A Novel Air-Dried Multiplex High Resolution Melt Assay for the Detection of Extended Spectrum Beta-Lactamase and Carbapenemase Genes.

OBJECTIVES: This study aimed to develop and evaluate a novel air-dried high-resolution melt (HRM) assay to detect eight major extended spectrum beta-Lactamase (ESBL) (blaSHV and blaCTXM groups 1 and 9) and carbapenemase (blaNDM, blaIMP, blaKPC, blaVIM and blaOXA-48-like) genes that cause antimicrobial resistance to cephalosporins and carbapenems. METHODS: The assay was evaluated using 439 DNA samples extracted from bacterial isolates from Nepal, Malawi and UK and 390 clinical isolates from Nepal with known antimicrobial susceptibility results. Assay reproducibility was evaluated across five different q-PCR instruments (Rotor-Gene Q, QuantStudioTM 5, CFX96, LightCycler® 480 and MIC). Assay stability was also assessed upon the assay storage in the refrigerator (6.2°C±0.9), room temperature (20.4°C±0.7) and oven (29.7°C±1.4) at six time points for eight months. RESULTS: The sensitivity and specificity for detecting the ESBL and carbapenemase genes in comparison to the reference gel-base PCR and sequencing was 94.7% (95%CI: 92.5%-96.5%) and 99.2% (95%CI: 98.8%-99.5%), and 98.5% (95%CI: 97.0%-99.4%) and 98.5% (95%CI: 98.0%-98.9%) when compared to the original HRM wet PCR mix format. The overall agreement was 91.1% (95%CI: 90.0%-92.9%) when predicting phenotypic resistance to cefotaxime and meropenem among Enterobacteriaceae isolates. We observed almost perfect inter-machine reproducibility of the air-dried HRM assay and no loss of sensitivity occurred under all storage conditions and time points. CONCLUSIONS: We present here a ready-to-use air-dried HRM-PCR assay that offers an easy, thermostable, fast and accurate tool for the detection of ESBL and carbapenemase genes in DNA samples to improve AMR