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Welcome! Welcome!
This week we're looking at Erba Mannheim again, and their clinical microbiology products. They have quite a few so this may be a long one with lots of tables. But first, who are Erba?
Who is Erba Mannheim/ Lachema?
For 50 years, the Erba Group has been developing and manufacturing products for urine analysis, clinical chemistry and bacterial identification. Their mission being to provide high quality, easily accessible products for reliable, quick and comfortable analyses, to shorten the time to patient treatment. Erba are able to offer a wide spectrum of progressive products focused on high reliability for analysis.
MIKROLATEST MIC
MIKROLATEST MIC are high quality systems designed for antibiotic susceptibility testing, based on minimal inhibitory concentration determination, designed for visual, or automated, reading. These kits allow for the quantitative determination of the MIC of antibiotics in preselected panels. The test procedure is based on broth micro-dilution methods that measure, quantitatively, in vitro activity of an antimicrobial agent against a bacterial isolate. The minimum inhibitory concentration is determined from a twofold dilution series (with 7 total concentrations and 1 growth control) as the lowest concentration of an antimicrobial agent that prevents visible growth of a microorganism.
Determination of MIC enables interpretation into three categories (EUCAST):
- Susceptible - The microorganism is defined as susceptible by a level of antimicrobial activity associated with a high probability of therapeutic success.
- Susceptible, increased exposure - The microorganism is defined as susceptible with increased exposure by a level of antimicrobial activity associated with uncertain therapeutic effect.
- Resistant - The microorganism is defined as resistant by a level of antimicrobial activity associated with a high probability of therapeutic failure.
There are 2 formats available for MIKROLATEST MIC kits:
- 6 different panels to cover antibiotic susceptibility testing of a wide range of most pathogenic groups of bacteria. Each kit contains 10 determinations, which consist of 12 antibiotics in 8 concentrations, including the growth control.
- 20 single MIC Strips offering 36 determinations per kit.
MIKROLATEST BP
MIKROLATEST BP is an economical system that is designed for antibiotic susceptibility testing based on EUCAST breakpoint determinations. These are also designed for visual, or automated, reading.
Breakpoints refer to standards of the European Committee for Antimicrobial Susceptibility testing (EUCAST issues 2011). Most is the antibiotics are represented by two (in exceptional cases this could be one or three) breakpoint concentrations, which enable the interpretation of either: sensitive, intermediate or resistant.
MIKROLATEST ID
MIKROLATEST ID kits are designed to be user-friendly kits for microbial identification using traditional biochemical tests, which are also designed for visual, or automated, reading. These kits offer a comfortable and reliable way to identify the most important bacteria, and yeasts. Tests are place on divided microplates with 1, 2, or 3 row strips. Each plate contains strips for identification of 12, 6 or 4 strains, respectively.
Only a relevant part of the plate, corresponding to the number of examined strains, can be used. The rest of the plate can be kept for future use. Reagents, suspension media, paraffin oil and additional tests can be supplied separately. Reagent necessary and non-reagent tests are available for most groups of microorganisms. Non-reagent kits bring even more working comfort, and save time.
There are 4 categories that MIKROLATEST ID can be divided into:
- Identification Kits
- Diagnostic strips
- Products for water microbiology
MIKROLATEST Identification Kits (more info)
See above for description on kits
Non-reagent kits:
- ENTEROtest 24 N
- STAPHYtest 24
- EN-COCCUStest
- NEISSERIAtest (suspension medium needed, supplied separately)
- NEFERMtest 24
- STREPTOtest 24 (suspension medium needed, supplied separately)
- CANDIDA-Screen
Reagents
Reagents enable visualisation/ strengthen the colour of the reaction. These reagents are standardised in preparation with the optimal composition.
Parafin oil (Its been sterilised)
Strong alkaline reactions in some of the tests (decarboxylases, indole, urease, etc) can influence reactions in surrounding wells, this can be avoided with the use of paraffin oil.
Suspension media
Suspension media are enriched media which have been designed for the preparation of bacterial suspensions. They contribute considerably to the standardisation of the identification procedure, ensuring osmotic stabilisation, oxide-reduction potential, and growth promotion of bacterial strains. Sterilised media is supplied in vials, with the content of one vial being used to prepare the suspension for one strain.
