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2142. Comparison of Molecular-Based vs. Conventional Culture-Based Screening Methods for Detection of Carriers of Extended-Spectrum β-Lactamases (ESBL) and Carbapenemases-Producing Enterobacteriacae (CPE)

BACKGROUND: Active surveillance and contact precautions may prevent cross-transmission of ESBL-producing Enterobacteriaceae and CPE. Culture-based methods delaying results might increase risk of cross-transmission, and lead to unnecessary preemptive contact precautions. This observational cohort stu...

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Autores principales: Martischang, Romain, Renzi, Gesuele, François, Patrice, Bonetti, Eve-Julie, Cherkaoui, Abdessalam, Pugin, Jérôme, Schrenzel, Jacques, Harbarth, Stephan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6810063/
http://dx.doi.org/10.1093/ofid/ofz360.1822
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author Martischang, Romain
Renzi, Gesuele
François, Patrice
Bonetti, Eve-Julie
Cherkaoui, Abdessalam
Pugin, Jérôme
Schrenzel, Jacques
Harbarth, Stephan
author_facet Martischang, Romain
Renzi, Gesuele
François, Patrice
Bonetti, Eve-Julie
Cherkaoui, Abdessalam
Pugin, Jérôme
Schrenzel, Jacques
Harbarth, Stephan
author_sort Martischang, Romain
collection PubMed
description BACKGROUND: Active surveillance and contact precautions may prevent cross-transmission of ESBL-producing Enterobacteriaceae and CPE. Culture-based methods delaying results might increase risk of cross-transmission, and lead to unnecessary preemptive contact precautions. This observational cohort study compared rapid Loop-Mediated Isothermal Amplification (LAMP) assays to conventional culture-based methods for ESBL and CPE screening of critically ill patients. METHODS: This study was conducted in the adult ICUs at Geneva University Hospitals. We collected consecutive rectal ESwabs routinely performed, either for admission screening of high-risk patients or once weekly routine screening of all patients hospitalized in the ICU. Eazyplex® SuperBug CRE system (Amplex Biosystems) assays were performed directly on rectal Eswabs according to the manufacturer’s instructions. For the conventional culture-based method, we used chromID® ESBL agar (ESBL) coupled with chromID®OXA-48. Discordant specimens were retested using disk diffusion tests and the same LAMP assay on isolates. Microbiological turn-around times (TAT; from the reception in the laboratory to result notification) were collected. RESULTS: Overall, 290 rectal ESwabs were analyzed. ESBL and CPE prevalence were 16.7% and 1.0%, respectively. Three discordant isolates could not be further investigated and considered as LAMP false positive. Adjusted analytical performances were for CPE: 100% (95IC 100–100%) sensitivity, 99.6% (99.0–100%) specificity, 75% (32.6–100%) PPV, and 100% (100–100%) NPV, and for ESBL: 85% (73.9–96.1%) sensitivity, 98.8% (97.4–100%) specificity, 91.9% (83.1–100%) PPV, and 97.6% (95.7–99.5%) NPV. A decrease in TAT was observed when comparing LAMP screening assay against conventional method (50.3 hours vs. 6.2 hours; Figure 1). Figure 2 shows time reductions comparing both screening strategies. CONCLUSION: Screening strategies based on LAMP could fasten discontinuation of unnecessary pre-emptive isolation time for patients at risk and earlier implementation of contact precautions for previously unknown carriers of ESBL or CPE. [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-68100632019-10-28 2142. Comparison of Molecular-Based vs. Conventional Culture-Based Screening Methods for Detection of Carriers of Extended-Spectrum β-Lactamases (ESBL) and Carbapenemases-Producing Enterobacteriacae (CPE) Martischang, Romain Renzi, Gesuele François, Patrice Bonetti, Eve-Julie Cherkaoui, Abdessalam Pugin, Jérôme Schrenzel, Jacques Harbarth, Stephan Open Forum Infect Dis Abstracts BACKGROUND: Active surveillance and contact precautions may prevent cross-transmission of ESBL-producing