scholarly journals Evaluation of the ePlex Blood Culture Identification Panels for Detection of Pathogens in Bloodstream Infections

2018 ◽  
Vol 57 (2) ◽  
Author(s):  
Te-Din Huang ◽  
Ekaterina Melnik ◽  
Pierre Bogaerts ◽  
Stephanie Evrard ◽  
Youri Glupczynski
Keyword(s):  
Blood Culture ◽  
Positive Blood Culture ◽  
Fungal Pathogens ◽  
Bacterial Resistance ◽  
Bloodstream Infections ◽  
Rapid Identification ◽  
Added Value ◽  
Gram Positive ◽  
Gram Negative ◽  
Culture Identification

ABSTRACT Rapid identification and susceptibility testing results are of importance for the early appropriate therapy of bloodstream infections. The ePlex (GenMark Diagnostics) blood culture identification (BCID) panels are fully automated PCR-based assays designed to identify Gram-positive and Gram-negative bacteria, fungi, and bacterial resistance genes within 1.5 h from positive blood culture. Consecutive non-duplicate positive blood culture episodes were tested by the ePlex system prospectively. The choice of panel(s) (Gram-positive, Gram-negative, and/or fungal pathogens) was defined by Gram-stained microscopy of blood culture-positive bottles (BacT/Alert; bioMérieux). Results with the ePlex panels were compared to the identification results obtained by standard culture-based workflow. In total, 216 positive blood culture episodes were evaluable, yielding 263 identification results. The sensitivity/positive predictive value for detection by the ePlex panels of targeted cultured isolates were 97% and 99% for the Gram-positive panel and 99% and 96% for the Gram-negative panel, resulting in overall agreement rates of 96% and 94% for the Gram-positive and Gram-negative panel, respectively. All 26 samples with targeted resistance results were correctly detected by the ePlex panels. The ePlex panels provided highly accurate results and proved to be an excellent diagnostic tool for the rapid identification of pathogens causing bloodstream infections. The short time to results may be of added value for optimizing the clinical management of patients with sepsis.

scholarly journals 2174. Comparison of the Verigene® and the ePlex® Blood Culture Identification Panels for Gram-Positive and Gram-Negative Bloodstream Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S738-S738
Author(s):  
J Kristie Johnson ◽  
Zegbeh Kpadeh-Rogers ◽  
Gwen Paszkiewicz ◽  
Kimberly C Claeys
Keyword(s):  
Blood Culture ◽  
Positive Blood Culture ◽  
Medical Center ◽  
Reference Method ◽  
Bloodstream Infections ◽  
Gram Positive ◽  
Gram Negative ◽  
E Coli ◽  
Culture Identification ◽  
Positive Agreement

Abstract Background Rapid diagnostic testing for the management of bloodstream infections has become paramount to improving patient outcomes. The primary objective of this study was to assess the differences between 2 FDA approved instruments. Methods Retrospective study from August 2018 to April 2019 at the University of Maryland Medical Center. One positive blood culture from each patient was tested using the Verigene® blood culture Gram-positive (BC-GP) or Gram-negative (BC-GN) panels based on the Gram stain and then analyzed using the ePlex® Blood Culture Identification (BCID) Gram-positive (BCID-GP) or Gram-negative (BCID-GN) research-use-only panels and compared with culture results. Results The study consisted of 140 positive blood culture bottles. 14 bottles were excluded for a total of 55 GN and 71 GP bottles. Of the 55 GN bottles, 3 had 2 GN rods for a total of 58 GNRs. BCID-GN missed 1 P. aeruginosa, 2 S. maltophilia, and 1 E. coli for a 93% (53/57) positive agreement. The BCID-GN does not detect A. junii and therefore it was excluded. BC-GN did not identify 1 K. pneumoniae with a 98% (47/48) positive agreement. BC-GN does not include the detection of S. maltophilia (4), Serratia (4), Morganella (1), and B. fragilis (1)and these were excluded in the BC-GN analysis. CTX-M was the only resistant marker detected and both panels identified it correctly. 5 samples using the BCID-GN also detected Pan Gram-Positive; 3 grew GP organisms, the other 2 only grew E. coli. Of the 71 GP bottles, 3 had two GP bacteria totaling 74 GPs. BCID-GP missed 1 S. aureus, 1 invalid, and called an E. faecalis that was not identified by the reference method for a 99% (72/73) positive agreement. BC-GP does not detect Micrococcus (6) or E. gallinarum (1) and missed 1 S. mitis/oralis for a 99% (66/67) positive agreement. 18 samples were positive for mecA detected by both panels. 4 samples were vanA/B positive; 1 by BCID-GP was sensitive to vancomycin and not detected by BC-GP. BCID-GP detected 1 sample as Pan Gram-negative although a GNR was not detected. Conclusion BothVerigene® and ePlex® GP and GN panels have a high percent positive agreement. Laboratories should take into consideration the epidemiology of their bloodstream infections when deciding on panels for the rapid detection of bloodstream infections. Disclosures All authors: No reported disclosures.

