Evaluation of the Xpert Carba-R Assay for Detection of Rectal Carbapenemase-producing Enterobacterales in a Korean Tertiary Hospital
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Background: Carbapenemase-producing Enterobacterales (CPE) have been highlighted as an urgent threat by international health authorities. Rapid detection of carbapenemase will allow implementation of infection control measures. Methods: We assessed the performance of the Xpert Carba-R assay (Cepheid, USA) designed for rapid detection of five most common carꠓbapenemases (blaKPC, blaNDM, blaOXA-48, blaVIM, and blaIMP-1) from rectal swab specimens by comparing with the reference method, culture plus inꠓhouse PCR. A total of 26,178 specimens were collected from August 2018 to July 2020 and tested using the Xpert Carba-R assay and culture plus in-house PCR. Results: Among the 26,178 specimens collected from 12,889 patients, 1,615 (6.2%) were detected using the Xpert Carba-R assay, whereas 1,525 specimens (5.8%) were detected using a reference method. The sensitivity, specificity, and positive and negative predictive values of the Xpert Carba-R assay compared to the results of the culture method were 97.4% (95% confidence interval [CI], 96.5% to 98.1%), 99.4% (95% CI, 99.3% to 99.5%), 91.8% (95% CI, 90.5% to 93.0%), and 99.8% (95% CI, 99.7% to 99.8%), respectively. The prevalence of CPE and carbapenꠓem-resistant Enterobacteriaceae were 1.7% (220/12,889) and 5.4% (695/12,889), respectively. Klebsiella pneumoniae (108/220, 49.1%) was the most common species, followed by Escherichia coli (68/220, 30.9%) and Citrobacter freundii (17/220, 7.7%). blaKPC was the most common carbapenemase gene (123/220, 55.9%), followed by blaNDM (56/220, 25.4%), blaOXA-48 (27/220, 12.2%), and blaNDM/OXA-48 (9/220, 4.1%).Conclusions: Based on our results, we conclude that the Xpert Carba-R assay is a very useful tool for rapid identification of CPE rectal colonization.
Abstract
Background: Carbapenemase-producing Enterobacterales (CPE) have been highlighted as an urgent threat by international health authorities. Rapid detection of carbapenemase will allow implementation of infection control measures. Methods: We assessed the performance of the Xpert Carba-R assay (Cepheid, USA) designed for rapid detection of five most common carꠓbapenemases (blaKPC, blaNDM, blaOXA-48, blaVIM, and blaIMP-1) from rectal swab specimens by comparing with the reference method, culture plus inꠓhouse PCR. A total of 26,178 specimens were collected from August 2018 to July 2020 and tested using the Xpert Carba-R assay and culture plus in-house PCR. Results: Among the 26,178 specimens collected from 12,889 patients, 1,615 (6.2%) were detected using the Xpert Carba-R assay, whereas 1,525 specimens (5.8%) were detected using a reference method. The sensitivity, specificity, and positive and negative predictive values of the Xpert Carba-R assay compared to the results of the culture method were 97.4% (95% confidence interval [CI], 96.5% to 98.1%), 99.4% (95% CI, 99.3% to 99.5%), 91.8% (95% CI, 90.5% to 93.0%), and 99.8% (95% CI, 99.7% to 99.8%), respectively. The prevalence of CPE and carbapenꠓem-resistant Enterobacteriaceae were 1.7% (220/12,889) and 5.4% (695/12,889), respectively. Klebsiella pneumoniae (108/220, 49.1%) was the most common species, followed by Escherichia coli (68/220, 30.9%) and Citrobacter freundii (17/220, 7.7%). blaKPC was the most common carbapenemase gene (123/220, 55.9%), followed by blaNDM (56/220, 25.4%), blaOXA-48 (27/220, 12.2%), and blaNDM/OXA-48 (9/220, 4.1%).Conclusions: Based on our results, we conclude that the Xpert Carba-R assay is a very useful tool for rapid identification of CPE rectal colonization.
