Comparative Diagnostic Accuracy of Xpert Carba-R and NG-Test CARBA-5 for Carbapenemase Detection in Carbapenem-Resistant Enterobacterales: A Systematic Review and Meta-Analysis
In brief
Xpert Carba-R detects carbapenemases with 99.9% sensitivity, slightly ahead of CARBA-5
In a 20-study meta-analysis, Xpert Carba-R had 99.9% sensitivity and 98.4% specificity, compared with 98.9% and 96.3% for NG-Test CARBA-5. The accuracy gap was small: Xpert takes 50 to 60 minutes and needs specialized equipment, while CARBA-5 gives results in 15 minutes; local needs and emerging variants may guide test choice.
- Journal
- Journal of global antimicrobial resistance (Q2)
- Published
- 14 October 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Ahmed J Alzahrani
- PMID
- 42874916
- DOI
- 10.1016/j.jgar.2026.10.002
Why clinicians should know about it
- Picked for Microbiology (medical) (top studies of the week, 18 October 2026): Pooled sensitivity 99.9%, specificity 98.4% for carbapenemase detection
Abstract
BACKGROUND: Carbapenem-resistant Enterobacterales (CRE) pose a critical public health threat, with carbapenemase-producing organisms driving treatment failures and nosocomial outbreaks. Xpert Carba-R (PCR-based) and NG-Test CARBA-5 (immunochromatographic) are widely adopted rapid diagnostics, yet no meta-analysis has compared their performance. METHODS: We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines, searching PubMed, EMBASE, and Cochrane Library (January 2016-December 2024). Two independent reviewers screened studies, extracted data, and assessed quality using QUADAS-2. Pooled sensitivity and specificity were estimated using bivariate random-effects models with SROC curves. Publication bias was evaluated using Deeks' funnel plot and Egger's regression. RESULTS: Twenty studies met inclusion criteria: 12 evaluating Xpert Carba-R (4,735 samples) and 8 evaluating NG-Test CARBA-5 (3,344 samples); 88% were rated at low risk of bias. Xpert Carba-R demonstrated pooled sensitivity of 99.9% (95% CI: 99.8-100.0%), specificity of 98.4% (95% CI: 97.9-98.9%), AUC of 0.998, and low heterogeneity (I²=15%). NG-Test CARBA-5 showed sensitivity of 98.9% (95% CI: 98.4-99.4%), specificity of 96.3% (95% CI: 95.4-97.2%), AUC of 0.987, and moderate heterogeneity (I²=24%). Xpert Carba-R demonstrated statistically higher diagnostic accuracy (p<0.001), though absolute differences were small (1-2 percentage points). No publication bias was detected (Egger's p=0.18 and p=0.24, respectively). CONCLUSIONS: Both platforms demonstrate excellent carbapenemase detection accuracy. Xpert Carba-R offers marginally superior performance but requires 50-60 minutes and specialized equipment; NG-Test CARBA-5 delivers results in 15 minutes with minimal infrastructure. Platform selection should integrate local epidemiology, carbapenemase subtypes, and cost. Emerging KPC-2-derived variants with altered epitopes may reduce immunochromatographic accuracy, warranting molecular confirmation in high-risk settings.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.