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Journal of Clinical Microbiology, May 2007, p. 1556-1560, Vol. 45, No. 5
0095-1137/07/$08.00+0     doi:10.1128/JCM.02116-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Evaluation of a Novel Chromogenic Agar Medium for Isolation and Differentiation of Vancomycin-Resistant Enterococcus faecium and Enterococcus faecalis Isolates{triangledown}

Nathan A. Ledeboer,1 Kingshuk Das,1 Michael Eveland,2 Céline Roger-Dalbert,3 Sandrine Mailler,3 Sonia Chatellier,3 and William Michael Dunne1*

Department of Pathology and Immunology, Washington University School of Medicine,1 Barnes-Jewish Hospital, St. Louis, Missouri,2 Microbiology Research and Development, bioMérieux, La-Balme-les-Grottes, France3

Received 15 October 2006/ Returned for modification 20 December 2006/ Accepted 15 February 2007

The development of reliable and rapid methods for the identification of patients colonized with vancomycin-resistant enterococci (VRE) is central to the containment of this agent within a hospital environment. To this end, we evaluated a prototype chromogenic agar medium (VRE-BMX; bioMérieux, Marcy l'Etoile, France) used to recover VRE from clinical specimens. This medium can also identify isolated colonies as either vancomycin-resistant Enterococcus faecium or Enterococcus faecalis, based on distinct colony colors. We compared the performance of VRE-BMX with bile esculin azide agar supplemented with vancomycin (BEAV). For this study, 147 stool samples were plated on each test medium and examined after 24 and 48 h of incubation. At 24 h, the sensitivity and specificity of each medium were as follows: BEAV, 90.9% and 89.9%, respectively; VRE-BMX, 96.4% and 96.6%, respectively. The positive predictive values (PPV) of VRE-BMX and BEAV at 24 h were 89.8% and 80.7%, respectively. VRE-BMX provided the identification of 10 isolates of vancomycin-resistant E. faecalis and 4 isolates of vancomycin-resistant E. faecium that were not recovered by BEAV. Further, VRE-BMX was capable of identifying patients colonized with both E. faecium and E. faecalis, a feature useful for infection control purposes that is not a function of BEAV. In terms of the recovery of vancomycin-resistant E. faecium and E. faecalis, the sensitivity and PPV were as follows: BEAV, 75.7% and 74.6%, respectively; VRE-BMX, 95.5% and 91.3%, respectively. In this initial evaluation, we found that VRE-BMX provided improved recovery of VRE from stool specimens, with the added advantage of being able to differentiate between vancomycin-resistant E. faecalis and E. faecium. Extending the incubation period beyond 24 h did not significantly improve the recovery of VRE and resulted in decreased specificity.

* Corresponding author. Mailing address: Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University School of Medicine, Campus Box 8118, 660 South Euclid, St. Louis, MO 63110. Phone: (314) 362-1547. Fax: (314) 362-1461. E-mail: dunne{at}wustl.edu

{triangledown} Published ahead of print on 28 February 2007.

Journal of Clinical Microbiology, May 2007, p. 1556-1560, Vol. 45, No. 5
0095-1137/07/$08.00+0     doi:10.1128/JCM.02116-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.



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