stent. However, some studies were limited to the detection of a specific group of genes responsible for carbapenemases using PCR \u003ca class=\"content-anchor refs-anchor\" href=\"javascript:void(0)\"\u003e[11-14]\u003c/a\u003e.\u003c/p\u003e\r\n\r\n\u003cp\u003eIn our study, the combined prevalence of mCIM and EDTA-carbapenem inactivation method (eCIM) was 97.5%, which aligns with the study by Li and co-workers have reported that the combined incidence of mCIM with eCIM and CDT was 97.5% and 96.2%, respectively \u003ca class=\"content-anchor refs-anchor\" href=\"javascript:void(0)\"\u003e[15]\u003c/a\u003e. Similarly, Koul et al. stated that the combined prevalence of mCIM and eCIM was 58.5% and 58.4%, respectively \u003ca class=\"content-anchor refs-anchor\" href=\"javascript:void(0)\"\u003e[16]\u003c/a\u003e.\u003c/p\u003e\r\n\r\n\u003cp\u003eMales constituted 61.2% and females constituted 38.8% in this study. This is similar to the study by Jaiswal et al., which showed a male predominance of 61% \u003ca class=\"content-anchor refs-anchor\" href=\"javascript:void(0)\"\u003e[17]\u003c/a\u003e. Our study revealed that the three most frequent samples were urine (35%), respiratory secretions (23%), and blood (14%) followed by pus and wound swabs (11%), tissue (7%), swabs (5%), and body fluids (5%) (Figure \u003ca class=\"content-anchor attachment-anchor\" data-anchor=\"figure-anchor-1053849\" href=\"javascript:void(0)\"\u003e\u003cem\u003e1\u003c/em\u003e\u003c/a\u003e). The highest prevalence of Carbapenem Resistant Enterobacteriaceae (CRE) (32.4%) was found in urine samples, followed by respiratory secretions (CRE-20%) and blood (CRE-14%). In contrast, Jaiswal et al. found urine to be the most common sample (29.33%), but the highest prevalence of CRE was in blood samples \u003ca class=\"content-anchor refs-anchor\" href=\"javascript:void(0)\"\u003e[17]\u003c/a\u003e.\u003c/p\u003e\r\n\r\n\u003cp\u003eAmong the carbapenem-resistant Enterobacterales, \u003cem\u003eKlebsiella pneumonia\u003c/em\u003e and \u003cem\u003eE. coli\u003c/em\u003e are the top two carbapenem-resistant organisms, accounting for 60.4% and 17.6%, respectively. This is confirmed by various studies, such as the one by Gao et al., which showed that \u003cem\u003eKlebsiella pneumonia\u003c/em\u003e was the most common CRE organism (44.8%), followed by \u003cem\u003eE. coli \u003c/em\u003e(25.8%), and \u003cem\u003eEnterobacter cloacia\u003c/em\u003e (13.8%) \u003ca class=\"content-anchor refs-anchor\" href=\"javascript:void(0)\"\u003e[18]\u003c/a\u003e.\u003c/p\u003e\r\n\r\n\u003cp\u003eIn this study, Pseudomonas aeruginosa was found to be most prevalent in respiratory secretions, followed by urine, and pus/wound swabs, with prevalence rates of 25.8%, 22.5%, and 22.5%, respectively. These findings are similar to the study by Khater et al., which reported prevalence rates of 37.2% in urine, 30.2% in sputum, 25.6% in pus samples, and 4.66% in blood \u003ca class=\"content-anchor refs-anchor\" href=\"javascript:void(0)\"\u003e[19]\u003c/a\u003e. In our study, the prevalence of carbapenem-resistant \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e was found to be 12.4%. This is comparable to the study by Cheemala et al., which reported a carbapenem resistance rate of 24% in \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e \u003ca class=\"content-anchor refs-anchor\" href=\"javascript:void(0)\"\u003e[20]\u003c/a\u003e. Another study by Vamsi et al. reported a carbapenem resistance rate of 10.9% in Pseudomonas spp \u003ca class=\"content-anchor refs-anchor\" href=\"javascript:void(0)\"\u003e[21]\u003c/a\u003e.\u003c/p\u003e\r\n\r\n\u003cp\u003eAccording to a report from the Antimicrobial Resistance (AMR) Surveillance Network of India, the prevalence of carbapenem resistance in Enterobacterales was 40%, and the average number of \u003cem\u003eMBL\u003c/em\u003e genes in these isolates was 30%. The occurrence of NDM was relatively high in certain parts of the country. The AMR Surveillance Network also reported that the increase in the prevalence of resistance in \u003cem\u003eE. coli\u003c/em\u003e and \u003cem\u003eKlebsiella pneumonia\u003c/em\u003e was 5% and 17%, respectively, over a five-year period in India (2017-2022) \u003ca class=\"content-anchor refs-anchor\" href=\"javascript:void(0)\"\u003e[22]\u003c/a\u003e.\u003c/p\u003e\r\n\r\n\u003cp\u003eThis study has many limitations and challenges. We have used a combination of mCIM and eCIM for phenotypic detection of carbapenem-producing Enterobacterales and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e. Further molecular detection of serine beta-lactamases genes and metallo beta-lactamases by real-time PCR would have been useful in discriminating specific enzymes However, we could not differentiate between the co-occurrence of genes with MBL genes and serine ß-lactamases. However, this will not impact the broad findings of the study regarding the use of eCIM and mCIM to detect and distinguish carbapenemase in resource-limited settings.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class='article-content-body article-tab'\u003e\n\u003ch3 class='reg' id='conclusions'\u003eConclusions\u003c/h3\u003e\n\u003cp\u003eThe prevalence of infections caused by Gram-negative, carbapenem-resistant pathogens is increasing at an alarming rate. With its high sensitivity and specificity, the mCIM proves to be an effective test for detecting these pathogens. However, for the mCIM to yield consistent and accurate results, it must be conducted as a phenotypic test under standardized conditions, as described by the CLSI guideline. The eCIM test shows a positive result irrespective of the presence or absence of the serine carbapenemase genes in combination with metallo-β-lactamase (MBL). Therefore, this method does not distinguish between the co-occurrence and presence of \u003cem\u003eMBL\u003c/em\u003e genes in combination with carbapenemases and those of MBL genes alone. The significant occurrence of MBL in eCIM cases implies that the ideal combination for mCIM-positive isolates in this study region is ceftazidime-avibactam plus aztreonam. Implementing phenotypic methods (eCIM and mCIM) to detect and distinguish carbapenemases would be useful in guiding empirical antibiotic therapy, especially in and useful in infection control in resource-limited settings.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\n\u003cdiv class='new-article-content-section'\u003e\n\u003cdiv class='article-content-body article-tab'\u003e\n\u003ch3 class='reg' id='references'\u003eReferences\u003c/h3\u003e\n\u003col class=\"references\"\u003e\u003cli\u003eSilva DD, Rampelotto RF, Lorenzoni VV, Santos SO, Damer J, Hörner M, Hörner R: \u003ca target=\"_blank\" href=\"https://dx.doi.org/10.1590/0037-8682-0471-2016?utm_medium=email\u0026utm_source=transaction\"\u003ePhenotypic methods for screening carbapenem-resistant Enterobacteriaceae and assessment of their antimicrobial susceptibility profile\u003c/a\u003e. Rev Soc Bras Med Trop. 2017, 50:173-8. \u003cspan class='citation-doi'\u003e\u003ca target=\"_blank\" href=\"https://dx.doi.org/10.1590/0037-8682-0471-2016?utm_medium=email\u0026utm_source=transaction\"\u003e10.1590/0037-8682-0471-2016\u003c/a\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003eGiri S, Sen S, Lall M: \u003ca target=\"_blank\" href=\"https://www.sciencegate.app/document/10.18410/jebmh/2021/50?utm_medium=email\u0026utm_source=transaction\"\u003eDescriptive study for detection of carbapenem resistant enterobacteriaceae by the modified carbapenem inactivation method in a tertiary care hospital of Western Maharashtra\u003c/a\u003e. Journal of Evidence Based Medicine and Healthcare. 