Identifying carriers of Ggram-negative bacilli harboring oxacillin-hydrolyzing beta-lactamase (OXA-48-like) or Verona integron-encoded metallo-beta-lactamase (VIM) genes
This test detects oxacillin-hydrolyzing beta-lactamase (blaOXA-48-like) and Verona integron-encoded metallo-beta-lactamase DNA (associated with antimicrobial resistance) in perirectal/rectal/perianal/anal swabs or fecal specimens.
Real-Time Polymerase Chain Reaction (PCR) using LightCycler and Fluorescent Resonance Energy Transfer (FRET)
Carbapenem resistant Enterobacteriaceae
Carbapenem resistant CRE
Carbapenemase
Carbapenemase producing, carbapenem resistant Enterobacteriaceae
CP-CRE
Oxacillinase
OXA
OXA-48
OXA-48-like
VIM
CRE
Varies
This assay is for surveillance testing on perirectal/rectal/perianal/anal swabs or fecal specimens only. If testing isolates from culture, request OXVRP / Oxacillin-Hydrolyzing Beta-Lactamase (blaOXA-48-like) and Verona integron-encoded metallo-beta-lactamase (blaVIM) in Gram-Negative Bacilli, Molecular Detection, PCR, Varies.
Other mechanisms of carbapenem resistance, including other carbapenemase-types, porin mutations, or hyper-expression of drug efflux pumps may result in carbapenem resistance. These are not detected by this assay. If testing for Klebsiella pneumoniae carbapenemase (KPC) or New Delhi metallo-beta-lactamase (NDM) is desired, order KNSRP / Klebsiella pneumoniae Carbapenemase (blaKPC) and New Delhi Metallo-beta-lactamase (blaNDM) Surveillance, PCR, Varies.
If testing for Klebsiella pneumoniae carbapenemase (KPC) or New Delhi metallo-beta-lactamase (NDM) is also needed; also order KNSRP / Klebsiella pneumoniae Carbapenemase (blaKPC) and New Delhi Metallo-beta-lactamase (blaNDM) Surveillance, PCR, Varies.
Specimen source is required.
Question ID | Description | Answers |
---|---|---|
OVSRC | Specimen source |
The high sensitivity of amplification by polymerase chain reaction requires the specimen to be processed in an environment in which contamination of the specimen by oxacillin-hydrolyzing beta-lactamase (blaOXA-48-like) or Verona integron-encoded metallo-beta-lactamase (blaVIM) DNA is unlikely.
Submit only 1 of the following specimens:
Preferred:
Specimen Type: Perianal, perirectal, rectal, anal
Supplies: Culturette (BBL Culture Swab) (T092)
Container/Tube: Culture transport swab (Dacron or rayon swab with aluminum or plastic shaft with either Stuart or Amies liquid medium)
Specimen Volume: Swab
Specimen Stability Information: Refrigerated (preferred)/Frozen
Acceptable:
Supplies: Culture and Sensitivity Stool Transport Vial (T058)
Specimen Type: Preserved feces
Container/Tube: Commercially available transport system specific for recovery of enteric pathogens from fecal specimens (15 mL of non-nutritive transport medium containing phenol red as a pH indicator, either Cary-Blair or Para-Pak C and S vial)
Specimen Volume: Representative portion of feces
Collection Instructions:
1. Collect fresh fecal specimen and submit 1 gram or 5 mL in container with transport medium.
2. Place feces in preservative within 2 hours of collection.
Specimen Stability Information: Ambient (preferred)/Refrigerated
If not ordering electronically, complete, print, and send a Microbiology Test Request (T244) with the specimen.
E-swab Calcium alginate swab Cotton-tipped swab Swab sent in gel transport medium Swab sent in viral or universal transport medium | Reject |
Specimen Type | Temperature | Time | Special Container |
---|---|---|---|
Varies | Varies |
Identifying carriers of Ggram-negative bacilli harboring oxacillin-hydrolyzing beta-lactamase (OXA-48-like) or Verona integron-encoded metallo-beta-lactamase (VIM) genes
In the United States, Klebsiella pneumoniae carbapenemase (KPC) is the most common carbapenemase, followed by New Delhi metallo-beta-lactamase (NDM). Oxacillin-hydrolyzing beta-lactamase (OXA-48-like) and Verona integron-encoded metallo-beta-lactamase (VIM) carbapenemases predominate in other parts of the globe but do occur in the United States. The genes blaOXA-48-like and blaVIM encode OXA-48-like and VIM enzyme production, respectively. Polymerase chain reaction is a sensitive, specific, and rapid means of identifying these genes.
This test detects the genes encoding OXA-48-like and VIM types of beta-lactamases in feces and perirectal/rectal/perianal/anal swabs. It can be used as a tool to find patients who have been colonized. The Centers for Disease Control and Prevention recommends surveillance to detect unrecognized patients who are colonized and who may be a potential source for transmission of carbapenemase-producing Ggram-negative bacilli under certain circumstances. Such surveillance may be focused oin certain high-risk settings or patient groups (eg, intensive care units, long-term care facilities, patients transferred from areas or facilities with a high prevalence of the relevant type of resistance) or may be directed by infection prevention and control to investigate an outbreak.
