A surge in Carbapenemase-producing Enterobacterales (CPE) instances, nationwide, is a rising concern for healthcare professionals, particularly due to the prevalence of more difficult-to-treat New Delhi metallo-β-lactamase (NDM) strains. These strains have triggered a shift and challenge in the resistance landscape, having a significant impact on last-line antibiotics. Our conversation with Lucas Schulz, PharmD, medical liaison for Cepheid, provides an insightful look at these trends and how rapid diagnostics and stewardship can protect patients while preserving antibiotic effectiveness.
CPE is widely recognized for its antimicrobial resistance, posing significant threats to the healthcare world today. Initially observed on a sporadic basis, these organisms’ broad proliferation across the US is increasingly concerning, with new resistance mechanisms inevitably affecting last-line antibiotic treatments. Schulz draws attention to increasing incidences of NDM-producing strains and the unique clinical and operational challenges that they pose for hospitals relying on effective antibiotics to uphold modern care standards.
Moreover, Schulz underlines the importance of diagnostic-driven antimicrobial stewardship and rapid diagnostics in enhancing patient outcomes, reducing excessive antibiotic exposure, and supporting infection prevention teams to stave off escalated resistance. Hospitals must be aware of certain alarming trends, including significant yearly increases in CE rates, some up to 70%, as recently reported by federal and state authorities. The widespread growth of NDM-producing strains is particularly noteworthy, especially as the epidemiology of CPE is transitioning from KPC-type carbapenemases to NDM-type enzymes, which prove more difficult to treat.
The emergence of resistance to last-resort agents presents dire consequences, with limitations in treatment options forcing reliance on older, more toxic drugs. The inability of some patients to respond to any available therapies further escalates mortality rates. In a broader context, such resistance threatens overall healthcare systems, jeopardizing the safety of routine care as more organisms develop resistance, and escalating costs due to longer hospital stays, increased interventions, and greater resource usage.
On the hopeful side, the rapid and accurate identification of resistant organisms can precipitate improvements in clinical decision-making and preserve antibiotic effectiveness. Rapid diagnostics can lead to earlier identification of the organism and its resistance, helping clinicians choose the right drug quickly, reducing broad-spectrum exposure.
Hospital practitioners across all levels, from infectious disease specialists to infection preventionists, must adopt and operate a stewardship mentality to ensure patients are prescribed the right therapy promptly, optimising outcomes, and reducing resistance and unnecessary antimicrobial pressure. Integrated with antimicrobial stewardship, diagnostic stewardship facilitates the transition from broad empirical treatments to tailored, responsible usage, reaffirming the significance of providing the right therapy at the right time while minimizing the selective pressure driving resistance.