MIKROLATEST ID: Diagnostic Strips
MIKROLATEST detection strips are plastic strips with a porous zone of filter paper, which contains reagent substrate for the detection of a bacterial enzyme or metabolite. These diagnostic strips are a user-friendly and economical alternative to diagnostic discs. According to their types, the bacterial culture being tested is either inoculated directly onto the reagent zone, or alternatively the strip itself is inserted into a tube containing an examined bacterial suspension and cultured.
The detection strips can be used together with a MIKROLATEST ID kit for additional testing, or separately as an independent test. One package contains 50 test strips.
MIKROLATEST ID: Products for water Microbiology
These products are especially designed for microbiological water examination. They are designed for rapid, quantitative presumptive determinations of important bacteria in water by using membrane filtration. Filter discs are impregnated with reagent substrate for the detection of specific bacterial activity. The diameter of these discs is compatible with the diameter of standard membrane filters. Each kit provides 15 determinations.
mOXItest
mOXItest is designed for rapid quantitative detection of cytchromeoxidase-positive bacteria. The presence is detected by a colour reaction of N,N-dimethyl 1.4-phenylenediamine with a-naphthol, accompanied by indophenol formation. The test is carried out by transferring a membrane filter with colonies on moistened pad of mOXItest and evaluation of oxidase reactions within 1-2 minutes.
Advantages of mOXItest:
- rapid determination, with results within 2 minutes.
- Quantitative determination of oxidase positive bacteria in water
- Simple to use
mCOLItest
mCOLItest is designed for the rapid quantitative presumptive detection of E. coli. The principle of the method is based on the detection of B-glucuronidase, the enzyme characteristic for E. coli. B-glucuronidase hydrolyses substrate 4-methylumbellipheryl-B-D-glucuronide, which is contained in the mCOLItest's nutritive pad. The reaction forms 4-methylumbellipheron that fluoresces blue under UV light.
Advantages of mCOLItest:
- Rapid determination with results within 4 hours in comparison with standard agar culture.
- Primary culture of membrane filters on any suitable agar for coliforms
- Simple to use!
With that, there's everything I'm going to talk about regarding Erba for this week! They do have more than just their MIKROLATEST line but outside of clinical microbiology. If you would like more information make sure to visit our Erba section on the news website for the catalogue and product specific information!
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The Section about background
Carbapenemase-producing organisms are a group of bacteria which produce carbapenemases, making them resistant to the antibiotic, carbapenems. Carbapenems are a beta-lactam antibacterial with a broad spectrum of activity. This spectrum includes many gram-positive and gram-negative bacteria, and anaerobes; imipenem (imipenem with cilastatin) and meropenem have activity against Pseudomonas aeruginosa, but emerging acquired resistance can be a problem. [1]
CPOs can usually be found in the normal gut flora of humans and animals, without causing a problem/ colonising. The issues are apparent when they get into places they are not supposed to be, like the bladder and especially the bloodstream (with a high mortality of 40-50%). This is why it is quite a big issue in hospitals (CPE outbreak 2015/2016) where people are already unwell and on antibiotics, or have a weakened immune system. [2]
[1] https://bnf.nice.org.uk/treatment-summaries/carbapenems/
[2] https://www.uclh.nhs.uk/patients-and-visitors/patient-information-pages/carbapenemase-producing-organisms-cpo
Prevalence and incidence
From October 2020 to December 2024, there were 20 544 reported episodes of acquired carbapenemase-producing organisms (to the UKHSA), with the majority of these being identified from screening samples, accounting for 71.7% of these reports and 910 cases (4.4%) being from sterile sites. However, in Q4 2024 the rate of reported CPO episodes decreased when compared to Q3 2024 (3.3/100 000 population compared to the previous 3.7/100 000 population). This being the highest since mandatory reporting initially began in 2020. [1]
To dive deeper, the highest rate of CPO continued to be in London and the North West (26.2 and 22.7 per 100 000 population, respectively). Furthermore, NHS North West London ICB had the highest rate (40.2 per 100 000 population) and NHS Gloucestershire ICB having the lowest (0.8 per 100 000 population). [1]
