Rapid detection of carbapenem resistance: targeting a zero level of inadequate empiric antibiotic exposure?

Excerpt

Resistance to carbapenems is an increasingly encountered phenomenon in the ICU, complicating empiric and targeted antimicrobial therapy. Infections due to carbapenem-resistant microorganisms are characterized by high morbidity and mortality [1, 2]. Recently, there has been an increasing interest in rapid detection techniques, based on real time on-demand easy-to-use PCR, to detect genes responsible for carbapenem resistance. One of these techniques is the Cepheid Xpert Carba-R assay, which is able to detect and differentiate five of the most frequent genes associated with non-susceptibility to carbapenems in Gram-negative bacteria (bla _KPC , bla _VIM , bla _OXA-48 , bla _IMP-1 , bla _NDM ). The diagnostic performance of this assay seems to be high when compared to classic microbiological cultures and gene identification with in-house PCR in a clinical setting, especially in intra-abdominal infections using samples from rectum or abdominal drainage material [3, 4]. Originally, assays for screening of patients carrying multidrug-resistant organisms were used to guide infection control programs, to restrict access to patients’ health-care zones, or for outbreak surveillance. However, several studies reported an association between detection from surveillance techniques and subsequent infection etiology, improving the rate of adequate empiric antimicrobial treatment [5]. …