Intestinal Carriage of Carbapenemase-Producing Organisms: Current Status of Surveillance Methods.
Carbapenemases have become a significant mechanism for broad-spectrum β-lactam resistance in Enterobacteriaceae and other Gram-negative bacteria such as Pseudomonas and Acinetobacter spp. Intestinal carriage of carbapenemase-producing organisms (CPOs) is an important source of transmission. Isolation of carriers is one strategy that can be used to limit the spread of these bacteria. In this review, we critically examine the clinical performance, advantages, and disadvantages of methods available for the detection of intestinal carriage of CPOs. Culture-based methods (Centers for Disease Control and Prevention [CDC] protocols, chromogenic media, specialized agars, and double-disk synergy tests) for detecting carriage of CPOs are convenient due to their ready availability and low cost, but their limited sensitivity and long turnaround time may not always be optimal for infection control practices. Contemporary nucleic acid amplification techniques (NAATs) such as real-time PCR, hybridization assays, loop-mediated isothermal amplification (LAMP), or a combined culture and NAAT approach may provide fast results and/or added sensitivity and specificity compared with culture-based methods. Infection control practitioners and clinical microbiologists should be aware of the strengths and limitations of available methods to determine the most suitable approach for their medical facility to fit their infection control needs.
Division of Infectious Diseases and HIV Medicine, Department of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA.
Roberto
http://orcid.org/0000-0003-4982-4708
R
Viau
Microbiology Service, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA.
Karen M
http://orcid.org/0000-0002-9970-4133
KM
Frank
Department of Pathology, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, Ohio, USA.
Michael R
MR
Jacobs
Geriatric Research, Education and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA.
Brigid
B
Wilson
Department of Medicine, Wayne State University and Detroit Medical Center, Detroit, Michigan, USA.
Keith
K
Kaye
Infectious Diseases Section, Medical Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA Infection Control and Prevention, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA.
Curtis J
CJ
Donskey
Infectious Diseases Section, Medical Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA.
Federico
F
Perez
Institute for Infectious Diseases, Faculty of Medicine, University of Bern, Bern, Switzerland.
Andrea
http://orcid.org/0000-0003-3186-5421
A
Endimiani
Division of Infectious Diseases and HIV Medicine, Department of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA Infectious Diseases Section, Medical Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA Department of Pharmacology, Molecular Biology and Microbiology, Case Western Reserve University, Cleveland, Ohio, USA robert.bonomo@va.gov.
Robert A
http://orcid.org/0000-0002-3299-894X
RA
Bonomo
D000150:Acinetobacter / Q000201:enzymology / Q000302:isolation & purification; D001426:Bacterial Proteins / Q000235:genetics / Q000378:metabolism*; D001431:Bacteriological Techniques / Q000379:methods; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D003428:Cross Infection / Q000517:prevention & control; D004755:Enterobacteriaceae / Q000201:enzymology* / Q000302:isolation & purification; D062665:Epidemiological Monitoring; D041981:Gastrointestinal Tract / Q000382:microbiology*; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D025202:Molecular Diagnostic Techniques / Q000379:methods; D011549:Pseudomonas / Q000201:enzymology / Q000302:isolation & purification; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism*
D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase