Treatment Regimen for CRE

Patient Management for Carbapenem Resistance (AMR) / Treatment Regimen using a robust & cost-effective TRURAPID OKNVI RESIST-5 TEST

A standard diagnosis for patients using DST/AST techniques guides antibiotic therapy for the Clinicians/ ICU in-charge/ transplant specialists. The VITEK system identifies various bacteria, with AST profile for many antibiotics. But it is costly, needing special cards, maintenance, and trained staff, taking hours for results.

The prevalence of CRE in India varies from 40% in E. coli to 72% in Klebsiella pneumoniae.¹ Many tests have been used to detect carbapenemase activity in cultured bacterial isolates, like the Carba NP tests and the carbapenem inactivation method. These tests broadly detect only the presence of carbapenemase activity and do not distinctly identify its type. Also, there is a lack of reliable phenotypical tests or chemical inhibitors for detecting OXA-48-like producers. Phenotypic assays are laborious, time-consuming, and require separate inhibitor-based confirmatory tests to identify each class of β-lactamases. Molecular techniques like real-time multiplex PCR, such as the Xpert® Carba-R, require special infrastructure, are expensive, and are unavailable in many routine clinical laboratories (particularly in low and middle-income settings).¹

Thus, the development of a lateral flow assay (LFA) has the potential to improve both the quality and time of detection of these major five carbapenemases in the routine microbiology laboratory, providing rapid and accurate results at a moderate cost.¹

The TRURAPID OKNVI RESIST-5 TEST, a multiplex LFA (made in India) in collaboration with CORIS BioConcept Inc., detects key carbapenemases (OXA-48-like, KPC, NDM, VIM, IMP) in 15 minutes from bacterial colony isolates of culture plate or directly from positive blood cultures. Each pouch contains 2 lateral flow cassettes for identifying:

(i) OXA-48, KPC, NDM
(ii) VIM, IMP

It is cost-effective, minimally complex, allows prompt antibiotic therapy adjustment based on resistant strains, and is suitable for all lab personnel.

Use of beta-lactams / beta-lactam inhibitors combination in Carbapenemases treatment:

The type of carbapenemase(s) produced by an organism significantly influences treatment options, as certain antibiotics such as ceftazidime-avibactam, meropenem-vaborbactam, and the combination of ceftazidime-avibactam with aztreonam exhibit efficacy against specific carbapenemase types.^1,2 Ceftazidime-avibactam is particularly effective against most Enterobacterales that produce OXA-48 type carbapenemase.² In contrast, meropenem-vaborbactam and imipenem-cilastatin-relebactam are only effective against Enterobacterales that produce KPC.¹ On the other hand, metallo-beta lactamases (NDM, VIM, or IMP) are not susceptible to ceftazidime-avibactam; therefore, alternative treatment strategies, including tigecycline, colistin, or other novel antimicrobial agents, must be employed.² The combination of ceftazidime-avibactam with aztreonam is regarded as the preferred treatment approach for infections caused by NDM and other metallo-β-lactamase-producing organisms.¹

The columns represent the antibiotics and the lines show the carbapenemases. When the box is colored, it means that the bacterium carrying the carbapenemase grows in presence of the antibiotic; when the box is empty of color, the bacterium does not grow, it means that it is sensitive to the antibiotic. Example with the 1st line: a bacterium carrying OXA-48 is resistant to penicillins, 1st generation cephalosporins (C1G), B-lactam + clavulonic acid mix) and carbapenems (obviously) ; on the other hand, it is sensitive to C3Gs, C4Gs, monobactam (Aztreonam) and the mix of CAZ-AVI.

References:

1. Rahmani S, Basu S, Simner PJ, Kambli P, Shetty A, Rodrigues C. Evaluation of the rapid lateral flow assay (LFA) for detection of five major carbapenemase enzyme families in genotypically characterised bacterial isolates. Indian J Med Res. 2025 Jun;161(6):695-701. doi: 10.25259/IJMR_1976_2024. PMID: 40878337.
2. Tarai B, et al. In Vitro Evaluation Performance of Recently Developed Rapid Diagnostic Test for Detecting Carbapenemases: The Multiplex Lateral Flow Assay. Ann Med Health Sci Res. 2025;15:1-4