scholarly journals A comparative study of bloodstream infections in acute myeloid leukemia according to different phases of treatment: Can we predict the organism?

2017 ◽  
Vol 06 (03) ◽  
pp. 132-133
Author(s):  
Preetam Kalaskar ◽  
Asha Anand ◽  
Harsha Panchal ◽  
Apurva Patel ◽  
Sonia Parikh ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Blood Culture ◽  
Myeloid Leukemia ◽  
Bloodstream Infections ◽  
Blood Cultures ◽  
Consolidation Therapy ◽  
Gram Positive ◽  
Gram Negative ◽  
Culture Positive ◽  
Acute Myeloid

Abstract Introduction: The treatment of acute myeloid leukemia (AML) consists of induction therapy with anthracyclines and cytarabine followed by two to four cycles of consolidation therapy with high-dose cytarabine after achieving remission. There have been very few studies comparing infections during induction and consolidation. We have analyzed blood cultures of patients with AML during episodes of fever occurring during induction and consolidation, for comparing the bloodstream infections in both the phases. Materials and Methods: Blood cultures of patients during febrile episodes were collected from central venous catheters and peripheral blood, both during induction and consolidation therapy of AML. Results: The study population included 52 AML patients. During induction, there were 52 episodes of fever and 25 (48%) blood cultures were positive, 15 of these blood cultures reported Gram-negative organisms, 9 reported Gram-positive organisms and 1 as yeast. During consolidation, 47 episodes of fever were recorded and blood cultures were positive in 12, of which 7 were Gram-negative, 5 were Gram-positive. Conclusion: The incidence of blood culture positive infections during therapy of AML at our center was higher. The predominant organism isolated was Gram-negative both during induction and consolidation. The incidence of blood culture positive infections had decreased by 50% during consolidation.

scholarly journals Evaluation of Verigene Blood Culture Test Systems for Rapid Identification of Positive Blood Cultures

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Jae-Seok Kim ◽  
Go-Eun Kang ◽  
Han-Sung Kim ◽  
Hyun Soo Kim ◽  
Wonkeun Song ◽  
...  
Keyword(s):  
Blood Culture ◽  
Resistance Genes ◽  
Rapid Identification ◽  
Blood Cultures ◽  
Gram Negative Bacteria ◽  
Gram Positive ◽  
Single Strain ◽  
Gram Negative ◽  
Gram Positive Bacteria ◽  
Susceptibility Tests

The performance of molecular tests using the Verigene Gram-Positive and Gram-Negative Blood Culture nucleic acid tests (BC-GP and BC-GN, resp.; Naosphere, Northbrook, IL, USA) was evaluated for the identification of microorganisms detected from blood cultures. Ninety-nine blood cultures containing Gram-positive bacteria and 150 containing Gram-negative bacteria were analyzed using the BC-GP and BC-GN assays, respectively. Blood cultures were performed using the Bactec blood culture system (BD Diagnostic Systems, Franklin Lakes, NJ, USA) and conventional identification and antibiotic-susceptibility tests were performed using a MicroScan system (Siemens, West Sacramento, CA, USA). When a single strain of bacteria was isolated from the blood culture, Verigene assays correctly identified 97.9% (94/96) of Gram-positive bacteria and 93.8% (137/146) of Gram-negative bacteria. Resistance genesmecAandvanAwere correctly detected by the BC-GP assay, while the extended-spectrumβ-lactamase CTX-M and the carbapenemase OXA resistance gene were detected from 30 cases cultures by the BC-GN assay. The BC-GP and BC-GN assays showed high agreement with conventional identification and susceptibility tests. These tests are useful for rapid identification of microorganisms and the detection of clinically important resistance genes from positive Bactec blood cultures.

