Evaluation of screening algorithms to detect rectal colonization with carbapenemase-producing Enterobacterales in a resource-limited setting.

IF 3.7 Q2 INFECTIOUS DISEASES JAC-Antimicrobial Resistance Pub Date : 2024-06-11 eCollection Date: 2024-06-01 DOI:10.1093/jacamr/dlae089
Thi Anh Mai Pham, Tung Xuan Nguyen, Troung Nhat My, Lan Thi Le, Huyen Thi Vu, Ngoc Thi Bich Hoang, Dien M Tran, Linh Viet Nguyen, Phuc D Pham, Dennis Nurjadi, Flavie Goutard, Thirumalaisamy P Velavan, Van Anh Thi Dinh, Y M Gildas Hounmanou, Bent Jörgensen, Le Huu Song, Nhung T T Nguyen, Etienne Loire, Åse Östholm, Lennart E Nilsson, Tuyet Hanh T Tran, Phuc H Phan, Anders Dalsgaard, Mattias Larsson, Linus Olson, Håkan Hanberger
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引用次数: 0

Abstract

Objectives: To improve and rationalize the detection of carbapenemase-producing Enterobacterales (CPE) in rectal swabs in a high-prevalence and resource-constrained setting, addressing surveillance challenges typically encountered in laboratories with limited resources.

Methods: A point prevalence survey (PPS) was conducted on 15 August 2022, in a provincial children's hospital in northern Vietnam. Rectal swab samples of all admitted children were collected and plated on a selective medium for carbapenem-resistant Enterobacterales (CRE). Species identification and antimicrobial susceptibility testing (AST) were performed by MALDI-TOF, and VITEK2 XL and interpreted according to CLSI breakpoints (2022). Carbapenemases were detected by the carbapenem inactivation method (CIM) and quantitative real-time PCR (qRT-PCR).

Results: Rectal swab samples were obtained from 376 patients. Of 178 isolates growing on the CRE screening agar, 140 isolates were confirmed as Enterobacterales of which 118 (84.3%) isolates were resistant to meropenem and/or ertapenem. CIM and PCR showed that 90/118 (76.3%) were carbapenemase producers. Overall, 83/367 (22.6%) were colonized by CPE. Klebsiella pneumoniae, Escherichia coli and Enterobacter cloacae complex were the most common CPE detected, with NDM as the predominant carbapenemase (78/90; 86.7%). Phenotypic resistance to meropenem was the best predictor of CPE production (sensitivity 85.6%, specificity 100%) compared with ertapenem resistance (95.6% sensitivity, 36% specificity). CIM was 100% concordant with PCR in detecting carbapenemases.

Conclusions: These findings underscore the effectiveness of meropenem resistance as a robust indicator of the production of carbapenemases and the reliability of the CIM method to detect such carbapenemases in resource-limited settings where the performance of molecular methods is not possible.

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评估在资源有限的环境中检测产碳青霉烯酶肠杆菌直肠定植的筛查算法。
目的在高发病率和资源有限的环境中,改进直肠拭子中产碳青霉烯酶肠杆菌(CPE)的检测并使之合理化,解决资源有限的实验室通常遇到的监测难题:方法:2022 年 8 月 15 日,在越南北部的一家省级儿童医院进行了一次点流行率调查(PPS)。收集了所有入院儿童的直肠拭子样本,并将其培养在耐碳青霉烯类肠杆菌(CRE)的选择性培养基上。通过 MALDI-TOF 和 VITEK2 XL 进行菌种鉴定和抗菌药物敏感性测试 (AST),并根据 CLSI 断点 (2022) 进行解释。采用碳青霉烯灭活法(CIM)和定量实时 PCR(qRT-PCR)检测碳青霉烯酶:结果:共采集了 376 名患者的直肠拭子样本。在 CRE 筛选琼脂上生长的 178 个分离株中,140 个被确认为肠杆菌,其中 118 个(84.3%)对美罗培南和/或厄他培南耐药。CIM 和 PCR 显示,90/118 株(76.3%)为碳青霉烯酶生产者。总体而言,83/367(22.6%)例患者体内有 CPE 定植。肺炎克雷伯菌、大肠埃希菌和复合泄殖腔肠杆菌是最常见的 CPE,NDM 是最主要的碳青霉烯酶(78/90;86.7%)。与厄他培南耐药性(敏感性 95.6%,特异性 36%)相比,对美罗培南的表型耐药性是预测 CPE 产生的最佳指标(敏感性 85.6%,特异性 100%)。在检测碳青霉烯酶方面,CIM 与 PCR 的一致性为 100%:这些发现强调了美罗培南耐药性作为碳青霉烯酶产生的可靠指标的有效性,以及 CIM 方法在资源有限且无法使用分子方法的环境中检测此类碳青霉烯酶的可靠性。
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