Microbiology and Biotechnology Letters (한국미생물·생명공학회지)

The Korean Society for Microbiology and Biotechnology (한국미생물·생명공학회)
권호 표지
DOI QR코드

DOI QR Code

Improving the Rapidity and Accuracy of Carbapenem-Resistant Enterobacteriaceae Detection by Shortening the Enrichment Duration

  • Miyoung, Lee (Department of Biomedical Laboratory Science, Daejeon Institute of Science and Technology)
  • Received : 2022.08.16
  • Accepted : 2022.10.28
  • Published : 2022.12.28
Download PDF
⟨ Previous Next ⟩

Abstract

Identifying carbapenem-resistant Enterobacteriaceae (CRE) is necessary to prevent nosocomial CRE infection outbreaks. Here, a rapid identification method with reduced enrichment time was developed without compromising accuracy. A total of 49 rectal swabs requested for CRE screening at the Department of Diagnostic Medicine at Hospital B in Busan, Korea, were included in this study. Specimens were inoculated on MacConkey and CHROMID Carba media either directly or following enrichment for 3, 6, and 24 h in 100 μl trypticase soy broth containing an ertapenem disk. The enriched cultures were further inoculated on CHROMID Carba or MacConkey media containing an ertapenem disk. In total, 19 CRE and 5 carbapenem-intermediate Enterobacteriaceae isolates were obtained from the 49 swabs. Among the 19 CRE isolates, carbapenemase-producing Enterobacteriaceae constituted 13 strains. Moreover, of the 19 CRE isolates, 16 (81.25%) and 17 (88.24%) were identified from the direct cultures on MacConkey and CHROMID Carba media, respectively. After 3 h of enrichment, the proportions of the CRE identified in the media were: MacConkey medium, 16/19 (81.25%); CHROMID Carba medium, 17/19 (88.24%); and MacConkey medium containing an ertapenem disk, 17/19 (88.24%). The detection rates after 6 h of enrichment were the same for all three media (19/19 strains, 100%), whereas those after 24 h of enrichment were 21, 22, and 24 strains, respectively, but included false positives. These findings suggest that a 6-h enrichment before inoculation on the CHROMID Carba medium is optimal for the rapid and accurate detection of CRE in clinical samples.

Keywords

Acknowledgement

This research was supported by the BHS Hanseo Hospital in 2019.

