Detection of Carbapenem-resistance in CRE by Comparative Assessment of RAPIDEC® CARBA NP and Xpert™Carba-R Assay

Abstract

Introduction Carbapenem-resistant Enterobacteriaceae (CRE) infections resist nearly most available antimicrobials, resulting in poor clinical outcomes. Saudi Arabia has a relatively high CRE prevalence. This study aims to evaluate the sensitivity of Rapidec Carba NP test and GeneXpert Carba-R assay compared with conventional manners for detection of carbapenemase-producing Enterobacteriaceae . Methods This is a cross-sectional study including a total of 90 CRE isolates examined at two tertiary hospitals in KSA from October 2020 to December 2021. Gram-negative Enterobacteriaceae were identified by using Vitek 2 system and were furtherly tested for imipenem and meropenem susceptibility by E- test strips, followed by Rapidec Carba NP test and the Xpert™Carba-R assay. Results Carbapenem-resistant K. pneumoniae (78.9%) and carbapenem-resistant E. coli (14.4%) were the two most common isolates species. Colistin (98.9%) and tigecycline (88.9%) were the most effective antibiotics against CRE isolates, followed by amikacin (52.2%), gentamicin (33.3%), cotrimoxazole (15.6%), and ciprofloxacin (8.9%). blaOXA-48 was the predominant carbapenemase gene (44.4%), followed by blaNDM (32.2%). blaKPC gene was not detected. The Rapidec Carba NP and the Xpert™Carba-R demonstrated an overall sensitivity of 69.3% and 88%, respectively, in comparison to gold standard detection of meropenem and imipenem resistance by Vitek 2 system and E- test strips. Discussion RAPIDEC ® CARBA NP may be a beneficial screening test for detecting CRE, but for confirmation of the results, Xpert Carba-R assay is more sensitive, significantly lowering the turnaround time compared to reference traditional methods. The information on carbapenemase genes may be used for epidemiologic purposes and outbreak management.

Prevalence and Characterization of Carbapenem-Resistant Klebsiella pneumoniae isolated from the intensive care units of Zagazig University Hospitals

“…On contrary to our results Eltahlawi et al (21) reported that blaOXA-48 was the most common carbapenemase gene (44.4%), followed by blaNDM (32.2%) while blaKPC gene was not found.…”

“…For CRE isolates, Eltahlawi et al (21) found that colistin (98.9%) and tigecycline (88.9%) were the most effective antibiotics, followed by amikacin (52.2%), gentamicin (33.3%), cotrimoxazole (15.6%), and ciprofloxacin (8.9%).…”

An Overview of Antimicrobial Resistance in Saudi Arabia (2013–2023) and the Need for National Surveillance

“…From the literature search, 17 studies were conducted in Saudi Arabia assessing the prevalence of CRE [ 39 , 54 , 55 , 56 , 57 , 59 , 63 , 69 , 70 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 ], and two of those evaluated urine samples only [ 55 , 75 ]. One study evaluating Gram-negative isolates from the urine found that 55.7%, 35.8%, and 12.4% of K. pneumoniae , P. mirabilis , and E. coli isolates were potential CREs, respectively.…”

“…A study that evaluated PCR test results for CRE detection in 90 Gram-negative isolates found that the majority of CRE isolates were K. pneumoniae (78.9%) and E. coli (14.4%), where the most commonly reported gene was OXA-48. Among antimicrobials, colistin and tigecycline were the most effective antibiotics [ 73 ]. Khan et al studied 120 Enterobacterales isolates, mostly K. pneumoniae (42%) and E. coli (41%).…”

Synthesis of a Series of Quinoxaline Derivatives and Their Antibacterial Effectiveness Against Pathogenic Bacteria

“…For instance, penicillin was effective against about 90 % of Staphylococcus aureus isolates in 1941, but penicillin resistance rapidly emerged due to natural bacterial evolution and human use. [17,18] The growing threat of antibiotic-resistant infections has become a global concern, with an estimated 700,000 deaths per year and 10 million deaths worldwide are expected by 2050. The increase in antibiotic resistance is due to both natural bacterial evolution and the extensive use of antibiotics by humans.…”