2021, 8:261-6.\u003c/li\u003e\u003cli\u003eVerma G, Nayak SR, Jena S, et al.: \u003ca target=\"_blank\" href=\"https://dx.doi.org/10.22207/JPAM.17.4.21?utm_medium=email\u0026utm_source=transaction\"\u003ePrevalence of carbapenem-resistant enterobacterales, acinetobacter baumannii, and pseudomonas aeruginosa in a tertiary care hospital in Eastern India: A pilot study\u003c/a\u003e. J Pure Appl Microbiol. 2023, 17:2243-9. \u003cspan class='citation-doi'\u003e\u003ca target=\"_blank\" href=\"https://dx.doi.org/10.22207/JPAM.17.4.21?utm_medium=email\u0026utm_source=transaction\"\u003e10.22207/JPAM.17.4.21\u003c/a\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003ca target=\"_blank\" href=\"https://main.icmr.nic.in/sites/default/files/upload_documents/AMRSN_Annual_Report_2022.pdf?utm_medium=email\u0026utm_source=transaction\"\u003eAntimicrobial Resistance Research \u0026amp; Surveillance Network-Annual report January 26, 2022\u003c/a\u003e. (2022). 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Accessed: June 2024: \u003ca target=\"_blank\" href=\"https://clsi.org/standards/products/microbiology/documents/m100/?utm_medium=email\u0026utm_source=transaction\"\u003ehttps://clsi.org/standards/products/microbiology/documents/m100/\u003c/a\u003e.\u003c/li\u003e\u003cli\u003eBaskaran V, Jeyamani L, Thangaraju D, Sivaraj R, Jayarajan J: \u003ca target=\"_blank\" href=\"https://pdfs.semanticscholar.org/e9dc/eb0fad154d3930b7f143079bcf4d1248b07f.pdf?utm_medium=email\u0026utm_source=transaction\"\u003eDetection of carbapenemase production by modified carbapenem inactivation method among carbapenem resistant Gram-negative bacilli at a tertiary care centre in Coimbatore, Tamil Nadu, India\u003c/a\u003e. National J of Lab Med. 2023, 12:11-4.\u003c/li\u003e\u003cli\u003eGallego M, Salazar-Ospina L, Jiménez JN: \u003ca target=\"_blank\" href=\"https://dx.doi.org/10.17533/udea.hm.v13n2a03?utm_medium=email\u0026utm_source=transaction\"\u003eThe modified carbapenem inactivation method (mCIM): highly sensitive and specific tool to assess carbapenemase producing and non-producing in Gram-negative bacilli (Article in Spanish)\u003c/a\u003e. Hechos Microbiológicos. 2022, 13:\u003cspan class='citation-doi'\u003e\u003ca target=\"_blank\" href=\"https://dx.doi.org/10.17533/udea.hm.v13n2a03?utm_medium=email\u0026utm_source=transaction\"\u003e10.17533/udea.hm.v13n2a03\u003c/a\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003eRahman M, Shukla SK, Prasad KN, et al.: \u003ca target=\"_blank\" href=\"https://dx.doi.org/10.1016/j.ijantimicag.2014.03.003?utm_medium=email\u0026utm_source=transaction\"\u003ePrevalence and molecular characterisation of New Delhi metallo-β-lactamases NDM-1, NDM-5, NDM-6 and NDM-7 in multidrug-resistant Enterobacteriaceae from India\u003c/a\u003e. 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Endoscopy. 2022, 54:1045-52. \u003cspan class='citation-doi'\u003e\u003ca target=\"_blank\" href=\"https://dx.doi.org/10.1055/a-1790-1314?utm_medium=email\u0026utm_source=transaction\"\u003e10.1055/a-1790-1314\u003c/a\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003eIsik A, Poyanli A, Tekant Y, Cagatay A, Acunas B, Ibis C, Ozden I: \u003ca target=\"_blank\" href=\"https://dx.doi.org/10.5604/01.3001.0015.0423?utm_medium=email\u0026utm_source=transaction\"\u003eIncomplete or inappropriate endoscopic and radiologic interventions as leading causes of cholangitis\u003c/a\u003e. Pol Przegl Chir. 2021, 93:47-52. \u003cspan class='citation-doi'\u003e\u003ca target=\"_blank\" href=\"https://dx.doi.org/10.5604/01.3001.0015.0423?utm_medium=email\u0026utm_source=transaction\"\u003e10.5604/01.3001.0015.0423\u003c/a\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003eMulvey MR, Grant JM, Plewes K, Roscoe D, Boyd DA: \u003ca target=\"_blank\" href=\"https://dx.doi.org/10.3201/eid1701.101358?utm_medium=email\u0026utm_source=transaction\"\u003eNew Delhi metallo-β-lactamase in Klebsiella pneumoniae and Escherichia coli, Canada\u003c/a\u003e. Emerg Infect Dis. 2011, 17:103-6. \u003cspan class='citation-doi'\u003e\u003ca target=\"_blank\" href=\"https://dx.doi.org/10.3201/eid1701.101358?utm_medium=email\u0026utm_source=transaction\"\u003e10.3201/eid1701.101358\u003c/a\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003eLi J, Li C, Cai X, et al.: \u003ca target=\"_blank\" href=\"https://dx.doi.org/10.21037/atm.2019.09.43?utm_medium=email\u0026utm_source=transaction\"\u003ePerformance of modified carbapenem inactivation method and inhibitor-based combined disk test in the detection and distinguishing of carbapenemase producing Enterobacteriaceae\u003c/a\u003e. Ann Transl Med. 2019, 7:566. \u003cspan class='citation-doi'\u003e\u003ca target=\"_blank\" href=\"https://dx.doi.org/10.21037/atm.2019.09.43?utm_medium=email\u0026utm_source=transaction\"\u003e10.21037/atm.2019.09.43\u003c/a\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003eKoul N, Kakati B, Agarwal S: \u003ca target=\"_blank\" href=\"https://dx.doi.org/10.22207/JPAM.16.2.52?utm_medium=email\u0026utm_source=transaction\"\u003eUse of the combined modified carbapenem inactivation method and EDTA-modified carbapenem inactivation method for detection of carbapenemase-producing Enterobacteriaceae causing ventilator-associated respiratory infections\u003c/a\u003e. J Pure Appl Microbiol. 2022, 16:1239-44. \u003cspan class='citation-doi'\u003e\u003ca target=\"_blank\" href=\"https://dx.doi.org/10.22207/JPAM.16.2.52?utm_medium=email\u0026utm_source=transaction\"\u003e10.22207/JPAM.16.2.52\u003c/a\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003eJaiswal SR, Gupta S, Kumar RS, et al.: \u003ca target=\"_blank\" href=\"https://dx.doi.org/10.4084/MJHID.2018.025?utm_medium=email\u0026utm_source=transaction\"\u003eGut colonization with carbapenem-resistant Enterobacteriaceae adversely impacts the outcome in patients with hematological malignancies: results of a prospective surveillance study\u003c/a\u003e. Mediterr J Hematol Infect Dis. 2018, 10:e2018025. \u003cspan class='citation-doi'\u003e\u003ca target=\"_blank\" href=\"https://dx.doi.org/10.4084/MJHID.2018.025?utm_medium=email\u0026utm_source=transaction\"\u003e10.4084/MJHID.2018.025\u003c/a\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003eGao B, Li X, Yang F, Chen W, Zhao Y, Bai G, Zhang Z: \u003ca target=\"_blank\" href=\"https://dx.doi.org/10.3389/fphar.2019.00262?utm_medium=email\u0026utm_source=transaction\"\u003eMolecular epidemiology and risk factors of ventilator-associated pneumonia infection caused by carbapenem-resistant Enterobacteriaceae\u003c/a\u003e. Front Pharmacol. 