Universität zu Köln

Klare, Ingo, Bender, Jennifer K., Fleige, Carola, Kriebel, Nancy, Hamprecht, Axel ORCID: 0000-0003-1449-5780, Gatermann, Soeren and Werner, Guido (2019). Comparison of VITEK (R) 2, three different gradient strip tests and broth microdilution for detecting vanB-positive Enterococcus faecium isolates with low vancomycin MICs. J. Antimicrob. Chemother., 74 (10). S. 2926 - 2930. OXFORD: OXFORD UNIV PRESS. ISSN 1460-2091

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Abstract

Objectives In 2018, EUCAST issued a warning regarding unreliable results of gradient strip tests for confirming vancomycin resistance in enterococci. We compared the performance of various diagnostic standard and confirmatory tests to identify and determine vanB-type vancomycin resistance. Methods We analysed a collection of vanB-positive Enterococcus faecium isolates (n=68) with low vancomycin MICs and compared the performance of VITEK (R) 2 (bioMerieux), broth microdilution and three gradient strip tests from different providers (Oxoid, Liofilchem and bioMerieux). For the latter we compared the standard procedure with a protocol with increased inoculum, a rich agar medium and a longer incubation time ('macromethod'). Results The sensitivity of VITEK (R) 2 was 81% compared with 72% for broth microdilution and 61%-63% for the three gradient strip tests using standard conditions. The macromethod substantially improved the performance of all strip tests resulting in a sensitivity of 89%-96% after 48h of incubation. Conclusions We recommend that EUCAST changes the present warning against the general use of MIC strips. When MIC strips are used to either exclude or confirm suspected vancomycin resistance in E. faecium, and a PCR is not available, the macromethod should be employed. For clinically relevant enterococci, where a rapid therapeutic decision is needed, a molecular test (e.g. PCR) should be favoured in order to save time and to further increase sensitivity.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Klare, Ingo UNSPECIFIED UNSPECIFIED UNSPECIFIED Bender, Jennifer K. UNSPECIFIED UNSPECIFIED UNSPECIFIED Fleige, Carola UNSPECIFIED UNSPECIFIED UNSPECIFIED Kriebel, Nancy UNSPECIFIED UNSPECIFIED UNSPECIFIED Hamprecht, Axel UNSPECIFIED orcid.org/0000-0003-1449-5780 UNSPECIFIED Gatermann, Soeren UNSPECIFIED UNSPECIFIED UNSPECIFIED Werner, Guido UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-132346
DOI:	10.1093/jac/dkz310
Journal or Publication Title:	J. Antimicrob. Chemother.
Volume:	74
Number:	10
Page Range:	S. 2926 - 2930
Date:	2019
Publisher:	OXFORD UNIV PRESS
Place of Publication:	OXFORD
ISSN:	1460-2091
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language RESISTANT ENTEROCOCCI; SUSCEPTIBILITY Multiple languages Infectious Diseases; Microbiology; Pharmacology & Pharmacy Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/13234