利用散射光集成收集装置快速测定临床血培养中革兰氏阴性菌的药敏性。

Rapid determination of antimicrobial susceptibility of Gram-negative bacteria from clinical blood cultures using a scattered light-integrated collection device.

机构信息

Division of Infection and Global Health, School of Medicine, University of St Andrews, St Andrews, UK.

Ninewells Hospital and Medical School, Dundee, UK.

出版信息

J Med Microbiol. 2024 Feb;73(2). doi: 10.1099/jmm.0.001812.

DOI:10.1099/jmm.0.001812

PMID:38415707

Abstract

A bloodstream infection (BSI) presents a complex and serious health problem, a problem that is being exacerbated by increasing antimicrobial resistance (AMR). The current turnaround times (TATs) for most antimicrobial susceptibility testing (AST) methods offer results retrospective of treatment decisions, and this limits the impact AST can have on antibiotic prescribing and patient care. Progress must be made towards rapid BSI diagnosis and AST to improve antimicrobial stewardship and reduce preventable deaths from BSIs. To support the successful implementation of rapid AST (rAST) in hospital settings, a rAST method that is affordable, is sustainable and offers comprehensive AMR detection is needed. To evaluate a scattered light-integrated collection (SLIC) device against standard of care (SOC) to determine whether SLIC could accelerate the current TATs with actionable, accurate rAST results for Gram-negative BSIs. Positive blood cultures from a tertiary referral hospital were studied prospectively. Flagged positive Gram-negative blood cultures were confirmed by Gram staining and analysed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, Vitek 2, disc diffusion (ceftriaxone susceptibility only) and an SLIC device. Susceptibility to a panel of five antibiotics, as defined by European Committee on Antimicrobial Susceptibility Testing breakpoints, was examined using SLIC. A total of 505 bacterial-antimicrobial combinations were analysed. A categorical agreement of 95.5 % (482/505) was achieved between SLIC and SOC. The 23 discrepancies that occurred were further investigated by the broth microdilution method, with 10 AST results in agreement with SLIC and 13 in agreement with SOC. The mean time for AST was 10.53±0.46 h and 1.94±0.02 h for Vitek 2 and SLIC, respectively. SLIC saved 23.96±1.47 h from positive blood culture to AST result. SLIC has the capacity to provide accurate AST 1 day earlier from flagged positive blood cultures than SOC. This significant time saving could accelerate time to optimal antimicrobial therapy, improving antimicrobial stewardship and management of BSIs.

摘要

血流感染（BSI）是一个复杂且严重的健康问题，而抗菌药物耐药性（AMR）的不断增加使这一问题更加恶化。目前大多数抗菌药物敏感性检测（AST）方法的周转时间（TAT）提供的结果是回顾性的，无法实时指导治疗决策，这限制了 AST 对抗生素处方和患者治疗的影响。为了改善抗菌药物管理和降低由 BSI 导致的可预防死亡，必须在快速 BSI 诊断和 AST 方面取得进展。为了支持在医院环境中成功实施快速 AST（rAST），需要一种负担得起、可持续且提供全面 AMR 检测的 rAST 方法。为了评估散射光集成收集（SLIC）设备与标准护理（SOC）相比，是否可以通过快速 AST 获得准确的结果来加速当前的 TAT，从而加快革兰氏阴性血流感染的 TAT 速度。前瞻性研究了一家三级转诊医院的阳性血培养物。通过革兰氏染色和基质辅助激光解吸/电离飞行时间质谱、Vitek 2、纸片扩散（仅头孢曲松药敏）和 SLIC 设备对 flagged 阳性革兰氏阴性血培养物进行确认和分析。使用 SLIC 检查了一组五种抗生素的药敏情况，这些抗生素的药敏情况是根据欧洲抗菌药物敏感性试验委员会的折点定义的。分析了总共 505 个细菌-抗生素组合。SLIC 和 SOC 之间达成了 95.5%（482/505）的分类一致性。进一步通过肉汤微量稀释法对发生的 23 个差异进行了研究，10 个 AST 结果与 SLIC 一致，13 个与 SOC 一致。AST 的平均时间分别为 SLIC 10.53±0.46 小时和 Vitek 2 1.94±0.02 小时。与 SOC 相比，SLIC 从 flagged 阳性血培养到 AST 结果的时间节省了 23.96±1.47 小时。SLIC 能够从 flagged 阳性血培养物中比 SOC 提前 1 天提供准确的 AST。这一显著的时间节省可以加快获得最佳抗菌治疗的时间，改善抗菌药物管理和血流感染的管理。