Screening for vancomycin-resistant enterococci with Xpert® vanA/vanB: diagnostic accuracy and impact on infection control decision making
Vancomycin-resistant enterococci (VRE) are increasingly important nosocomial pathogens and screening for colonization status is a mainstay in infection control. We implemented PCR-based screening during vanA-positive Enterococcus faecium outbreaks in four university hospitals in Copenhagen, Denmark....
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2017-03-01
|
| Series: | New Microbes and New Infections |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2052297516301573 |
| _version_ | 1819052495814524928 |
|---|---|
| author | B.J. Holzknecht D.S. Hansen L. Nielsen A. Kailow J.O. Jarløv |
| author_facet | B.J. Holzknecht D.S. Hansen L. Nielsen A. Kailow J.O. Jarløv |
| author_sort | B.J. Holzknecht |
| collection | DOAJ |
| description | Vancomycin-resistant enterococci (VRE) are increasingly important nosocomial pathogens and screening for colonization status is a mainstay in infection control. We implemented PCR-based screening during vanA-positive Enterococcus faecium outbreaks in four university hospitals in Copenhagen, Denmark. Xpert® vanA/vanB was performed directly on rectal swabs and the vanA PCR result was used to guide infection control measures. Concurrently, all samples were selectively cultured including an overnight enrichment step. Diagnostic accuracy was calculated as well as turnaround time and the impact of the earlier available PCR results on infection control decision making. In all, 1110 samples were analysed. The vanA PCR positivity rate was 13.8% and culture positivity rate was 15.2%. The diagnostic accuracy of the vanA part of the assay was high with a sensitivity of 87.1%, a specificity of 99.7%, and positive and negative predictive values of 98.0% and 97.7%, respectively. The vanB PCR had a considerably lower specificity of 77.6% and a positive predictive value of 0.4%. In 1067 (96.1%) samples, PCR results were reported within 1 day, whereas median culture turnaround time was 3 days. The saving of time to available results corresponded to 141 saved isolation days and 292 saved transmission risk days. False-negative or false-positive PCR results led to six additional transmission risk days and 13 additional isolation days, respectively.
The vanA PCR had high diagnostic accuracy and the prompt availability of results gave a considerable benefit for infection control decision making. |
| first_indexed | 2024-12-21T12:20:45Z |
| format | Article |
| id | doaj.art-b414cea2a83c460fbafc6b1366b06abb |
| institution | Directory Open Access Journal |
| issn | 2052-2975 |
| language | English |
| last_indexed | 2024-12-21T12:20:45Z |
| publishDate | 2017-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | New Microbes and New Infections |
| spelling | doaj.art-b414cea2a83c460fbafc6b1366b06abb2022-12-21T19:04:20ZengElsevierNew Microbes and New Infections2052-29752017-03-0116C545910.1016/j.nmni.2016.12.020Screening for vancomycin-resistant enterococci with Xpert® vanA/vanB: diagnostic accuracy and impact on infection control decision makingB.J. HolzknechtD.S. HansenL. NielsenA. KailowJ.O. JarløvVancomycin-resistant enterococci (VRE) are increasingly important nosocomial pathogens and screening for colonization status is a mainstay in infection control. We implemented PCR-based screening during vanA-positive Enterococcus faecium outbreaks in four university hospitals in Copenhagen, Denmark. Xpert® vanA/vanB was performed directly on rectal swabs and the vanA PCR result was used to guide infection control measures. Concurrently, all samples were selectively cultured including an overnight enrichment step. Diagnostic accuracy was calculated as well as turnaround time and the impact of the earlier available PCR results on infection control decision making. In all, 1110 samples were analysed. The vanA PCR positivity rate was 13.8% and culture positivity rate was 15.2%. The diagnostic accuracy of the vanA part of the assay was high with a sensitivity of 87.1%, a specificity of 99.7%, and positive and negative predictive values of 98.0% and 97.7%, respectively. The vanB PCR had a considerably lower specificity of 77.6% and a positive predictive value of 0.4%. In 1067 (96.1%) samples, PCR results were reported within 1 day, whereas median culture turnaround time was 3 days. The saving of time to available results corresponded to 141 saved isolation days and 292 saved transmission risk days. False-negative or false-positive PCR results led to six additional transmission risk days and 13 additional isolation days, respectively. The vanA PCR had high diagnostic accuracy and the prompt availability of results gave a considerable benefit for infection control decision making.http://www.sciencedirect.com/science/article/pii/S2052297516301573Infection controlmolecular screeningPCR-based screeningselective culturevanAvancomycin-resistant enterococci |
| spellingShingle | B.J. Holzknecht D.S. Hansen L. Nielsen A. Kailow J.O. Jarløv Screening for vancomycin-resistant enterococci with Xpert® vanA/vanB: diagnostic accuracy and impact on infection control decision making New Microbes and New Infections Infection control molecular screening PCR-based screening selective culture vanA vancomycin-resistant enterococci |
| title | Screening for vancomycin-resistant enterococci with Xpert® vanA/vanB: diagnostic accuracy and impact on infection control decision making |
| title_full | Screening for vancomycin-resistant enterococci with Xpert® vanA/vanB: diagnostic accuracy and impact on infection control decision making |
| title_fullStr | Screening for vancomycin-resistant enterococci with Xpert® vanA/vanB: diagnostic accuracy and impact on infection control decision making |
| title_full_unstemmed | Screening for vancomycin-resistant enterococci with Xpert® vanA/vanB: diagnostic accuracy and impact on infection control decision making |
| title_short | Screening for vancomycin-resistant enterococci with Xpert® vanA/vanB: diagnostic accuracy and impact on infection control decision making |
| title_sort | screening for vancomycin resistant enterococci with xpert r vana vanb diagnostic accuracy and impact on infection control decision making |
| topic | Infection control molecular screening PCR-based screening selective culture vanA vancomycin-resistant enterococci |
| url | http://www.sciencedirect.com/science/article/pii/S2052297516301573 |
| work_keys_str_mv | AT bjholzknecht screeningforvancomycinresistantenterococciwithxpertvanavanbdiagnosticaccuracyandimpactoninfectioncontroldecisionmaking AT dshansen screeningforvancomycinresistantenterococciwithxpertvanavanbdiagnosticaccuracyandimpactoninfectioncontroldecisionmaking AT lnielsen screeningforvancomycinresistantenterococciwithxpertvanavanbdiagnosticaccuracyandimpactoninfectioncontroldecisionmaking AT akailow screeningforvancomycinresistantenterococciwithxpertvanavanbdiagnosticaccuracyandimpactoninfectioncontroldecisionmaking AT jojarløv screeningforvancomycinresistantenterococciwithxpertvanavanbdiagnosticaccuracyandimpactoninfectioncontroldecisionmaking |