Triton X-100 Enhanced the Detection of Hodge Test and Carba NP Test for Carbapenemase-producing Acinetobacter baumannii Complex

Objective To find out highly effective phenotypic methods to detect carbapenemase-producing Acinetobacter baumannii (A. baumannii complex) so as to support the epidemiological investigation and clinical application. Methods We included 113 A. baumannii complex and compared the detection performance of modified Hodge test, Carba NP test, Triton Hodge test, and the simplified Carba NP-direct test with Tritont X-100. Results We tested 83 carbapenemase-producing A. baumannii complex and 30 non-carbapenemase producers. The sensitivity and specificity of Hodge test were significantly higher than those of Carba NP test (71.1% versus 35.0%，100% versus 86.7%，P<0.05, respectively). The sensitivity of Triton Hodge test and Carba NP-direct test was respectively significantly higher than Hodge test and Carba NP test (98.8% versus 71.1%, 85.5% versus 35.0%,P<0.001, respectively ). However, the specificities were comparable (P>0.05). The positive additive effects of the two methods with Triton X-100 were more obvious than those of the methods without Triton X-100 (P<0.001). Conclusions Triton X-100 could increase the sensitivity and positive additive effect on phenotypic detection of A. baumannii complex. Triton Hodge test and Carba NP-direct test were more applicable for clinical routine procedure.