The effect of transport temperature and time on the recovery of antimicrobial-resistant Enterobacterales in stool

Sarah E Turbett; Margaret Becker; Lisa Desrosiers; Elizabeth Oliver; Sowmya R Rao; Alison Taylor Walker; Maroya Walters; Edward T Ryan; Regina C LaRocque

doi:10.1016/j.diagmicrobio.2020.115210

The effect of transport temperature and time on the recovery of antimicrobial-resistant Enterobacterales in stool

Diagn Microbiol Infect Dis. 2021 Feb;99(2):115210. doi: 10.1016/j.diagmicrobio.2020.115210. Epub 2020 Sep 19.

Authors

Sarah E Turbett¹, Margaret Becker², Lisa Desrosiers², Elizabeth Oliver³, Sowmya R Rao³, Alison Taylor Walker⁴, Maroya Walters⁵, Edward T Ryan⁶, Regina C LaRocque⁷

Affiliations

¹ Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Pathology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Department of Medicine, Boston, MA, USA. Electronic address: Turbett.Sarah@MGH.harvard.edu.
² Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.
³ Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁴ Division of Global Migration and Quarantine, Travelers' Health Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
⁵ Division of Healthcare Quality Promotion, Prevention and Response Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
⁶ Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Immunology & Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Harvard Medical School, Department of Medicine, Boston, MA, USA.
⁷ Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Harvard Medical School, Department of Medicine, Boston, MA, USA.

PMID: 33242837
DOI: 10.1016/j.diagmicrobio.2020.115210

Abstract

Surveillance for antibiotic-resistant (AR) bacteria is challenging. We evaluated AR Enterobacterales survival in stool over various transport conditions. Stool in Cary-Blair medium was spiked with AR Enterobacterales, held at 3 °C, 20 °C, or 37 °C, and cultured on days 3, 8, and 15. Stool from US international travelers sent through the US mail was also screened. We compared recovery rates using Fisher's exact tests and linear regression models. AR Enterobacterales recovery reduced with time (86% versus 75% versus 61% at days 3, 8, and 15; Beta for linear trend=-0.02, r²=0.99, P=0.02) and colder temperatures [56% (3 °C) versus 89% (20 °C) versus 86% (37 °C); P=0.003]. Traveler sample recovery also reduced with transport time (Beta for linear trend=-0.03, r²=0.70, P=0.01) but not with season [20% (cold) versus 22% (warm), P=0.7]. AR Enterobacterales are found over variable transport conditions, providing rationale for expanding surveillance sample processing timelines.

Keywords: Antimicrobial resistance; Bacteriology; Clinical microbiology.

MeSH terms

Culture Media
Drug Resistance, Bacterial*
Enterobacteriaceae / isolation & purification*
Enterobacteriaceae Infections / diagnosis
Feces / microbiology*
Humans
Microbial Viability
Specimen Handling*
Temperature
Time Factors

Substances

Culture Media

Grants and funding

U01 CK000490/CK/NCEZID CDC HHS/United States