Impact of rapid carbapenemase detection using immunochromatographic testing and polymerase chain reaction on carbapenem-resistant enterobacterales acquisition and infection control in two intensive care units

BACKGROUND: Carbapenem-resistant Enterobacterales (CRE) poses a substantial burden in healthcare settings, where delayed detection increases transmission risk and prolongs unnecessary isolation. Rapid screening methods are essential for effective infection prevention and control (IPC). Immunochromatographic tests (ICTs) offer a faster and more affordable alternative to culture and polymerase chain reaction (PCR). AIM: The aim of this study was to assess the impact of implementing ICT rapid carbapenemase screening on CRE acquisition and IPC measures. METHODS: We conducted a quasi-experimental study in two intensive care units (ICUs) of a tertiary hospital in Brazil, comparing a baseline period with an intervention period. During baseline, CRE screening consisted of rectal swab culture with weekly follow-up. During intervention, units additionally implemented either GeneXpert Carba-R PCR or broth-enriched ICT. Outcomes evaluated were CRE admission prevalence, ICU acquisition rate, time to initiation or discontinuation of Contact Precautions, test performance compared with culture and cost. Analyses included descriptive statistics, segmented regression, and survival methods. FINDINGS: In total, 1128 patients were admitted during baseline and 385 during intervention; 5% and 12%, respectively, were colonized with CRE on admission. ICT demonstrated 91% sensitivity, 99% specificity, 86% positive predictive value, and 99% negative predictive value for detecting carbapenemase-producing CRE. ICT and PCR reduced time to diagnosis from 181 to 108 h and from 155 to 77 h, respectively (both P