Introduction. Lack of laboratory capacity hampers consistent national antimicrobial resistance (AMR) surveillance. Chromogenic media may provide a practical screening tool for detection of individuals colonized by extended-spectrum beta-lactamase (ESBL)-producing organisms. Hypothesis. CHROMagar ESBL media represent an adequate screening method for the detection of extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE), isolated from rectal swabs. Aim. To evaluate the performance of CHROMagar ESBL media to accurately identify ESCrE isolates from rectal swab samples attained from hospitalized and community participants. Methodology. All participants provided informed consent prior to enrolment. Rectal swabs from 2469 hospital and community participants were inoculated onto CHROMagar ESBL. The performance of CHROMagar ESBL to differentiate Escherichia coli and Klebsiella spp., Enterobacter spp. and Citrobacter spp. (KEC spp.) as well as select for extended-spectrum cephalosporin resistance were compared to matrix-assisted laser desorption/ionization-time-of-flight MS (MALDI-TOF-MS) and VITEK-2 automated susceptibility testing. Results. CHROMagar ESBL had a positive and negative agreement of 91.2 % (95 % CI, 88.4–93.3) and 86.8 % (95 % CI, 82.0–90.7) for E. coli and 88.1 % (95 % CI 83.2–92.1) and 87.6 % (95 % CI 84.7–90.2) for KEC spp. differentiation, respectively, when compared to species ID by MALDI-TOF-MS. When evaluated for phenotypic susceptibilities (VITEK-2), 88.1 % (714/810) of the isolates recovered on the selective agar exhibited resistance to third-generation cephalosporins. Conclusion. The performance characteristics of CHROMagar ESBL media suggest that they may be a viable screening tool for the identification of ESCrE from hospitalized and community participants and could be used to inform infection prevention and control practices in Botswana and potentially other low-and middle-income countries (LMICs). Further studies are required to analyse the costs and the impact on time-to-result of the media in comparison with available laboratory methods for ESCrE surveillance in the country.

中文翻译：

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科玛嘉 ESBL 培养基用于监测博茨瓦纳直肠拭子中的超广谱头孢菌素耐药肠杆菌 (ESCrE) 的性能

介绍。实验室能力的缺乏阻碍了国家抗菌素耐药性（AMR）监测的一致性。显色培养基可以提供实用的筛选工具，用于检测产生超广谱β-内酰胺酶（ESBL）的生物体定植的个体。假设。科玛嘉 ESBL 培养基是检测从直肠拭子中分离的超广谱头孢菌素耐药肠杆菌(ESCrE) 的适当筛查方法。目的。评估科玛嘉 ESBL 培养基的性能，以准确识别从住院和社区参与者获得的直肠拭子样本中的 ESCrE 分离株。方法。所有参与者在注册前均提供了知情同意书。来自 2469 名医院和社区参与者的直肠拭子接种了科玛嘉 ESBL。科玛嘉 ESBL 区分大肠杆菌、克雷伯菌属、肠杆菌属的性能。和柠檬酸杆菌属。(KEC spp.) 以及广谱头孢菌素耐药性的选择与基质辅助激光解吸/电离飞行时间 MS (MALDI-TOF-MS) 和 VITEK-2 自动药敏测试进行比较。结果。科玛嘉 ESBL 对大肠杆菌的阳性和阴性一致性分别为 91.2 % (95 % CI, 88.4–93.3) 和 86.8 % (95 % CI, 82.0–90.7)，对大肠杆菌的阳性和阴性一致性为 88.1 % (95 % CI 83.2–92.1) 和 87.6 % (95% CI 84.7–90.2) 对于 KEC 属。分别通过 MALDI-TOF-MS 与物种 ID 进行比较。当评估表型敏感性 (VITEK-2) 时，在选择性琼脂上回收的分离株中有 88.1% (714/810) 对第三代头孢菌素表现出耐药性。结论。科玛嘉 ESBL 培养基的性能特征表明，它们可能是一种可行的筛查工具，用于从住院和社区参与者中识别 ESCrE，并可用于为博茨瓦纳和其他潜在低收入和中等收入国家的感染预防和控制实践提供信息。中低收入国家）。需要进一步研究来分析媒体的成本以及对结果时间的影响，并与该国现有的 ESCrE 监测实验室方法进行比较。