Fig. 1
From: Carbapenemase producing Enterobacterales clinical isolates from a tertiary care hospital in Egypt
a Confirmation of carbapenemase production through expression of MBL activity detected by the combination test: A carbapenem resistant isolate showing > 5 mm difference in zone diameter between disk A (meropenem 10 µg) and disk B (meropenem 10 µg + MBL inhibitor) indicating MBL activity. b Confirmation of carbapenemase production through expression of OXA-48 activity detected by the combination test: A carbapenem resistant isolate showing resistance to T (temocillin30 µg) disk &no significant zone difference was observed between disk A (meropenem 10µ) and disks B (meropenem 10 µg + MBL inhibitor), C (meropenem 10 µg + KPC inhibitor) or D (meropenem 10 µg + AmpC inhibitor) indicating OXA-48 activity. c Confirmation of carbapenemase production through expression of KPC activity detected by the combination test: A carbapenem resistant isolate showing > 4 mm difference in zone diameter between disk A (meropenem 10µg) and disk C (meropenem 10 µg + KPC inhibitor) indicating KPC activity. d Amp C activity detected by the combination test: A carbapenem resistant isolate in which both C (meropenem 10 µg + KPC inhibitor) and D (meropenem 10 µg + AmpC inhibitor) disks show significant zone differences (≥ 4 mm and ≥ 5 mm respectively) compared to disk A (meropenem 10 µg) while the zone difference between disks B (meropenem 10 µg + MBL inhibitor) and A (meropenem 10 µg) is less than 4 mm (B-A < 4 mm) indicating Amp-C activity. e Non-conclusive result by the combination test: A carbapenem resistant isolate in which a non-conclusive result was detected. Disk A: meropenem 10 µg, disk B: meropenem 10 µg + MBL inhibitor, disk C: meropenem 10 µg + KPC inhibitor, disk D: meropenem 10 µg + AmpC inhibitor, disk T: temocillin disk 30 µg.