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Lee and Lee: Surveillance Culture of Carbapenemase-Producing Enterobacteriaceae in a Tertiary-Care Hospital
Original Article

Ann Clin Microbiol 2018;21(1):8-11.

Published online: 12 March 2018

DOI: https://doi.org/10.5145/ACM.2018.21.1.8

Surveillance Culture of Carbapenemase-Producing Enterobacteriaceae in a Tertiary-Care Hospital

Eunyoung Lee, Yangsoon Lee

1Department of Laboratory Medicine, Hanyang University College of Medicine, Seoul, Korea

Correspondence: Yangsoon Lee, Department of Laboratory Medicine, Hanyang University Seoul Hospital, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea. (Tel) 82-2-2290-9655, (Fax) 82-2-2290-9193, (E-mail) yangsoon@hanyang.ac.kr

Received 29 September 2017       Revised 28 October 2017       Accepted 1 November 2017

Copyright © 2018 The Korean Society of Clinical Microbiology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Carbapenem-resistant Enterobacteriaceae (CRE) are increasingly being reported throughout the world, which is a significant problem for patient treatment and infection control. Carbapenem-resistance in Enterobacteriaceae is mainly due to carbapenem-hydrolyzing β-lactamase, which tends to spread through genetic mobile elements. Therefore, the detection of carbapenemase-producing Enterobacteriaceae (CPE) carriers is particularly important for the prevention and epidemiological monitoring of these infections. In this study, we performed surveillance cultures for CPE in patients admitted to the hospital and evaluated the prevalence of CPE.

Methods

Stool cultures were obtained from a total of 228 patients at our tertiary-care hospital between March and May 2017. Stool specimens were inoculated on ChromID CARBA agar (bioMérieux, France) and incubated for 18–24 hours. Suspicious colonies with pink or bluish-green color were screened for CPE by the modified Hodge test (MHT) and carbapenemase inhibition test (CIT). We performed PCR to detect five carbapenemase genes, bla KPC, bla IMP, bla VIM, bla NDM, and bla OXA-48.

Results

Among 228 isolates, seven were suspicious for CPE: four Klebsiella pneumoniae, one Escherichia coli, one Enterobacter aerogenes, and one Serratia marcescens. Two K. pneumoniae isolates showed positive reactions in both the modified Hodge test and inhibition test with phenylboronic acid. By PCR, bla KPC was identified in these two K. pneumoniae isolates.

Conclusion

Our results showed a very low prevalence (2/228, 0.9%) of CPE in our tertiary-care hospital based on surveillance culture in a recent three month period.

Keywords: Carbapenemase-producing Enterobacteriaceae, Healthcare-associated infection, Infection control

References

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Table 1.
Isolates suspicious for carbapenemase-producing Enterobacteriaceae on chromogenic agar
No. of isolate Sex/age Species Colony Modified Hodge test Inhibition test (zone diameter, mm) CPE gene
MEM PBA EDTA
1 M/71 K. pneumoniae Green − 13 22 (+) 17 (+) ND
2 F/73 K. pneumoniae Green − 21 24 (w+)* 22 (−) ND
3 M/37 K. pneumoniae Green + 14 22 (+) 16 (−) bla KPC
4 F/80 K. pneumoniae Green + 14 22 (+) 14 (−) bla KPC
5 M/84 E. coli Pink − 26 27 (−) 27 (−) ND
6 M/68 E. aerogenes Green − 21 23 (−) 22 (−) ND
7 M/74 S. marcesens Green − 27 28 (−) 28 (−) ND

*Indicates a positive result when the size difference was 4 mm or more and weakly positive at 3 mm. Abbreviations: MEM, meropenem; PBA, phenylboronic acid; EDTA, ethylenediaminetetraacetic acid; CPE, carbapenemase-producing Enterobacteriaceae; M, male; ND, not detected; F, female.

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