Evaluation of PCR assays for direct screening of Carbapenemase-Producing Enterobacteriaceae (CPE) from rectal swabs: a diagnostic meta-analysis.

BACKGROUND: Recently, molecular assays have been demonstrated to be reliable for rapid detection of CPE directly from positive blood cultures, reducing significantly the time for identification. Few studies have tested their performance on rectal swabs and no comprehensive conclusion have been reached regarding their utility for infection control management. AIM: Tto review and assess the overall diagnostic test accuracy of PCR for the detection of CPE in rectal swabs. METHODS: We searched the electronic database PubMed, up to October 1, 2019, without language restriction or publication date restrictions. We began by defining the concepts of the research questions: "Carbapenemase-producing Enterobacteriaceae", "molecular testing", "test detection" and "rectal screening". Two reviewers independently screened studies, extracted data, and assessed quality using the QUADAS-2 instrument. Statistical analyses were carried out in STATA using the bivariate model. FINDINGS: One hundred forty-three articles were screened and 16 studies were included. Five (31%) of the studies were conducted in a context of a CPE outbreak, 1 study (6%) included patients pre-identified with CPE in clinical samples (blood or tracheal secretions), while the rest (63%) collected rectal swabs from patients considered at high-risk of colonization. The molecular assays evaluated have a relatively good sensitivity of 0.95 (IC: 0.902-0.989), and an excellent specificity of 0.994 (IC: 0.965-1). CONCLUSIONS: Molecular techniques seem to be a useful accurate diagnostic tool in screening for carriage of CPE in contact patients around a fortuitous discovery of a non-isolated hospitalized carrier patient.