Direct detection of OXA-48-like carbapenemase variants with and without co-expression of an extended-spectrum β-lactamase from bacterial cell lysates using mass spectrometry

• Published in: Journal of mass spectrometry and advances in the clinical lab 2021-04, Vol.20, p.25-34
• Main Authors: McGee, William M., Verma, Arvind, Viirtola, Marjaana, Kronewitter, Scott R., Neil, Jason R., Stephenson, James L.
• Format: Article
• Language: English
• Subjects: Antimicrobial-resistant organisms; Carbapenem-resistant Enterobacterales; Carbapenemase; Carbapenemase-producing organisms; CTX-M-15; Liquid chromatography; Mass Spectrometry; OXA-48; OXA-48-like; Regular; Tandem mass spectrometry; β-Lactamase
• ISSN: 2667-145X; 2667-1468; 2667-145X
• DOI: 10.1016/j.jmsacl.2021.05.001

•LC-MS methods are used to identify intact OXA-48 like enzymes from bacterial lysates.•Individual protein variants of the OXA-48 like carbapenemases can be detected with tandem mass spectrometry.•OXA-48 like carbapenemases can be distinguished from extended spectrum β-lactamases like CTX-M-15.•The method for detection can be run in five minutes or less. Antibiotic-resistant Gram-negative bacteria are of a growing concern globally, especially those producing enzymes conferring resistance. OXA-48-like carbapenemases hydrolyze most β-lactam antibiotics, with typically low-level hydrolysis of carbapenems, but have limited effect on broad-spectrum cephalosporins. These are frequently co-expressed with extended spectrum β-lactamases, especially CTX-M-15, which typically shows high level resistance to broad-spectrum cephalosporins, yet is carbapenem susceptible. The combined resistance profile makes the need for successful detection of these specific resistance determinants imperative for effective antibiotic therapy. The objective of this study is to detect and identify OXA-48-like and CTX-M-15 enzymes using mass spectrometry, and to subsequently develop a method for detection of both enzyme types in combination with liquid chromatography. Cells grown in either broth or on agar were harvested, lysed, and, in some cases buffer-exchanged. Lysates produced from bacterial cells were separated and analyzed via liquid chromatography with mass spectrometry (LC-MS) and tandem mass spectrometry (LC-MS/MS). The intact proteins of OXA-48, OXA-181, and OXA-232 (collectively OXA-48-like herein) and CTX-M-15 were characterized and detected. Acceptance criteria based on sequence-informative fragments from each protein group were established as confirmatory markers for the presence of the protein(s). A total of 25 isolates were successfully tested for OXA-48 like (2), CTX-M-15 (3), or expression of both (7) enzymes. Thirteen isolates served as negative controls. Here we present a method for the direct and independent detection of both OXA-48-like carbapenemases and CTX-M-15 β-lactamases using LC-MS/MS. The added sensitivity of MS/MS allows for simultaneous detection of at least two co-eluting, co-isolated and co-fragmented proteins from a single mass spectrum.