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. 2024 Jun 11;6(3):dlae089.
doi: 10.1093/jacamr/dlae089. eCollection 2024 Jun.

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

Thi Anh Mai Pham  1   2   3   4 , Tung Xuan Nguyen  5 , Troung Nhat My  3 , Lan Thi Le  5 , Huyen Thi Vu  5 , Ngoc Thi Bich Hoang  5 , Dien M Tran  6 , Linh Viet Nguyen  7 , Phuc D Pham  7 , Dennis Nurjadi  3   4 , Flavie Goutard  8 , Thirumalaisamy P Velavan  2   3   9 , Van Anh Thi Dinh  10   11 , Y M Gildas Hounmanou  12 , Bent Jörgensen  13   14   15 , Le Huu Song  3   16 , Nhung T T Nguyen  7   10 , Etienne Loire  8 , Åse Östholm  14 , Lennart E Nilsson  14 , Tuyet Hanh T Tran  7 , Phuc H Phan  6   10 , Anders Dalsgaard  12 , Mattias Larsson  1   13 , Linus Olson  1   13   17 , Håkan Hanberger  13   14
Affiliations

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

Thi Anh Mai Pham et al. JAC Antimicrob Resist. .

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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Figures

Figure 1.
Figure 1.
Detection of carbapenemase genes in carbapenem-resistant Enterobacterales (CRE) from rectal swabs in Vietnam. (a) Frequency (%) of carbapenemase gene detection in CRE and (b) by species (n = 140). (c) Distribution of carbapenemase genes by ertapenem MIC. (d) Distribution of carbapenemase genes by meropenem MIC, one missing value for meropenem MIC (total n = 89).
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