2019, 10:262. \u003cspan class='citation-doi'\u003e\u003ca target=\"_blank\" href=\"https://dx.doi.org/10.3389/fphar.2019.00262?utm_medium=email\u0026utm_source=transaction\"\u003e10.3389/fphar.2019.00262\u003c/a\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003eKhater ES, Abdo KM: \u003ca target=\"_blank\" href=\"https://dx.doi.org/10.21608/mid.2022.142569.1320?utm_medium=email\u0026utm_source=transaction\"\u003eDetection of carbapenem-resistant Pseudomonas aeruginosa in tertiary care hospital in Saudi Arabia\u003c/a\u003e. Microbes and Infectious Diseases. 2022, 3:693-702. \u003cspan class='citation-doi'\u003e\u003ca target=\"_blank\" href=\"https://dx.doi.org/10.21608/mid.2022.142569.1320?utm_medium=email\u0026utm_source=transaction\"\u003e10.21608/mid.2022.142569.1320\u003c/a\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003eCheemala SS, Vara A, Lakshmi MS, Pradhan S, Kalyani K: \u003ca target=\"_blank\" href=\"https://dx.doi.org/10.22207/JPAM.17.4.07?utm_medium=email\u0026utm_source=transaction\"\u003ePhenotypic detection of carbapenemase production in Gram negative bacilli from clinical isolates in a tertiary care hospital in Telangana\u003c/a\u003e. J Pure Appl Microbiol. 2023, \u003cspan class='citation-doi'\u003e\u003ca target=\"_blank\" href=\"https://dx.doi.org/10.22207/JPAM.17.4.07?utm_medium=email\u0026utm_source=transaction\"\u003e10.22207/JPAM.17.4.07\u003c/a\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003eVamsi SK, Moorthy RS, Hemiliamma MN, Chandra Reddy RB, Chanderakant DJ, Sirikonda S: \u003ca target=\"_blank\" href=\"https://dx.doi.org/10.15537/smj.2022.43.3.20210809?utm_medium=email\u0026utm_source=transaction\"\u003ePhenotypic and genotypic detection of carbapenemase production among gram negative bacteria isolated from hospital acquired infections\u003c/a\u003e. Saudi Med J. 2022, 43:236-43. \u003cspan class='citation-doi'\u003e\u003ca target=\"_blank\" href=\"https://dx.doi.org/10.15537/smj.2022.43.3.20210809?utm_medium=email\u0026utm_source=transaction\"\u003e10.15537/smj.2022.43.3.20210809\u003c/a\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003eRajkumar S, Sistla S, Manoharan M, et al.: \u003ca target=\"_blank\" href=\"https://dx.doi.org/10.4103/ijmm.IJMM_16_427?utm_medium=email\u0026utm_source=transaction\"\u003ePrevalence and genetic mechanisms of antimicrobial resistance in Staphylococcus species: a multicentre report of the indian council of medical research antimicrobial resistance surveillance network\u003c/a\u003e. Indian J Med Microbiol. 2017, 35:53-60. \u003cspan class='citation-doi'\u003e\u003ca target=\"_blank\" href=\"https://dx.doi.org/10.4103/ijmm.IJMM_16_427?utm_medium=email\u0026utm_source=transaction\"\u003e10.4103/ijmm.IJMM_16_427\u003c/a\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\n\u003c/div\u003e\n","created_at":"2024-06-27T23:12:47.823-07:00","updated_at":"2024-06-27T23:12:47.823-07:00"},"hero":{"id":329438,"public_view_id":63511,"tab_type":"hero","html":"\u003cdiv class='row small-collapse top-section'\u003e\n\u003cdiv class='small-12 columns'\u003e\n\u003cdiv class='hero-image-container' id='hero-background-image-container'\u003e\u003c/div\u003e\n\u003cdiv class='article-header-container'\u003e\n\u003cdiv class='article-header-content'\u003e\n\u003cdiv class='row'\u003e\n\u003cdiv class='small-12 columns badges-container'\u003e\n\u003cdiv class='channels-container'\u003e\u003c/div\u003e\n\u003cimg class='channel-badge hide' src='https://public.cureus.com/article-show-redesign/channel-badge.png'\u003e\n\u003cimg class='type-badge OriginalArticle show-for-medium-up' src='https://public.cureus.com/article-show-redesign/types-badge/OriginalArticle.png'\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class='row peer-reviewed show-for-small-only'\u003e\n\u003cdiv class='small-12 columns text-center peer-reviewed-section'\u003e\n\u003cdiv class='article-type text-center'\u003e\n\u003cstrong class='title OriginalArticle'\u003eOriginal Article\u003c/strong\u003e\n\u003c/div\u003e\n\u003cdiv class='bulletpoint-mobile show-for-medium-down'\u003e\n\u0026#x2022;\n\u003c/div\u003e\n\u003cdiv class='peer-reviewed-decal'\u003e\n\u003cimg class='peer-reviewed-icon' src='https://public.cureus.com/article-show-redesign/new-peer-review-badge.png'\u003e\nPeer-Reviewed\n\u003c/div\u003e\n\u003cdiv class='bulletpoint-mobile show-for-small-only'\u003e\n\u0026#x2022;\n\u003c/div\u003e\n\u003cdiv class='more-info text-center show-for-small-only'\u003e\n\u003cstrong\u003e\nMore info\n\u003c/strong\u003e\n\u003c/div\u003e\n\u003cimg class='has-tip tip-top show-for-small-only' data-html='true' data-options='show_on:small' data-tooltip='' id='more-info-icon' src='https://public.cureus.com/article-show-redesign/more-info-icon-new.png' title='\u0026lt;b\u0026gt;Published:\u0026lt;/b\u0026gt; June 27, 2024 \u0026lt;a href=\u0026quot;/articles/258514#!/authors\u0026quot;\u0026gt;(see history)\u0026lt;/a\u0026gt; \u0026lt;br/\u0026gt; \u0026lt;b\u0026gt;DOI:\u0026lt;/b\u0026gt; 10.7759/cureus.63340'\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class='row'\u003e\n\u003cdiv class='small-12 columns article-title-container text-center'\u003e\n\u003ch2 class='roboto-font article-title title-margin-bottom'\u003e\n\u003cstrong\u003e\u003c/strong\u003eModified Carbapenem Inactivation Method and Ethylenediaminetetraacetic Acid (EDTA)-Carbapenem Inactivation Method for Detection of Carbapenemase-Producing Enterobacterales and Pseudomonas aeruginosa\n\u003c/h2\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class='row article-details-section name-container text-center show-for-small-only'\u003e\n\u003cp class='author-list font-fourteen blue-font semibold-font'\u003e\n\u003ca target=\"_blank\" href=\"https://www.cureus.com/users/633846-gaurav-verma\"\u003eGaurav Verma\u003c/a\u003e • \u003ca target=\"_blank\" href=\"https://www.cureus.com/users/342090-nipa-singh\"\u003eNipa Singh\u003c/a\u003e\u003csup class=\"text-link-blue-highlight\"\u003e\u003ca href=\"mailto:nipa.singh@kims.ac.in\"\u003e\u003ci class=\"fas fa-envelope\"\u003e \u003c/i\u003e\u003c/a\u003e\u003c/sup\u003e • \u003ca target=\"_blank\" href=\"https://www.cureus.com/users/776233-shradha-smriti\"\u003eShradha Smriti\u003c/a\u003e • \u003ca target=\"_blank\" href=\"https://www.cureus.com/users/207363-subhra-snigdha-panda\"\u003eSubhra Snigdha Panda\u003c/a\u003e • \u003ca target=\"_blank\" href=\"https://www.cureus.com/users/312100-dipti-pattnaik\"\u003eDipti Pattnaik\u003c/a\u003e • \u003ca target=\"_blank\" href=\"https://www.cureus.com/users/776238-sukanta-tripathy\"\u003eSukanta Tripathy\u003c/a\u003e • \u003ca target=\"_blank\" href=\"https://www.cureus.com/users/776242-ashok-k-praharaj\"\u003eAshok K. Praharaj\u003c/a\u003e • \u003ca target=\"_blank\" href=\"https://www.cureus.com/users/330862-a-raj-kumar-patro\"\u003eA. Raj Kumar Patro\u003c/a\u003e\n\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class='row' id='like-button-container'\u003e\u003c/div\u003e\n\u003cdiv class='row