Every year many hospitalizations and deaths in the U.S. result from serious infections caused by bacteria resistant to a powerful group of antibiotics called carbapenems.
To fight these dangerous infections, the Centers for Disease Control and Prevention (CDC) has created guidelines that focus on:
- Carefully watching for these bacteria
- Quickly finding out if someone is carrying them (colonized)
- Quickly responding when resistant bacteria are found
- Separating infected patients from others
- Thoroughly cleaning the environment
These bacteria (carbapenem-resistant Enterobacterales (CRE), Acinetobacter, and Pseudomonas) can become resistant to carbapenems by acquiring one or more of five specific genes: blaKPC, blaNDM, blaVIM, blaIMP, and blaOXA-48. A quick and accurate test called the Xpert® Carba-R Assay can identify these genes in less than an hour. The CDC suggests using rectal swabs to check for these bacteria; however, this assay has not been fully tested for use with rectal swabs in children.
The Wadsworth Center, which is the Northeast Regional AR (Antimicrobial Resistance) Lab Network laboratory, validated the Carba-R Assay for detecting carbapenemase genes in pediatric patients. The assay was tested using rectal swab specimens from patients under 21 years old and showed 100% accuracy and excellent precision. This indicates that the Carba-R assay is a reliable and rapid method for screening carbapenemase-producing organisms in this age group. Pre-approval is required for testing and must be coordinated through jurisdictional healthcare-associated infections epidemiology groups.
The study also analyzed retrospective clinical data from over 24,000 rectal specimens. While pediatric patients showed a lower percentage of positive results compared to adults, this difference was attributed to factors such as smaller sample sizes and differences in healthcare exposure. Overall, the findings support the use of the Carba-R Assay as a valuable tool for rapid and sensitive carbapenemase screening in pediatric populations, aiding in infection control and epidemiological surveillance.
A paper describing this work has been published:
Validation of Rectal Swab Specimens for Sensitive and Specific Carbapenemase Gene Detection in Pediatric Patients. Majie C. Foster, Kailee Cummings, Shannon L. Morris, Elizabeth J. Nazarian, Kimberlee A. Musser. Accepted July 17, 2026, at Journal of Applied Laboratory Medicine.