Liquid based microbiological transport systems: conformity assessment of two commercial devices

Comparison of the certified Copan eSwab system with commercially available cotton swabs for the detection of multidrug-resistant bacteria in rectal swabs

BACKGROUND

Rectal swabs are well-implemented screening tools for multidrug-resistant bacteria (MDRB). Since certified swabs such as the Copan eSwab system experienced a delivery bottleneck during the COVID-19 pandemic, commercially available alternatives such as commonly used double-tipped cotton swabs had to be investigated, especially considering their similarity to professional cotton swabs for microbiological purposes.

METHODS

Diagnostic properties of commercial cotton swabs (comparable to Q-tips) and Copan eSwabs were qualitatively compared in a prospective single-center study using microbiological standard cultures and PCR methods for the detection of multidrug-resistant Gram-negative bacteria and vancomycin-resistant enterococci (VRE).

RESULTS

A total of 196 swab pairs were collected from 164 participants. MDRB were detected in 36 of 164 cases (22%). There were neither false-negative nor false-positive results using commercial cotton swabs. In 8 of 196 samples (4.1%) MDRB species were detected only by using cotton swabs, including vancomycin-resistant Enterococcus faecium, OXA-48 producing Escherichia coli, ESBL-producing Klebsiella pneumoniae and ESBL-producing Escherichia coli.

DISCUSSION

Commercial cotton swabs turned out to be a reliable alternative to Copan eSwabs. For practical use as a screening tool, relevant storage- and manufacturer-related contamination must be ruled out beforehand.

CONCLUSIONS

Commonly available double-tipped cotton swabs can be used for rectal MDRB screening in the event of supply shortages of certified swabs. Further studies should clarify their suitability as a sampling system for nasopharyngeal MRSA carriage or even for the molecular biological detection of SARS-CoV-2.

Effectiveness of using liquid transport media in bacteriological diagnostics of diphtheria infection

The results of evaluating the effectiveness of the use of liquid transport media at the preanalytical stage of bacteriological diagnosis of diphtheria infection are presented. A typical toxigenic strain of C. diphtheriae biovar gravis № 665 was used. The experiments were carried out using a laboratory-prepared medium based on GRM-broth (State research center for applied biotechnology and microbiology, Obolensk), a transport system with a fleecy probe swab (DELTALAB) and a transport system ∑-Transwab ® with a polyurethane Sigma-swab (Medical Wire & Equipment Co. (Bath) Ltd.). The tampons were pooled with a 24-hour bacterial culture of C. diphtheriae, then immediately seeded on Tellurite-containing blood agar. Storage conditions were simulated for 6-24 hours: at room conditions +(20-25)° C, in the refrigerator +(4-8)° C, in a thermostat +(37±1)° C. Storage of C. diphtheriae was most optimal on two liquid transport systems in a refrigerator +(4-8)° C for 6 and 24 hours; in room conditions +(20-25)° C - there was a decrease in seeding after 6 hours and loss of pathological material after 24 hours, more pronounced on a fleecy probe swab; under thermostat conditions +(37±1)° C on both transport systems, a decrease in seeding was noted after 6 hours and a complete loss of pathological material after 24 hours. The results obtained demonstrated the efficiency of using the Amies liquid transport medium and justify the need to develop a domestic analogue of the transport system based on the Amies liquid medium for the bacteriological diagnosis of diphtheria infection.

Evaluation of Liquid-Based Swab Transport Systems against the New Approved CLSI M40-A2 Standard

Following revised information pertaining to newer swab types and testing protocols in the new CLSI M40-A2 standard, we evaluated three liquid swab transport systems for the recovery of aerobic, anaerobic, and fastidious organisms at room temperature and at 4°C. All tested liquid swab transport systems were fully compliant with the M40-A2 standard, with acceptable performance at both temperatures after the full specified holding period, using both qualitative (roll-plate) and quantitative (swab elution) methods.