Between Q1 2024 and Q4 2024, the most reported acquired carabapenemase was NDM (35.9%), followed up by OXA-48-like (34.4%) and finally KPC (19.6%). This was also seen to vary by region, OXA-48-like was the most reported mechanism in the East of England and the West Midlands, whereas KPC dominated the reports for the North West (NDM being the most reported mechanism throughout). [1]
11 years ago, in 2015, there was a sudden rise in cases of faecal colonisation with KPC-producing E. coli, detected in the Manchester Heart Centre at the Manchester Royal Infirmary. Between the 1st of April 2014 and the 30th of December 2014, there were 23 new CRE-colonised individuals, detected in the MHC, including 2 with E. coli. A CRE outbreak was declared on the 2nd of January 2015, following 6 new CRE-colonised individuals identifications (4 with blaKPC and 2 with blaNDM; no E. coli). [2]
Following the outbreak, investigations identified that the bacteria were present in clinical hand-wash basins, sink sites and floor scrubbers. This lead to the trust implementing strict environmental cleaning, enhanced surveillance for patients, and routine screening of patients. By January 2015, the Manchester foundation trust were operating a trust-wide screening program (>110 screens/day). From September-December 2014, 16 612 samples from 7 239 inpatients were screened using either culture (9 808 samples), or PCR and culture (6 804). Overall, CRE prevalence was 3.8% (438 positive samples from 272 patients), with molecular mechanism data for 135/163 PCR-positive samples indicating that blaKPC accounted for most carbapenem resistance (97%). [2]
[1] https://www.gov.uk/government/publications/carbapenemase-producing-gram-negative-bacteria-laboratory-surveillance/carbapenemase-producing-gram-negative-organisms-in-england-since-october-2020-quarterly-update-q4-2024#background
[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC6256751/
CHROMagar mSuperCARBA was designed to simplify the detection of CPEs, including the big five (OKNVI), this allows for the improved monitoring of high-risk patients and routine screening of inpatients and transfers. The distinctive colours produced by individual colonies allows for the presumptive positive results to be assessed within 24hrs of reception of the sample.
What more can I say? It's dehydrated media that you can sit on your shelf in your storeroom, it has a shelf life of almost 2 years so you'll never go to use it to find it's gone out of date. You just pour the plates when you need them, in the exact quantity you need them. 5L of dehydrated media will make about 250 plates too!
Rosco Diagnostica has developed and produces convenient systems for the detection, rapid colorimetric and assembled kits with disc diffusion tablets, complete with ready-to-use cartridges of the necessary combined Neo-Sensitabs or Diatabs, and a guide to their use. Rosco diagnostica rapid colorimetric kits have the following advantages over their competitors:
- No reagent preparation needed
- Longer shelf-life, most Neo-sensitabs do NOT need refrigeration, and the ones that do can remain on a bench out of the fridge for 2 months during use!
- Stable crystalline imipenem.
- Lower cost
Helix Elite molecular standards are advanced quality control materials designed to support the development, validation, and routine monitoring of molecular diagnostic assays. Used across PCR and other nucleic acid-based technologies, these controls help laboratories across the UK and US ensure accuracy, detect visibility, and maintain confidence in test results while meeting regulatory requirements. For Carabpenem-resistant Enterobacteriaceae, there is one control panel, this being: #8187 Carbapenem-resistant Enterobacteriaceae (CRE) Control Panel (Inactivated swab). This kit includes 6 positive control swabs and 6 negative control swabs. Each positive swab consisting of:
- Escherichia coli derived from NCTC 13476
- Klebsiella pneumoniae derived from NCTC 13440
- Klebsiella pneumoniae derived from NCTC 13443
- Klebsiella pneumoniae derived from NCTC 13438
- Klebsiella pneumoniae derived from NCTC 13442
For your OKNVI's (OXA, KPC, NDM, VIM, IMP) there are individual organisms that can be used for your phenotyping and quality controls. These being:
- OXA: #01148P - Klebsiella pneumoniae derived from NCTC 13442
- KPC: #01117P - Klebsiella pneumoniae derived from NCTC 13438
- NDM: #01060P - Klebsiella pneumoniae derived from ATCC BAA-2146*
- VIM: #01112P - Klebsiella pneumoniae derived from NCTC 13440
- IMP - #01136P - Escherichia coli derived from NCTC 13476
The eazyPlex SuperBug series is a molecular identification product based on LAMP technology, with key features such as:
- Turn-around-times under 30 minutes
- Ease of use, no DNA extraction
- Suitable for single or small numbers of tests
- Samples from urine, rectal swab, blood culture and agar plates
- High accuracy
