title: Efficacy of an Enrichment Media for Increasing Threshold for Carbapenem-Resistant Enterobacteriaceae Screening.
abstract: BACKGROUND
  Identification of carbapenem-resistant Enterobacteriaceae (CRE) is complex and a major laboratory challenge; clinical cultures may diagnose only some of the CRE carriers among patients, thus it is crucial to perform asymptomatic carriage screening.
  
  
  METHODS
  We compare the efficacy of a rectal sample culture prior to enrichment with BHI (Brain Heart Infusion) Broth and following 18-24 h. All rectal samples were applied on CHROMagar KPC selective growth media and then seeded on MacConkey agar selective growth media with an applied disk of Imipenem antibiotic on top of the media, then inserted into enrichment BHI Broth. After 18-24 h incubation with enrichment media, all samples were applied again on this media.
  
  
  RESULTS
  From the 2,245 rectal samples, CRE colonies were found in 96 (4.3%). Following enrichment with BHI Broth, CRE colonies were found in 111 (4.9%) CHROMagar KPC plates and 106 (4.7%) MacConkey agar.
  
  
  CONCLUSIONS
  We were able to demonstrate that the number of CRE-positive results increased due to use of additional enrichment with BHI Broth. Therefore, we recommend applying this method of addition of liquid enrichment media as part of a culture protocol routine for CRE screening.
authors.affiliation: Clinical Microbiology Laboratory, Baruch Padeh Medical Center, Poriya, affiliated with the Faculty of Medicine, Bar Ilan University, Galilee, Israel. aperetz@poria.health.gov.il.|Unit for Infectious Diseases, Baruch Padeh Medical Center, Poriya, affiliated with the Faculty of Medicine, Bar Ilan University, Galilee, Israel. aperetz@poria.health.gov.il.
authors.forename: Avi
authors.initials: A
authors.lastname: Peretz
authors.affiliation: Clinical Microbiology Laboratory, Baruch Padeh Medical Center, Poriya, affiliated with the Faculty of Medicine, Bar Ilan University, Galilee, Israel.
authors.forename: Nina
authors.initials: N
authors.lastname: Pastukh
authors.affiliation: Clinical Microbiology Laboratory, Baruch Padeh Medical Center, Poriya, affiliated with the Faculty of Medicine, Bar Ilan University, Galilee, Israel.
authors.forename: Natlya
authors.initials: N
authors.lastname: Isakovich
authors.affiliation: Clinical Microbiology Laboratory, Baruch Padeh Medical Center, Poriya, affiliated with the Faculty of Medicine, Bar Ilan University, Galilee, Israel.
authors.forename: Anna
authors.initials: A
authors.lastname: Koifman
authors.affiliation: Clinical Microbiology Laboratory, Baruch Padeh Medical Center, Poriya, affiliated with the Faculty of Medicine, Bar Ilan University, Galilee, Israel.
authors.forename: Diana
authors.initials: D
authors.lastname: Brodsky
authors.affiliation: Clinical Microbiology Laboratory, Baruch Padeh Medical Center, Poriya, affiliated with the Faculty of Medicine, Bar Ilan University, Galilee, Israel.
authors.forename: Hila
authors.initials: H
authors.lastname: Mizrahi
authors.affiliation: Unit for Infectious Diseases, Baruch Padeh Medical Center, Poriya, affiliated with the Faculty of Medicine, Bar Ilan University, Galilee, Israel.
authors.forename: Ilana
authors.initials: I
authors.lastname: Aharon
authors.affiliation: Unit for Infectious Diseases, Baruch Padeh Medical Center, Poriya, affiliated with the Faculty of Medicine, Bar Ilan University, Galilee, Israel.
authors.forename: Kozitta
authors.initials: K
authors.lastname: Labay
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D015780:Carbapenems / Q000009:adverse effects*; D003470:Culture Media / Q000494:pharmacology*; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000472:pathogenicity*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy*; D006801:Humans; D008826:Microbial Sensitivity Tests; D012680:Sensitivity and Specificity
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D003470:Culture Media
keywords: Brain-Heart Infusion Broth; CHROMagar KPC; Carbapenem-resistant Enterobacteriaceae; MacConkey agar