BACKGROUND Detection of faecal carriers of carbapenemase-producing Enterobacteriaceae (CPE) and vancomycin-resistant Enterococci (VRE) has become a routine medical practice in many countries. In an outbreak setting, several public health organizations recommend three-weekly rectal screenings to rule-out acquisition in contact patients. This strategy, associated with bed closures and reduction of medical activity for a relatively long time, seems costly. AIM The objective of this study was to test the positive and negative predictive values of reverse transcription polymerase chain reaction (RT-PCR; GeneXpert®) carried-out at Day 0, compared with conventional three-weekly culture-based rectal screenings, in identifying, among contact patients, those who acquired CPE/VRE. METHODS A multicentre retrospective study was conducted from January2015 to October2018. All contact patients (CPs) were included identified from index patients (IPs) colonized or infected with CPE/VRE, incidentally discovered. Each CP was investigated at Day 0 by PCR (GeneXpert®), and by the recommended three-weekly screenings. FINDINGS Twenty-two IPs and 159 CPs were included. An average of 0.77 secondary cases per patient was noted, with a mean duration of contact of 10 days (range 1-64). Among the 159 CPs, 16 (10%) had a CPE/VRE-positive culture during the monitoring period. Rectal screenings were positive at Day 0 (10 patients), Day 7 (two patients), Day 14 (four patients). Thirteen of 16 patients with positive culture had a positive PCR at Day 0. Overall, a concordance of 97.5% (155/159) was observed between the three-weekly screenings and Day 0 PCR results. When performed on CPs at Day 0 of the identification of an IP, PCR (GeneXpert®) allowed the reduction in turnaround time by five to 27 days, compared to three-weekly screenings. Positive predictive value and negative predictive value were 100% and 98%, respectively. CONCLUSIONS The use of RT-PCR (GeneXpert®) can avoid the three-weekly rectal samplings needed to rule-out acquisition of CPE/VRE.

中文翻译：

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如果偶然发现产生碳青霉烯酶的肠杆菌科细菌和耐万古霉素的肠球菌携带者，实时聚合酶链反应能否使医院的活动恢复更快？

背景技术在许多国家，检测产生碳青霉烯酶的肠杆菌科（CPE）和耐万古霉素的肠球菌（VRE）的粪便载体已成为常规医学实践。在暴发流行的情况下，一些公共卫生组织建议每三个星期进行一次直肠检查，以排除接触患者的排异。这种与关闭床并在相当长的时间内减少医疗活动有关的策略似乎很昂贵。目的本研究的目的是测试第0天进行的逆转录聚合酶链反应（RT-PCR;GeneXpert®）的阳性和阴性预测值，与传统的每周三次基于培养物的直肠筛查相比，以鉴定在接触患者中，那些获得了CPE / VRE的患者。方法从2015年1月至2018年10月进行了多中心回顾性研究。所有接触患者（CP）均从偶然发现的CPE / VRE定植或感染的索引患者（IP）中进行鉴定。在第0天，通过PCR（GeneXpert®）和建议的三周筛选对每个CP进行了研究。结果包括22个IP和159个CP。记录到每名患者平均有0.77例继发病例，平均接触时间为10天（范围1-64）。在159个CP中，有16个（10％）在监测期间具有CPE / VRE阳性培养。直肠筛查在第0天（10例患者），第7天（2例患者），第14天（4例患者）为阳性。16例培养阳性的患者中有13例在第0天的PCR阳性。总体而言，一致性为97。在三周一次的筛选和第0天PCR结果之间观察到5％（155/159）。当在IP鉴定的第0天对CP进行检测时，PCR（GeneXpert®）使得周转时间减少了5到27天，而每周进行的筛查为3周。阳性预测值和阴性预测值分别为100％和98％。结论使用RT-PCR（GeneXpert®）可以避免排除CPE / VRE采集所需的三周直肠采样。