article-details-section name-container text-center show-for-medium-up'\u003e\n\u003cp class='author-list font-fourteen blue-font semibold-font'\u003e\n\u003ca target=\"_blank\" href=\"https://www.cureus.com/users/633846-gaurav-verma\"\u003eGaurav Verma\u003c/a\u003e • \u003ca target=\"_blank\" href=\"https://www.cureus.com/users/342090-nipa-singh\"\u003eNipa Singh\u003c/a\u003e\u003csup class=\"text-link-blue-highlight\"\u003e\u003ca href=\"mailto:nipa.singh@kims.ac.in\"\u003e\u003ci class=\"fas fa-envelope\"\u003e \u003c/i\u003e\u003c/a\u003e\u003c/sup\u003e • \u003ca target=\"_blank\" href=\"https://www.cureus.com/users/776233-shradha-smriti\"\u003eShradha Smriti\u003c/a\u003e • \u003ca target=\"_blank\" href=\"https://www.cureus.com/users/207363-subhra-snigdha-panda\"\u003eSubhra Snigdha Panda\u003c/a\u003e • \u003ca target=\"_blank\" href=\"https://www.cureus.com/users/312100-dipti-pattnaik\"\u003eDipti Pattnaik\u003c/a\u003e • \u003ca target=\"_blank\" href=\"https://www.cureus.com/users/776238-sukanta-tripathy\"\u003eSukanta Tripathy\u003c/a\u003e • \u003ca target=\"_blank\" href=\"https://www.cureus.com/users/776242-ashok-k-praharaj\"\u003eAshok K. Praharaj\u003c/a\u003e • \u003ca target=\"_blank\" href=\"https://www.cureus.com/users/330862-a-raj-kumar-patro\"\u003eA. Raj Kumar Patro\u003c/a\u003e\n\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class='row article-details-section date-container'\u003e\n\u003cp class='margin-between font-fourteen roboto-font gray-font'\u003e\n\u003cb\u003e\nPublished:\n\u003c/b\u003e\n\u003cspan id='published-date'\u003e\nJune 27, 2024\n\u003c/span\u003e\n\u003c/p\u003e\n\u003cp class='margin-between font-fourteen roboto-font gray-font'\u003e\n\u003cb\u003e\nDOI:\n\u003c/b\u003e\n10.7759/cureus.63340\n\u003cimg class='doi-image has-tip tip-top icon-size margin-left' data-doi='10.7759/cureus.63340' data-tooltip='' id='doi-copy' src='https://public.cureus.com/article-show-redesign/doi-icon.png' title='Copy to clipboard'\u003e\n\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class='row show-for-medium-up'\u003e\n\u003cdiv class='small-12 columns text-center peer-reviewed-section'\u003e\n\u003cdiv class='peer-reviewed-decal'\u003e\n\u003cimg class='peer-reviewed-icon' src='https://public.cureus.com/article-show-redesign/new-peer-review-badge.png'\u003e\nPeer-Reviewed\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class='row article-details-section citation-container'\u003e\n\u003cp class='text-center font-fourteen gray-font'\u003e\n\u003cb\u003e\nCite this article as:\n\u003c/b\u003e\nVerma G, Singh N, Smriti S, et al. (June 27, 2024) Modified Carbapenem Inactivation Method and Ethylenediaminetetraacetic Acid (EDTA)-Carbapenem Inactivation Method for Detection of Carbapenemase-Producing Enterobacterales and Pseudomonas aeruginosa. Cureus 16(6): e63340. doi:10.7759/cureus.63340\n\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n","created_at":"2024-06-27T23:12:47.947-07:00","updated_at":"2024-06-27T23:12:47.947-07:00"},"figures":{"id":329439,"public_view_id":63511,"tab_type":"figures","html":"\u003cdiv class='article-content-wrap'\u003e\n\u003cdiv class='gallery-wrap'\u003e\n\u003cdiv class=\"article-attachment-wrap\" data-number=\"1\" id=\"figure-anchor-1053849\" style=\"page-break-inside: avoid;\"\u003e\n\u003cdiv class=\"attachment-container\"\u003e\n\u003ca class=\"mfp-image gallery-item\" data-thumbnail=\"https://assets.cureus.com/uploads/figure/file/1053849/large_thumbnail_385b7f5020b311ef9c36235e5dde3803-Figure-2-revised.png\" title=\"Sample-wise-distribution-of-carbapenem-resistant-isolates\" href=\"https://assets.cureus.com/uploads/figure/file/1053849/lightbox_385b7f5020b311ef9c36235e5dde3803-Figure-2-revised.png\"\u003e\u003cimg itemprop=\"image\" contenteditable=\"false\" alt=\"Sample-wise-distribution-of-carbapenem-resistant-isolates\" title=\"Sample-wise-distribution-of-carbapenem-resistant-isolates\" src=\"https://public.cureus.com/spinner.gif\" data-lazy=\"https://assets.cureus.com/uploads/figure/file/1053849/article_river_385b7f5020b311ef9c36235e5dde3803-Figure-2-revised.png\" class=\"spinner\"\u003e\n\u003c/a\u003e\n\u003c/div\u003e\n\u003cdiv class=\"attachment-metadata\"\u003e\n\u003ch6 class=\"attachment-title\"\u003e\n\u003cspan\u003eFigure\u003c/span\u003e\n1:\nSample-wise distribution of carbapenem-resistant isolates\n\u003c/h6\u003e\n\u003cdiv class=\"attachment-caption\"\u003e\n\n\u003c/div\u003e\n\u003cdiv class=\"attachment-actions\"\u003e\n\u003ca class=\"button secondary\" href=\"/publish/articles/258514-modified-carbapenem-inactivation-method-and-ethylenediaminetetraacetic-acid-edta-carbapenem-inactivation-method-for-detection-of-carbapenemase-producing-enterobacterales-and-pseudomonas-aeruginosa/attachments/1053849/download_figure\"\u003e\u003ci class=\"fa fa-cloud-download\"\u003e\u003c/i\u003e\n \nDownload full-size\n\u003c/a\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class=\"fancy-bottom\"\u003e\u003c/div\u003e\n\u003c/div\u003e\n\n\u003cdiv class=\"article-attachment-wrap\" data-number=\"2\" id=\"figure-anchor-1053852\" style=\"page-break-inside: avoid;\"\u003e\n\u003cdiv class=\"attachment-container\"\u003e\n\u003ca class=\"mfp-image gallery-item\" data-thumbnail=\"https://assets.cureus.com/uploads/figure/file/1053852/large_thumbnail_8ff297d020b311ef81d8f76277cd6528-Figure-1-revised.png\" title=\"mCIM-and-eCIM-test-setup\" href=\"https://assets.cureus.com/uploads/figure/file/1053852/lightbox_8ff297d020b311ef81d8f76277cd6528-Figure-1-revised.png\"\u003e\u003cimg itemprop=\"image\" contenteditable=\"false\" alt=\"mCIM-and-eCIM-test-setup\" title=\"mCIM-and-eCIM-test-setup\" src=\"https://public.cureus.com/spinner.gif\" data-lazy=\"https://assets.cureus.com/uploads/figure/file/1053852/article_river_8ff297d020b311ef81d8f76277cd6528-Figure-1-revised.png\" class=\"spinner\"\u003e\n\u003c/a\u003e\n\u003c/div\u003e\n\u003cdiv class=\"attachment-metadata\"\u003e\n\u003ch6 class=\"attachment-title\"\u003e\n\u003cspan\u003eFigure\u003c/span\u003e\n2:\nmCIM and eCIM test setup\n\u003c/h6\u003e\n\u003cdiv class=\"attachment-caption\"\u003e\n\u003cp\u003e(A) Modified carbapenem inactivation method (mCIM) test: Isolate 1: Positive Control; Isolate 23, 24 \u0026amp; 25: Carbapenemase +ve. (B). Ethylenediaminetetraacetic acid (EDTA)-carbapenem inactivation method (eCIM) test: Isolate 14 \u0026amp; 20: Serine positive; Isolate 15 \u0026amp; 19: Metallo-β-lactamases (MBL) positive.