References

  1. European Centre for Disease Prevention and Control (ECDC). 2019. Carbapenem-resistant Enterobacteriaceae, second update - 26 September 2019, pp. 1-10. ECDC, Stockholm.
  2. Centers for Disease Control and Prevention. 2015. FAQs about choosing and implementing a CRE definition. Atlanta: Centers for Disease Control and Prevention. Available from https://www.cdc.gov/hai/organisms/cre/definition.html. Accessed Aug. 28,
  3. Marston HD, Dixon DM, Knisely JM, Palmore TN, Fauci AS. 2016. Antimicrobial resistance. JAMA 316: 1193-1204. https://doi.org/10.1001/jama.2016.11764
  4. Centers for Disease Control and Prevention (CDC). 2019. Antibiotic resistance threats in the United States, 2019, pp. 73. CDC. Atlanta (GA).
  5. McCann E, Srinivasan A, DeRyke CA, DePestel DD, Murray J, Gupta V. 2018. Carbapenem-nonsusceptible gram-negative pathogens in ICU and non-ICU settings in US hospitals in 2017: A multicenter study. Open Forum Infect. Dis. 5: ofy241.
  6. Potter RF, D'Souza AW, Dantas G. 2016. The rapid spread of carbapenem-resistant Enterobacteriaceae. Drug Resist. Updat. 29: 30-46. https://doi.org/10.1016/j.drup.2016.09.002
  7. Iovleva A, Doi Y. 2017. Carbapenem-resistant Enterobacteriaceae. Clin. Lab. Med. 37: 303-315. https://doi.org/10.1016/j.cll.2017.01.005
  8. Lee HJ, Lee DG. 2018. Carbapenem-resistant Enterobacteriaceae: recent updates and treatment strategies. J. Korean Med. Assoc. 61: 281-289. https://doi.org/10.5124/jkma.2018.61.4.281
  9. Kim JO, Song SA, Yoon EJ, Shin JH, Lee H, Jeong SH, et al. 2017. Outbreak of KPC-2-producing Enterobacteriaceae caused by clonal dissemination of Klebsiella pneumoniae ST307 carrying an IncX3-type plasmid harboring a truncated Tn4401a. Diagn. Microbiol. Infect. Dis. 87: 343-348. https://doi.org/10.1016/j.diagmicrobio.2016.12.012
  10. Jeong SH, Kim HS, Kim JS, Shin DH, Kim HS, Park MJ, et al. 2016. Prevalence and molecular characteristics of carbapenemase-producing Enterobacteriaceae from five hospitals in Korea. Ann. Lab. Med. 36: 529-535. https://doi.org/10.3343/alm.2016.36.6.529
  11. Korea Centers for Disease Control & Prevention (KCDC). 2019. Infectious diseases surveillance yearbook, 2019, pp. 38. Report No.: 11-1352159-000048-10. KCDC, Cheongju.
  12. Korea Centers for Disease Control & Prevention (KCDC). Infectious disease portal. 2020. Available from: http://www.cdc.go.kr/nptbiz/npp/ist/simple/simplePdStatsMain.do. Accessed Mar. 7, 2020.
  13. Korea Centers for Disease Control & Prevention (KCDC). 2018. Healthcare associated infection control guideline: VRSA/CRE. pp. 38-51. Report No.: 11-1352159-00832-10. KCDC, Cheongju.
  14. Centers for Disease Control and Prevention (CDC). Facility guidance for control of carbapenem-resistant Enterobacteriaceae (CRE). 2015. Available from: https://www.cdc.gov/hai/pdfs/cre/CRE-guidance-508.pdf. Accessed Mar. 7, 2020.
  15. Tischendorf J, de Avila RA, Safdar N. 2016. Risk of infection following colonization with carbapenem-resistant Enterobactericeae: A systematic review. Am. J. Infect. Control. 44: 539-543. https://doi.org/10.1016/j.ajic.2015.12.005
  16. Ho KW, Ng WT, Ip M, You JH. 2016. Active surveillance of carbapenem-resistant Enterobacteriaceae in intensive care units: Is it cost-effective in a nonendemic region? Am. J. Infect. Control. 44: 394-399. https://doi.org/10.1016/j.ajic.2015.10.026
  17. Poirel L, Nordmann P. 2015. Rapidec Carba NP test for rapid detection of carbapenemase producers. J. Clin. Microbiol. 53: 3003-3008. https://doi.org/10.1128/JCM.00977-15
  18. Clinical and Laboratory Standards Institute. 2018. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically. Wayne, Pennsylvania.
  19. Simner PJ, Martin I, Opene B, Tamma PD, Carroll KC, Milstone AM. 2016. Evaluation of multiple methods for detection of gastrointestinal colonization of carbapenem-resistant organisms from rectal swabs. J. Clin. Microbiol. 54: 1664-1667. https://doi.org/10.1128/JCM.00548-16
  20. Copur-Cicek A, Ozad Duzgun A, Saral A, Sandalli C. 2014. Determination of a novel integron-located variant (blaOXA-320) of Class D β-lactamase in Proteus mirabilis. J. Basic Microbiol. 54: 1030-1035. https://doi.org/10.1002/jobm.201300264
  21. Tsai YM, Wang S, Chiu HC, Kao CY, Wen LL. 2020. Combination of modified carbapenem inactivation method (mCIM) and EDTA-CIM (eCIM) for phenotypic detection of carbapenemase-producing Enterobacteriaceae. BMC Microbiol. 20: 315.
  22. van der Zwaluw K, de Haan A, Pluister GN, Bootsma HJ, de Neeling AJ, Schouls LM. 2015. The carbapenem inactivation method (CIM), a simple and low-cost alternative for the Carba NP test to assess phenotypic carbapenemase activity in gram-negative rods. PLoS One 10: e0123690.
  23. Jeong S, Kim JO, Jeong SH, Bae IK, Song W. 2015. Evaluation of peptide nucleic acid-mediated multiplex real-time PCR kits for rapid detection of carbapenemase genes in gram-negative clinical isolates. J. Microbiol. Methods 113: 4-9. https://doi.org/10.1016/j.mimet.2015.03.019
  24. Korea Centers for Disease Control and Prevention. Distribution of carbapenem-resistant Enterobacteriaceae (CRE) in Korea, 2018-2020. Available from https://www.kdca.go.kr/upload_comm/syview/doc.html?fn=163238757067000.pdf&rs=/upload_comm/docu/0034/. Accessed Mar. 11, 2022.
  25. Seo SM, Jeong IS. 2020. External validation of carbapenem-resistant Enterobacteriaceae acquisition risk prediction model in a medium sized hospital. J. Korean Acad. Nurs. 50: 621-630. https://doi.org/10.4040/jkan.20137
  26. Kim D-K, Kim HS, Pinto N, Jeon J, D'Souza R, Kim YS, et al. 2016. Xpert CARBA-R assay for the detection of carbapenemase-producing organisms in intensive care unit patients of a Korean tertiary care hospital. Ann. Lab. Med. 36: 162-165. https://doi.org/10.3343/alm.2016.36.2.162
  27. Peretz A, Pastukh N, Isakovich N, Koifman A, Brodsky D, Mizrahi H, et al. 2016. Efficacy of an enrichment media for increasing threshold for carbapenem-resistant Enterobacteriaceae screening. J. Clin. Lab. Anal. 30: 563-566. https://doi.org/10.1002/jcla.21903