ABSTRACT
BACKGROUND: Carbapenem-resistant organism (CRO) colonization is a serious problem that increases the risk of infection and contributes to dissemination of antimicrobial resistance in healthcare-associated environments. The risk of acquisition and dissemination of CRO is high in chronic renal failure patients and the surveillance culture is recommended as a component of infection control programmes. AIM: To assess colonization by CRO, comparing phenotypic and molecular-based methods of diagnostics, in rectal swabs in a large population of chronic renal failure patients. METHODS: A total of 1092 rectal swabs (ESwab™) were collected at two different times from 546 chronic kidney disease (CKD) patients from a specialized tertiary care university centre. They were divided into three groups: conservative treatment (N = 129), dialysis (N = 217), and transplanted patients (N = 200). A chromogenic (CHROMagar™) KPC agar and the multiplex real-time polymerase chain reaction (qPCR) targeting carbapenemase-encoding genes were tested as phenotypic and molecular screening for carbapenemase production. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and conventional PCR were also performed on the isolates grown on chromogenic agar. FINDINGS: Among the 1092 samples, 150 (13.7%) were identified as CRO producers according to chromogenic agar. Only 26 (2.4%) were confirmed as KPC by conventional PCR. According to qPCR direct from swab, 31 (2.8%) were positive for KPC, 39 (3.6%) for GES, and three (0.3%) for SPM with kappa index of 0.256. CONCLUSION: The qPCR technique provides faster results when compared to culture method and enables rapid implementation of control measures and interventions to reduce the spread of CRO in healthcare settings, especially among CKD patients.
Subject(s)
Bacterial Proteins/genetics , Gram-Negative Bacteria/isolation & purification , Gram-Negative Bacterial Infections/diagnosis , Real-Time Polymerase Chain Reaction/methods , Rectum/microbiology , Renal Insufficiency, Chronic/complications , beta-Lactam Resistance , beta-Lactamases/genetics , Bacterial Proteins/analysis , Bacteriological Techniques/methods , Carrier State/diagnosis , Carrier State/microbiology , Gram-Negative Bacterial Infections/microbiology , Hospitals, University , Humans , Molecular Diagnostic Techniques/methods , Time Factors , beta-Lactamases/analysisABSTRACT
The objective of this study was to investigate the occurrence of vancomycin-resistant Enterococcus (VRE) cross-transmission between two patient groups (long-term dialysis and kidney transplant patients). Molecular typing, by automated ribotyping with the RiboPrinter Microbial Characterization System (Qualicon, USA), was used to analyze VRE isolates from 31 fecal samples of 320 dialysis patients and 38 fecal samples of 280 kidney transplant patients. Clonal spread of E. faecalis and E. casseliflavus was observed intragroup, but not between the two groups of patients. In turn, transmission of E. gallinarum and E. faecium between the groups was suggested by the finding of vancomycin-resistant isolates belonging to the same ribogroup in both dialysis and transplant patients. The fact that these patients were colonized by VRE from the same ribogroup in the same health care facility provides evidence for cross-transmission and supports the adoption of stringent infection control measures to prevent dissemination of these bacteria.
Subject(s)
Humans , Cross Infection/microbiology , Enterococcus/drug effects , Kidney Transplantation/adverse effects , Renal Dialysis/adverse effects , Vancomycin Resistance , Cross-Sectional Studies , Enterococcus/classification , Enterococcus/isolation & purification , Feces/microbiology , RibotypingABSTRACT
The objective of this study was to investigate the occurrence of vancomycin-resistant Enterococcus (VRE) cross-transmission between two patient groups (long-term dialysis and kidney transplant patients). Molecular typing, by automated ribotyping with the RiboPrinter Microbial Characterization System (Qualicon, USA), was used to analyze VRE isolates from 31 fecal samples of 320 dialysis patients and 38 fecal samples of 280 kidney transplant patients. Clonal spread of E. faecalis and E. casseliflavus was observed intragroup, but not between the two groups of patients. In turn, transmission of E. gallinarum and E. faecium between the groups was suggested by the finding of vancomycin-resistant isolates belonging to the same ribogroup in both dialysis and transplant patients. The fact that these patients were colonized by VRE from the same ribogroup in the same health care facility provides evidence for cross-transmission and supports the adoption of stringent infection control measures to prevent dissemination of these bacteria.