\u003c/p\u003e\n\n\u003c/div\u003e\n\u003cdiv class=\"attachment-actions\"\u003e\n\u003ca class=\"button secondary\" href=\"/publish/articles/258514-modified-carbapenem-inactivation-method-and-ethylenediaminetetraacetic-acid-edta-carbapenem-inactivation-method-for-detection-of-carbapenemase-producing-enterobacterales-and-pseudomonas-aeruginosa/attachments/1053852/download_figure\"\u003e\u003ci class=\"fa fa-cloud-download\"\u003e\u003c/i\u003e\n \nDownload full-size\n\u003c/a\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class=\"fancy-bottom\"\u003e\u003c/div\u003e\n\u003c/div\u003e\n\n\u003cdiv class='article-attachment-wrap table-attachment-wrap' data-number='1' id='table-anchor-1053856'\u003e\n\u003cdiv class='table-container' contenteditable='false'\u003e\n\u003ctable\u003e\n\t\u003ctbody\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eSample\u003c/td\u003e\n\t\t\t\u003ctd\u003eNo. of CRGNB\u003c/td\u003e\n\t\t\t\u003ctd\u003eNo. of mCIM +ve isolates N (%)\u003c/td\u003e\n\t\t\t\u003ctd\u003eNo. of eCIM +ve isolates N (%)\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eUrine\u003c/td\u003e\n\t\t\t\u003ctd\u003e88\u003c/td\u003e\n\t\t\t\u003ctd\u003e85 (96.6)\u003c/td\u003e\n\t\t\t\u003ctd\u003e85 (96.5)\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eRespiratory secretions\u003c/td\u003e\n\t\t\t\u003ctd\u003e58\u003c/td\u003e\n\t\t\t\u003ctd\u003e56 (96.5)\u003c/td\u003e\n\t\t\t\u003ctd\u003e55 (94.8)\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eBlood \u003c/td\u003e\n\t\t\t\u003ctd\u003e35\u003c/td\u003e\n\t\t\t\u003ctd\u003e32 (91.4)\u003c/td\u003e\n\t\t\t\u003ctd\u003e32 (91.4)\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003ePus \u0026amp; wound swab\u003c/td\u003e\n\t\t\t\u003ctd\u003e28\u003c/td\u003e\n\t\t\t\u003ctd\u003e27 (96.4)\u003c/td\u003e\n\t\t\t\u003ctd\u003e25 (89.2)\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eTissue\u003c/td\u003e\n\t\t\t\u003ctd\u003e16\u003c/td\u003e\n\t\t\t\u003ctd\u003e16 (100)\u003c/td\u003e\n\t\t\t\u003ctd\u003e15 (93.7)\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eSwabs\u003c/td\u003e\n\t\t\t\u003ctd\u003e13\u003c/td\u003e\n\t\t\t\u003ctd\u003e13 (100)\u003c/td\u003e\n\t\t\t\u003ctd\u003e11 (84.6)\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eFluids\u003c/td\u003e\n\t\t\t\u003ctd\u003e12\u003c/td\u003e\n\t\t\t\u003ctd\u003e11 (91.6)\u003c/td\u003e\n\t\t\t\u003ctd\u003e11 (91.6)\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eTotal\u003c/td\u003e\n\t\t\t\u003ctd\u003e250\u003c/td\u003e\n\t\t\t\u003ctd\u003e240 (96.0)\u003c/td\u003e\n\t\t\t\u003ctd\u003e234 (93.6)\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class='attachment-metadata'\u003e\n\u003ch6 class='attachment-title'\u003e\n\u003cspan\u003eTable\u003c/span\u003e\n1: Distribution of carbapenemase producer samples analysis (positivity to mCIM and eCIM)\n\u003c/h6\u003e\n\u003cdiv class='attachment-caption'\u003e\n\u003cp\u003emCIM:\u0026nbsp;Modified carbapenem inactivation method;\u0026nbsp;eCIM:\u0026nbsp;Ethylenediaminetetraacetic acid (EDTA)-carbapenem inactivation method;\u0026nbsp;CRGNB: Carbapenem-resistant Gram-negative bacilli.\u003c/p\u003e\n\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class='pdf-hidden'\u003e\n\u003cdiv class='attachment-actions'\u003e\n\u003ca data-mfp-src=\"#table-1053856-gallery-item\" class=\"button secondary gallery-item\" data-thumbnail=\"https://assets.cureus.com/packs/media/images/fallback/figures/article_box_default-28f78253afa1adefe3e2bcdb029e78fa.gif\" data-title=\"Distribution-of-carbapenemase-producer-samples-analysis-(positivity-to-mCIM-and-eCIM)\" href=\"#\"\u003e\u003ci class='fa fa-expand'\u003e\u003c/i\u003e\nView larger\n\u003c/a\u003e\u003c/div\u003e\n\u003cdiv class='table-gallery-item mfp-hide' id='table-1053856-gallery-item'\u003e\n\u003cdiv class='table-wrap'\u003e\n\u003ctable\u003e\n\t\u003ctbody\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eSample\u003c/td\u003e\n\t\t\t\u003ctd\u003eNo. of CRGNB\u003c/td\u003e\n\t\t\t\u003ctd\u003eNo. of mCIM +ve isolates N (%)\u003c/td\u003e\n\t\t\t\u003ctd\u003eNo. of eCIM +ve isolates N (%)\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eUrine\u003c/td\u003e\n\t\t\t\u003ctd\u003e88\u003c/td\u003e\n\t\t\t\u003ctd\u003e85 (96.6)\u003c/td\u003e\n\t\t\t\u003ctd\u003e85 (96.5)\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eRespiratory secretions\u003c/td\u003e\n\t\t\t\u003ctd\u003e58\u003c/td\u003e\n\t\t\t\u003ctd\u003e56 (96.5)\u003c/td\u003e\n\t\t\t\u003ctd\u003e55 (94.8)\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eBlood \u003c/td\u003e\n\t\t\t\u003ctd\u003e35\u003c/td\u003e\n\t\t\t\u003ctd\u003e32 (91.4)\u003c/td\u003e\n\t\t\t\u003ctd\u003e32 (91.4)\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003ePus \u0026amp; wound swab\u003c/td\u003e\n\t\t\t\u003ctd\u003e28\u003c/td\u003e\n\t\t\t\u003ctd\u003e27 (96.4)\u003c/td\u003e\n\t\t\t\u003ctd\u003e25 (89.2)\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eTissue\u003c/td\u003e\n\t\t\t\u003ctd\u003e16\u003c/td\u003e\n\t\t\t\u003ctd\u003e16 (100)\u003c/td\u003e\n\t\t\t\u003ctd\u003e15 (93.7)\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eSwabs\u003c/td\u003e\n\t\t\t\u003ctd\u003e13\u003c/td\u003e\n\t\t\t\u003ctd\u003e13 (100)\u003c/td\u003e\n\t\t\t\u003ctd\u003e11 (84.6)\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eFluids\u003c/td\u003e\n\t\t\t\u003ctd\u003e12\u003c/td\u003e\n\t\t\t\u003ctd\u003e11 (91.6)\u003c/td\u003e\n\t\t\t\u003ctd\u003e11 (91.6)\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eTotal\u003c/td\u003e\n\t\t\t\u003ctd\u003e250\u003c/td\u003e\n\t\t\t\u003ctd\u003e240 (96.0)\u003c/td\u003e\n\t\t\t\u003ctd\u003e234 (93.6)\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cdiv class='mfp-bottom-bar'\u003e\n\u003cdiv class='mfp-title'\u003e\u003c/div\u003e\n\u003cdiv class='mfp-counter'\u003e\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class='fancy-bottom'\u003e\u003c/div\u003e\n\u003c/div\u003e\n\n\u003cdiv class='article-attachment-wrap table-attachment-wrap' data-number='2' id='table-anchor-1053857'\u003e\n\u003cdiv class='table-container' contenteditable='false'\u003e\n\u003ctable\u003e\n\t\u003ctbody\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eAntibiotic\u003c/td\u003e\n\t\t\t\u003ctd\u003eSusceptible N (%)\u003c/td\u003e\n\t\t\t\u003ctd\u003eModerately Susceptible N (%)\u003c/td\u003e\n\t\t\t\u003ctd\u003eResistant N (%)\u003c/td\u003e\n\t\t\t\u003ctd\u003eTotal\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eImipenem\u003c/td\u003e\n\t\t\t\u003ctd\u003e15 (6.0)\u003c/td\u003e\n\t\t\t\u003ctd\u003e9 (3.6)\u003c/td\u003e\n\t\t\t\u003ctd\u003e226 (90.4)\u003c/td\u003e\n\t\t\t\u003ctd\u003e250\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eMeropenem\u003c/td\u003e\n\t\t\t\u003ctd\u003e18 (7.2)\u003c/td\u003e\n\t\t\t\u003ctd\u003e12 (4.8)\u003c/td\u003e\n\t\t\t\u003ctd\u003e220 (88.0)\u003c/td\u003e\n\t\t\t\u003ctd\u003e250\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eErtapenem *\u003c/td\u003e\n\t\t\t\u003ctd\u003e3 (1.2)\u003c/td\u003e\n\t\t\t\u003ctd\u003e1 (0.4)\u003c/td\u003e\n\t\t\t\u003ctd\u003e207 (82.8)\u003c/td\u003e\n\t\t\t\u003ctd\u003e211*\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class='attachment-metadata'\u003e\n\u003ch6 class='attachment-title'\u003e\n\u003cspan\u003eTable\u003c/span\u003e\n2: Carbapenem susceptibility test results (as per VITEK AST 2)\n\u003c/h6\u003e\n\u003cdiv class='attachment-caption'\u003e\n\u003cp\u003eVITEK AST 2 System (bioM\u0026eacute;rieux, USA); AST:\u0026nbsp;Antimicrobial susceptibility testing.