Enterobacteriaceae and CPE. Culture-based methods delaying results might increase risk of cross-transmission, and lead to unnecessary preemptive contact precautions. This observational cohort study compared rapid Loop-Mediated Isothermal Amplification (LAMP) assays to conventional culture-based methods for ESBL and CPE screening of critically ill patients. METHODS: This study was conducted in the adult ICUs at Geneva University Hospitals. We collected consecutive rectal ESwabs routinely performed, either for admission screening of high-risk patients or once weekly routine screening of all patients hospitalized in the ICU. Eazyplex® SuperBug CRE system (Amplex Biosystems) assays were performed directly on rectal Eswabs according to the manufacturer’s instructions. For the conventional culture-based method, we used chromID® ESBL agar (ESBL) coupled with chromID®OXA-48. Discordant specimens were retested using disk diffusion tests and the same LAMP assay on isolates. Microbiological turn-around times (TAT; from the reception in the laboratory to result notification) were collected. RESULTS: Overall, 290 rectal ESwabs were analyzed. ESBL and CPE prevalence were 16.7% and 1.0%, respectively. Three discordant isolates could not be further investigated and considered as LAMP false positive. Adjusted analytical performances were for CPE: 100% (95IC 100–100%) sensitivity, 99.6% (99.0–100%) specificity, 75% (32.6–100%) PPV, and 100% (100–100%) NPV, and for ESBL: 85% (73.9–96.1%) sensitivity, 98.8% (97.4–100%) specificity, 91.9% (83.1–100%) PPV, and 97.6% (95.7–99.5%) NPV. A decrease in TAT was observed when comparing LAMP screening assay against conventional method (50.3 hours vs. 6.2 hours; Figure 1). Figure 2 shows time reductions comparing both screening strategies. CONCLUSION: Screening strategies based on LAMP could fasten discontinuation of unnecessary pre-emptive isolation time for patients at risk and earlier implementation of contact precautions for previously unknown carriers of ESBL or CPE. [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6810063/ http://dx.doi.org/10.1093/ofid/ofz360.1822 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Martischang, Romain
Renzi, Gesuele
François, Patrice
Bonetti, Eve-Julie
Cherkaoui, Abdessalam
Pugin, Jérôme
Schrenzel, Jacques
Harbarth, Stephan
2142. Comparison of Molecular-Based vs. Conventional Culture-Based Screening Methods for Detection of Carriers of Extended-Spectrum β-Lactamases (ESBL) and Carbapenemases-Producing Enterobacteriacae (CPE)
title 2142. Comparison of Molecular-Based vs. Conventional Culture-Based Screening Methods for Detection of Carriers of Extended-Spectrum β-Lactamases (ESBL) and Carbapenemases-Producing Enterobacteriacae (CPE)
title_full 2142. Comparison of Molecular-Based vs. Conventional Culture-Based Screening Methods for Detection of Carriers of Extended-Spectrum β-Lactamases (ESBL) and Carbapenemases-Producing Enterobacteriacae (CPE)
title_fullStr 2142. Comparison of Molecular-Based vs. Conventional Culture-Based Screening Methods for Detection of Carriers of Extended-Spectrum β-Lactamases (ESBL) and Carbapenemases-Producing Enterobacteriacae (CPE)
title_full_unstemmed 2142. Comparison of Molecular-Based vs. Conventional Culture-Based Screening Methods for Detection of Carriers of Extended-Spectrum β-Lactamases (ESBL) and Carbapenemases-Producing Enterobacteriacae (CPE)
title_short 2142. Comparison of Molecular-Based vs. Conventional Culture-Based Screening Methods for Detection of Carriers of Extended-Spectrum β-Lactamases (ESBL) and Carbapenemases-Producing Enterobacteriacae (CPE)
title_sort 2142. comparison of molecular-based vs. conventional culture-based screening methods for detection of carriers of extended-spectrum β-lactamases (esbl) and carbapenemases-producing enterobacteriacae (cpe)
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6810063/
http://dx.doi.org/10.1093/ofid/ofz360.1822
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