EUCAST rapid antimicrobial susceptibility testing (RAST): analytical performance and impact on patient management

2021 ◽  
Author(s):  
Benjamin Berinson ◽  
Flaminia Olearo ◽  
Anna Both ◽  
Nicole Brossmann ◽  
Martin Christner ◽  
...  
Keyword(s):  
Antimicrobial Susceptibility ◽  
Clinical Management ◽  
Patient Management ◽  
Susceptibility Testing ◽  
Real Life ◽  
Antimicrobial Susceptibility Testing ◽  
Susceptibility Data ◽  
Resistant Species ◽  
Acinetobacter Baumannii Complex ◽  
Phenotypic Susceptibility

Abstract Background The emergence of antibiotic-resistant species calls for fast and reliable phenotypic susceptibility testing to adapt clinical management as fast as possible. Objectives We assessed the real-life performance of EUCAST rapid antimicrobial susceptibility testing (RAST) and analysed its impact on patient management. Methods RAST was performed on clinical blood cultures containing Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa or Acinetobacter baumannii complex. Categorical agreement with VITEK2 was analysed. A pre-post quasi-experimental observational study was designed to compare antibiotic treatment in sepsis patients in the RAST patient group (n = 51) and a historical control cohort (n = 54). Results In total, 436 isolates, corresponding to 2314 disc diameters, were measured; 18.4% of these measurements were in the area of technical uncertainty. For the 81.6% categorical results, which could be compared, 94.7% were in agreement, whereas 5.3% of the results were not. In the RAST group, optimal therapy was initiated on the same day as blood culture positivity, while this was the case in the historical group after 24 h. In six cases, RAST allowed for rapid antibiotic escalation. The 30 day mortality rate was lower in the RAST group, although this was not statistically significant. Conclusions RAST provides a reliable tool to improve clinical management of sepsis patients by providing rapid phenotypic susceptibility data. While not necessarily being an instrument for de-escalation, especially in areas of low prevalence, early detection allows for timely coverage of resistant isolates. Thus, RAST significantly adds to successful antibiotic stewardship programmes.

scholarly journals The Slow March toward Rapid Phenotypic Antimicrobial Susceptibility Testing: Are We There Yet?

2018 ◽  
Vol 56 (4) ◽  
pp. e01999-17 ◽  
Author(s):  
Christopher D. Doern
Keyword(s):  
Antimicrobial Susceptibility ◽  
Rapid Growth ◽  
Gold Standard ◽  
Historical Perspective ◽  
Susceptibility Testing ◽  
Turnaround Time ◽  
Antimicrobial Susceptibility Testing ◽  
Standard Methods ◽  
Phenotypic Susceptibility ◽  
Made In

ABSTRACT Antimicrobial susceptibility testing (AST) provides critical information for the management of patients with infections. The gold standard methods for assessing organism susceptibility are still based on growth and require incubation over relatively long periods of time. Until now, little progress has been made in developing rapid, growth-based, phenotypic AST systems. This commentary puts the recently FDA-cleared Accelerate PhenoTest (P. Pancholi et al., J Clin Microbiol 56:e01329-17, 2018, https://doi.org/10.1128/JCM.01329-17) in context by providing a historical perspective on attempts to accelerate phenotypic susceptibility results. In addition, some promising new innovations that promise to shorten the turnaround time for phenotypic AST will be briefly reviewed.

scholarly journals Real Life Clinical Impact of Antimicrobial Stewardship Actions on the Blood Culture Workflow from a Microbiology Laboratory

Antibiotics ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 1511
Author(s):  
Jose Maria López-Pintor ◽  
Javier Sánchez-López ◽  
Carolina Navarro-San Francisco ◽  
Ana Maria Sánchez-Díaz ◽  
Elena Loza ◽  
...  
Keyword(s):  
Blood Culture ◽  
Antimicrobial Susceptibility ◽  
Susceptibility Testing ◽  
Intervention Group ◽  
Real Life ◽  
Antimicrobial Susceptibility Testing ◽  
Control Group ◽  
Correct Treatment ◽  
Significant Difference ◽  
The Impact

