Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
Department of Clinical Microbiology, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
Ann Clin Microbiol Antimicrob. 2024 Jun 10;23(1):50. doi: 10.1186/s12941-024-00707-1.
Detection of carbapenem-resistant Pseudomonas aeruginosa (CR-PA) in humans is important to prevent transmission. However, the most optimal culture method to detect CR-PA is unknown. This systematic review aims to determine which culture method is most sensitive and which culture methods are used to detect CR-PA in humans. Second, to establish the most feasible culture method taking into account the turnaround time (TAT), and third, to provide an overview of the sampling sites used to detect carriage.
We systematically searched the electronic databases Embase, Medline Ovid, Cochrane, Scopus, CINAHL, and Web of Science until January 27, 2023. All diagnostic accuracy studies comparing two or more culture methods to detect CR-PA and recent outbreak or surveillance reports on CR-PA carriage or infection in humans, which describe culture methods and their results, were eligible for inclusion. We used QUADAS-2 guideline for diagnostic accuracy studies and the STROBE or ORION guideline for outbreak-surveillance studies to assess the risk of bias.
Six diagnostic accuracy studies were included. An enrichment broth was found to increase the detection of CR-PA. Using an enrichment broth extended the TAT by 18-24 h, yet selective media could reduce the TAT by 24 h compared to routine media. In total, 124 outbreak-surveillance studies were included, of which 17 studies with surveillance samples and 116 studies with clinical samples. In outbreak-surveillance studies with surveillance samples, perianal, rectal swabs or stools were the most common sampling site/specimen (13/17, 76%). A large variety was observed in whether and which kind of enrichment broth and selective media were used.
We found a benefit of using an enrichment step prior to inoculation of the material onto selective media for the detection of CR-PA. More research is needed to determine the most sensitive sampling site and culture method.
This study was registered in the PROSPERO International prospective register of systematic reviews (registration number: CRD42020207390, http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42020207390 ).
在人类中检测耐碳青霉烯铜绿假单胞菌（CR-PA）对于预防传播非常重要。然而，最理想的培养方法来检测 CR-PA 尚不清楚。本系统综述旨在确定哪种培养方法最敏感，以及哪种培养方法用于人类中检测 CR-PA。其次，考虑到周转时间（TAT），确定最可行的培养方法，第三，提供用于检测携带的采样部位概述。
我们系统地搜索了电子数据库 Embase、Medline Ovid、Cochrane、Scopus、CINAHL 和 Web of Science，截至 2023 年 1 月 27 日。所有比较两种或更多种培养方法检测 CR-PA 的诊断准确性研究，以及最近关于人类中 CR-PA 携带或感染的暴发或监测报告，描述了培养方法及其结果，均符合纳入标准。我们使用 QUADAS-2 诊断准确性研究指南和 STROBE 或 ORION 暴发监测研究指南来评估偏倚风险。
纳入了六项诊断准确性研究。发现增菌肉汤可增加 CR-PA 的检测率。使用增菌肉汤将 TAT 延长了 18-24 小时，但与常规培养基相比，选择性培养基可将 TAT 缩短 24 小时。共纳入了 124 项暴发监测研究，其中 17 项为监测样本研究，116 项为临床样本研究。在暴发监测研究中，使用监测样本时，肛周、直肠拭子或粪便最常见的采样部位/标本（17 项研究中的 13 项，76%）。观察到使用何种增菌肉汤和选择性培养基以及使用哪种培养基存在很大差异。
我们发现，在将材料接种到选择性培养基之前，使用增菌步骤有助于检测 CR-PA。需要进一步研究以确定最敏感的采样部位和培养方法。
本研究已在 PROSPERO 国际前瞻性系统评价注册中心（注册号：CRD42020207390，http://www.crd.york.ac.uk/PROSPERO/display_record.asp？ID=CRD42020207390）注册。
