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

  • Author Footnotes
    1 Both authors contributed equally.
    Norman Lippmann
    Footnotes
    1 Both authors contributed equally.
    Affiliations
    Institute of Medical Microbiology and Virology, Leipzig University Hospital, Leipzig, Germany

    Interdisciplinary Center for Infectious Diseases (ZINF), Leipzig University Hospital, Leipzig, Germany
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  • Author Footnotes
    1 Both authors contributed equally.
    Sebastian Wendt
    Footnotes
    1 Both authors contributed equally.
    Affiliations
    Institute of Medical Microbiology and Virology, Leipzig University Hospital, Leipzig, Germany

    Interdisciplinary Center for Infectious Diseases (ZINF), Leipzig University Hospital, Leipzig, Germany

    Division of Infectious Diseases and Tropical Medicine, Department of Medicine II, Leipzig University Hospital, Leipzig, Germany
    Search for articles by this author
  • Catalina-Suzana Stîngu
    Affiliations
    Institute of Medical Microbiology and Virology, Leipzig University Hospital, Leipzig, Germany

    Interdisciplinary Center for Infectious Diseases (ZINF), Leipzig University Hospital, Leipzig, Germany
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  • Johannes Wiegand
    Affiliations
    Division of Hepatology, Department of Medicine II, Leipzig University Hospital, Leipzig, Germany
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  • Christoph Lübbert
    Correspondence
    Address correspondence to Christoph Lübbert, MD, PhD, DTM&H, Leipzig University Medical Center, Division of Infectious Diseases and Tropical Medicine, Department of Medicine II, Liebigstraße 20, D-04103 Leipzig, Germany.
    Affiliations
    Interdisciplinary Center for Infectious Diseases (ZINF), Leipzig University Hospital, Leipzig, Germany

    Division of Infectious Diseases and Tropical Medicine, Department of Medicine II, Leipzig University Hospital, Leipzig, Germany
    Search for articles by this author
  • Author Footnotes
    1 Both authors contributed equally.
Published:February 11, 2022DOI:https://doi.org/10.1016/j.ajic.2022.02.002

      Highlights

      • Commercially available double-tipped cotton swabs can be used for screening of MDRB.
      • Their product-specific contamination flora does not confound detection of MDRB in humans.
      • Further studies should clarify their status for other screenings (eg, MRSA, SARS-CoV-2).
      • In resource-restricted countries, cotton swabs could be a cost-saving alternative to Copan eSwabs.

      Abstract

      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.

      Key Words

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