title: Comparative evaluation of three chromogenic agars for detection and rapid identification of aerobic Gram-negative bacteria in the normal intestinal microflora.
abstract: OBJECTIVE
  To compare three different chromogenic agars and MacConkey agar for the detection of aerobic Gram-negative bacteria in the normal intestinal microflora and to assess the accuracy of the chromogenic agars for the direct identification of Escherichia coli.
  
  
  METHODS
  A total of 164 Gram-negative clinical isolates (E. coli, Proteus, Klebsiella, Enterobacter, Morganella and Pseudomonas species) and 30 stool specimens were inoculated in parallel on four media: Chromagar E. coli/Coliform, Chromogenic urinary tract infection UTI medium, CHROMagar Orientation and MacConkey agar. All colonies that differed by color and/or morphology were selected for further identification by VITEK 1 and/or API 20E from each medium.
  
  
  RESULTS
  On E. coli/Coliform agar five out of 32 (16%) E. coli strains failed to produce the color as described by the manufacturer. No remarkable discrepancies were found for the other clinical isolates. There was no significant difference in detection rate (DR) of aerobic Gram-negative bacteria in stool specimens between the different chromogenic agars and MacConkey agar. The overall DR was about 84%, and varied from 100% for monomicrobial specimens to 33% for polymicrobial specimens. The positive predictive values (PPV) for the direct identification of E. coli on Chromagar E. coli/Coliform, Chromogenic UTI medium and CHROMagar Orientation were 1.00, 0.93 and 0.93, respectively. The negative predictive values (NPV) were 0.53, 0.68 and 0.69, respectively.
  
  
  CONCLUSIONS
  Chromogenic UTI medium and CHROMagar Orientation are the preferred media because of the higher NPV. The high PPV of these agars allows accurate and rapid identification of E. coli.
authors: Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Dr Molewaterplein 40, 3015 GD Rotterdam, the Netherlands. p.filius@erasmusmc.nl
authors: P M G
authors: PM
authors: Filius
authors: D
authors: D
authors: van Netten
authors: P J E
authors: PJ
authors: Roovers
authors: A G
authors: AG
authors: Vulto
authors: I C
authors: IC
authors: Gyssens
authors: H A
authors: HA
authors: Verbrugh
authors: H P
authors: HP
authors: Endtz
mesh_terms: D000362:Agar; D002863:Chromogenic Compounds; D003470:Culture Media; D004926:Escherichia coli / Q000254:growth & development / Q000302:isolation & purification*; D004927:Escherichia coli Infections / Q000097:blood / Q000382:microbiology*; D005243:Feces / Q000382:microbiology; D006090:Gram-Negative Bacteria / Q000254:growth & development / Q000302:isolation & purification*; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis / Q000382:microbiology*; D011237:Predictive Value of Tests
chemical_list: D002863:Chromogenic Compounds; D003470:Culture Media; D000362:Agar