The continued increase in the incidence of CPEs is creating workload issues for reference laboratories, but the diagnostics industry is responding with simple, more affordable identification methods that can be adopted by front-line microbiology laboratories, speeding confirmation and reporting.
In 2006, four carbapenemases were referred to Public Health England (PHE) Colindale for identification; in 2015 a total of 1893 carbapenemases were referred to PHE Colindale (now AMRHAI) for identification. When this increase in workload at AMRHAI is added to significant increases in other aspects of combating the rise in antimicrobial resistance (AMR), it is not surprising that there is pressure to encourage first-line laboratories to consider increasing their own in-house capability.
The recently published issue of PHE AMRHAI News makes it clear that identification of the ‘Big Four’ carbapenemases should be done in front-line microbiology laboratories and not referred to AMRHAI, except under circumstances outlined in the newsletter. To encourage this change (or discourage referrals), charges for some testing will be implemented from 1 April 2018.
AMRHAI News makes similar comments about colistin minimum inhibitory concentration (MIC) testing, pointing out that commercial products are available for carbapenemase identification and colistin MIC by broth microdilution. Both carbapenemase identification and colistin MIC products should be more widely adopted.
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