\u003c/p\u003e\n\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class='pdf-hidden'\u003e\n\u003cdiv class='attachment-actions'\u003e\n\u003ca data-mfp-src=\"#table-1053857-gallery-item\" class=\"button secondary gallery-item\" data-thumbnail=\"https://assets.cureus.com/packs/media/images/fallback/figures/article_box_default-28f78253afa1adefe3e2bcdb029e78fa.gif\" data-title=\"Carbapenem-susceptibility-test-results-(as-per-VITEK-AST-2)\" href=\"#\"\u003e\u003ci class='fa fa-expand'\u003e\u003c/i\u003e\nView larger\n\u003c/a\u003e\u003c/div\u003e\n\u003cdiv class='table-gallery-item mfp-hide' id='table-1053857-gallery-item'\u003e\n\u003cdiv class='table-wrap'\u003e\n\u003ctable\u003e\n\t\u003ctbody\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eAntibiotic\u003c/td\u003e\n\t\t\t\u003ctd\u003eSusceptible N (%)\u003c/td\u003e\n\t\t\t\u003ctd\u003eModerately Susceptible N (%)\u003c/td\u003e\n\t\t\t\u003ctd\u003eResistant N (%)\u003c/td\u003e\n\t\t\t\u003ctd\u003eTotal\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eImipenem\u003c/td\u003e\n\t\t\t\u003ctd\u003e15 (6.0)\u003c/td\u003e\n\t\t\t\u003ctd\u003e9 (3.6)\u003c/td\u003e\n\t\t\t\u003ctd\u003e226 (90.4)\u003c/td\u003e\n\t\t\t\u003ctd\u003e250\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eMeropenem\u003c/td\u003e\n\t\t\t\u003ctd\u003e18 (7.2)\u003c/td\u003e\n\t\t\t\u003ctd\u003e12 (4.8)\u003c/td\u003e\n\t\t\t\u003ctd\u003e220 (88.0)\u003c/td\u003e\n\t\t\t\u003ctd\u003e250\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eErtapenem *\u003c/td\u003e\n\t\t\t\u003ctd\u003e3 (1.2)\u003c/td\u003e\n\t\t\t\u003ctd\u003e1 (0.4)\u003c/td\u003e\n\t\t\t\u003ctd\u003e207 (82.8)\u003c/td\u003e\n\t\t\t\u003ctd\u003e211*\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cdiv class='mfp-bottom-bar'\u003e\n\u003cdiv class='mfp-title'\u003e\u003c/div\u003e\n\u003cdiv class='mfp-counter'\u003e\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class='fancy-bottom'\u003e\u003c/div\u003e\n\u003c/div\u003e\n\n\u003cdiv class='article-attachment-wrap table-attachment-wrap' data-number='3' id='table-anchor-1053860'\u003e\n\u003cdiv class='table-container' contenteditable='false'\u003e\n\u003ctable\u003e\n\t\u003ctbody\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003e Variables\u003c/td\u003e\n\t\t\t\u003ctd\u003eIsolates sensitive or moderately sensitive to at least one of the carbapenem\u003c/td\u003e\n\t\t\t\u003ctd\u003e Isolates resistant to all carbapenem\u003c/td\u003e\n\t\t\t\u003ctd\u003e Total\u003c/td\u003e\n\t\t\t\u003ctd\u003e Chi-square\u003c/td\u003e\n\t\t\t\u003ctd\u003e p-value\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003emCIM +ve\u003c/td\u003e\n\t\t\t\u003ctd\u003e55\u003c/td\u003e\n\t\t\t\u003ctd\u003e185\u003c/td\u003e\n\t\t\t\u003ctd\u003e240\u003c/td\u003e\n\t\t\t\u003ctd\u003e \u003c/td\u003e\n\t\t\t\u003ctd\u003e \u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003emCIM-ve\u003c/td\u003e\n\t\t\t\u003ctd\u003e7\u003c/td\u003e\n\t\t\t\u003ctd\u003e3\u003c/td\u003e\n\t\t\t\u003ctd\u003e10\u003c/td\u003e\n\t\t\t\u003ctd\u003e11.413\u003c/td\u003e\n\t\t\t\u003ctd\u003e0.0027\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eTotal\u003c/td\u003e\n\t\t\t\u003ctd\u003e62\u003c/td\u003e\n\t\t\t\u003ctd\u003e188\u003c/td\u003e\n\t\t\t\u003ctd\u003e250\u003c/td\u003e\n\t\t\t\u003ctd\u003e \u003c/td\u003e\n\t\t\t\u003ctd\u003e \u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003e\u003cstrong\u003e Variables\u003c/strong\u003e\u003c/td\u003e\n\t\t\t\u003ctd\u003e\u003cstrong\u003eIsolates sensitive or moderately sensitive to at least one of the carbapenem\u003c/strong\u003e\u003c/td\u003e\n\t\t\t\u003ctd\u003e\u003cstrong\u003e Isolates resistant to all carbapenem\u003c/strong\u003e\u003c/td\u003e\n\t\t\t\u003ctd\u003e\u003cstrong\u003e Total\u003c/strong\u003e\u003c/td\u003e\n\t\t\t\u003ctd\u003e\u003cstrong\u003e Chi-square\u003c/strong\u003e\u003c/td\u003e\n\t\t\t\u003ctd\u003e\u003cstrong\u003e p-value\u003c/strong\u003e\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eeCIM +ve\u003c/td\u003e\n\t\t\t\u003ctd\u003e22\u003c/td\u003e\n\t\t\t\u003ctd\u003e212\u003c/td\u003e\n\t\t\t\u003ctd\u003e234\u003c/td\u003e\n\t\t\t\u003ctd\u003e \u003c/td\u003e\n\t\t\t\u003ctd\u003e \u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eeCIM-ve\u003c/td\u003e\n\t\t\t\u003ctd\u003e5\u003c/td\u003e\n\t\t\t\u003ctd\u003e1\u003c/td\u003e\n\t\t\t\u003ctd\u003e6\u003c/td\u003e\n\t\t\t\u003ctd\u003e32.0255\u003c/td\u003e\n\t\t\t\u003ctd\u003e0.0001\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eTotal\u003c/td\u003e\n\t\t\t\u003ctd\u003e27\u003c/td\u003e\n\t\t\t\u003ctd\u003e213\u003c/td\u003e\n\t\t\t\u003ctd\u003e240\u003c/td\u003e\n\t\t\t\u003ctd\u003e \u003c/td\u003e\n\t\t\t\u003ctd\u003e \u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class='attachment-metadata'\u003e\n\u003ch6 class='attachment-title'\u003e\n\u003cspan\u003eTable\u003c/span\u003e\n3: Investigation of the pattern of susceptibility to carbapenems in relation to the positivity of mCIM and eCIM\n\u003c/h6\u003e\n\u003cdiv class='attachment-caption'\u003e\n\u003cp\u003eThere is a statistically significant association of modified carbapenem inactivation method (mCIM) positivity with the degree of resistance to carbapenem p-value: 0.0027; There is a statistically significant association of ethylenediaminetetraacetic acid (EDTA)-carbapenem inactivation method (eCIM) positivity with the degree of resistance to carbapenem p-value: 0.0001.\u003c/p\u003e\n\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class='pdf-hidden'\u003e\n\u003cdiv class='attachment-actions'\u003e\n\u003ca data-mfp-src=\"#table-1053860-gallery-item\" class=\"button secondary gallery-item\" data-thumbnail=\"https://assets.cureus.com/packs/media/images/fallback/figures/article_box_default-28f78253afa1adefe3e2bcdb029e78fa.gif\" data-title=\"Investigation-of-the-pattern-of-susceptibility-to-carbapenems-in-relation-to-the-positivity-of-mCIM-and-eCIM\" href=\"#\"\u003e\u003ci class='fa fa-expand'\u003e\u003c/i\u003e\nView larger\n\u003c/a\u003e\u003c/div\u003e\n\u003cdiv class='table-gallery-item mfp-hide' id='table-1053860-gallery-item'\u003e\n\u003cdiv class='table-wrap'\u003e\n\u003ctable\u003e\n\t\u003ctbody\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003e Variables\u003c/td\u003e\n\t\t\t\u003ctd\u003eIsolates sensitive or moderately sensitive to at least one of the carbapenem\u003c/td\u003e\n\t\t\t\u003ctd\u003e Isolates resistant to all carbapenem\u003c/td\u003e\n\t\t\t\u003ctd\u003e Total\u003c/td\u003e\n\t\t\t\u003ctd\u003e Chi-square\u003c/td\u003e\n\t\t\t\u003ctd\u003e p-value\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003emCIM +ve\u003c/td\u003e\n\t\t\t\u003ctd\u003e55\u003c/td\u003e\n\t\t\t\u003ctd\u003e185\u003c/td\u003e\n\t\t\t\u003ctd\u003e240\u003c/td\u003e\n\t\t\t\u003ctd\u003e \u003c/td\u003e\n\t\t\t\u003ctd\u003e \u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003emCIM-ve\u003c/td\u003e\n\t\t\t\u003ctd\u003e7\u003c/td\u003e\n\t\t\t\u003ctd\u003e3\u003c/td\u003e\n\t\t\t\u003ctd\u003e10\u003c/td\u003e\n\t\t\t\u003ctd\u003e11.413\u003c/td\u003e\n\t\t\t\u003ctd\u003e0.0027\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eTotal\u003c/td\u003e\n\t\t\t\u003ctd\u003e62\u003c/td\u003e\n\t\t\t\u003ctd\u003e188\u003c/td\u003e\n\t\t\t\u003ctd\u003e250\u003c/td\u003e\n\t\t\t\u003ctd\u003e \u003c/td\u003e\n\t\t\t\u003ctd\u003e \u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003e\u003cstrong\u003e Variables\u003c/strong\u003e\u003c/td\u003e\n\t\t\t\u003ctd\u003e\u003cstrong\u003eIsolates sensitive or moderately sensitive to at least one of the carbapenem\u003c/strong\u003e\u003c/td\u003e\n\t\t\t\u003ctd\u003e\u003cstrong\u003e Isolates resistant to all carbapenem\u003c/strong\u003e\u003c/td\u003e\n\t\t\t\u003ctd\u003e\u003cstrong\u003e Total\u003c/strong\u003e\u003c/td\u003e\n\t\t\t\u003ctd\u003e\u003cstrong\u003e Chi-square\u003c/strong\u003e\u003c/td\u003e\n\t\t\t\u003ctd\u003e\u003cstrong\u003e p-value\u003c/strong\u003e\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eeCIM +ve\u003c/td\u003e\n\t\t\t\u003ctd\u003e22\u003c/td\u003e\n\t\t\t\u003ctd\u003e212\u003c/td\u003e\n\t\t\t\u003ctd\u003e234\u003c/td\u003e\n\t\t\t\u003ctd\u003e \u003c/td\u003e\n\t\t\t\u003ctd\u003e \u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eeCIM-ve\u003c/td\u003e\n\t\t\t\u003ctd\u003e5\u003c/td\u003e\n\t\t\t\u003ctd\u003e1\u003c/td\u003e\n\t\t\t\u003ctd\u003e6\u003c/td\u003e\n\t\t\t\u003ctd\u003e32.0255\u003c/td\u003e\n\t\t\t\u003ctd\u003e0.0001\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd\u003eTotal\u003c/td\u003e\n\t\t\t\u003ctd\u003e27\u003c/td\u003e\n\t\t\t\u003ctd\u003e213\u003c/td\u003e\n\t\t\t\u003ctd\u003e240\u003c/td\u003e\n\t\t\t\u003ctd\u003e \u003c/td\u003e\n\t\t\t\u003ctd\u003e \u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cdiv class='mfp-bottom-bar'\u003e\n\u003cdiv class='mfp-title'\u003e\u003c/div\u003e\n\u003cdiv class='mfp-counter'\u003e\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class='fancy-bottom'\u003e\u003c/div\u003e\n\u003c/div\u003e\n\n\u003c/div\u003e\n\u003c/div\u003e\n","created_at":"2024-06-27T23:12:48.194-07:00","updated_at":"2024-06-27T23:12:48.194-07:00"},"authors":{"id":329440,"public_view_id":63511,"tab_type":"authors","html":"\u003cdiv class='new-article-content-wrap'\u003e\n\u003cdiv class='new-article-content-section'\u003e\n\u003cdiv class='article-content-body authors'\u003e\n\u003ch3 class='reg'\u003eAuthors\u003c/h3\u003e\n\u003cdiv class='author-row'\u003e\n\u003cdiv class='large-1 medium-1 small-2 columns avatar-container'\u003e\n\u003cdiv class='avatar'\u003e\n\u003ca target=\"_blank\" href=\"/users/633846-gaurav-verma\"\u003e\u003cimg alt=\"Gaurav Verma\" title=\"Gaurav Verma\" src=\"https://public.cureus.com/new-default-user-image.png\" /\u003e\n\u003c/a\u003e\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class='large-9 medium-9 small-10 columns end'\u003e\n\u003ca href=\"/users/633846-gaurav-verma\"\u003e\u003ch6\u003eGaurav Verma\u003c/h6\u003e\n\u003c/a\u003e\u003cdiv class='aff-name'\u003e\nMicrobiology, Kalinga Institute of Medical Sciences, Bhubaneswar, IND\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class='author-row'\u003e\n\u003cdiv class='large-1 medium-1 small-2 columns avatar-container'\u003e\n\u003cdiv class='avatar'\u003e\n\u003ca target=\"_blank\" href=\"/users/342090-nipa-singh\"\u003e\u003cimg alt=\"Nipa Singh\" title=\"Nipa Singh\" src=\"https://public.cureus.com/new-default-user-image.png\" /\u003e\n\u003c/a\u003e\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class='large-9 medium-9 small-10 columns end'\u003e\n\u003ca href=\"/users/342090-nipa-singh\"\u003e\u003ch6\u003eNipa Singh\u003c/h6\u003e\n\u003c/a\u003e\u003cspan class='corresponding'\u003eCorresponding Author\u003c/span\u003e\n\u003cdiv class='aff-name'\u003e\nMicrobiology, Kalinga Institute of Medical Sciences, Bhubaneswar, IND\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class='large-2 medium-2 columns end hide-for-small'\u003e\n\u003ca class=\"mail-link\" href=\"mailto:nipa.singh@kims.ac.in\"\u003e\u003cspan class='mail-link'\u003eSend Email\u003c/span\u003e\n\u003ci class='fas fa-envelope'\u003e\u003c/i\u003e\n\u003c/a\u003e\u003c/div\u003e\n\u003cdiv class='small-10 small-offset-2 columns show-for-small-only'\u003e\n\u003ca class=\"mail-link\" href=\"mailto:nipa.singh@kims.ac.in\"\u003e\u003cspan class='mail-link'\u003eSend Email\u003c/span\u003e\n\u003ci class='fas fa-envelope'\u003e\u003c/i\u003e\n\u003c/a\u003e\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class='author-row'\u003e\n\u003cdiv class='large-1 medium-1 small-2 columns avatar-container'\u003e\n\u003cdiv class='avatar'\u003e\n\u003ca target=\"_blank\" href=\"/users/776233-shradha-smriti\"\u003e\u003cimg alt=\"Shradha Smriti\" title=\"Shradha Smriti\" src=\"https://public.cureus.com/new-default-user-image.png\" /\u003e\n\u003c/a\u003e\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class='large-9 medium-9 small-10 columns end'\u003e\n\u003ca href=\"/users/776233-shradha-smriti\"\u003e\u003ch6\u003eShradha Smriti\u003c/h6\u003e\n\u003c/a\u003e\u003cdiv class='aff-name'\u003e\nMicrobiology, Kalinga Institute of Medical Sciences, Bhubaneswar, IND\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class='author-row'\u003e\n\u003cdiv class='large-1 medium-1 small-2 columns avatar-container'\u003e\n\u003cdiv class='avatar'\u003e\n\u003ca target=\"_blank\" href=\"/users/207363-subhra-snigdha-panda\"\u003e\u003cimg alt=\"Subhra Snigdha Panda\" title=\"Subhra Snigdha Panda\" src=\"https://public.cureus.com/new-default-user-image.png\" /\u003e\n\u003c/a\u003e\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class='large-9 medium-9 small-10 columns end'\u003e\n\u003ca href=\"/users/207363-subhra-snigdha-panda\"\u003e\u003ch6\u003eSubhra Snigdha Panda\u003c/h6\u003e\n\u003c/a\u003e\u003cdiv class='aff-name'\u003e\nMicrobiology, Kalinga Institute of Medical Sciences, Bhubaneswar, IND\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class='author-row'\u003e\n\u003cdiv class='large-1 medium-1 small-2 columns avatar-container'\u003e\n\u003cdiv class='avatar'\u003e\n\u003ca target=\"_blank\" href=\"/users/312100-dipti-pattnaik\"\u003e\u003cimg alt=\"Dipti Pattnaik\" title=\"Dipti Pattnaik\" src=\"https://public.cureus.com/new-default-user-image.png\" /\u003e\n\u003c/a\u003e\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class='large-9 medium-9 small-10 columns end'\u003e\n\u003ca href=\"/users/312100-dipti-pattnaik\"\u003e\u003ch6\u003eDipti Pattnaik\u003c/h6\u003e\n\u003c/a\u003e\u003cdiv class='aff-name'\u003e\nMicrobiology, Kalinga Institute of Medical Sciences, Bhubaneswar, IND\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class='author-row'\u003e\n\u003cdiv class='large-1 medium-1 small-2 columns avatar-container'\u003e\n\u003cdiv class='avatar'\u003e\n\u003ca target=\"_blank\" 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Praharaj\" title=\"Ashok K. Praharaj\" src=\"https://public.cureus.com/new-default-user-image.png\" /\u003e\n\u003c/a\u003e\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class='large-9 medium-9 small-10 columns end'\u003e\n\u003ca href=\"/users/776242-ashok-k-praharaj\"\u003e\u003ch6\u003eAshok K. Praharaj\u003c/h6\u003e\n\u003c/a\u003e\u003cdiv class='aff-name'\u003e\nMicrobiology, Kalinga