Achieving 24-hour reporting turnaround for clinical surveillance detection of eight carbapenemase genes using combined multiplex molecular assays

Carbapenemase-producing organisms, including carbapenem-resistant Enterobacterales, Acinetobacter and Pseudomonas species, contribute to over 49,000 infections and >4,000 deaths annually in the United States. The Centers for Disease Control and Prevention recommends surveillance using dual swab testing. While a culture-first approach is routinely utilized for carbapenemase-producing organism screening, results require 3 workdays or more. In contrast, Wadsworth Center employs a molecular-first algorithm, combining the Cepheid Xpert Carba-R assay with laboratory developed test multiplex PCR. Using shared reagents for efficiency and specimen preservation, this method detects the most prevalent carbapenemase genes, bla_KPC, bla_NDM, bla_VIM, bla_OXA-48-like, and bla_IMP, as well as Acinetobacter baumannii-associated genes, bla_OXA-23-like, bla_{OXA-24/40-like}, and bla_OXA-58-like, and produces actionable results in less than one workday. Wadsworth Center's rapid carbapenemase-producing organism colonization screening algorithm supports prompt healthcare protocol initiation and epidemiological response.