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Comparison of nine different selective agars for the detection of carbapenemase-producing Enterobacterales (CPE)

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Abstract

The rapid identification of patients colonized with carbapenem-resistant Enterobacterales (CRE) is important for infection control purposes. Here, we compared and evaluated nine different agars for the detection of carbapenemase-producing Enterobacterales (CPE) from clinical samples. In the study, 69 CPE and 40 carbapenemase-negative isolates were included. Overall, seven commercially available screening agars were assessed: Brilliance CRE (Oxoid), Chromatic CRE (Liofilchem), chromID CARBA and chromID OXA-48 (both bioMérieux), three ESBL agars (Chromatic ESBL [Liofilchem], chromID ESBL [bioMérieux], Brilliance ESBL [Oxoid]), and two agars produced in-house (McCARB and McCARB-T). The sensitivity of CRE agars for CPE detection ranged from 34.8 to 98.6%. Brilliance CRE and McCARB/McCARB-T showed the overall highest sensitivity (98.6 and 97.1%, respectively). OXA-48 producers were the most difficult to detect; only 4/9 agars detected all isolates (McCARB/McCARB-T, Chromatic CRE, ChromID OXA-48). Additionally, all ESBL-negative OXA-48 isolates failed to grow on ESBL screening agars. Specificity ranged from 30 (Brilliance ESBL) to 100% (ChromID OXA-48). The limit of detection for different CPE in spiked stool samples ranged from 1.5 × 101 to 1.5 × 103 CFU/ml. Overall, Brilliance CRE and the McCARB in-house agars showed the best performance and were able to detect most CPE, including almost all OXA-48. ESBL agars were not suitable for detection of CPE alone, as OXA-48 isolates negative for ESBL were suppressed. The highest sensitivity was achieved by a combination of a CRE agar and an ESBL agar.

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Acknowledgments

We thank Anne Brunke and Marco Schwabe for excellent technical assistance. We are furthermore grateful to ThermoFisher, BioMérieux, Liofilchem for providing agars at reduced prices or free of charge.

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Authors and Affiliations

  1. Institute for Medical Microbiology and Infection Control, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany

    Stephan Göttig & Julian Sommer

  2. Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Goldenfelsstrasse 19-21, 50935, Cologne, Germany

    Sarah V. Walker, Ahmad Saleh, Florian Koroska, Yvonne Stelzer & Axel Hamprecht

  3. DZIF (German Centre for Infection Research), partner site Bonn-Cologne, Cologne, Germany

    Sarah V. Walker, Ahmad Saleh, Yvonne Stelzer & Axel Hamprecht

  4. Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany

    Joerg Steinmann

  5. Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Paracelsus Medical University Nuremberg, Klinikum Nürnberg, Nuremberg, Germany

    Joerg Steinmann

  6. Institute for Medical Microbiology and Virology, University of Oldenburg, Oldenburg, Germany

    Axel Hamprecht

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  1. Stephan Göttig
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  2. Sarah V. Walker
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  3. Ahmad Saleh
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  4. Florian Koroska
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  8. Axel Hamprecht
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Correspondence to Axel Hamprecht.

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Göttig, S., Walker, S.V., Saleh, A. et al. Comparison of nine different selective agars for the detection of carbapenemase-producing Enterobacterales (CPE). Eur J Clin Microbiol Infect Dis 39, 923–927 (2020). https://doi.org/10.1007/s10096-019-03786-7

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  • DOI: https://doi.org/10.1007/s10096-019-03786-7

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