Comparison of Five Different Selective Agar for the Detection of Vancomycin-Resistant Enterococcus faecium

Abstract

Five commercially available selective agar were evaluated regarding sensitivity and specificity to detect vancomycin-resistant Enterococcus (E.) faecium. Altogether 187 E. faecium strains were included, comprising 119 van-carrying strains (phenotypically vancomycin-resistant n = 105; phenotypically vancomycin-susceptible VVE-B n = 14) and 68 vancomycin-susceptible isolates. Limit of detection was calculated for each selective agar for pure cultures, stool suspensions and artificial rectal swabs. After 24-h incubation sensitivity ranged between 91.6% and 95.0%. It increased in 2 out of 5 agar after 48-h incubation. Specificity ranged between 94.1% and 100% and was highest after 24 h in 4 out of the 5 agar. Sensitivity of van-carrying phenotypically vancomycin-resistant strains was higher after 24 h (97.1–100%) and 48 h (99.1–100%) when compared to van-carrying strains that tested vancomycin-susceptible (50.0–57.1% after both incubation periods). Overall, chromID VRE, CHROMagar VRE and Brilliance VRE demonstrated the highest detection rates after 24 h. Detection rates of Chromatic VRE and VRESelect improved after 48 h. Adjustment of incubation time depending on the applied media may be advised. As detection of VVE-B was impeded with all selective agar, screening for vancomycin-resistant enterococci relying solely on selective media would not be recommended for critical clinical samples, but rather in combination with molecular methods to improve detection of these strains. Furthermore, stool samples were demonstrated to be superior to rectal swabs and should be favoured, if possible, in screening strategies.

Vancomycin-resistant enterococci (VRE) in hospital settings across European borders: a scoping review comparing the epidemiology in the Netherlands and Germany

“…Variations in diagnostic protocols, including sample collection, culturing techniques, and antimicrobial susceptibility testing, can impact VRE detection. For example, variances in media and selective agents used for VRE isolation affect sensitivity and specificity [ 108 ]. Differences in the adoption and implementation of surveillance guidelines can also affect VRE detection and reporting, particularly in screening frequency and extent for VRE colonization in specific patient populations [ 98 , 100 ].…”

Enterococci, Van Gene-Carrying Enterococci, and Vancomycin Concentrations in the Influent of a Wastewater Treatment Plant in Southeast Germany

“…Colony-forming units (cfus) were enumerated after an incubation time of 48 h at 37 • C. For characterization, three randomly selected colonies per sampling date were picked, dispersed in cryo vials (Microbank, Prolab, Richmond Hill, ON, Canada), and stored at −80 • C. To compare the total number of enterococci with the number of VREs in the same sample, pre-diluted wastewater was spread on VRESelect agar (Bio-Rad, Hercules, CA, USA) in duplicate and in parallel to processing of the SBA. After 48 h at 37 • C [19], grown blue (E. faecalis) and purple (E. faecium) colonies were picked and treated as described. To compare the quantitative growth of the enterococci on both agars, different van gene-carrying isolates were diluted in sterilefiltered wastewater and spread in duplicate on the SBA and VRESelect agars, and the colonies were counted.…”