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Test ID: CARBI Carbapenem Resistance Genes, Molecular Detection, PCR, Varies

Infectious


Ordering Guidance


This assay should be used for testing of isolates of Enterobacterales, Pseudomonas aeruginosa and Acinetobacter baumannii. If testing directly from rectal swabs is desired, order CRPCR / Carbapenem Resistance Genes, Molecular Detection, PCR, Rectal Swab.

 

Other mechanisms of carbapenem resistance, including other carbapenemase not targeted by this assay, porin mutations, and hyperexpression of drug efflux pumps, may result in carbapenem resistance. These mechanisms are not detected by this assay.



Additional Testing Requirements


1. Organism identification must be provided. If organism identification is unknown, concomitantly order IDENT / Organism Referred for Identification, Aerobic Bacteria.

2. If susceptibility testing is needed, also order ZMMLS / Antimicrobial Susceptibility, Aerobic Bacteria, Varies.



Shipping Instructions


1. For shipping information, see Infectious Specimen Shipping Guidelines.

2. Place specimen in a large infectious container and label as an etiologic agent/infectious substance if appropriate.



Necessary Information


Organism identification and specimen source are required.



Specimen Required


The high sensitivity of amplification by polymerase chain reaction requires the specimen to be processed in an environment in which contamination of the specimen by Klebsiella pneumoniae carbapenemase (KPC), New Delhi metallo-beta-lactamase (NDM), Verona integron-encoded metallo-beta-lactamase (VIM), oxacillin-hydrolyzing beta-lactamase (OXA-48), and imipenemase-type metallo-beta-lactamase (IMP) DNA is not likely.

 

Supplies: Infectious Container, Large (T146)

Container/Tube: Slant

Specimen Volume: Isolate

Collection Instructions:

1. Perform isolation of infecting bacteria.

2. Bacterial organism must be submitted in pure culture, actively growing. Do not submit mixed cultures.


Useful For

Detecting and differentiating blaKPC, blaNDM, blaVIM, blaOXA-48, and blaIMP gene sequences associated with carbapenem intermediate or resistant results

 

Aiding in infection control in the detection of gastrointestinal colonization of patients in healthcare settings with bacteria not susceptible to carbapenems using bacterial isolates from rectal or perirectal swabs

Method Name

Real-Time Polymerase Chain Reaction (PCR)/Reverse Transcription (RT-PCR)

Reporting Name

Carbapenem Resistance Genes, Varies

Specimen Type

Varies

Specimen Stability Information

Specimen Type Temperature Time Special Container
Varies Ambient (preferred)
  Refrigerated 

Clinical Information

The global spread of carbapenemase-producing Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter baumannii (organisms not-susceptible to carbapenem antimicrobials) is a critical public health issue. These bacteria are often resistant to all beta-lactam agents and frequently also resistant to multiple classes of other antimicrobial agents, leaving very few treatment options. Tracing the spread of organisms not-susceptible to carbapenems is complicated by the diversity of carbapenem-hydrolyzing enzymes that have emerged and the ability of the genes to spread among multiple bacterial species.

Reference Values

Not Detected

Interpretation

A detected result is when blaKPC, blaNDM, blaVIM, blaOXA-48, or blaIMP target DNA is detected. This indicates the presence of gene sequences associated with carbapenem intermediate or resistant results.

 

A not detected result is when blaKPC, blaNDM, blaVIM, blaOXA-48, and blaIMP target DNA is not detected.

 

A not detected Xpert Carba-R Assay result does not preclude the presence of other carbapenem-resistance mechanisms.

Clinical Reference

1. Bush K, Bradford PA. Epidemiology of beta-lactamase-producing pathogens. Clin Microbiol Rev. 2020;33(2): e00047-19

2. Tenover FC, Nicolau DP, Gill CM. Carbapenemase-producing Pseudomonas aeruginosa - an emerging challenge. Emerg Microbes Infect. 2022;11(1):811-814

3. Clinical and Laboratory Standards Institute (CLSI). Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria that Grow Aerobically. 11th ed. CLSI standard M07. CLSI; 2018

Day(s) Performed

Monday through Friday

Report Available

2 to 4 days

Test Classification

This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information

87150

LOINC Code Information

Test ID Test Order Name Order LOINC Value
CARBI Carbapenem Resistance Genes, Varies 85502-3

 

Result ID Test Result Name Result LOINC Value
IMPCB IMP Resistance Gene 85498-4
VIMCB VIM Resistance Gene 85501-5
NDMCB NDM Resistance Gene 73982-1
KPPCB KPC Resistance Gene 49617-4
OXACB OXA-48-like Resistance Gene 85503-1
CRORG Organism Identified by Client In Process
CRSRC Specimen Source 31208-2

Forms

If not ordering electronically, complete, print, and send a Microbiology Test Request (T244) with the specimen.