A study evaluating patients at high risk of being carriers of carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CRE) demonstrated that routine surveillance testing may effectively guide infection control programs to limit the spread of CRE, even in low-prevalence areas.
While early detection of patients colonized with carbapenemase-producing CRE is crucial for infection control, there are no clear recommendations on when to use molecular methods for active surveillance in low-prevalence settings. This study demonstrated that a rapid molecular test is well adapted for routine surveillance testing of high-risk patients even in low-prevalence regions: It found Cepheid’s Xpert® Carba-R test to be 100% sensitive and 99.13% specific for the detection of carbapenemase-producing CRE from rectal swab samples, compared to chromogenic culture after enrichment.
The study was conducted at a hospital in France where carbapenemase-producing CRE prevalence is <1%. The “high risk patients” included those repatriated from countries known for high CRE prevalence or contact patients of a known carbapenemase-producing CRE carrier. The study allowed rapid cohorting of carriers, which is crucial (i) to prevent outbreaks and (ii) to reduce the social impact and the cost of infection control measures empirically implemented for high-risk patients who end up being negative for colonization with carbapenemase-producing CRE.
The report of the findings was published in International Journal of Antimicrobial Agents.
This study demonstrated that Xpert® Carba-R is well adapted for rapid [surveillance testing] of high-risk patients even in low prevalence regions.”
Hoyos-Mallecot et al. Int J Antimicrob Agents 49 (6), 774-777. 2017 Apr 12.