Does the time come for rapid NG Carba 5 test to replace Xeprt Carba-R assay to detect carbapenem resistance among Enterobacterales?

Background: Carbapenem resistant Enterobacterales (CRE), currently listed by the WHO as top priority critical pathogens, are a major global menace to human health. In low- and middle-income countries, the threat is mounting fueled by selective pressures caused by antibiotic abuse and inadequate diagnostic resources. Aim: The aim of this study is to evaluate the performance of new rapid NG-test (CARBA 5 test) for detection of carbapenem producing Enterobacterales (CPE) by comparing it to Xpert-Carba R assay. Methods: This study phenotypically and genotypically characterized carbapenem resistance among 102 Enterobacterales isolates including 98 K. pneumoniae, 4 E. coli. Molecular characterization of the carbapenemases encoding genes (KPC, NDM, and OXA-48) was conducted using NG Carba 5 and Gene Xpert Carba R assay. Results: In results, One hundred and two carbapenem-resistant Enterobacterales isolates were included in this study. Isolates were collected from different hospital units. 21.6% and 3.9% of these multidrug resistant organisms were collected from the Emergency room and the Out Patient Department respectively. OXA48 was the most prevalent carbapenemase encoding gene 52% by Gene Xpert. The analysis of NG-Test Carba 5 results versus the results of the composite reference method (Gene Xpert) showed a significant agreement (P≤0.005) between the two methods, demonstrating overall sensitivity of NG- Carba 5 test 91.1%. Conclusion: Routine surveillance of hospital-associated infections and antibiotic sensitivity patterns are of extreme importance in adjusting antibiotic treatment and reducing and controlling the prevalence and spread of carbapenem resistance. This goal can be achieved via NG Carba 5 method, compared with the current PCR assays, particularly in countries with limited resources and/or high prevalence of carbapenemases .