1Department of Laboratory Medicine, Korea University College of Medicine, 126-1, Anam-dong 5-ga, Seongbuk-gu, Seoul, 02841 Republic of Korea.
2Present address: Department of Laboratory Medicine, Chosun University Hospital, Gwangju, Republic of Korea.
Antimicrob Resist Infect Control. 2019 Jul 29;8:127. doi: 10.1186/s13756-019-0579-2. eCollection 2019.
There are growing concerns regarding the spread of carbapenemase-producing organisms (CPOs) among patients in long-term care facilities (LTCFs) and hospitals in South Korea. We have established a screening protocol for the detection of CPOs in high-risk patients upon admission to intensive care units (ICUs). The diagnostic performance of the Xpert Carba-R assay was compared to that of rectal culture for CPO detection in high-risk patients upon ICU admission.
A total of 408 consecutive rectal swabs were obtained from December 2016 to December 2017. CPO screening was performed using the Xpert Carba-R assay (Cepheid, Sunnyvale, CA, USA). When a carbapenemase gene was detected, additional rectal swabs were incubated overnight and inoculated on chromID CARBA medium (bioMérieux, Marcy l'Etoile, France). Bacterial carbapenemase genes, including , , , , and , were confirmed by conventional PCR. The diagnostic performance of the Carba-R assay was ascertained based on the culture results.
The prevalence of CPO carriage was 7.4% according to the Carba-R assay and 3.7% according to rectal culture. The median Ct values of IMP-1 and KPC were significantly different (35.2 vs. 26.6, = 0.0143). The overall sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the Carba-R assay were 100.0% (95% confidence interval [CI], 78.2-100.0), 96.7% (94.4-98.2), 53.6% (40.4-66.4) and 100.0% (99.0-100.0), respectively.
We demonstrated the prevalence of CPO carriage in high-risk patients upon ICU admission and evaluated the diagnostic performance of the Carba-R assay. The combined use of the Xpert Carba-R assay and culture produces rapid and reliable results for the active surveillance of rectal CPO in ICU patients.
在韩国，长期护理机构（LTCF）和医院的患者中产碳青霉烯酶的生物体（CPO）的传播引起了越来越多的关注。我们已经建立了一个筛选方案，用于在入住重症监护病房（ICU）时对高危患者进行 CPO 检测。比较了 Xpert Carba-R 检测法与直肠培养法在 ICU 高危患者中检测 CPO 的诊断性能。
2016 年 12 月至 2017 年 12 月，共采集了 408 例连续直肠拭子。使用 Xpert Carba-R 检测法（Cepheid，加利福尼亚州桑尼维尔）进行 CPO 筛查。当检测到碳青霉烯酶基因时，将额外的直肠拭子孵育过夜并接种在 chromID CARBA 培养基（bioMérieux，法国马西·勒托勒）上。通过常规 PCR 确认细菌碳青霉烯酶基因，包括 、 、 、 、和 。根据培养结果确定 Carba-R 检测的诊断性能。
根据 Carba-R 检测，CPO 携带率为 7.4%，根据直肠培养为 3.7%。IMP-1 和 KPC 的中位 Ct 值有显著差异（35.2 与 26.6，=0.0143）。Carba-R 检测的总灵敏度、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为 100.0%（95%置信区间 [CI]，78.2-100.0）、96.7%（94.4-98.2）、53.6%（40.4-66.4）和 100.0%（99.0-100.0）。
我们证明了 ICU 入住时高危患者中 CPO 的携带率，并评估了 Carba-R 检测的诊断性能。Xpert Carba-R 检测法与培养法的联合使用为 ICU 患者直肠 CPO 的主动监测提供了快速可靠的结果。