What are the critical steps in processing blood cultures? A prospective audit evaluating current practice of reporting blood cultures in a centralised laboratory serving secondary care hospitals

2016 ◽  
Vol 70 (4) ◽  
pp. 361-366 ◽  
Author(s):  
Manjula Meda ◽  
James Clayton ◽  
Reela Varghese ◽  
Jayakeerthi Rangaiah ◽  
Clive Grundy ◽  
...  
Keyword(s):  
Blood Culture ◽  
Secondary Care ◽  
Rapid Identification ◽  
Antimicrobial Treatment ◽  
Blood Cultures ◽  
National Standards ◽  
Gram Stain ◽  
Gram Positive ◽  
Gram Negative ◽  
Common Intervention

AimsTo assess current procedures of processing positive blood cultures against national standards with an aim to evaluate its clinical impact and to determine the utility of currently available rapid identification and susceptibility tests in processing of blood cultures.MethodsBlood cultures from three secondary care hospitals, processed at a centralised laboratory, were prospectively audited. Data regarding processing times, communication with prescribers, changes to patient management and mortality within 30 days of a significant blood culture were collected in a preplanned pro forma for a 4-week period.ResultsOf 2206 blood cultures, 211 positive blood cultures flagged positive. Sixty-nine (3.1%) of all cultures were considered to be contaminated. Fifty per cent of blood cultures that flagged positive had a Gram stain reported within 2 hours. Two (0.99%) patients with a significant bacteraemia had escalation of antimicrobial treatment at the point of reporting the Gram stain that was subsequently deemed necessary once sensitivity results were known. Most common intervention was de-escalation of therapy for Gram-positive organisms at the point of availability of pathogen identification (25.6% in Gram positive vs 10% in Gram negative; p=0.012). For Gram-negative organisms, the most common intervention was de-escalation of therapy at the point of availability of sensitivity results (43% in Gram negatives vs 17.9% in Gram positive; p=0.0097). Overall mortality within 30 days of a positive blood culture was 10.9% (23/211). Antibiotic resistance may have contributed to mortality in four of these patients (three Gram negative and one Gram positive).ConclusionGram stain result had the least impact on antibiotic treatment interventions (escalation or de-escalation). Tests that improve identification time for Gram-positive pathogens and sensitivity time for Gram-negative pathogens had the greatest impact in making significant changes to antimicrobial treatment.

scholarly journals 300. Pediatric Center Evaluation of the BioFire® Blood Culture Identification 2 Panel Versus the Original BioFire®FilmArray® Blood Culture Identification Panel for the Detection of Microorganisms and Resistance Markers in Positive Blood Cultures

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S148-S149
Author(s):  
Kristina B Pierce ◽  
Rebecca Barr ◽  
Aubrie Hopper ◽  
Charlotte Bowerbank ◽  
Anne Shaw ◽  
...  
Keyword(s):  
Blood Culture ◽  
False Negative ◽  
Bloodstream Infections ◽  
Turnaround Time ◽  
Rapid Identification ◽  
Blood Cultures ◽  
Species Level ◽  
Genus Level ◽  
Antimicrobial Resistance Genes ◽  
Culture Identification

Abstract Background Studies show a rising annual incidence of severe sepsis, with bloodstream infections continuing to impact children. Rapid identification of causative agents and timely administration of targeted therapy can positively impact patient outcomes and improve antibiotic stewardship. The BioFire® Blood Culture Identification 2 (BCID2) Panel (BioFire Diagnostics, LLC), an updated version of the FDA-cleared BioFire® FilmArray® Blood Culture Identification (BCID) Panel, designed for use on positive blood cultures (PBCs), assesses 43 analytes, including 17 novel analytes (8 bacterial, 2 fungal, and 7 antimicrobial resistance genes), with a similar turnaround time. Methods De-identified residual PBCs for which clinician-ordered testing per standard of care (SoC) had been performed were enrolled and tested with an Investigation-Use-Only version of the BCID2 Panel. Only one positive bottle per patient was enrolled. Results of BCID2 and BCID were compared. Results 116 PBCs (48 aerobic and 68 anaerobic) were evaluated using the BioFire BCID2 Panel and results were compared to the BioFire BCID Panel. Of the 116 cases, 103 were positive on both the BioFire BCID2 Panel and the BioFire BCID Panel. Ten cases were negative on both tests. While the two panels showed 97% agreement, three cases were discrepant. Using culture (SoC) as the tiebreaker, two cases were false positive and one case was false negative on the BioFire BCID Panel. In all three cases, results from culture and the BioFire BCID2 Panel were in agreement. As expected, no organisms were detected on the BioFire BCID2 Panel in PBCs from 10% (12/116) of PBC bottles where culture identified only organisms that are not part of the panel menu. With the BioFire BCID2 Panel’s expanded platform, two cases identified as Enterobacteriaceae on the BioFire BCID Panel were identified to the genus level on the BioFire BCID2 Panel; 31 cases detected to the genus level on the BioFire BCID Panel were identified to the species level on the BioFire BCID2 Panel. Conclusion Overall, the BioFire BCID2 Panel performed well against the BioFire BCID Panel for identification of bloodstream pathogens and provided additional discrimination of some pathogens to the genus or species level. Data presented are from assays that have not been cleared or approved for diagnostic use. Disclosures All Authors: No reported disclosures