참고문헌 (21)
- Albiger B, "the European Survey of Carbapenemase-Producing Enterobacteriaceae(EuSCAPE)working group. Carbapenemase-producing Enterobacteriaceae in Europe : assessment by national experts from 38 countries, May 2015", Euro Surveill, 20, pp.30062~ (2015)
- Tokatlidou D, "Outbreak caused by a multidrug-resistant Klebsiella pneumoniae clone carrying blaVIM-12 in a university hospital", J Clin Microbiol, 46, pp.1005~1008 (2008)
- "Incidence of carbapenem-resistant enterobacteriae in Korea, 2018-2020"[URL]
- "Facility guidance for control of carbapenem-resistant Enterobacteriaceae (CRE): November 2015 update - CRE toolkit 2015" (2015)[URL]
- Viau R, "Intestinal carriage of carbapenemase-producing organisms : current status of surveillance methods", Clinical Microbiol Rev, 29, pp.1~27 (2016)
- Nijhuis R, "Evaluation of a new real-time PCR assay(Check-Direct CPE)for rapid detection of KPC, OXA-48, VIM, and NDM carbapenemases using spiked rectal swabs", Diagn Microbiol Infect Dis, 77, pp.316~320 (2013)
- Braun SD, "Rapid identification of carbapenemase genes in gram-negative bacteria with an oligonucleotide microarray-based assay", PLoS One, 9, pp.e107079~ (2014)
- Lolans K, "Direct ertapenem disk screening method for identification of KPC-producing Klebsiella pneumoniae and Escherichia coli in surveillance swab specimens", J Clin Microbiol, 48, pp.836~841 (2010)
- Poirel L, "Multiplex PCR for detection of acquired carbapenemase genes", Diagn Microbiol Infect Dis, 70, pp.119~123 (2011)
- Bradford PA, "Emergence of carbapenem-resistant Klebsiella species possessing the class A carbapenem-hydrolyzing KPC-2 and inhibitor-resistant TEM-30 beta-lactamases in New York City", Clin Infect Dis, 39, pp.55~60 (2004)
- Clark RB, "Cumitech 31A: Verification and validation of procedures in the clinical microbiology laboratory" (2009), American Society for Microbiology
- Sang-Hun Park, "Prevalence of Carbapenem-Resistant Enterobacteriaceae in Seoul, Korea", Journal of Bacteriology and Virology, 50(2), pp.107~116 (2020), 대한미생물학회
- Tato M, "Multisite evaluation of Cepheid Xpert Carba-R assay for detection of carbapenemase-producing organisms in rectal swabs", J Clin Microbiol, 54, pp.1814~1819 (2016)
- Moore NM, "Rapid identification of five classes of carbapenem resistance genes directly from rectal swabs by use of the Xpert Carba-R assay", J Clin Microbiol, 55, pp.2268~2275 (2017)
- Logan LK, "The epidemiology of carbapenem-resistant Enterobacteriaceae : the impact and evolution of a global menace", J Infect Dis, 215, pp.S28~S36 (2017)
- "Prevalence" (2021)[URL]
- Pham HP, "Laboratory assay evaluation demystified : a review of key factors in uencing interpretation of test results using different assays for SARS-CoV-2 infection diagnosis", Lab Med, 51, pp.e66~e70 (2020)
- Jung-Hyun Byun, "Evaluation of Xpert Carba-R Assay v.2 to Detect Carbapenemase Genes in Two Hospitals in Korea", Annals of Laboratory Medicine, 40(3), pp.209~215 (2020), 대한진단검사의학회[DOI]
- 홍덕진, "Epidemiology and Characteristics of Metallo-β-Lactamase-Producing Pseudomonas aeruginosa", Infection and Chemotherapy, 47(2), pp.81~97 (2015), 대한감염학회[DOI]
- van Duin D, "The global epidemiology of carbapenemase-producing Enterobacteriaceae", Virulence, 8, pp.460~469 (2017)
- Jeong SH, "Clonal and horizontal spread of the blaOXA-232 gene among Enterobacteriaceae in a Korean hospital", Diagn Microbiol Infect Dis, 82, pp.70~72 (2015)