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Review
. 2016 Jan;29(1):1-27.
doi: 10.1128/CMR.00108-14.

Intestinal Carriage of Carbapenemase-Producing Organisms: Current Status of Surveillance Methods

Roberto Viau  1 , Karen M Frank  2 , Michael R Jacobs  3 , Brigid Wilson  4 , Keith Kaye  5 , Curtis J Donskey  6 , Federico Perez  7 , Andrea Endimiani  8 , Robert A Bonomo  9
Affiliations
Review

Intestinal Carriage of Carbapenemase-Producing Organisms: Current Status of Surveillance Methods

Roberto Viau et al. Clin Microbiol Rev. 2016 Jan.

Abstract

Carbapenemases have become a significant mechanism for broad-spectrum β-lactam resistance in Enterobacteriaceae and other Gram-negative bacteria such as Pseudomonas and Acinetobacter spp. Intestinal carriage of carbapenemase-producing organisms (CPOs) is an important source of transmission. Isolation of carriers is one strategy that can be used to limit the spread of these bacteria. In this review, we critically examine the clinical performance, advantages, and disadvantages of methods available for the detection of intestinal carriage of CPOs. Culture-based methods (Centers for Disease Control and Prevention [CDC] protocols, chromogenic media, specialized agars, and double-disk synergy tests) for detecting carriage of CPOs are convenient due to their ready availability and low cost, but their limited sensitivity and long turnaround time may not always be optimal for infection control practices. Contemporary nucleic acid amplification techniques (NAATs) such as real-time PCR, hybridization assays, loop-mediated isothermal amplification (LAMP), or a combined culture and NAAT approach may provide fast results and/or added sensitivity and specificity compared with culture-based methods. Infection control practitioners and clinical microbiologists should be aware of the strengths and limitations of available methods to determine the most suitable approach for their medical facility to fit their infection control needs.

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Figures

FIG 1
FIG 1
Appearances of different Enterobacteriaceae on chromID Carba and Supercarba media. (Left) chromID Carba plate. Red colonies represent K. pneumoniae, blue colonies represent E. coli, and yellow colonies represent Pseudomonas aeruginosa. (Right) Supercarba medium composite picture. The top half shows K. pneumoniae (yellow colonies due to lactose fermentation). The bottom half shows Pseudomonas aeruginosa (black/dark green colonies with no lactose fermentation).
FIG 2
FIG 2
Per-observation estimates of sensitivity, specificity, and DOR for screening methods used on pure cultures included in statistical analyses (137, 138, 140, 141, 143).
FIG 3
FIG 3
Aggregate estimates of sensitivity, specificity, and DOR for screening methods used on pure cultures. The number of studies used to calculate the performance of each method is shown in parentheses.
FIG 4
FIG 4
Per-observation estimates of sensitivity, specificity, and DOR for screening of rectal/perirectal swabs (75, 133, 135, 144, 145, 149, 150).
FIG 5
FIG 5
Aggregate estimates of sensitivity, specificity, and DOR for screening methods using rectal/perirectal swabs. The number of studies used to calculate the performance of each method is shown in parentheses.
FIG 6
FIG 6
Screening by conventional microbiology.
FIG 7
FIG 7
Molecular screening algorithm.
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References

    1. Stewardson A, Fankhauser C, De Angelis G, Rohner P, Safran E, Schrenzel J, Pittet D, Harbarth S. 2013. Burden of bloodstream infection caused by extended-spectrum β-lactamase-producing Enterobacteriaceae determined using multistate modeling at a Swiss university hospital and a nationwide predictive model. Infect Control Hosp Epidemiol 34:133–143. doi: 10.1086/669086. - DOI - PubMed
    1. Swaminathan M, Sharma S, Poliansky Blash S, Patel G, Banach DB, Phillips M, LaBombardi V, Anderson KF, Kitchel B, Srinivasan A, Calfee DP. 2013. Prevalence and risk factors for acquisition of carbapenem-resistant Enterobacteriaceae in the setting of endemicity. Infect Control Hosp Epidemiol 34:809–817. doi: 10.1086/671270. - DOI - PubMed
    1. Peña C, Pujol M, Ardanuy C, Ricart A, Pallares R, Liñares J, Ariza J, Gudiol F. 1998. Epidemiology and successful control of a large outbreak due to Klebsiella pneumoniae producing extended-spectrum β-lactamases. Antimicrob Agents Chemother 42:53–58. - PMC - PubMed
    1. Rottier WC, Ammerlaan HSM, Bonten MJM. 2012. Effects of confounders and intermediates on the association of bacteraemia caused by extended-spectrum β-lactamase-producing Enterobacteriaceae and patient outcome: a meta-analysis. J Antimicrob Chemother 67:1311–1320. doi: 10.1093/jac/dks065. - DOI - PubMed
    1. Schwaber MJ, Navon-Venezia S, Kaye KS, Ben-Ami R, Schwartz D, Carmeli Y. 2006. Clinical and economic impact of bacteremia with extended-spectrum-β-lactamase-producing Enterobacteriaceae. Antimicrob Agents Chemother 50:1257–1262. doi: 10.1128/AAC.50.4.1257-1262.2006. - DOI - PMC - PubMed

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