New selective and differential chromogenic agar medium, chromID VRE, for screening vancomycin-resistant Enterococcus species

Kuch, Alicja; Stefaniuk, Elżbieta; Ozorowski, Tomasz; Hryniewicz, Waleria

doi:10.1016/j.mimet.2009.01.004

Journal of Microbiological Methods

2009

DOI: 10.1016/j.mimet.2009.01.004

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New selective and differential chromogenic agar medium, chromID VRE, for screening vancomycin-resistant Enterococcus species

Alicja Kuch

Elżbieta Stefaniuk

Tomasz Ozorowski

et al.

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Cited by 20 publications

(18 citation statements)

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“…Thus, in our experience, stool specimens are inappropriate for direct plating onto the C-ID and CHR media. Our study confirmed that overnight precultivation of stool specimens to enable selective enrichment is essential before specimen plating onto these chromogenic media (2,6).…”

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confidence: 79%

Comparison of Two Chromogenic Media for Selective Isolation of Vancomycin-Resistant Enterococci from Stool Specimens

Peltroche-Llacsahuanga

Top

Weber-Heynemann

et al. 2009

J Clin Microbiol

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Two chromogenic media (Chromagar VRE and chromID VRE [C-ID]) performed equally well in the direct detection of vancomycin-resistant enterococci (VRE) in stool specimens after an overnight enrichment step and a 48-h incubation period, with a sensitivity of 98.2% (56/57) for both and specificities of 96.5% (195/202) and 97.5% (197/202), respectively. However, assigning discriminatory colony color was sometimes difficult, especially on C-ID. In order to facilitate simple species identification, biochemical key reactions were implemented.Prevalence rates of vancomycin-resistant enterococci (VRE) associated with serious clinical infections have increased worldwide over the past 15 years (3, 12). Therefore, to prevent further spread, active control measures are increasingly being implemented in hospitals. A cornerstone of those control measures is the detection of noninfected but gut-colonized patients that might serve as a source of the spread of VRE. The use of improved cultural-based methods, e.g., chromogenic media, may provide a feasible alternative for cost-effective VRE surveillance (2, 7). This study systematically compared the performance characteristics of chromID VRE (C-ID) medium (bioMérieux, Nürtingen, Germany) with those of CHROMagar VRE (CHR) medium (CHROMagar, Paris, France) with special regard to (i) selectivity, (ii) stability of colony color and growth characteristics, and (iii) the ability to recover VRE from clinical stool specimens.In order to check the selectivity of the two media, all of the type strains (as of June 2009) of the genus Enterococcus (n ϭ 38; vancomycin MICs ranging from 0.125 to Ն256 g/ml) were tested. As positive controls, VRE reference strains obtained from culture collections (n ϭ 4) and from the culture collection of the National

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supporting

confidence: 79%

Comparison of Two Chromogenic Media for Selective Isolation of Vancomycin-Resistant Enterococci from Stool Specimens

Peltroche-Llacsahuanga

Top

Weber-Heynemann

et al. 2009

J Clin Microbiol

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“…All studies reported similar rates of recovery of both VRENFM and VRENFS from chromogenic agars to those from BEAV (1,2,(4)(5)(6)(7)10). CVRE appeared to perform better than the other chromogenic agars compared to BEAV, but a direct comparison is needed to provide the most accurate comparison.…”

mentioning

confidence: 89%

“…Confirmation of VRE using this medium requires 48 to 72 h. Chromogenic agars to detect VRE demonstrate promise (1)(2)(3)(4)(5)(6)(7)10). BBL CHROMagar VanRE (CVRE; BD Diagnostics, Sparks, MD) is a selective and differential chromogenic agar under development for the detection of vancomycin-resistant E. faecium (VRENFM) and vancomycin-resistant Enterococcus faecalis (VRENFS).…”

mentioning

confidence: 99%

Evaluation of BBL CHROMagar VanRE for Detection of Vancomycin-Resistant Enterococci in Rectal Swab Specimens

et al. 2010

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A study was performed on 517 surveillance rectal swabs to evaluate a selective and differential chromogenic medium, the BBL CHROMagar VanRE (CVRE), which enables recovery and identification of VanA-and VanB-containing Enterococcus faecium (ENFM) and Enterococcus faecalis (ENFS) isolates. Compared to BBL Enterococcosel agar, a bile-esculin-azide-vancomycin (BEAV) agar, the initial overall sensitivity, specificity, and positive and negative predictive values of CVRE for the detection of vancomycin-resistant ENFM and ENFS were 99.1% and 94.8% and 84.2% and 99.7%, respectively. Among our patient population, more vancomycin-resistant enterococci (VRE) were recovered with CVRE than BEAV.Vancomycin-resistant enterococci (VRE) are major causes of nosocomial infections in health care facilities, and those patients infected with VRE have worse outcomes while hospitalized (8). Rapid, reliable identification of these antibioticresistant organisms is crucial for patient management and infection control measures (9, 12).Culture from rectal swabs or stool specimens onto bileesculin-azide agar with vancomycin (BEAV) is the VRE screening method used in many clinical laboratories. Confirmation of VRE using this medium requires 48 to 72 h. Chromogenic agars to detect VRE demonstrate promise (1-7, 10). BBL CHROMagar VanRE (CVRE; BD Diagnostics, Sparks, MD) is a selective and differential chromogenic agar under development for the detection of vancomycin-resistant E. faecium (VRENFM) and vancomycin-resistant Enterococcus faecalis (VRENFS). CVRE contains 8 g/ml of vancomycin and uses chromogenic substrates to phenotypically differentiate VRENFM as mauve colonies and VRENFS as green colonies. Other bacteria are inhibited or typically grow as a color other than mauve or green. Our study compared the clinical performance of CVRE with that of BEAV for primary isolation and detection of VRE from surveillance rectal swabs.Patient samples. This industry-sponsored clinical trial was approved by the Johns Hopkins University School of Medicine Institutional Review Board. At the Johns Hopkins Hospital, VRE surveillance cultures are obtained weekly from patients in all intensive care units (ICUs) and from other high-risk groups, such as oncology, transplant, and HIV patients. Multiple specimens per patient were permitted in the study if previous cultures were negative. Two positive specimens were admissible, provided the specimens were collected Ͼ5 days apart.Surveillance rectal swabs were first inoculated onto BEAV followed by inoculation onto CVRE. Both plates were aseptically streaked for isolation and incubated at 37°C for 24 to 48 h. BEAV. BEAV plates with 6 g/ml of vancomycin were incubated aerobically. No-growth cultures or those not consistent with VRE by 48 h had no further workup. Presumptive colonies for VRE (black colonies with a Gram stain of positive cocci) were isolated to 5% sheep blood agar (SBA) and incubated for an additional 18 to 24 h. L-Pyrrolidonyl-␤-naphthylamide enzyme (PYR)-positive colonies were identified with the BD ...