Background: Accelerating the diagnosis of bacteremia is one of the biggest challenges in clinical microbiology departments. The fast establishment of a correct treatment is determinant on bacteremic patients’ outcomes. Our objective was to evaluate the impact of antimicrobial therapy and clinical outcomes of a rapid blood culture workflow protocol in positive blood cultures with Gram-negative bacilli (GNB). Methods: A quasi-experimental before–after study was performed with two groups: (i) control group (conventional work-protocol) and (ii) intervention group (rapid workflow-protocol: rapid identification by Matrix-Assisted Laser Desorption/Ionization-Time-Of-Flight (MALDI-TOF) and antimicrobial susceptibility testing (AST) from bacterial pellet without overnight incubation). Patients were divided into different categories according to the type of intervention over treatment. Outcomes were compared between both groups. Results: A total of 313 patients with GNB-bacteremia were included: 125 patients in the control group and 188 in the intervention. The time from positive blood culture to intervention on antibiotic treatment decreased from 2.0 days in the control group to 1.0 in the intervention group (p < 0.001). On the maintenance of correct empirical treatment, the control group reported 2.0 median days until the clinical decision, while in the intervention group was 1.0 (p < 0.001). In the case of treatment de-escalation, a significant difference between both groups (4.0 vs. 2.0, p < 0.001) was found. A decreasing trend on the change from inappropriate treatments to appropriate ones was observed: 3.5 vs. 1.5; p = 0.12. No significant differences were found between both groups on 7-days mortality or on readmissions in the first 30-days. Conclusions: Routine implementation of a rapid workflow protocol anticipates the report of antimicrobial susceptibility testing results in patients with GNB-bacteremia, decreasing the time to effective and optimal antibiotic therapy.

scholarly journals Species and antimicrobial susceptibility testing of coagulase-negative staphylococci in periprosthetic joint infections

2018 ◽  
Vol 146 (14) ◽  
pp. 1771-1776 ◽  
Author(s):  
J. Lourtet-Hascoët ◽  
M. P. Félicé ◽  
A. Bicart-See ◽  
A. Bouige ◽  
G. Giordano ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Antimicrobial Susceptibility ◽  
Susceptibility Testing ◽  
Antimicrobial Susceptibility Testing ◽  
Coagulase Negative Staphylococci ◽  
Resistant Species ◽  
Joint Infections ◽  
Multicentre Retrospective Study

AbstractThe objective was to evaluate the distribution of coagulase-negative staphylococci (CNS) involved in periprosthetic-joint infections (PJIs) and to describe their susceptibility profile to antibiotics. We conducted a multicentre retrospective study in France, including 215 CNS PJIs between 2011 and 2015. CNS PJIs involved knees in 54% of the cases, hips in 39%, other sites in 7%. The distribution of the 215 strains was:Staphylococcus epidermidis129 (60%),Staphylococcus capitis24 (11%),Staphylococcus lugdunensis21 (10%),Staphylococcus warneri8 (4%),Staphylococcus hominis7 (3%),Staphylococcus haemolyticus7 (3%). More than half of the strains (52.1%) were resistant to methicillin, 40.9% to ofloxacin, 20% to rifampicin. The species most resistant to antibiotics wereS.hominis,S. haemolyticus,S. epidermidis,with 69.7% of the strains resistant to methicillin and 30% simultaneously resistant to clindamycin, cotrimoxazole, ofloxacin and rifampicin. No strain was resistant to linezolid or daptomycin. In this study on CNS involved in PJIs, resistance to methicillin is greater than 50%.S. epidermidisis the most frequent and resistant species to antibiotics. Emerging species suchS. lugdunensis,S. capitisandStaphylococcus capraeexhibit profiles more sensitive to antibiotics. The antibiotics most often activein vitroare linezolid and daptomycin.

scholarly journals Implementation of rapid antimicrobial susceptibility testing combined with routine infectious disease bedside consultation in clinical practice (RAST-ID): a prospective single-centre study

2020 ◽  
Vol 76 (1) ◽  
pp. 233-238
Author(s):  
Thomas Valentin ◽  
Elisabeth Koenig ◽  
Juergen Prattes ◽  
Stefanie Wunsch ◽  
Tobias Loizenbaur ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Antimicrobial Susceptibility ◽  
Susceptibility Testing ◽  
Real Life ◽  
Antimicrobial Treatment ◽  
Antimicrobial Susceptibility Testing ◽  
Resistance Testing ◽  
Single Centre ◽  
Life Impact ◽  
Clinical Consequences

Abstract Objectives Recently, EUCAST released guidelines for rapid antimicrobial susceptibility testing (RAST) directly from positive blood culture bottles. The aim of our prospective single-centre clinical study was to assess the proportion of readable results and errors compared with routine antimicrobial susceptibility testing and the clinical consequences drawn by infectious disease (ID) physicians from RAST results during same-day bedside consultation. Methods All positive blood cultures suitable for RAST from January to December 2019 were included and RAST results at 4 and 6 h compared with standard disc diffusion. The real-life impact of RAST on clinical decisions was assessed during same-day ID bedside consultation. Results The proportion of readable RAST results was significantly higher after 6 h of incubation compared with after 4 h (881/930 versus 642/847; P &lt; 0.0001). Major and very major errors were rare (17/642 after 4 h and 12/881 after 6 h; P = 0.087). ID consultation was performed in 134 patients after the RAST result. Antimicrobial treatment was changed in 73 patients and 84 additional measures (i.e. imaging studies, surgery, additional resistance testing) were ordered in 62 patients. Conclusions RAST according to EUCAST methods was easy to implement with a low number of major and very major errors after 6 h of incubation. ID physicians performing bedside consultations frequently used this information to change antimicrobial treatment and recommended additional measures.

