Novel biochemical and reliable technique for the rapid detection of extended-spectrum β-lactamase-producing Enterobacterales; the rapid ESBL NP test

Abstract

Extended-Spectrum β-lactamase-producing Enterobacterales (ESBL-E) constitutes a global burden and is one of the major threats to public health. The production of ESBLs precludes the use of broad-spectrum cephalosporins, making carbapenems the drug of choice for these infections. Thus, the increased prevalence of these organisms has stimulated the empiric use of carbapenems as therapy where ESBL-E are suspected, favoring selection of carbapenem-resistant Enterobacterales. Rapid detection of ESBL-E constitutes a challenge for clinical microbiologists to prevent delaying efficient antibiotic therapy that worsens the survival of the most severely ill patients. Rapid diagnostic tests may identify drug-resistant bacteria, determine antimicrobial susceptibility, and distinguish viral from bacterial infections, therefore guiding effective treatment strategies. Indeed, implementation of strategies for antibiotic stewardship are now required by the Federal government in hospitals across the USA. Rapid diagnostic tests facilitate epidemiological surveillance, by providing the possibility to monitor the transmission of emerging and antibiotic-resistant microorganisms. Traditional techniques for detecting ESBL-PE include phenotypic tests (to detect the presence of the enzyme) or molecular tests (to detect the genes encoding such enzymes). Both current approaches are time-consuming (24-48 h) since they usually require the isolation or growth of the organism before the test is performed. In this review article, we discussed the rapid diagnostic strategies particularly the rapid ESBL test and how such rapid tests can facilitate the surveillance of resistance evolution and guide effective therapeutic strategies.