european congres of clinical microbiology and infectious diseases
ECCMID edition:23 location:Berlin date:27-30 April 2013
Objectives: Carbapenemase producing Enterobacteriaceae (CPE) and vancomycine resistant enterococci (VRE) increase all over the world. The role of the community, including long-term-care facilities, remains unclear. We aimed to evaluate the prevalence of rectal colonization with CPE and VRE among residents of a long-term care facility in Leuven (Belgium) with frequent contacts with the tertiary care University Hospitals Leuven.
Methods: In this observational study, 150 residents with debilitating conditions were examined in the summer of 2012. Rectal Eswabs (Copan, Italy) were taken after informed consent and transported within 4 hrs to UHLeuven. They were immediately inoculated onto 5 different CPE screening agars (Brilliance CRE (Oxoid), Brilliance ESBL (Oxoid), CHROMagar KPC (Chromagar), in-house made MacConkey with meropenem 0.5μg/mL, and a MacConkey with ertapenem (10μg, Neo-Sensitabs) and temocillin (30μg, Neo-Sensitabs) discs) and 2 VRE screening agars (chromID VRE (bioMérieux) and a selective agar for gram positive cocci with nalidixic acid/colistin sulphate and a vancomycin disc (30μg,Neo-Sensitabs)). Plates were incubated for 24 and 48 hrs. All strains growing on every agar or within restricted diameters of the discs were identified with Maldi-TOF MS (Bruker Daltonics). For CPE, each Enterobacteriaceae was tested with Modified Hodge Test (MHT) and antimicrobial susceptibility was tested with Vitek2 (bioMérieux). In case MHT was not negative or the strain was not meropenem and temocillin susceptible, Etests for the non-susceptible antibiotic(s) and a KPC/Metallo-B-Lactamase (MBL) Confirmation test (Rosco diagnostica) were performed. In case of increased MIC or a non-negative MBL test, a real-time PCR (Checkpoints-MDRCarba) was performed for the detection of carbapenemase genes. In case Enterococcus spp. was isolated from the VRE screening plates, confirmation was performed with Etest vancomycin. Results: Neither CPE nor VRE were found in the total population of 150 residents. Special attention was given to detect OXA-48, which is prevalent in Belgium and sometimes difficult to detect because of its possible low meropenem MIC values. Conclusion: The prevalence of CPE and VRE in this population of residents revealed to be zero. However, outbreaks of both CPE and VRE in some Belgian hospitals make us alert of unknown reservoirs. This study was additionally conducted to optimize the detection of OXA-48 strains that are particularly difficult to identify.