Veronika L Tchesnokova1, Linda L Ottley2, Kyoko Sakamoto3, Joshua Fierer4, Evgeni Sokurenko5, Michael A Liss6. 1. Department of Medicine, VA Healthcare System Minneapolis, Minneapolis, MN. 2. Departments of Medicine and Urology, VA Healthcare System San Diego, San Diego, CA. 3. Departments of Medicine and Urology, VA Healthcare System San Diego, San Diego, CA; Department of Urology, University of California, San Diego School of Medicine, La Jolla, CA. 4. Departments of Medicine and Urology, VA Healthcare System San Diego, San Diego, CA; Department of Medicine, University of California, San Diego School of Medicine, La Jolla, CA; Department of Pathology, University of California, San Diego School of Medicine, La Jolla, CA. 5. Department of Urology, University of California, San Diego School of Medicine, La Jolla, CA; Department of Microbiology, University of Washington, Seattle, WA. 6. Department of Urology, University of Texas Health Science Center San Antonio, San Antonio, TX. Electronic address: mliss008@gmail.com.
Abstract
OBJECTIVE: To develop and evaluate a rapid multiplex-quantitative polymerase chain reaction (qPCR) to identify fecal carriers of multidrug-resistant extraintestinal pathogenic Escherichia coli (MDR-ExPEC) clonal groups. METHODS: Men presenting for transrectal prostate biopsy (TPB) at the San Diego Veterans Affairs Medical Center underwent rectal culture immediately before TPB. Rectal swabs were streaked onto ciprofloxacin-supplemented (4 mg/L) MacConkey agar plates, identified, and susceptibility tested. The same swab was sent to the University of Washington for qPCR test (EST200) targeting 2 major MDR-ExPEC clonal groups--ST131 and ST69--that combined were expected to represent majority of fluoroquinolone (FQ)- and trimethoprim-sulfamethoxazole-resistant E coli. We calculate test characteristics including the area under the receiver operative curve (AUC). RESULTS: We enrolled 104 men from 11/5/2013 to 6/10/2014. FQ-resistant E coli were cultured from 19.2% (20/104) of rectal swabs, and 26% (27/104) of all swabs were positive for EST200 by PCR. The test characteristics comparing the EST200 to the culture-based detection of FQ resistance were 75%, 86%, 94%, and 56%, respectively. The AUC was 0.84 for the EST200 to detect FQ resistance before TPB. CONCLUSION: Compared to the reference standard rectal culture, EST200 was able to detect majority of FQ-resistant E coli on rectal swabs before prostate biopsy.
OBJECTIVE: To develop and evaluate a rapid multiplex-quantitative polymerase chain reaction (qPCR) to identify fecal carriers of multidrug-resistant extraintestinal pathogenic Escherichia coli (MDR-ExPEC) clonal groups. METHODS:Men presenting for transrectal prostate biopsy (TPB) at the San Diego Veterans Affairs Medical Center underwent rectal culture immediately before TPB. Rectal swabs were streaked onto ciprofloxacin-supplemented (4 mg/L) MacConkey agar plates, identified, and susceptibility tested. The same swab was sent to the University of Washington for qPCR test (EST200) targeting 2 major MDR-ExPEC clonal groups--ST131 and ST69--that combined were expected to represent majority of fluoroquinolone (FQ)- and trimethoprim-sulfamethoxazole-resistant E coli. We calculate test characteristics including the area under the receiver operative curve (AUC). RESULTS: We enrolled 104 men from 11/5/2013 to 6/10/2014. FQ-resistant E coli were cultured from 19.2% (20/104) of rectal swabs, and 26% (27/104) of all swabs were positive for EST200 by PCR. The test characteristics comparing the EST200 to the culture-based detection of FQ resistance were 75%, 86%, 94%, and 56%, respectively. The AUC was 0.84 for the EST200 to detect FQ resistance before TPB. CONCLUSION: Compared to the reference standard rectal culture, EST200 was able to detect majority of FQ-resistant E coli on rectal swabs before prostate biopsy.
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