Test Characteristics of Perirectal and Rectal Swab Compared to Stool Sample for Detection of Fluoroquinolone-Resistant
            <i>Escherichia coli</i>
            in the Gastrointestinal Tract

Lautenbach, Ebbing; Harris, Anthony D.; Perencevich, Eli N.; Nachamkin, Irving; Tolomeo, Pam; Metlay, Joshua P.

doi:10.1128/aac.49.2.798-800.2005

Cited by 71 publications

(61 citation statements)

References 12 publications

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“…Because perirectal swabs are less invasive and may be more acceptable to patients, our data provide support for the use of perirectal swabs as the preferred method for the detection of carriers. Our findings are consistent with previous studies demonstrating that perirectal swabs are equivalent to rectal swabs for the detection of rectal carriers of vancomycin-resistant enterococci and fluoroquinolone-resistant Escherichia coli (6,7).…”

supporting

confidence: 83%

Comparison of Perirectal versus Rectal Swabs for Detection of Asymptomatic Carriers of Toxigenic Clostridium difficile

et al. 2013

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bFor long-term care and spinal cord injury patients, the sensitivity, specificity, and positive and negative predictive values of perirectal versus rectal cultures for detection of asymptomatic carriers of Clostridium difficile were 95%, 100%, 100%, and 97%, respectively. Perirectal cultures provide an accurate method to detect asymptomatic carriers of C. difficile. Clostridium difficile is the most important cause of health careassociated infectious diarrhea. Asymptomatic carriage of toxigenic C. difficile is also common in hospitals and long-term-care facilities (LTCF) (1-4). Although the presence of patients with C. difficile infection (CDI) is considered the major risk for transmission, asymptomatic carriers also have the potential to shed spores and contribute to transmission (1, 2, 4). Rectal or perirectal swab cultures are commonly used for the detection of carriers of health care-associated pathogens. Because rectal swabs may cause discomfort for patients and are contraindicated in the setting of neutropenia to avoid the risk of infection with skin and mucosal breakdown (5), perirectal swabs may be preferred. Perirectal swabs have been shown to be equivalent to rectal swab specimens for the detection of other health care-associated pathogens (6, 7), but no previous studies have compared the two methods for the detection of carriers of C. difficile. We have previously shown that perirectal swabs provide excellent sensitivity in comparison to stool samples for the detection of patients with CDI (8); however, CDI patients typically have much higher levels of C. difficile in stool than asymptomatic carriers (1,8). Here, we tested the hypothesis that the collection of perirectal swab cultures would provide an accurate but less invasive diagnostic strategy for the detection of asymptomatic carriers of toxigenic C. difficile.The study was conducted at the Cleveland VA Medical Center. All residents on two LTCF wards and on a spinal cord injury unit who were available and without abdominal pain or unformed stool were approached for enrollment; these groups were chosen for study because we have previously demonstrated relatively frequent asymptomatic carriage of C. difficile in these patient populations (1, 9). Subjects with unformed stool or abdominal pain were excluded from participation. Using BD BBL CultureSwabs (Becton, Dickinson, Cockeysville, MD), cultures were first obtained from the perirectal area. A second swab was then used to collect rectal cultures through insertion into the rectum. The perirectal swab was collected first to avoid the potential for contamination of the perirectal area during collection of the rectal swab. It was noted whether the swabs had evidence of fecal staining, but all swabs were processed. The swabs were transferred to a Whitley MG1000 anaerobic workstation (Microbiology International, Frederick, MD) and cultured for C. difficile on prereduced cycloserine-cefoxitin-brucella agar containing 0.1% taurocholic acid and lysozyme at 5 mg/ml (CDBA) as previously described (10). The n...

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confidence: 83%

Comparison of Perirectal versus Rectal Swabs for Detection of Asymptomatic Carriers of Toxigenic Clostridium difficile

et al. 2013

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“…The intestine/rectal flora is a likely source of the resistant organisms being introduced into the bloodstream at the time of the biopsy and is the logical site to isolate bacteria which may be a future offending organism. In this study, we used rectal swabs, since they have been shown by others to have comparable sensitivity and specificity to the gold standard, fecal specimens, for the detection of fluoroquinolone-resistant E. coli from the intestine (8). Many groups have monitored the prevalence of fluoroquinoloneresistant organisms by using rectal or fecal specimens (2,7,14).…”

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confidence: 99%

Detection of Fluoroquinolone-Resistant Organisms from Rectal Swabs by Use of Selective Media Prior to a Transrectal Prostate Biopsy

2011

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“…For this reason faecal samples may perform better than rectal swabs 9 , although the latter is more practical. Using more than one screening specimen or specimen type may increase sensitivity 6 , but again for practical purposes one specimen is usual.…”

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confidence: 99%

Active screening for multiresistant Enterobacteriaceae

Ingram

Iredell

2014

Microbiol. Aust.

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The control of multiresistant organisms (MROs) is made difficult by a large reservoir of unrecognised, asymptomatic colonised patients. Hence, active screening is generally used as part of a multifaceted infection control intervention. For MRGNB the ratio of colonised to infected patients has been estimated at~8:1 for extended spectrum beta-lactamases 2 and 9:1 for carbapenem-resistant Enterobacteriaceae (CRE) 3 . In addition to this, the very mechanism by which antibiotic resistance is transferred between common species like Escherichia coli and Klebsiella pneumoniae is such that resistance acquisition can be highly variable in phenotype and often relatively 'silent' 4 . Antibiotic susceptible organisms can acquire resistance mechanisms very quickly 5 , so that the potential for acquisition by gene transfer is itself an important risk to understand.The most appropriate specimen type for screening of MRGNBs depends on the organism's likely habitat on the human body or clinical environment. Thus, the most sensitive specimens for detecting Enterobacteriaceae may be rectal swab, peri-rectal swab or faeces, but wounds and respiratory samples and even environmental sampling (sinks, drains, surfaces) may be more important for the control of outbreaks due to organisms such as Pseudomonas or Acinetobacter 6 .Increased specimen volume and a higher MRO faecal density both increase yield of screening 7,8 . For this reason faecal samples may perform better than rectal swabs 9 , although the latter is more practical. Using more than one screening specimen or specimen type may increase sensitivity 6 , but again for practical purposes one specimen is usual. Concurrent antibiotic use has a variable impact on MRO faecal density 10 but logic dictates that detection of a reservoir of resistance is more likely in the presence of relevant selection pressure.Active screening specimens may be processed in the laboratory using phenotypic (culture based) or direct genotypic (amplification and detection of bacterial DNA) methods. There is no consensus as to the optimal laboratory processing method but factors that should be considered are local molecular epidemiology (including the likely minimum inhibitory concentration (MIC) of relevant antibiotics against target isolates), availability of expertise and equipment, cost, capacity for integration into laboratory workflow and test performance including sensitivity, specificity, limit of detection and turnaround time. Currently, phenotypic methods are more widely used, although we anticipate that with advances in automation, dataIn Focus

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Test Characteristics of Perirectal and Rectal Swab Compared to Stool Sample for Detection of Fluoroquinolone-Resistant Escherichia coli in the Gastrointestinal Tract

Cited by 71 publications

References 12 publications

Comparison of Perirectal versus Rectal Swabs for Detection of Asymptomatic Carriers of Toxigenic Clostridium difficile

Comparison of Perirectal versus Rectal Swabs for Detection of Asymptomatic Carriers of Toxigenic Clostridium difficile

Detection of Fluoroquinolone-Resistant Organisms from Rectal Swabs by Use of Selective Media Prior to a Transrectal Prostate Biopsy

Active screening for multiresistant Enterobacteriaceae

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