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Test Code VRERP Vancomycin-Resistant Enterococcus, Molecular Detection, PCR, Varies

Reporting Name

VRE PCR

Useful For

Identifying carriers of vancomycin-resistant enterococci

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Specimen Type

Varies


Necessary Information


Specimen source is required.



Specimen Required


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 vancomycin-resistant Enterococcus DNA is unlikely.

 

Submit only 1 of the following specimens:

 

Preferred:

Specimen Type: Perianal, perirectal, rectal

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

 

Acceptable:

Specimen Type: Preserved Feces

Supplies: C and S Vial (T058)

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, Para-Pak C and S)

Specimen Volume: Representative portion of feces

Collection Instructions:

1. Collect fresh feces and submit 1 gram or 5 mL in container with transport medium.

2. Place feces in preservative within 2 hours of collection.

 

Specimen Type: Unpreserved Feces

Supplies:

-Stool container, Small (Random), 4 oz Random (T288)

-Stool Collection Kit, Random (T635)

Container/Tube: Fecal container

Specimen Volume: Representative portion of feces

Collection Instructions: Collect fresh fecal specimen and submit representative sample in fecal container.


Specimen Stability Information

Specimen Type Temperature Time Special Container
Varies Refrigerated (preferred) 7 days
  Ambient  7 days
  Frozen  7 days

Reference Values

Not applicable

Day(s) and Time(s) Performed

Monday through Friday

Test Classification

This test was developed using an analyte specific reagent. Its performance characteristics were determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.

CPT Code Information

87500

LOINC Code Information

Test ID Test Order Name Order LOINC Value
VRERP VRE PCR 62261-3

 

Result ID Test Result Name Result LOINC Value
SRC60 Specimen source 31208-2
84406 VRE PCR 62261-3

Clinical Information

Vancomycin-resistant enterococci (VRE) are major nosocomial pathogens. Patients who are particularly vulnerable to fatal disease from VRE include those with hematologic malignancies and liver transplants. Nosocomial spread of VRE occurs as the result of fecal carriage. Risks for both colonization and infection include prolonged hospitalization, intensive care unit stay, transplantation, hematologic malignancies, and prolonged exposure to antibiotics.

 

The Centers for Disease Control and Prevention provides recommendations to prevent the spread of VRE in institutional settings. These recommendations include isolation of patients experiencing active VRE infection, screening of patients by perianal swab or fecal testing to identify carriers of VRE, and subsequent isolation or cohorting of VRE carriers. Identification and isolation of VRE carriers has been shown to be cost-effective.

 

In Enterococcus faecalis or E faecium, vancomycin resistance is usually associated with the presence of vanA or vanB. The presence of these genes is detected by a molecular method in this assay.

Interpretation

Positive test results indicate the presence of either vanA or vanB , which confer vancomycin resistance in Enterococcus faecalis and Enterococcus faecium (and occasionally other organisms). Patients with a positive test result should be placed in isolation or cohorted with other vancomycin-resistant enterococci (VRE) carriers according to the institution's infection control practices.

 

A negative result indicates the absence of detectable vanA or vanB DNA, but does not rule-out carrier status and may occur due to inhibition of polymerase chain reaction (PCR), sequence variability underlying primers or probes, or the presence of VRE DNA in quantities less than the limit of detection of the assay. In the rare event that PCR testing appears to be negative but there is evidence of PCR inhibition, the result will read "PCR inhibition present." In such cases, a new specimen should be submitted for repeat testing.

Clinical Reference

1. Sloan LM, Uhl JR, Vetter EA, et al: Comparison of the Roche LightCycler vanA/vanB detection assay and culture for detection of vancomycin-resistant enterococci from perianal swabs. J Clin Microbiol. 2004;42:2636-2643

2. Mayo Medical Laboratories Communique: Vancomycin-resistant enterococci: Colonization, infection, detection, and treatment. Vol 32, No. 11, November 2007

3. Zirakzadeh A, Patel R: Epidemiology and mechanisms of glycopeptide resistance in enterococci. Curr Opin Infect Dis. 2005;18:507-512

4. Zirakzadeh A, Patel R: Vancomycin-resistant enterococci colonization, infection detection and treatment. Mayo Clinic Proc. 2006;81:529-536

5. Patel R: Enterococcal-type glycopeptide resistance genes in non-enterococcal organisms. FEMS Microbiol Lett. 2000 Apr 1;185(1):1-7

6. Hefazi M, Damlaj M, Alkhateeb HB, et al: Vancomycin-resistant Enterococcus colonization and bloodstream infection: prevalence, risk factors, and the impact on early outcomes after allogeneic hematopoietic cell transplantation in patients with acute myeloid leukemia. Transplant Infect Dis. 2016 Sept 19;18(6):913-920. doi.org/10.1111/tid.12612

Analytic Time

1 day

Reject Due To

E-swab, calcium alginate swab, cotton-tipped swab, swab sent in gel transport medium, swab sent in viral or universal transport medium, or dry swab; formalin or PVA fixative Reject

Method Name

Real-Time Polymerase Chain Reaction (PCR)

Forms

If not ordering electronically, complete, print, and send a Microbiology Test Request (T244) with the specimen.

Secondary ID

84406

Specimen Minimum Volume

See Specimen Required