[Implementation of vanA and vanB genes by PCR technique research interest in system (Xpert vanA/vanB CepheidR) closed in a laboratory of microbiology in managing an outbreak to Enterococcus faecium resistant glycopeptide (EfRG)].
METHODS
The closed system PCR for the rapid detection of vanA and vanB genes (Xpert vanA/vanB Cepheid(®)) was evaluated in our laboratory, to improve the rapidity of the response and thus the management of patients and isolation measures during two GRE outbreaks.


METHODS
From March to December2009, 565 samples were analysed by PCR associated to bacterial culture initially for all samples for 2months (n = 75), and thereafter for PCR-positive samples only.


RESULTS
In this study, sensitivity and negative predictive values of the PCR were 100%. Specificity was evaluated in the presence and absence of outbreak: 69.3 and 76.8% respectively. The variability of false positive rates between units were lower in nonepidemic than during epidemic phase. The global false positive rate was 23.9%.


CONCLUSIONS
This easy-to-use technology provides rapid results… four samples are tested in 1h versus 72h for culture. Despite its reagent cost, it represents an important hospital diagnostic tool: improvement of the management of cohorting areas and patient transfer between units, adaptation of isolation measures and treatments. However, culture remains necessary to confirm any positive result obtained by PCR and for epidemiological surveillance.
Dekeyser
S
S
Laboratoire, centre hospitalier Germon-et-Gauthier-de-Béthune, rue Delbecque, 62408 Béthune, France. sdekeyser@ch-bethune.fr
Beclin
E
E
Descamps
D
D
D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001426:Bacterial Proteins / Q000235:genetics*; D019729:Carbon-Oxygen Ligases / Q000235:genetics*; D003199:Computer Systems; D003428:Cross Infection / Q000382:microbiology*; D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial; D042241:Early Diagnosis; D016984:Enterococcus faecium / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification; D005602:France / Q000453:epidemiology; D006020:Glycopeptides / Q000494:pharmacology*; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D007755:Laboratories, Hospital; D016133:Polymerase Chain Reaction / Q000379:methods*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D006020:Glycopeptides; C071437:VanA ligase, Bacteria; C079913:VanB protein, Enterococcus; D019729:Carbon-Oxygen Ligases