Letter to the Editor
Ann Lab Med 2022; 42(3): 367-369
Published online May 1, 2022 https://doi.org/10.3343/alm.2022.42.3.367
Copyright © Korean Society for Laboratory Medicine.
Active Surveillance for Carbapenem-resistant Enterobacteriaceae at a Single Center for Four Years
Department of Laboratory Medicine, Hanyang University College of Medicine, Seoul, Korea
Correspondence to: Yangsoon Lee, M.D., Ph.D.
Department of Laboratory Medicine, Hanyang University Seoul Hospital, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea
Tel: +82-2-2290-8973, Fax: +82-2-2290-9193
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
The main resistance mechanism of carbapenem-resistant
We retrospectively analyzed active surveillance data for CRE at Hanyang University Seoul Hospital, Seoul, Korea, from July 2017 to December 2020. The candidates for CRE surveillance were patients who were transferred from long-term care facilities in the previous three months, those admitted to the intensive care unit, and those who had positive results for CRE isolates in the previous six months. Stool or rectal swab samples were inoculated onto chromID CARBA medium (bioMérieux, Marcy l’Etoile, France) and incubated at 35°C for 24 hours. Bacterial species were identified using matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) with a MALDI Biotyper (Bruker Daltonics, Bremen, Germany). Antimicrobial susceptibility testing was performed using the MicroScan WalkAway system (Beckman Coulter, Brea, CA, USA). Screening for carbapenemase-producing organisms was carried out according to the Clinical Laboratory Standards Institute guidelines using the modified Hodge test (MHT) during 2017–2018 and the modified carbapenem inactivation method (mCIM) during 2019–2020 . The carbapenemase inhibition test (CIT) using phenylboronic acid and EDTA was performed in conjunction with the MHT or mCIM . Carbapenemase genes were detected using the Xpert Carba-R assay (Cepheid, Sunnyvale, CA, USA). The study was approved by the Hanyang University Hospital Institute Review Board, Seoul, Korea (IRB number 202105037).
During the four years of the study period, 10,174 surveillance tests were conducted. Among the patients tested, 229 (2.3%) were new cases that carried CRE and 182 (1.8%) were positive for CPE. The CRE trends were analyzed quarterly from 2017 to 2020. Trends in the number of CRE screening tests that identified CRE or CPE cases are shown in Fig. 1. The average number of CRE screening tests per three months was 727 (range: 580–893), including an average of 16 CRE (range: 9–30) and 10 CPE cases (range: 3–19). The CRE-positive rate was 2.3% (range: 1.1%–4.3%). Interestingly, the positive rates were highest in the third quarters of 2018 and 2020. Among the 229 total CRE isolates,
Figure 1. Quarterly trends in the number of carbapenem-resistant
Enterobacteriaceae(CRE) screening tests administered and the rates of positive CRE and carbapenemase-producing Enterobacteriaceae(CPE) cases from July 2017 to December 2020.
Carbapenemase screening using MHT or mCIM was performed on 229 CRE isolates (Table 1), of which, 147 isolates (64.2%) were positive and 82 (35.8%) were negative. The CIT results revealed that 151 isolates (65.9%) were positive. Carbapenemase-specific PCR was carried out for 178 CRE isolates, with carbapenemase genes being detected in 75.8% (135/178) of the isolates. Among the 135 isolates, 93 harbored
This study investigated the trends for CRE and CPE cases at a single hospital for the past four years. Our results were similar to the 1.4% rate reported in another study conducted in 2017 . CRE cases in this study may have exhibited seasonal and temperature variations, consistent with those shown in the study by Kim,
In conclusion, the prevalence of CRE and CPE at the study hospital were 2.3% and 1.8%, respectively. The
Lee Y designed the study; Choi I collected the data; and Lee Y and Choi I wrote, edited, and reviewed the manuscript. All authors revised and accepted the final version of the manuscript.
CONFLICTS OF INTEREST
No potential conflicts of interest relevant to this article were reported.
This work was supported by a National Research Foundation of Korea (NRF) grant (2019R1F1A1061400) funded by the Korean government through the Ministry of Science and ICT (MSIT).
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