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It's a new week, so it's a new BioConnections post! This week we're talking blood culture identification (BCID). BCID is covered mainly by Microbiologics and their QC panels, but you'll never guess what! We supply our own Fastidious Anaerobe Agar (F.A.A) for culturing your positive blood cultures on!
Blood Culture Identification
Complementing this, BioConnections (our own) FAA Agar provides a high-performance medium for the cultivation of fastidious anaerobes, supporting consistent growth and reproducible results. Together, these tools empower laboratories to maintain the highest standards in microbiological testing while enhancing efficiency and patient outcomes.
Microbiologics
The Gram-Negative Blood Culture Control Panel also includes 3 pools containing 3-5 inactivated microorganisms per pool. Kits contain 5 vials of each pool (15 total vials) and feature colour coordinated labels for easy pool identification.
BioConnections
Yes your eyes are working correctly, We offer our own F.A.A agar for you to pour your own plates. These plates have one of the same benefits as CHROMagar dehydrated media (if you think back to last week), it has a super long shelf-life! It comes in either 500g or 2.5kg that can be sent to you!
Our medium also has the option to be made selective with the addition of antibiotic supplements. This is the medium of choice for the routine isolation of clinically significant anaerobes, our medium supports the growth of most fastidious anaerobes. Classical colony formation, odour and fluorescence under UV are diagnostic features on this medium. The choice of peptones and growth factors provide early growth of most organisms whilst the starch has an important role as a de-toxification agent. The medium is often made selective for various groups of anaerobes by the addition of appropriate selective agents.
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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
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For the un-initiated, I will include a bit of information about what chromogenic media is and why it's neat so don't worry if you've never heard of a CHROMagar!
What we're talking about today is a little different to how you might know CHROMagar, as we instead deal with their plates in powder form! Now you may think this is pretty old-school, BUT!, there are benefits to dehydrated media compared to your usual fridge-stored plates.
What are chromogenic media plates?
Chromogenic materials are defined as substances that exhibit a reversible change in coloration, in response to external stimuli. Chromogenic media contains chromogens, consisting of a substrate and a chromophore. Plates, before use are colourless because the chromophore does not absorb visible light whilst conjugated to the substrate [1].
When a specific bacterial organisms enzymatic activity comes into contact with the chromogen molecule, that enzyme cleaves the chromogen molecule which releases the chromophore, as this chromophore is no longer conjugated, the light becomes visible [1].
The chromophore used does not diffuse readily into the surrounding media, meaning that the colour stays concentrated in the area specifically where the bacterial colony with the target enzymatic activity grew. This is why the colony itself takes on the chromophores colour [1].
Chromogenic media utilise synthetic chromogenic enzyme substrates in order to specifically target pathogenic species, based on their enzyme activity. This enzyme activity is never completely species-specific, requiring the use of complementary enzyme substrates and/ or selective agents. This means that the majority of chromogenic media are both selective and differential as they accommodate the inhibition of non-target organisms whilst enabling target pathogens to grow as coloured colonies due to their metabolism, which is usually through hydrolysis, of one or more chromogenic enzyme substrates [2].
[1] https://asm.org/articles/2020/september/how-chromagar-tm-revolutionized-bacterial-identifi
[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC5355637/
What CHROMagar plates are there?
For more information on each specific product, and to speak with us about these chromogenic plates, visit our CHROMagar website at: https://www.bioconnections.co.uk/chromagar-home.html.
Cherry Picking
CHROMagar ESBL
CHROMagar mSuperCARBA
CHROMagar MRSA
CHROMagar Acinetobacter
CHROMagar COL-APSE
CHROMagar LIN-R
The power of powder
- Dehydrated media has a much longer shelf-life, instead of a month or two (I think that's the norm for pre-poured media) this stuff LASTS, you can see in the above photo, this bottle of CHROMagar mSuperCARBA does't expire for YEARS.
- So, these bottles are from 5L to 25L, and with 5L (pouring at 20mL per plate) that will make somewhere in the range of 250 plates. Which is quite a lot for how much space it takes up (not as much as your box of 200 plates that needs to go in the fridge).
Now, I am not saying dehydrated media is better than pre-poured plates, as it just isn't as convenient as grabbing the plates out the fridge when you need them. But think of the times where you have to bin expired media that just didn't get used. Especially with the lesser-used highly selective (expensive) media, with dehydrated media, you could always have it in stock, and you could make up only what you need when you need it, reducing waste and lost money.
Okay I'm done talking now, you can check out CHROmagar if you want! I think they're pretty neat.