Göttig Stephan, Walker Sarah V, Saleh Ahmad, Koroska Florian, Sommer Julian, Stelzer Yvonne, Steinmann Joerg, Hamprecht Axel
Institute for Medical Microbiology and Infection Control, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany.
Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Goldenfelsstrasse 19-21, 50935, Cologne, Germany.
Eur J Clin Microbiol Infect Dis. 2020 May;39(5):923-927. doi: 10.1007/s10096-019-03786-7. Epub 2020 Jan 4.
The rapid identification of patients colonized with carbapenem-resistant Enterobacterales (CRE) is important for infection control purposes. Here, we compared and evaluated nine different agars for the detection of carbapenemase-producing Enterobacterales (CPE) from clinical samples. In the study, 69 CPE and 40 carbapenemase-negative isolates were included. Overall, seven commercially available screening agars were assessed: Brilliance CRE (Oxoid), Chromatic CRE (Liofilchem), chromID CARBA and chromID OXA-48 (both bioMérieux), three ESBL agars (Chromatic ESBL [Liofilchem], chromID ESBL [bioMérieux], Brilliance ESBL [Oxoid]), and two agars produced in-house (McCARB and McCARB-T). The sensitivity of CRE agars for CPE detection ranged from 34.8 to 98.6%. Brilliance CRE and McCARB/McCARB-T showed the overall highest sensitivity (98.6 and 97.1%, respectively). OXA-48 producers were the most difficult to detect; only 4/9 agars detected all isolates (McCARB/McCARB-T, Chromatic CRE, ChromID OXA-48). Additionally, all ESBL-negative OXA-48 isolates failed to grow on ESBL screening agars. Specificity ranged from 30 (Brilliance ESBL) to 100% (ChromID OXA-48). The limit of detection for different CPE in spiked stool samples ranged from 1.5 × 10 to 1.5 × 10 CFU/ml. Overall, Brilliance CRE and the McCARB in-house agars showed the best performance and were able to detect most CPE, including almost all OXA-48. ESBL agars were not suitable for detection of CPE alone, as OXA-48 isolates negative for ESBL were suppressed. The highest sensitivity was achieved by a combination of a CRE agar and an ESBL agar.
快速鉴定耐碳青霉烯类肠杆菌科细菌（CRE）定植患者对于感染控制至关重要。在此，我们比较并评估了九种不同的琼脂用于从临床样本中检测产碳青霉烯酶肠杆菌科细菌（CPE）。在该研究中，纳入了69株CPE和40株碳青霉烯酶阴性菌株。总体而言，评估了七种市售筛选琼脂：Brilliance CRE（奥克托克斯）、Chromatic CRE（利奥菲勒姆）、chromID CARBA和chromID OXA - 48（均为生物梅里埃公司）、三种ESBL琼脂（Chromatic ESBL [利奥菲勒姆]、chromID ESBL [生物梅里埃公司]、Brilliance ESBL [奥克托克斯]）以及两种自制琼脂（McCARB和McCARB - T）。CRE琼脂检测CPE的敏感性范围为34.8%至98.6%。Brilliance CRE和McCARB/McCARB - T总体显示出最高的敏感性（分别为98.6%和97.1%）。OXA - 48产酶菌最难检测；只有4/9种琼脂检测出所有菌株（McCARB/McCARB - T、Chromatic CRE、chromID OXA - 48）。此外，所有ESBL阴性的OXA - 48菌株在ESBL筛选琼脂上均未生长。特异性范围为30%（Brilliance ESBL）至100%（chromID OXA - 48）。加标粪便样本中不同CPE的检测限范围为1.5×10至1.5×10 CFU/ml。总体而言，Brilliance CRE和自制的McCARB琼脂表现最佳，能够检测出大多数CPE，包括几乎所有的OXA - 48。ESBL琼脂单独不适用于检测CPE，因为ESBL阴性的OXA - 48菌株受到抑制。通过CRE琼脂和ESBL琼脂联合使用可实现最高敏感性。
