Evaluation of a New Chromogenic Medium, chromID VRE, for Detection of Vancomycin-Resistant Enterococci in Stool Samples and Rectal Swabs

Delmas, Julien; Robin, Frédéric; Schweitzer, Cédric; Lesens, Olivier; Bonnet, Richard

doi:10.1128/jcm.00448-07

Cited by 31 publications

(26 citation statements)

References 21 publications

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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).…”

supporting

confidence: 70%

“…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.…”

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confidence: 99%

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

Peltroche-Llacsahuanga

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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: 70%

mentioning

confidence: 99%

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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“…The early detection of VRE may facilitate the timely implementation of infection control measures, and surveillance by examination of fecal and rectal swab specimens has been adopted as a means of reducing outbreaks caused by VRE (16). Recently, it has been reported from Europe and the United States that the use of new chromogenic agars improves the ability to detect VRE isolates from fecal and rectal swab specimens (5,11,12). ChromID VRE agar (cIDVRE; bioMérieux, Marcyl'Etoile, France), which contains 8 mg/liter vancomycin, also has the advantage of differentiating Enterococcus faecalis and Enterococcus faecium, as it detects the ␤-glucosidase and the ␤-galactosidase produced by the two species respectively (5, 11, 12; cIDVRE product insert, reference no.…”

mentioning

confidence: 99%

Comparative Study of Selective Chromogenic (chromID VRE) and Bile Esculin Agars for Isolation and Identification of vanB -Containing Vancomycin-Resistant Enterococci from Feces and Rectal Swabs

Grabsch¹,

Ghaly-Derias²,

Gao³

et al. 2008

J Clin Microbiol

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The new chromogenic agar chromID VRE (cIDVRE; bioMérieux) was compared with bile esculin agar (BD) containing 6 mg/liter vancomycin for the detection of colonization with vanB-containing vancomycin-resistant enterococci (VRE). At 48 h of incubation, the results obtained with both media were comparable. However, cIDVRE detected significantly more VRE at 24 h (39.3% versus 21.3%, P ‫؍‬ 0.003), and its use may facilitate the timely implementation of infection control procedures.Vancomycin-resistant enterococci (VRE) are significant nosocomial pathogens, and both vanA-and vanB-containing strains of VRE may cause serious infections, including bacteremia (10, 17). In Australia, unlike the United States and Europe, vanB-containing VRE strains predominate (2, 6). The early detection of VRE may facilitate the timely implementation of infection control measures, and surveillance by examination of fecal and rectal swab specimens has been adopted as a means of reducing outbreaks caused by VRE (16). Recently, it has been reported from Europe and the United States that the use of new chromogenic agars improves the ability to detect VRE isolates from fecal and rectal swab specimens (5,11,12). ChromID VRE agar (cIDVRE; bioMérieux, Marcyl'Etoile, France), which contains 8 mg/liter vancomycin, also has the advantage of differentiating Enterococcus faecalis and Enterococcus faecium, as it detects the ␤-glucosidase and the ␤-galactosidase produced by the two species respectively (5, 11, 12; cIDVRE product insert, reference no. 43 002, 2007; bioMérieux). vanA-containing VRE typically have vancomycin MICs of Ն64 mg/liter (4, 15) and would be expected to grow well in the presence of 8 mg/liter vancomycin. However, vanBcontaining VRE strains, which may exhibit much lower vancomycin MICs, including MICs of Յ4 mg/liter (4, 8), may not be as readily isolated on cIDVRE as they are on bile esculin agar (Enterococcosel; BD, Sparks, MD) containing 6 mg/liter vancomycin (EVA). At Austin Health, where vanB-containing VRE predominate, we compared cIDVRE for the detection of vancomycin-resistant strains of E. faecalis and E. faecium with EVA for the isolation of VRE from fecal and rectal swab specimens.Feces and rectal swabs were inoculated directly onto both cIDVRE and EVA. The media were inoculated with separate cotton-tipped swab sticks for fecal specimens. As only one rectal swab specimen was collected from each patient, rectal swabs with laboratory accession numbers that were an odd number were inoculated onto cIDVRE first and then onto EVA. Inoculation of the media was in the reverse order for even-numbered specimens. The cultures were incubated at 35°C in ambient air and were examined daily, with cIDVRE incubated for 48 h, according to the manufacturer's recommendations (cIDVRE product insert; bioMérieux), and EVA plates were incubated for 72 h, as reported previously (13). Strains producing ␤-galactosidase (violet color) and ␤-glucosidase (blue-green color) on cIDVRE and esculin-positive isolates (black color) on EVA were considered possi...

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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.…”

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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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Evaluation of a New Chromogenic Medium, chromID VRE, for Detection of Vancomycin-Resistant Enterococci in Stool Samples and Rectal Swabs

Cited by 31 publications

References 21 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

Comparative Study of Selective Chromogenic (chromID VRE) and Bile Esculin Agars for Isolation and Identification of vanB -Containing Vancomycin-Resistant Enterococci from Feces and Rectal Swabs

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

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