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

Pham Thi Anh Mai, Nguyen Tung Xuan, My Troung Nhat, Le Lan Thi, Vu Huyen Thi, Hoang Ngoc Thi Bich, Tran Dien M., Nguyen Linh Viet, Phuc Pham Duc, Nurjadi Dennis, Goutard Flavie, Velavan Thirumalaisamy P., Dinh Van Anh Thi, Hounmanou Yaovi Mahuton Gildas, Jörgensen Bent, Song Le Huu, Nguyen Nhung T.T., Loire Etienne, Östholm Åse, Nilsson Lennart E., Tran Tuyet Hanh T., Phan Phuc H., Dalsgaard Anders, Larsson Mattias, Olson Linus, Hanberger Håkan. 2024. Evaluation of screening algorithms to detect rectal colonization with carbapenemase-producing Enterobacterales in a resource-limited setting. JAC-Antimicrobial Resistance, 6 (3):dlae089, 6 p.

Résumé : 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.

Mots-clés Agrovoc : identification, PCR, phénotype

Agences de financement hors UE : Swedish Research Council, Bundesministerium für Bildung und Forschung, Agence Nationale de la Recherche, Innovationsfonden, International Centre for Antimicrobial Resistance Solution, Joint Programming Initiative on Antimicrobial Resistance

Auteurs et affiliations

• Pham Thi Anh Mai, Karolinska Institutet (SWE)
• Nguyen Tung Xuan, Vietnam National Children's Hospital (VNM)
• My Troung Nhat, VG-CARE (VNM)
• Le Lan Thi, Vietnam National Children's Hospital (VNM)
• Vu Huyen Thi, Vietnam National Children's Hospital (VNM)
• Hoang Ngoc Thi Bich, Vietnam National Children's Hospital (VNM)
• Tran Dien M., Vietnam National Children's Hospital (VNM)
• Nguyen Linh Viet, HUPH (VNM)
• Phuc Pham Duc, HUPH (VNM)
• Nurjadi Dennis, VG-CARE (VNM)
• Goutard Flavie, CIRAD-BIOS-UMR ASTRE (VNM) ORCID: 0000-0002-8618-4132
• Velavan Thirumalaisamy P., University of Tübingen (DEU)
• Dinh Van Anh Thi, Vietnam National Children's Hospital (VNM)
• Hounmanou Yaovi Mahuton Gildas, UCPH (DNK)
• Jörgensen Bent, Linköping University (SWE)
• Song Le Huu, VG-CARE (VNM)
• Nguyen Nhung T.T., HUPH (VNM)
• Loire Etienne, CIRAD-BIOS-UMR ASTRE (VNM)
• Östholm Åse, Linköping University (SWE)
• Nilsson Lennart E., Linköping University (SWE)
• Tran Tuyet Hanh T., HUPH (VNM)
• Phan Phuc H., Vietnam National Children's Hospital (VNM)
• Dalsgaard Anders, UCPH (DNK)
• Larsson Mattias, Karolinska Institutet (SWE)
• Olson Linus, Karolinska Institutet (SWE) - auteur correspondant
• Hanberger Håkan, Linköping University (SWE)

Source : Cirad-Agritrop (https://agritrop.cirad.fr/612233/)

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