Detection of carbapenem-resistant Enterobacteriaceae

Thermo Fisher Scientific has launched Oxoid Brilliance CRE Agar, a medium for faster and easier detection of carbapenem-resistant Enterobacteriaceae (CRE). 

It is recognised 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 strain.  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 resistance. 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. 

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 2011. Some of these isolates caused severe infections, including fatal septicaemia. 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 genera. 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 reported.
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