scholarly journals 285. Evaluation of the ePlex® Blood Culture Identification (BCID) Panels for Gram-positive/Gram-negative bacteria and yeasts

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S143-S143
Author(s):  
Kimberle Chapin ◽  
Giannoula Tansarli
Keyword(s):  
Blood Culture ◽  
Gram Positive ◽  
Gram Negative ◽  
Soc Testing ◽  
Percent Agreement ◽  
Culture Identification ◽  
Reduced Time ◽  
Gram Positive Cocci ◽  
Pna Fish ◽  
Vitek Ms

Abstract Background Multiple methods used for blood culture identification create inconsistent to reporting of critical results. Study aim was to evaluate performance characteristics of the ePlex BCID panels compared to current standard of care (SOC) methods used in our lab. Methods Identification sensitivity and specificity were assessed across all targets detected by the ePlex as well as time to final identification (from time of bottle positive Gram stain) between ePlex and SOC testing. SOC included Xpert MRSA/SA or latex agglutination for Gram-positive cocci in clusters (GPCC), Vitek MS + Accelerate Pheno for Gram-negative rods (GNRs), serotyping or optochin disk ± Vitek MS for Gram-positive cocci in chains (GPC chains), Vitek MS or Vitek-2 for Gram-positive rods (GPR), and PNA-FISH or Vitek MS for yeasts. Results 313 unique prospective blood culture specimens were tested with ePlex BCID panels during a 3-month period (January-March 2020). The positive percent agreement was 100% for GNR (n= 98), S. aureus (n= 42), coagulase-negative staphylococci (n= 38), Group A Streptococcus (n= 3), Group B Streptococcus (n= 5), S. pneumoniae (n= 10), GPR (n= 21), and yeasts (n= 20). There was 1 false negative, (S.mutans) which should have been detected. The negative percent agreement was 100% across all targets except for 1 false positive Corynebacterium spp. In total, 6.7% of blood cultures had an off-panel organism which ePlex did not detect. The median time to final identification was 3 (2 – 4) hrs. for ePlex and calculated for all other SOC methods. Compared to SOC molecular methods, the ePlex reduced time to identification 0.5 h compared to Xpert MRSA/SA, 6.7 h compared to Accelerate Pheno for GNR (but Accelerate Pheno provides susceptibilities), and 3 h compared to PNA-FISH for yeasts (p< 0.05). ePlex compared to non-molecular techniques (MALDI-TOF), SOC for Streptococcus spp. and Enteroococcus spp., the time to final identification was reduced by 24 – 30 hours (p< 0.05). Workflow chart comparison eplex to SOC Time to results eplex vs SOC Conclusion The ePlex BCID system provided highly accurate identification results for GP and GN bacteria as well as for yeasts. Our evaluation showed that this system significantly reduced time to final identification compared to SOC testing methods. Disclosures Kimberle Chapin, MD, genmark (Scientific Research Study Investigator) Giannoula Tansarli, MD, GenMark (Grant/Research Support)

scholarly journals Evaluation of a new Rapid Antimicrobial Susceptibility system for Gram-negative and Gram-positive bloodstream infections: Speed and accuracy of Alfred 60 AST

2019 ◽  
Author(s):  
Vanesa Anton-Vazquez ◽  
Adjepong Samuel ◽  
Suarez Cristina ◽  
Planche Timothy
Keyword(s):  
Blood Culture ◽  
Patient Care ◽  
Antimicrobial Susceptibility ◽  
Antibiotic Sensitivity ◽  
Positive Culture ◽  
Bloodstream Infections ◽  
Blood Stream ◽  
Gram Positive ◽  
Culture Bottle ◽  
Gram Negative