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“…The most common specimens to screen for colonization with VRE are rectal swabs or stool specimens. Several selective and differential media have been developed and evaluated specifically for the purpose of screening for VRE (2)(3)(4)(5)(6)(7)(8)10). Campylobacter (Campy) agar, which supports the growth of VRE and contains 10 g/ml vancomycin, is readily available in most clinical laboratories due to its use in the plating of routine stool cultures to isolate Campylobacter jejuni.…”

mentioning

confidence: 99%

Comparison of Medium, Temperature, and Length of Incubation for Detection of Vancomycin-Resistant Enterococcus

et al. 2012

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Campylobacter (Campy; BD Diagnostics, Sparks, MD), Spectra VRE (Remel, Lenexa, KS), and bile-esculin-azide-vancomycin (BEAV; Remel) agars were compared for their ability to detect vancomycin-resistant enterococci (VRE) in 750 stool specimens. The media were compared at 24 h and 48 h of incubation at 35°C and 42°C. When incubated for 24 h at 35°C, Campy was the most sensitive (97.8%) and specific (99.9%) but was comparable to Spectra, which has a sensitivity of 95.6% and a specificity of 99.1%, whereas BEAV was significantly less sensitive (90%) and specific (96.1%). Incubation at 42°C or extended incubation at 35°C for 48 h yielded no advantage over incubation at 35°C for 24 h. Screening for vancomycin-resistant enterococci (VRE) has been suggested as a method for reducing the nosocomial transmission of this organism. VRE are more commonly found in patients that are in critical care units and those who have been on antibiotics. The most common specimens to screen for colonization with VRE are rectal swabs or stool specimens. Several selective and differential media have been developed and evaluated specifically for the purpose of screening for VRE (2-8, 10). Campylobacter (Campy) agar, which supports the growth of VRE and contains 10 g/ml vancomycin, is readily available in most clinical laboratories due to its use in the plating of routine stool cultures to isolate Campylobacter jejuni. We have previously reported on the use of this medium for the detection of VRE (9). Due to its sensitivity and relatively low cost and the fact that it is already incorporated into most laboratory routines, it is a reasonable choice that has served as a cost-effective way to screen for this potential pathogen. In this present study, we compared Campy medium, which contains 10 g/ml of vancomycin (BD Diagnostics, Sparks, MD) to two media designed for the detection of VRE, bile-esculinazide-vancomycin agar (BEAV; Remel) and the newer chromogenic agar Spectra VRE Agar (Remel, Lenexa, KS), both of which contain 6 g/ml of vancomycin. In addition, since incubation of stools at a higher temperature, as done for C. jejuni isolation, also selects for enterococci due to its ability to grow at this elevated temperature, the media were further evaluated at different temperatures, 35°C and 42°C, as well as at 24 h and 48 h of incubation.Rectal swabs (n ϭ 730) and stool specimens (n ϭ 20) from 750 patients that were submitted to the Medical Microbiology Laboratory at the University of California, Irvine, Medical Center for VRE screening were included in this evaluation. Rectal swabs were collected using either a single or a double BBL CultureSwab (BD), while feces were submitted in a sterile container. All specimens were plated upon receipt or refrigerated at 4 to 8°C for up to 24 h prior to being cultured. In order to ensure an even distribution of the specimen for the culture media, swabs were placed into 0.5 ml of sterile saline (BD) and vortexed for 5 s. This suspension was then used to inoculate two sets of media, each consisting of the C...

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New selective and differential chromogenic agar medium, chromID VRE, for screening vancomycin-resistant Enterococcus species

Cited by 20 publications

References 15 publications

Comparison of Two Chromogenic Media for Selective Isolation of Vancomycin-Resistant Enterococci from Stool Specimens

Comparison of Two Chromogenic Media for Selective Isolation of Vancomycin-Resistant Enterococci from Stool Specimens

Evaluation of BBL CHROMagar VanRE for Detection of Vancomycin-Resistant Enterococci in Rectal Swab Specimens

Comparison of Medium, Temperature, and Length of Incubation for Detection of Vancomycin-Resistant Enterococcus

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