Negative
Reference values apply to all ages.
This polymerase chain- reaction (PCR) assay detects and differentiates blaOXA-48-like and blaVIM in surveillance specimens (perirectal/rectal/perianal/anal swabs or feces). A positive OXA-48-like (oxacillin-hydrolyzing beta-lactamase) and/or VIM (Verona integron-encoded metallo-beta-lactamase) PCR indicates that the patient is colonized by a Gram-negative bacillus (or Gram-negative bacilli) harboring blaOXA-48-like and/or blaVIM, respectively. A negative result indicates the absence of detectable DNA.
False-negative results may occur due to inhibition of the polymerase chain reaction, sequence variability underlying primers and probes, or the presence of the blaOXA-48-like or blaVIM genes in quantities lower than the limit of detection of the assay.
The assay was validated using 46 gram-negative bacilli, including 30 carbapenemase-producers (26 OXA/VIM-type, 1 NMC/IMI, 1 NDM-1, and 2 KPC), and 2 gram-positive organisms. The assay provided 100% sensitivity and specificity for both targets.
The assay detects oxacillin-hydrolyzing beta-lactamase (OXA-48-like) and Verona integron-encoded metallo-beta-lactamase (VIM) in surveillance perirectal/rectal/perianal/anal swabs and stool with the following limits of detection: OXA-48-like and VIM, 78 and 75 CFU/mL, respectively. A blinded panel of spiked perirectal/rectal/perianal/anal surveillance swabs and stool was assayed. The assay had 100% sensitivity and specificity, for both targets, in all spiked clinical samples.
1. Fernandez J, Cunningham SA, Fernandez-Verdugo A, et al: Evaluation of a real-time PCR assay for rectal screening of OXA-48-producing Enterobacteriaceae in a general intensive care unit of an endemic hospital. Diagn Microbiol Infect Dis. 2017 Jul;88(3):252-258. doi: 10.1016/j.diagmicrobio.2017.04.001
2. Bush K, Fisher JF: Epidemiological expansion, structural studies, and clinical challenges of new beta-lactamases from gram-negative bacteria. Annu Rev Microbiol. 2011;65:455-478
3. Poirel L, Potron A, Nordmann P: OXA-48-like carbapenemases: the phantom menace. J Antimicrob Chemother. 2012 Jul;67(7):1597-1606
4. Nordmann P, Naas T, Poirel L: Global spread of carbapenemase-producing Enterobacteriaceae. Emerg Infect Dis. 2011 Oct;17(10):1791-1798
Perirectal, rectal, perianal, and anal swabs are processed in neutralization buffer tubes, and organisms are lysed to release their genomic material. Fecal specimens undergo DNA extraction prior to polymerase chain- reaction (PCR). This assay amplifies and detects a specific portion of the genes encoding the oxacillin-hydrolyzing beta-lactamase (OXA-48-like) and Verona integron-encoded metallo-beta-lactamase (VIM) enzymes. The LightCycler instrument amplifies and monitors target nucleic acid sequences by fluorescence during PCR cycling. This is an automated PCR system that can rapidly detect amplified product development through stringent air-controlled temperature cycling and capillary cuvettes. The detection of amplified products is based on the fluorescent-resonance energy transfer (FRET) principle. For FRET product detection, hybridization probes with a donor fluorophore, fluorescein, on the 3' end are excited by an external light source, which emits light that is absorbed by secondary hybridization probes with acceptor fluorophores, LC-Red 610 (blaOXA-48-like) and LC-Red 670 (blaVIM) on the 5' end. The acceptor fluorophore then emits a light of a different wavelength that can be measured with a signal that is proportional to the amount of specific PCR product. The detection process is completed in less than 1 hour using a closed tube system.(Cunningham SA, Noorie T, Meunier D, Woodford N, Patel R: Rapid and simultaneous detection of genes encoding Klebsiella pneumoniae carbapenemase (blaKPC) and New Delhi metallo-beta-lactamase (blaNDM) in Gram-negative bacilli. J Clin Microbiol. 2013 Apr;519[(4]):1269-1271)
Monday through Friday
This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.
87798 x 2
87999 (if appropriate for government payers)
Test Id | Test Order Name | Order LOINC Value |
---|---|---|
OVSRP | OXA-48 and VIM Surveillance PCR | 85502-3 |
Result Id | Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
---|---|---|
OVSRC | Specimen Source | 31208-2 |
41746 | OXA-48-like PCR | 85827-4 |
41747 | VIM PCR | 85501-5 |
Change Type | Effective Date |
---|---|
Test Changes - Specimen Information | 2021-08-04 |
Test Changes - Specimen Information | 2021-08-18 |