@article{3111118,
    title = "Comparative evaluation of a prototype chromogenic medium (ChromID CARBA) for detecting carbapenemase-producing Enterobacteriaceae in surveillance rectal swabs",
    author = "Vrioni, G. and Daniil, I. and Voulgari, E. and Ranellou, K. and Koumaki, V. and Ghirardi, S. and Kimouli, M. and Zambardi, G. and Tsakris, A.",
    journal = "Journal of Clinical Microbiology",
    year = "2012",
    volume = "50",
    number = "6",
    pages = "1841-1846",
    issn = "0095-1137, 1098-660X",
    doi = "10.1128/JCM.06848-11",
    keywords = "carbapenem;  carbapenemase;  chromogenic substrate;  ertapenem;  meropenem, antibiotic sensitivity;  article;  bacterial strain;  bacterium detection;  carbapenemase producing Enterobacteriaceae;  comparative study;  controlled study;  Enterobacter aerogenes;  Enterobacteriaceae;  Enterobacteriaceae infection;  enzyme synthesis;  genotype;  health survey;  human;  human tissue;  intermethod comparison;  Klebsiella pneumoniae;  major clinical study;  minimum inhibitory concentration;  nonhuman;  phenotype;  polymerase chain reaction;  priority journal;  screening test;  sensitivity and specificity;  species differentiation, Bacterial Proteins;  Bacteriological Techniques;  beta-Lactamases;  Carbapenems;  Culture Media;  Enterobacter aerogenes;  Enterobacteriaceae;  Enterobacteriaceae Infections;  Genotype;  Humans;  Klebsiella pneumoniae;  Mass Screening;  Microbial Sensitivity Tests;  Phenotype;  Polymerase Chain Reaction;  Rectum;  Sensitivity and Specificity, Enterobacter aerogenes;  Enterobacteriaceae;  Klebsiella pneumoniae",
    abstract = "Carbapenemase-producing Enterobacteriaceae (CPE) are an increasing problem worldwide, and rectal swab surveillance is recommended as a component of infection control programs. The performance of a prototype chromogenic medium (chromID CARBA) was evaluated and compared with media tested by four other screening methods: (i) overnight selective enrichment in 5 ml tryptic soy broth with a 10-μg ertapenem disk followed by plating onto MacConkey agar (CDC-TS), (ii) short selective enrichment in 9 ml brain heart infusion broth with a 10-μg ertapenem disk followed by plating onto chromID ESBL medium (ESBL-BH), (iii) direct plating onto chromID ESBL, and (iv) direct plating onto MacConkey agar supplemented with meropenem (1 μg/ml) (MCM). The screening methods were applied to detect CPE in 200 rectal swab specimens taken from different hospitalized patients. Identification and antimicrobial susceptibility were performed by the Vitek 2 system. Carbapenem MICs were checked by Etest. Carbapenemase production was confirmed using the modified Hodge test, combined-disk tests, and PCR assays. In total, 133 presumptive CPE strains were detected. Phenotypic and genotypic assays confirmed 92 strains to be CPE (56 KPC-positive Klebsiella pneumoniae, 29 VIM-positive K. pneumoniae, and 7 KPC-positive Enterobacter aerogenes strains) recovered from 73 patients, while the remaining 41 strains were confirmed to be CPE negative (19 ESBL producers and 22 nonfermenters). chromID CARBA, ESBL-BH, and chromID ESBL exhibited the highest sensitivity (92.4%), followed by CDC-TS and MCM (89.1%) (P = 0.631). The specificity was greater for chromID CARBA (96.9%) and ESBL-BH (93.2%) than for CDC-TS (86.4%), MCM (85.2%), and chromID ESBL (84.7%) (P = 0.014). In conclusion, chromID CARBA was found to be a rapid and accurate culture screening method for active CPE surveillance. Copyright © 2012, American Society for Microbiology. All Rights Reserved."
}