Abstract Background Blood stream infections (BSIs) are a major cause of morbidity and mortality. The time from taking blood cultures to obtain results of antibiotic sensitivity can be up to five days which impacts patient care. The Alfred 60 AST™ can reduce laboratory time from positive culture bottle to susceptibility results from 16-25 hours to 5-6 hours, transforming patient care. Objective To evaluate the diagnostic accuracy of a rapid antimicrobial susceptibility system, the Alfred 60 AST™, in clinical isolates from patients with BSIs and confirm time to results. Methods 301 Gram-negative and 86 Gram-positive isolates were analysed directly from positive blood culture bottles following Gram staining. Antimicrobial susceptibility results and time-to-results obtained by rapid Alfred 60 AST system and BD Phoenix were compared . Results A total of 2,196 antimicrobial susceptibility test results (AST) were performed: 1,863 Gram-negative and 333 Gram-positive. AST categorical agreement (CA) for Alfred 60 AST™ was 95% (1772/1863) for Gram-negative and 89% (295/333) for Gram-positive isolates. Gram-negative CA: ampicillin 96% (290/301); ciprofloxacin 95% (283/297); ceftriaxone 96% (75/78); meropenem 97% (288/297); piperacillin-tazobactam 95% (280/295); gentamicin 94% (279/297) and amikacin 93% (277/298). The median time to susceptibility results from blood culture flagging positive was 6.3 h vs 20 h (p<0.01) for Alfred system vs BD Phoenix™. Conclusion Alfred 60 AST system greatly reduced time to antimicrobial susceptibility results in Gram-negative and Gram-positive BSIs with good performance and cost, particularly for Gram-negative bacteraemia.

scholarly journals Evaluation of a new Rapid Antimicrobial Susceptibility system for Gram-negative and Gram-positive bloodstream infections: Speed and accuracy of Alfred 60 AST

2019 ◽  
Author(s):  
Vanesa Anton-Vazquez ◽  
Adjepong Samuel ◽  
Suarez Cristina ◽  
Planche Timothy
Keyword(s):  
Blood Culture ◽  
Patient Care ◽  
Antimicrobial Susceptibility ◽  
Antibiotic Sensitivity ◽  
Positive Culture ◽  
Bloodstream Infections ◽  
Rapid Diagnostics ◽  
Gram Positive ◽  
Culture Bottle ◽  
Gram Negative

Abstract Background: Blood stream infections (BSIs) are a major cause of morbidity and mortality. The time from taking blood cultures to obtain results of antibiotic sensitivity can be up to five days which impacts patient care. The Alfred 60 AST™ can reduce laboratory time from positive culture bottle to susceptibility results from 16-25 hours to 5-6 hours, transforming patient care. To evaluate the diagnostic accuracy of a rapid antimicrobial susceptibility system, the Alfred 60 AST™, in clinical isolates from patients with BSIs and confirm time to results. 301 Gram-negative and 86 Gram-positive isolates were analysed directly from positive blood culture bottles following Gram staining. Antimicrobial susceptibility results and time-to-results obtained by rapid Alfred 60 AST system and BD Phoenix were compared . Results: A total of 2,196 antimicrobial susceptibility test results (AST) were performed: 1,863 Gram-negative and 333 Gram-positive. AST categorical agreement (CA) for Alfred 60 AST™ was 95% (1772/1863) for Gram-negative and 89% (295/333) for Gram-positive isolates. Gram-negative CA: ampicillin 96% (290/301); ciprofloxacin 95% (283/297); ceftriaxone 96% (75/78); meropenem 97% (288/297); piperacillin-tazobactam 95% (280/295); gentamicin 94% (279/297) and amikacin 93% (277/298). The median time to susceptibility results from blood culture flagging positive was 6.3 h vs 20 h (p<0.01) for Alfred system vs BD Phoenix™. Conclusion: Alfred 60 AST system greatly reduced time to antimicrobial susceptibility results in Gram-negative and Gram-positive BSIs with good performance and cost, particularly for Gram-negative bacteraemia. Keywords: Rapid diagnostics. Bloodstream infection. Bacteraemia. Antimicrobial susceptibility testing. Gram-negative bacteria. Gram-positive bacteria

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