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Journal of Clinical Microbiology, June 2004, p. 2636-2643, Vol. 42, No. 6
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.6.2636-2643.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Comparison of the Roche LightCycler vanA/vanB Detection Assay and Culture for Detection of Vancomycin-Resistant Enterococci from Perianal Swabs

L. M. Sloan,1 J. R. Uhl,1 E. A. Vetter,1 C. D. Schleck,2 W. S. Harmsen,2 J. Manahan,3 R. L. Thompson,3 J. E. Rosenblatt,1,3 and F. R. Cockerill III1,3*

Divisions of Clinical Microbiology,1 Infectious Diseases,3 Department of Health Sciences Research, Mayo Clinic and Foundation, Rochester, Minnesota 559052

Received 8 September 2003/ Returned for modification 5 December 2003/ Accepted 17 March 2004

We compared the performance characteristics of a real-time PCR method, the LightCycler vanA/vanB detection assay (Roche Diagnostics Corporation, Indianapolis, Ind.) to that of Enterococcosel agar (BBL, Sparks, Md.) for direct detection of vancomycin-resistant enterococci (VRE) from 894 perianal stool swabs. For 421 of 894 swabs, the result for LightCycler PCR was compared to an Enterococcosel plate containing vancomycin at 6 µg/ml; for the remaining 473 swabs, the result for LightCycler PCR was compared to an Enterococcosel plate containing 8 µg/ml vancomycin. The LightCycler method produced considerably more positive results than either the Enterococcosel plate containing vancomycin at 6 µg/ml (n = 25 versus n = 11; sensitivity, 100%; specificity, 97%; positive predictive value [PPV], 42%; negative predictive value [NPV], 100%) or the Enterococcosel plate containing vancomycin at 8 µg/ml (n = 31 versus n = 10; sensitivity, 100%; specificity, 95%; PPV, 32%; NPV, 100%). When possible, additional testing, including culture, LightCycler PCR, and/or a conventional PCR method (PCR-restriction fragment length polymorphism assay), were performed on either the original specimens or original cultures or subsequent specimens for cases in which the original specimen was positive by LightCycler PCR but the Enterococcosel plate was negative. This additional testing demonstrated positive results for 7 of 14 (50%) evaluable discordant specimens which initially tested as LightCycler PCR positive but culture negative using the Enterococcosel plate containing vancomycin at 6 µg/ml and 12 of 17 (71%) evaluable discordant specimens which initially tested as LightCycler positive but culture negative using the Enterococcosel plate containing vancomycin at (8 µg/ml). These results demonstrate that the LightCycler VRE detection assay is considerably more sensitive than the standard culture method for detecting VRE directly from perianal swab specimens. The LightCycler assay also provides results much faster than culture (~3.5 versus >=72 h). The use of this test could have important implications for the effective control and prevention of nosocomial outbreaks of VRE.

* Corresponding author. Mailing address: Mayo Clinic, 200 First St., S.W., Hilton 470, Rochester, MN 55905. Phone: (507) 284-2901. Fax: (507) 284-4272. E-mail: cockerill.franklin{at}mayo.edu.

Journal of Clinical Microbiology, June 2004, p. 2636-2643, Vol. 42, No. 6
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.6.2636-2643.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.



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