Repository logo

Rapid Detection of Antimicrobial Resistance Genes in Critically Ill Children Using a Custom TaqMan Array Card

Published version

Repository DOI

Change log


Curran, Martin D. 
Gouliouris, Theodore 
Conway Morris, Andrew  ORCID logo
Bousfield, Rachel 


Bacteria are identified in only 22% of critically ill children with respiratory infections treated with antimicrobial therapy. Once an organism is isolated, antimicrobial susceptibility results (phenotypic testing) can take another day. A rapid diagnostic test identifying antimicrobial resistance (AMR) genes could help clinicians make earlier, informed antimicrobial decisions. Here we aimed to validate a custom AMR gene TaqMan Array Card (AMR-TAC) for the first time and assess its feasibility as a screening tool in critically ill children. An AMR-TAC was developed using a combination of commercial and bespoke targets capable of detecting 23 AMR genes. This was validated using isolates with known phenotypic resistance. The card was then tested on lower respiratory tract and faecal samples obtained from mechanically ventilated children in a single-centre observational study of respiratory infection. There were 82 children with samples available, with a median age of 1.2 years. Major comorbidity was present in 29 (35%) children. A bacterial respiratory pathogen was identified in 13/82 (16%) of children, of which 4/13 (31%) had phenotypic AMR. One AMR gene was detected in 49/82 (60%), and multiple AMR genes were detected in 14/82 (17%) children. Most AMR gene detections were not associated with the identification of phenotypic AMR. AMR genes are commonly detected in samples collected from mechanically ventilated children with suspected respiratory infections. AMR-TAC may have a role as an adjunct test in selected children in whom there is a high suspicion of antimicrobial treatment failure.


Peer reviewed: True

Acknowledgements: We express our deepest thanks to the families who volunteered to participate in the study. This study could not have taken place without the support of all the Paediatric Intensive Care Unit staff and Addenbrooke’s Hospital, Cambridge. We also wish to acknowledge physiotherapists Helen Starace and Colin Hamilton for assisting with developing the mini-BAL sampling procedure and scientist Claire Jenkins for assisting with sample workflow.

Publication status: Published

Funder: NIHR Cambridge Biomedical Research Centre


rapid diagnostic tests, respiratory system, antimicrobial resistance, critical illness, antibacterial agents, child

Journal Title


Conference Name

Journal ISSN


Volume Title



Addenbrooke’s Charitable Trust, Cambridge University Hospitals (900240)
Gates Cambridge Trust (OPP1144)
Wellcome Trust (215515)
Wellcome Trust Clinical Research Career Development Fellowship (WT 2055214/Z/16/Z)
MRC Clinician Scientist Fellowship (MR/V006118/1)
Action Medical Research (GN2751, GN2903)
Bill & Melinda Gates Foundation (OPP1144)