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Abstract
The spread of carbapenem-resistant Enterobacteriaceae (CRE) has been enabled by the lack of control measures directed at carriers of multidrug-resistant organisms in healthcare settings. Screening patients for asymptomatic colonization on the one hand, and implementation of contact precautions on the other hand, reduces patient-to-patient transmission. Screening plates represents a relatively low-cost method for isolating CRE from rectal swabs; however, molecular assays have become widely available. This study compared the performance of four commercial molecular platforms in detecting clinically significant carbapenemase genes versus routine screening for CRE. A total of 1015 non-duplicated rectal swabs were cultured on a chromogenic carbapenem-resistant selective medium. All growing Enterobacteriaceae strains were tested for carbapenemase-related genes. The same specimens were processed using the following molecular assays: Allplex™ Entero-DR, Amplidiag® CarbaR + MCR, AusDiagnostics MT CRE EU, and EasyScreen™ ESBL/CPO. The prevalence of Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae detected by swab culture was 2.2%, while organisms producing oxacillinase (OXA)-48 and metallo-β-lactamases were infrequent. The cost of CRE-related infection control precautions, which must be kept in place while waiting for screening results, are significant, so the molecular tests could become cost-competitive, especially when the turnaround time is decreased dramatically. Molecular assays represent a powerful diagnostic tool as they allow the rapid detection of the most clinically relevant carbapenemases.
Highlights
Antimicrobial resistance is one of the most complex global health challenges [1]
The prevalence detected for Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae was around 2,2% (22/1015), while the detection of MBLs and OXA-48 was infrequent (NDM-1 = 2 samples, VIM = 1 sample, OXA-48 = 2 samples)
22 0 22 a A specimen was KPC-positive for routine screening, while with the Amplidiag kit, specimens were positive for KPC and VIM targets
Summary
Antimicrobial resistance is one of the most complex global health challenges [1]. The World Health Organization puts the development of new antibacterial agents to treat carbapenem-resistant Enterobacteriaceae (CRE) among the most critical priorities [2]. Because CRE are resistant to the majority of β-lactams, carbapenem resistance has minimized the usefulness of many commercially available drugs [3]. CRE frequently carry mechanisms conferring resistance to other antimicrobial classes, further limiting the available therapeutic options [4,5,6]. Resistance to carbapenems is typically based on two main mechanisms. The first one is related to structural mutations combined with the activity of other β-lactamases, such as AmpC cephalosporinase (AmpC)
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