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04 July 2011

Faster Screening of CRE, Including NDM-1

NEW Brilliance CRE Agar detects carbapenem-resistant Enterobacteriaceae in only 18 hours

Oxoid Brilliance™ CRE Agar, a medium for faster and easier detection of carbapenem-resistant Enterobacteriaceae (CRE), has now been launched. It is recognized that the only way to stop the spread of infections by resistant bacteria, such as CRE, is to rapidly identify and isolate any hospital patients who are infected with the resistant strain¹. Laboratories can use Brilliance CRE Agar to screen patient samples for CRE and provide clinicians with results in just 18-24 hours. This faster time to result accelerates the start of infection control measures, including accurate antibiotic prescription, for better patient outcomes.

Brilliance CRE Agar is easier to use and read than the Hodge test traditionally used to detect resistance to carbapenems. Brilliance CRE Agar contains a modified carbapenem, at levels recommended by both the CLSI and EUCAST, ensuring reliable detection of numerous CRE strains, including those with the NDM-1 mechanism of resistance². Chromogenic compounds in the medium differentiate between resistant E. coli (pink colonies) and Klebsiella, Enterobacter, Serratia or Citrobacter (KESC) organisms (blue colonies). The colonies of other resistant organisms appear white and are easy to spot against the novel pigmented agar.

For more information visit www.oxoidhai.com/cre

Brilliance CRE Agar is not FDA cleared for sale in the US.

About CRE

Carbapenem antibiotics are vital in the treatment of infections caused by otherwise multiresistant gram negative bacteria, including extended spectrum ß-lactamase (ESBL) producers.

Carbapenem resistant Enterobacteriaceae (CRE) were first reported in the UK in 2003. Only a handful of cases were reported every year until 2008, when the number of cases reported jumped to 22. Since then, there has been a dramatic increase in CRE isolates in the UK, with 333 reported in 2010 and already 217 in the first half of 2011³. Some of these isolates caused severe infections, including fatal septicaemia². Elsewhere in Europe, large nationwide outbreaks with carbapenemase-producing Klebsiella pneumoniae have occurred in Israel and Greece, and problems of variable scale are unfolding in other countries⁴.

In the United States, infection with CRE is emerging as an important challenge in health-care settings. Here, carbapenem-resistant Klebsiella pneumoniae (CRKP) is the species of CRE most commonly encountered⁵.

Of particular concern to the medical profession, the genes conferring resistance to carbapenems in this group of organisms are located on horizontally transmissible plasmids, allowing resistance to spread between strains, species and even genera³. The rapid emergence of CRE is worrying since only one antibiotic remains active against the majority of isolates, namely colistin. However, a few colistin resistant CRE isolates have already been reported³.

References

1. BBC News, 11 August 2010. New Superbug found in UK hospitals. http://www.bbc.co.uk/news/health-10925411
2. Kumarasamy KK, Toleman MA, Walsh TR (2010) Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. The Lancet Infectious Diseases 10(9): 597 – 602
3. HPA (2011) Carbapenemase-producing Enterobacteriaceae in the UK, 2003-2011. Health Protection Report, Volume 5 No 24; 1 June 2011. http://www.hpa.org.uk/hpr/archives/2011/news2411.htm#crbpnmses
4. Grundmann H, Livermore DM, Giske CG et al - the CNSE Working Group (2010) Carbapenem-non-susceptible Enterobacteriaceae in Europe: conclusions from a meeting of national experts. Euro Surveill. 15(46):pii=19711. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19711
5. CDC (2009) Guidance for Control of Infections with Carbapenem-Resistant or Carbapenemase-Producing Enterobacteriaceae in Acute Care Facilities. MMWR Weekly 58(10):256-260.
6. ARHAI-HPA (2011). Advice on carbapenemase producers: recognition, infection control and treatment. http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1294740725984