Diagnostic Approaches to Carbapenemase Detection in Pseudomonas aeruginosa: A Comparative Review of Phenotypic and Genotypic Methods.

Largely due to the emergence of carbapenem-resistant strains, antibiotic resistance in Pseudomonas aeruginosa has become a serious concern in contemporary healthcare. The generation of carbapenemase enzymes is the primary mechanism underlying carbapenem resistance, which severely restricts treatment options and raises morbidity and mortality. For proper clinical care and efficient infection control, timely and precise detection of these enzymes is critical for optimizing antimicrobial therapy, reducing morbidity and mortality, and preventing the spread of resistant strains. Carbapenemase production can be detected using both phenotypic and genotypic approaches, each of which has unique principles and clinical implications. Phenotypic techniques, such as the modified carbapenem inactivation method, the modified Hodge test, and the Carba NP test, identify the functional activity of resistance mechanisms and are typically affordable and appropriate for ordinary laboratory use. However, they are frequently associated with inconsistent sensitivity and specificity, as well as longer turnaround times. On the other hand, particular resistance genes like blaNDM, blaVIM, and blaIMP can be quickly and accurately identified using genotypic methods like polymerase chain reaction, multiplex PCR, and whole genome sequencing. These techniques are highly accurate but require sophisticated infrastructure and technical expertise and may not detect novel or uncharacterized resistance factors. All things considered, both methods offer useful but complementary information. While genotypic approaches provide molecular-level understanding and epidemiological significance, phenotypic approaches validate the expression of resistance. To improve infection control tactics, direct focused medication, and increase detection accuracy in healthcare settings, an integrated diagnostic strategy including both approaches is crucial.