Abstract
Screening recommendations for multidrug-resistant Gram-negative bacteria comprise microbiological analyses from rectal swabs. However, essential specifications of the preanalytic steps of such screenings, i.e. the sampling technique, sampling devices and sampling site, are lacking. For standardized and optimum screening conditions these parameters are indispensable. Here, the optimum parameters were examined irrespective of the antibiotic resistance patterns of the target bacteria in order to establish a general basis for this type of screening. Swabs with rayon, polyurethane-cellular-foam and nylon-flocked tips were tested. Different sampling locations were evaluated, i.e. perianal, intraanal and deep intraanal. Subjects were swabbed and quantities of E. coli, K. pneumoniae, P. aeruginosa and A. baumannii were assessed. Overall prevalences of E. coli, K. pneumoniae, P. aeruginosa, and A. baumannii were 94%, 16%, 12%, and 2%, respectively. Bacterial recovery rates were independent from the sampling-timepoint during hospital stay. Polyurethane-cellular-foam or nylon-flocked swabs recovered significantly more bacteria as compared to rayon swabs. Intraanal swabbing resulted in significantly higher bacterial quantities as compared to perianal swabbing. In contrast, for the detection of A. baumannii, perianal swabbing seems more suitable than intraanal swabbing. Gender-related differences in bacterial recovery could be detected from perianal but not from intraanal swabs.
Highlights
Infections caused by multidrug-resistant Gram-negative organisms (MDR-GNO) are associated with higher mortality rates, longer hospitalization and higher costs as compared to infections by corresponding non-resistant isolates[1,2,3,4]
The present study investigates the screening performance of three widely used swab-tip materials, i.e. rayon, polyurethane cellular foam or nylon-flocked fibers
To investigate the optimum swab-tip material, by means of recovering the highest quantities of bacteria, subjects were swabbed with rayon, PU-foam and nylon-flocked swabs
Summary
Infections caused by multidrug-resistant Gram-negative organisms (MDR-GNO) are associated with higher mortality rates, longer hospitalization and higher costs as compared to infections by corresponding non-resistant isolates[1,2,3,4]. E. coli, K. pneumoniae, P. aeruginosa, and A. baumannii are among the most frequently isolated bacteria from nosocomial infections and revealed increasing resistance rates in the last years[5,6,7,8,9,10,11]. In microbiological diagnostics swab-based sample acquisition is commonly used due to its performance ease and swiftness, both from screening sites and sites of infection. Current rectal swab based screening recommendations for MDR-GNO either do not comprise such fundamental information on screening preanalysis or present contradicting information especially on the sampling locations. Quantitative recovery of E. coli, K. pneumoniae, P. aeruginosa and A. baumannii from three defined rectal swabbing locations, i.e. perianal, intraanal and deep intraanal, is systematically assessed. Aim of the study was to define the optimum preanalytic conditions for rectal screening in terms of recovering the highest quantities for each of the four bacterial species
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