Evaluation of CARBA PAcE, a novel rapid test for detection of carbapenemase-producing Enterobacterales

Introduction. Carbapenemase-producing Enterobacterales (CPE) are an increasing threat to global health. Fast detection is crucial for patient management and outbreak control. Hypothesis/Gap statement. Recently, a new commercial colorimetric test, CARBA PAcE, was released that has not yet been scientifically evaluated. Aim. Our goals were to evaluate the performance of CARBA PAcE using a large variety of different CPE. Methodology. CARBA PAcE was challenged with 107 molecularly characterized CPE and 53 non- CPE controls. Isolates were grown on MuellerHinton agar (MHA); in the case of a falsenegative result, isolates were additionally inoculated on Columbia blood agar (CBA) and CARBA PAcE was repeated. The test was performed according to the manufacturer's protocol. Results. CARBA PAcE showed an overall sensitivity and specificity of 72 % [confidence interval (CI) 62-80 %] and 91 % (CI 79-97 %), respectively, when isolates were grown on MHA. With growth on CBA, detection improved (especially of metallo-fllactamases), resulting in an extrapolated sensitivity of 89 % (CI 81-94 %) for all carbapenemases and 96 % (CI 89-99 %) for the four major carbapenemases (NDM, OXA-48- like, KPC, VIM). Conclusion. CARBA PAcE is a simple and very rapid test for the detection of CPE which performs well for the major carbapenemases when isolates are grown on CBA. Laboratories should be aware of the limitations of this assay, such as moderate sensitivity when isolates are grown on more challenging agars such as MHA and the poor detection of some rare carbapenemases (e.g. IMI, OXA-58)