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A Combined Disk Test for Direct Differentiation of Carbapenemase-Producing Enterobacteriaceae in Surveillance Rectal Swabs

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Autor
Pournaras, S.; Zarkotou, O.; Poulou, A.; Kristo, I.; Vrioni, G.; Themeli-Digalaki, K.; Tsakris, A.
Fecha
2013
DOI
10.1128/jcm.00901-13
Materia
RESISTANT KLEBSIELLA-PNEUMONIAE
REAL-TIME PCR
SCREENING AGAR PLATES
INFECTION-CONTROL
RAPID DETECTION
CHROMAGAR KPC
SPREAD
MEDIA
SPECIMENS
BLA(KPC)
Microbiology
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Resumen
Carbapenemase-producing Enterobacteriaceae (CPE) are rapidly spreading worldwide. Early detection of fecal CPE carriers is essential for effective infection control. Here, we evaluated the performance of a meropenem combined disk test (CDT) for rapidly differentiating CPE isolates directly from rectal swabs. The screening method was applied for 189 rectal swabs from hospitalized patients at high risk for CPE carriage. Swabs were suspended in 1 ml saline and cultured for confluent growth onto a MacConkey agar plate with a meropenem (MER) disk alone, a MER disk plus phenyl boronic acid (PBA), a MER disk plus EDTA, and a MER disk plus PBA and EDTA. An inhibition zone of <= 25 mm around the MER disk alone indicated carriage of carbapenem-resistant organisms. Furthermore, >= 5-mm differences in the inhibition zone between MER disks without and with the inhibitors (PBA, EDTA, or both) were considered positive results for detecting Klebsiella pneumoniae carbapenemase (KPC), metallo-beta-lactamase (MBL), or both carbapenemases, respectively. For comparison, rectal suspensions were tested using MacConkey plates with ertapenem (MacERT) disks and PCR (PCR-S) for carbapenemase genes. Of the 189 samples, 97 were genotypically confirmed as CPE positive by one of the three protocols tested. The CDT, MacERT disks, and PCR-S assays exhibited sensitivities of 94.8%, 96.9%, and 94.8% and specificities of 100%, 98.9%, and 100%, respectively, for detecting CPE-positive swabs. Moreover, the CDT correctly differentiated the production of KPC, MBL, or both carbapenemases in 78 of the 97 (80.4%) CPE-positive rectal swabs. Our results demonstrate that the CDT may provide a simple and inexpensive method for detecting and differentiating the carbapenemase type within a single day without requiring further testing and additional delay, supporting the timely implementation of infection control measures.
URI
http://hdl.handle.net/11615/32479
Colecciones
  • Δημοσιεύσεις σε περιοδικά, συνέδρια, κεφάλαια βιβλίων κλπ. [19672]
Η δικτυακή πύλη της Ευρωπαϊκής Ένωσης
Ψηφιακή Ελλάδα
ΕΣΠΑ 2007-2013
 

 

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