Institute of Medical Sciences, Bhubaneswar, IND\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class='author-row'\u003e\n\u003cdiv class='large-1 medium-1 small-2 columns avatar-container'\u003e\n\u003cdiv class='avatar'\u003e\n\u003ca target=\"_blank\" href=\"/users/330862-a-raj-kumar-patro\"\u003e\u003cimg alt=\"A. Raj Kumar Patro\" title=\"A. Raj Kumar Patro\" src=\"https://public.cureus.com/new-default-user-image.png\" /\u003e\n\u003c/a\u003e\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class='large-9 medium-9 small-10 columns end'\u003e\n\u003ca href=\"/users/330862-a-raj-kumar-patro\"\u003e\u003ch6\u003eA. Raj Kumar Patro\u003c/h6\u003e\n\u003c/a\u003e\u003cdiv class='aff-name'\u003e\nMicrobiology, Kalinga Institute of Medical Sciences, Bhubaneswar, IND\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class='new-article-content-section'\u003e\n\u003cdiv class='article-content-body'\u003e\n\u003ch3 class='reg'\u003eAuthor Contributions\u003c/h3\u003e\n\u003cp\u003eAll authors have reviewed the final version to be published and agreed to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConcept and design:\u003c/strong\u003e\u0026nbsp; \u003cspan\u003eGaurav Verma, Nipa Singh, Dipti Pattnaik, Shradha Smriti, Ashok K. Praharaj\u003c/span\u003e\u003cp\u003e\u003cp\u003e\u003cstrong\u003eAcquisition, analysis, or interpretation of data:\u003c/strong\u003e\u0026nbsp; \u003cspan\u003eGaurav Verma, Nipa Singh, A. Raj Kumar Patro, Subhra Snigdha Panda, Shradha Smriti, Sukanta Tripathy\u003c/span\u003e\u003cp\u003e\u003cp\u003e\u003cstrong\u003eDrafting of the manuscript:\u003c/strong\u003e\u0026nbsp; \u003cspan\u003eGaurav Verma, A. Raj Kumar Patro, Shradha Smriti, Ashok K. Praharaj\u003c/span\u003e\u003cp\u003e\u003cp\u003e\u003cstrong\u003eCritical review of the manuscript for important intellectual content:\u003c/strong\u003e\u0026nbsp; \u003cspan\u003eNipa Singh, A. Raj Kumar Patro, Dipti Pattnaik, Subhra Snigdha Panda, Sukanta Tripathy, Ashok K. Praharaj\u003c/span\u003e\u003cp\u003e\u003cp\u003e\u003cstrong\u003eSupervision:\u003c/strong\u003e\u0026nbsp; \u003cspan\u003eNipa Singh, A. Raj Kumar Patro, Dipti Pattnaik, Sukanta Tripathy, Ashok K. Praharaj\u003c/span\u003e\u003cp\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\n\u003cdiv class='new-article-content-section'\u003e\n\u003cdiv class='article-content-body'\u003e\n\u003ch3 class='reg'\u003eEthics Statement and Conflict of Interest Disclosures\u003c/h3\u003e\n\u003cp\u003e\u003cb\u003eHuman subjects:\u003c/b\u003e Consent was obtained or waived by all participants in this study. Institutional Ethics Committee at Kalinga Institute of Medical Sciences, Bhubaneswar issued approval KIIT/KIMS/IEC/1344/2023. The study was approved by the Institutional Ethics Committee (reference no. KIIT/KIMS/IEC/1344/2023. \u003cstrong\u003eAnimal subjects:\u003c/strong\u003e All authors have confirmed that this study did not involve animal subjects or tissue. \u003cstrong\u003eConflicts of interest:\u003c/strong\u003e In compliance with \u003ca href=\"http://www.icmje.org/coi_disclosure.pdf\"\u003ethe ICMJE uniform disclosure form\u003c/a\u003e, all authors declare the following: \u003cstrong\u003ePayment/services info:\u003c/strong\u003e All authors have declared that no financial support was received from any organization for the submitted work. \u003cstrong\u003eFinancial relationships:\u003c/strong\u003e All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. \u003cstrong\u003eOther relationships:\u003c/strong\u003e All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\n\u003cdiv class='new-article-content-section' id='article-info-section'\u003e\n\u003cdiv class='article-content-body'\u003e\n\u003ch3 class='reg'\u003eArticle Information\u003c/h3\u003e\n\u003ch6\u003eDOI\u003c/h6\u003e\n\u003cp\u003e10.7759/cureus.63340\u003c/p\u003e\n\u003ch6\u003eCite this article as:\u003c/h6\u003e\n\u003cp\u003eVerma G, Singh N, Smriti S, et al. (June 27, 2024) Modified Carbapenem Inactivation Method and Ethylenediaminetetraacetic Acid (EDTA)-Carbapenem Inactivation Method for Detection of Carbapenemase-Producing Enterobacterales and Pseudomonas aeruginosa. Cureus 16(6): e63340. doi:10.7759/cureus.63340\u003c/p\u003e\n\u003ca id='article-information-publication-history'\u003e\u003c/a\u003e\n\u003ch6\u003ePublication history\u003c/h6\u003e\n\u003cp\u003e\nPeer review began: June 04, 2024\n\u003cbr\u003e\nPeer review concluded: June 20, 2024\n\u003cbr\u003e\nPublished: June 27, 2024\n\u003c/p\u003e\n\u003ch6\u003eCopyright\u003c/h6\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026copy; Copyright \u003c/strong\u003e2024\u003cbr/\u003eVerma et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.\u003c/p\u003e\n\u003ch6\u003eLicense\u003c/h6\u003e\n\u003cp\u003eThis is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\n\u003c/div\u003e\n","created_at":"2024-06-27T23:12:49.276-07:00","updated_at":"2024-06-27T23:12:49.276-07:00"}},"tableOfContents":["abstract","introduction","materials_and_methods","results","discussion","conclusions","references"],"heroImage":"https://public.cureus.com/article-show-default-pic/Medical-Education.jpeg","currentUserId":null,"preview":null,"retracted":false,"page":"article","sidebarAd":{"divNum":0,"adType":"medicaleducation","position":"top","slot":"box1","ugc":"0","page":"articles-258514","categories":["medicaleducation","primarycare","infectiousdisease","informationtechnology","primarycare","serinebetalactamase","metallolactamase","phenotypictest","ecim","mcim","carbapenemresistant"],"plt":"mobileweb","mdv":"null","spec":"","size":"square","dims":[300,250],"altDims":[300,250],"altSlot":null,"altDiv":null,"lazyLoad":true},"bannerAdTop":{"divNum":1,"adType":"medicaleducation","position":"top","slot":"leader1","ugc":"0","page":"articles-258514","categories":["medicaleducation","primarycare","infectiousdisease","informationtechnology","primarycare","serinebetalactamase","metallolactamase","phenotypictest","ecim","mcim","carbapenemresistant"],"plt":"mobileweb","mdv":"null","spec":"","size":"banner","dims":[728,90],"altDims":[300,250],"altSlot":"box1","altDiv":1,"lazyLoad":true},"bannerAdBottom":{"divNum":2,"adType":"medicaleducation","position":"bottom","slot":"leader2","ugc":"0","page":"articles-258514","categories":["medicaleducation","primarycare","infectiousdisease","informationtechnology","primarycare","serinebetalactamase","metallolactamase","phenotypictest","ecim","mcim","carbapenemresistant"],"plt":"mobileweb","mdv":"null","spec":"","size":"banner","dims":[728,90],"altDims":[300,250],"altSlot":"box2","altDiv":2,"lazyLoad":true},"comments":{"signedIn":false,"commentsIndexPath":"/comments","commentsCreatePath":"/comments","signInPath":"/users/sign_in?return_to=%2Farticles%2F258514-modified-carbapenem-inactivation-method-and-ethylenediaminetetraacetic-acid-edta-carbapenem-inactivation-method-for-detection-of-carbapenemase-producing-enterobacterales-and-pseudomonas-aeruginosa","signUpPath":"/registrations/sign_up","currentUserId":null,"currentUserAvatar":"\u003cimg 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