The Carba NP test (CNPt) is a biochemical test for the rapid detection (≥2 h) of carbapenemase production in Gram-negative bacilli. Clinical and Laboratory Standards Institute (CLSI) recommends Carba NP test for ensuring the production of carbapenemases in Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter spp with elevated carbapenem MICs or reduced disk diffusion inhibition zones, for epidemiological or infection control purposes.
CNPt is highly sensitive for the detection of Klebsiella pneumoniae carbapenemase (KPC) and metallo-beta-lactamase (MBL) producers but less sensitive for detection of OXA-48-like carbapenemase.
When bacterial lysate hydrolyse imipenem, a carboxylic derivative is formed which decreases the pH of the medium. This change in pH is detected by a pH indicator, by changing the color of the medium to yellow from red.
The test requires the separate preparation of few solutions.
Solution A: Concentrated solution of 0.5% w/v phenol red with 0.1 mmol/liter ZnSO4
- Prepare a concentrated solution of 0.5% w/v phenol red (0.5gm in 100ml distilled water)
- Mix 2ml of concentrated phenol red solution (vortex strongly before pipetting to resuspend the solution) with 16.6 mL of distilled water.
- Adjust the pH to 7.8 using drops of 1N sodium hydroxide (NaOH) solution.
- Add 180 µl of 10 mM zinc sulphate (ZnSo4) to obtain a final concentration of 0.1mM.
Note: This solution can be prepared and used at room temperature for 1 week and at -20ºC for months.
Solution B: Solution A + 6 mg/ml imipenem
Batches of imipenem powder solution can prepared and kept in advance at 4 ºC for 2 weeks if not mixed with solution A.
- 20mM Tris-HCl lysis buffer
- Add 100μl of 20 mM Tris-HCl lysis buffer (available commercially) in each of two 1.5-ml Eppendorf tubes.
- Suspend 10μl of bacterial suspension in each of those 2 Eppendorf tubes. Ensure that the bacterial colonies have been resuspended or mix up and down using a pipette.
Alternatively, bacterial colony grown overnight on MHA can be scraped off using a loop and suspended in 100μl of 20 mM Tris-HCl lysis buffer mixed using a vortex device for 5 seconds.
- Add 100μl of solution A in the first and 100μl of solution B (solution A+6mg/ml of imipenem) in the second Eppendorf tube respectively.
- Incubate both tubes at 37°C for a maximum of 2 hours
- Observe the color change in both tubes and interpret accordingly.
The Carba NP test is interpreted with the change in color from the original red solution in both tubes.
|Color in Tube A (without antibiotic)||Color in tube B (with imipenem)||Interpretation|
|Red||Red||Non- carbapenemase producer|
Usually, the time required for obtaining positive result varies for various type of carbapenemase
|Type of carbapenemase||Time period for positive result|
|KPC producers||2 to 30min|
|OXA-48 like producers||20 min to 1hour|
|Metallo beta-lactamases (NDM, VIM, IMP)||15 min to 1 hour|
Modification of Carba NP
Various modification and commercial test kits are available based on the principle of Carba NP for rapid detection of carbapenemase, each one having its own advantage and limitations.
References and further readings
- Pragasam A.K, Veeraraghavan B, Bakthavatchalam Y.D, Gopi R, Aslam R.F “ Strengths and limitations of various screening methods for carbapenem resistant Enterobacteriaceae including new method recommended by clinical and laboratory standards institute, 2017: A tertiary care experience”, Indian journal of medical microbiology, 2017; Volume: 35 | Issue : 1 | Page : 116-119
- Rudresh S.M, Ravi G. S, Sunitha L, Hajira S N, Kalaiarasan E , Harish B N “Simple, rapid, and cost-effective modified Carba NP test for carbapenemase detection among Gram-negative bacteria” Journal of Laboratory Physicians. 2017 Oct-Dec; 9(4): 303–307