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KMID : 1100820220120030175
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Laboratory Medicine Online
2022 Volume.12 No. 3 p.175 ~ p.182
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Evaluation of the Xpert Carba-R Assay for Detection of Rectal Carbapenemase-producing Enterobacterales in a Korean Tertiary Hospital
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Han Jay-Ho
Ha Sung-Il
Shin Dong-Pil
Cha Young-Jong
Yoo In-Young
Park Yeon-Joon
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Abstract
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Background: Carbapenemase-producing Enterobacterales (CPE) have been highlighted as an urgent threat by international health authorities. Rapid detection of carbapenemase will allow implementation of infection control measures.
Methods: We assessed the performance of the Xpert Carba-R assay (Cepheid, USA) designed for rapid detection of five most common carbapenemases (blaKPC, blaNDM, blaOXA-48, blaVIM, and blaIMP-1) from rectal swab specimens by comparing with the reference method, culture plus in-house PCR. A total of 26,178 specimens were collected from August 2018 to July 2020 and tested using the Xpert Carba-R assay and culture plus in-house PCR.
Results: Among the 26,178 specimens collected from 12,889 patients, 1,615 (6.2%) were detected using the Xpert Carba-R assay, whereas 1,525 specimens (5.8%) were detected using a reference method. The sensitivity, specificity, and positive and negative predictive values of the Xpert Carba-R assay compared to the results of the culture method were 97.4% (95% confidence interval [CI], 96.5% to 98.1%), 99.4% (95% CI, 99.3% to 99.5%), 91.8% (95% CI, 90.5% to 93.0%), and 99.8% (95% CI, 99.7% to 99.8%), respectively. The prevalence of CPE and carbapenem-resistant Enterobacteriaceae were 1.7% (220/12,889) and 5.4% (695/12,889), respectively. Klebsiella pneumoniae (108/220, 49.1%) was the most common species, followed by Escherichia coli (68/220, 30.9%) and Citrobacter freundii (17/220, 7.7%). blaKPC was the most common carbapenemase gene (123/220, 55.9%), followed by blaNDM (56/220, 25.4%), blaOXA-48 (27/220, 12.2%), and blaNDM/OXA-48 (9/220, 4.1%).
Conclusions: Based on our results, we conclude that the Xpert Carba-R assay is a very useful tool for rapid identification of CPE rectal colonization.
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KEYWORD
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Carbapenemase, Carbapenemase-producing Enterobacterales, Xpert Carba-R assay, Surveillance, Infection control
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