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Performance of two methods of carbapenem-resistant Enterobacterales surveillance on a kidney transplant ward: selective culture of and real-time PCR directly from rectal swabs

Abstract

Background

Infection with carbapenem-resistant Enterobacterales (CRE) is associated with a high mortality rate in kidney transplant recipients, and colonization with CRE is one of the major risk factors for CRE infection. There is, therefore, a need to improve the capacity to detect colonization with CRE among inpatients.

Methods

In this prospective study, we compared the performance of real-time PCR for carbapenemase directly from rectal swabs with that of conventional CRE surveillance culture in all patients admitted to a kidney transplant ward between February 2019 and March 2020. Surveillance culture and real-time PCR were performed at admission and weekly until hospital discharge. Two perineum-rectal swabs were collected: one for culture and one for PCR.

Results

We collected 905 paired samples for CRE surveillance from 399 patients, of whom 347 (87.0%) were kidney transplant recipients and 52 were waiting list patients. CRE was detected by culture and/or PCR in 75 patients (18.8%). Positivity for CRE was identified by PCR in 62 (15.5%) of the 399 patients and by culture in 55 (13.8%); 20 (5.0%) of the patients tested positive only on PCR, and 13 (3.3%) tested positive only on culture. The most common carbapenemase and species were, respectively, blaKPC (in 85.5%) and Klebsiella pneumoniae (in 80.0%). Infection with CRE occurred in 21.6% of the colonized patients, those cases occurred only among kidney transplant recipients. None of the patients who tested negative on culture developed CRE infection.

Conclusion

In conclusion, the two methods are complementary and could be useful in a scenario of high CRE prevalence.

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Acknowledgements

This work was supported by the Brazilian Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq, National Council for Scientific and Technological Development; Grant no. 402470/2018-4 from Call for Projects no. 01/2018—Line 2—Development and innovation in new diagnostic methods to control and combat antimicrobial resistance). The funder had no role in study design, data collection and interpretation, or the decision to submit the work for publication.

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Correspondence to Maristela P. Freire.

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The authors declare that they have no competing interests. The authors have approved the final article.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the University of São Paulo Human Research Ethics Committee (Reference no. 82685818.0.0000.0068) and Adolfo Lutz Institute (CTC 70-L/2019). The requirement for informed consent was waived.

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Freire, M.P., de Oliveira Garcia, D., Lima, S.G. et al. Performance of two methods of carbapenem-resistant Enterobacterales surveillance on a kidney transplant ward: selective culture of and real-time PCR directly from rectal swabs. Infection (2022). https://doi.org/10.1007/s15010-022-01839-2

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  • DOI: https://doi.org/10.1007/s15010-022-01839-2

Keywords

  • Kidney transplant
  • Carbapenem resistance
  • Surveillance
  • Carbapenemase
  • Risk factors
  • Real time PCR