Division of Infection, Barts and the London NHS Trust, London, UK.
Division of Infection, Barts and the London NHS Trust, London, UK; Blizard Institute, Queen Mary, University of London, London, UK.
J Hosp Infect. 2018 Mar;98(3):270-274. doi: 10.1016/j.jhin.2017.10.012. Epub 2017 Oct 23.
Successful laboratory detection of carbapenemase-producing Enterobacteriaceae (CPE) in patient surveillance samples is a diagnostic challenge. In the absence of a reference standard for screening rectal swabs for CPE, many phenotypic, genotypic, culture- and non-culture-based assays have been proposed for identifying these bacteria.
To develop and optimize a CPE screening protocol capable of identifying all frequently encountered CPE, including those producing OXA-48-like carbapenemases.
Faropenem susceptibility testing was performed on 507 presumptive CPE isolated from diagnostic samples and CPE rectal screens between March and August 2016. Results from this CPE screening method were compared to those from direct culture on mSuperCARBA™, temocillin enrichment culture, and use of an antibiotic resistance algorithm, to determine the optimal method to employ in the detection of CPE.
Faropenem was a poor predictor of carbapenemase production (58% true positives). The combination of a temocillin enrichment stage and interpretive reading of antibiotic resistance phenotypes improved the recovery and identification of CPE significantly (91% true positives), especially for OXA-48 producers (P = 0.03).
The combination of temocillin enrichment, a selective chromogenic medium, and an antibiotic resistance-based algorithm significantly improved the detection of all CPE recovered from routine and targeted surveillance samples.
在患者监测样本中成功检测出产碳青霉烯酶肠杆菌科（CPE）是一项诊断挑战。在缺乏用于筛查直肠拭子中 CPE 的参考标准的情况下，已经提出了许多表型、基因型、基于培养和非培养的方法来识别这些细菌。
开发和优化一种 CPE 筛选方案，能够识别所有常见的 CPE，包括产生 OXA-48 样碳青霉烯酶的 CPE。
对 2016 年 3 月至 8 月期间从诊断样本和 CPE 直肠筛查中分离出的 507 株疑似 CPE 进行 faropenem 药敏试验。将该 CPE 筛选方法的结果与直接在 mSuperCARBA™上培养、替莫西林富集培养和使用抗生素耐药算法的结果进行比较，以确定在检测 CPE 时使用的最佳方法。
faropenem 对碳青霉烯酶产生的预测能力较差（58%的真阳性）。替莫西林富集阶段和抗生素耐药表型解读的结合显著提高了 CPE 的回收率和鉴定率（91%的真阳性），特别是对 OXA-48 生产者（P=0.03）。
替莫西林富集、选择性显色培养基和基于抗生素耐药性的算法的结合显著提高了从常规和靶向监测样本中回收的所有 CPE 的检测能力。