Clinical and Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing Position Statements on Polymyxin B and Colistin Clinical Breakpoints

2020 ◽  
Author(s):  
Michael J Satlin ◽  
James S Lewis ◽  
Melvin P Weinstein ◽  
Jean Patel ◽  
Romney M Humphries ◽  
...  
Keyword(s):  
Antimicrobial Susceptibility ◽  
Susceptibility Testing ◽  
Polymyxin B ◽  
Antimicrobial Susceptibility Testing ◽  
In Vitro Susceptibility ◽  
Susceptibility Data ◽  
European Committee ◽  
Clinical Breakpoints ◽  
State Concentration

Abstract Recent data on polymyxin pharmacokinetics, pharmacodynamics, toxicity, and clinical outcomes suggest these agents have limited clinical utility. Pharmacokinetics-pharmacodynamics data show a steady-state concentration of 2 μg/mL is required for killing bacteria with colistin minimum inhibitory concentrations of 2 μg/mL. Less than 50% of patients with normal renal function achieve this exposure, and it is associated with high risk of nephrotoxicity. This exposure does not achieve bacterial stasis in pneumonia models. Randomized and observational studies consistently demonstrate increased mortality for polymyxins compared with alternative agents. The Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST) are 2 global organizations that establish interpretive criteria for in vitro susceptibility data. CLSI has recently taken the step to eliminate the “susceptible” interpretive category for the polymyxins, whereas EUCAST maintains this interpretive category. This viewpoint describes the opinions of these organizations and the data that were used to inform their perspectives.

Effect on Physician Prescribing Practices of Changing from a Qualitative to a Quantitative Antimicrobial Susceptibility Test Reporting System

1983 ◽  
Vol 17 (7-8) ◽  
pp. 552-555 ◽  
Author(s):  
Thomas T. Ward ◽  
Michael J. Regner ◽  
Karen L. Collell ◽  
Ronald R. Brown ◽  
David L. Sewell
Keyword(s):  
Antimicrobial Susceptibility ◽  
Antimicrobial Agents ◽  
Susceptibility Testing ◽  
Antimicrobial Susceptibility Testing ◽  
Susceptibility Test ◽  
Disc Diffusion ◽  
Prescribing Practices ◽  
Susceptibility Data ◽  
Before And After ◽  
Physician Prescribing

The use of disc diffusion susceptibility testing has been criticized because it often fails to take into consideration achievable levels of antimicrobial agents at the actual sites of infection. An increasing number of hospitals are converting from disc diffusion antimicrobial susceptibility testing to more quantitative susceptibility testing techniques. Advocates of these latter techniques have suggested that providing information beyond sensitive, intermediate, and resistant reporting will emphasize, more effectively, the importance of considering achievable antibiotic concentrations at the site of infection, when choosing an antimicrobial agent. This study examined whether providing more quantitative susceptibility test reports would affect physicians' antimicrobial prescribing practices. Results obtained on the preeducation and posteducation questionnaires indicate success in improving the collective knowledge of physicians. In retrospective audits of the appropriateness of antimicrobial use, both before and after the educational program, physician usage of antimicrobial agents was categorized as inappropriate in more than ⅔ of the cases. The major reason for the negative outcome in this study is probably due to physicians' indifference to the results of urine culture and susceptibility test data. A change was made in antimicrobial therapy after return of the susceptibility report less than 20 percent of the time. As more laboratories convert to quantitative antimicrobial susceptibility testing, there will be a need for a closer liaison among physicians, clinical pharmacists, microbiologists, and infectious disease specialists, to ensure optimum utilization of the additional susceptibility data provided.

scholarly journals In Vitro Activities of Various Antifungal Drugs against Aspergillus terreus: Global Assessment Using the Methodology of the European Committee on Antimicrobial Susceptibility Testing

2008 ◽  
Vol 53 (2) ◽  
pp. 794-795 ◽  
Author(s):  
Cornelia Lass-Flörl ◽  
Ana Alastruey-Izquierdo ◽  
Manuel Cuenca-Estrella ◽  
Susanne Perkhofer ◽  
Juan Luis Rodriguez-Tudela
Keyword(s):  
Antimicrobial Susceptibility ◽  
Aspergillus Terreus ◽  
Susceptibility Testing ◽  
Antimicrobial Susceptibility Testing ◽  
Antifungal Drugs ◽  
In Vitro Susceptibility ◽  
Susceptibility Data ◽  
European Committee ◽  
Susceptibility Patterns

ABSTRACT This study presents in vitro susceptibility data for clinical (n = 48) and environmental (n = 31) isolates of Aspergillus terreus against nine antifungal agents. The methodology of the European Committee on Antimicrobial Susceptibility Testing was applied. Posaconazole and anidulafungin had the lowest and amphotericin B the highest MICs. No differences in susceptibility patterns were observed between environmental and clinical isolates.

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