Microbiological characteristics of bloodstream infections in a reference hospital in northeastern Brazil

Abstract Routine blood culture is used for the detection of bloodstream infections by aerobic and anaerobic bacteria and by common pathogenic yeasts. A retrospective study was conducted in a public hospital in Maceió-AL, by collecting data of all medical records with positive blood cultures. Out of the 2,107 blood cultures performed, 17% were positive with Staphylococcus coagulase negative (51.14%), followed by Staphylococcus aureus (11.21%) and Klebsiella pneumoniae (6.32%). Gram-positive bacteria predominated among positive blood cultures, highlighting the group of Staphylococcus coagulase-negative. While Gram-negative bacteria had a higher number of species among positive blood cultures.

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Rapid demonstration of septic or infectious arthritis due to Gram-negative bacteria

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100123830 ◽

1992 ◽

Vol 50 (1) ◽

pp. 686-687

Author(s):

Jacob S. Hanker ◽

Paul R. Gross ◽

Beverly L. Giammara

Keyword(s):

Chronic Arthritis ◽

Blood Cultures ◽

Gram Negative Bacteria ◽

Infectious Arthritis ◽

Bacterial Arthritis ◽

Gram Positive ◽

Gram Negative ◽

Gram Positive Bacteria

Blood cultures are positive in approximately only 50 per cent of the patients with nongonococcal bacterial infectious arthritis and about 20 per cent of those with gonococcal arthritis. But the concept that gram-negative bacteria could be involved even in chronic arthritis is well-supported. Gram stains are more definitive in staphylococcal arthritis caused by gram-positive bacteria than in bacterial arthritis due to gram-negative bacteria. In the latter situation where gram-negative bacilli are the problem, Gram stains are helpful for 50% of the patients; they are only helpful for 25% of the patients, however, where gram-negative gonococci are the problem. In arthritis due to gram-positive Staphylococci. Gramstained smears are positive for 75% of the patients.

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A Review of the Characteristics, Properties and Methods for Quantification of Roxithromycin

Current Pharmaceutical Analysis ◽

10.2174/1573412916999200818103758 ◽

2020 ◽

Vol 16 ◽

Author(s):

Marcus Vinicius Martins Rubatino ◽

Ana Laura Araújo Santos ◽

Rayssa Araújo dos Santos ◽

Magali Benjamim de Araújo

Keyword(s):

Analytical Methods ◽

Environmental Samples ◽

Biological Fluids ◽

Pharmaceutical Preparations ◽

Gram Negative Bacteria ◽

Analytical Technique ◽

Detection Systems ◽

Gram Positive Bacteria ◽

Microbiological Characteristics ◽

Biological And Environmental Samples

: Roxithromycin is one of the most frequently used macrolide antibiotics, a safe group of antimicrobials that acts against Gram-positive bacteria and some Gram-negative bacteria. It is sold in several countries in different dosage forms (tablets and capsules) and strengths (50, 100, 150 and 300 mg). Several analytical methods have been described to quantify roxithromycin in different matrices, such as biological and environmental samples and food. Identifying the main characteristics of the drugs and selecting appropriate analytical methods for their quantification are of paramount importance for understanding the behavior of drugs, metabolites and impurities. This review presents the physicalchemical and microbiological characteristics, properties as well as methods for quantification of roxithromycin in biological fluids, pharmaceutical preparations, food and environmental samples. HPLC coupled to various detection systems is the most used analytical technique to determine roxithromycin in these matrices. Although many analytical methods have been reported for the analysis of this drug, it is very important to include in this context a prospective view, in order to implement new analytical technologies for the quality control of this antimicrobial that contribute to the preservation of economic and environmental impacts.

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Clinical Evaluation of the iCubate iC-GPC Assay for Detection of Gram-Positive Bacteria and Resistance Markers from Positive Blood Cultures

Journal of Clinical Microbiology ◽

10.1128/jcm.00485-18 ◽

2018 ◽

Vol 56 (9) ◽

Cited By ~ 5

Author(s):

Paul A. Granato ◽

Melissa M. Unz ◽

Raymond H. Widen ◽

Suzane Silbert ◽

Stephen Young ◽

...

Keyword(s):

Blood Culture ◽

Staphylococcus Epidermidis ◽

Bloodstream Infections ◽

Blood Cultures ◽

Gram Positive ◽

Content Type ◽

Gram Positive Bacteria ◽

Sequencing Method ◽

Resistance Markers ◽

Gram Positive Cocci

ABSTRACT The iC-GPC Assay (iCubate, Huntsville, AL) is a qualitative multiplex test for the detection of five of the most common Gram-positive bacteria (Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Enterococcus faecalis, and Enterococcus faecium) responsible for bacterial bloodstream infections, performed directly from positive blood cultures. The assay also detects the presence of the mecA, vanA, and vanB resistance determinants. This study comparatively evaluated the performance of the iC-GPC Assay against the Verigene Gram-positive blood culture (BC-GP) assay (Luminex Corp., Austin, TX) for 1,134 patient blood culture specimens positive for Gram-positive cocci. The iC-GPC Assay had an overall percent agreement with the BC-GP assay of 95.5%. Discordant specimens were further analyzed by PCR and a bidirectional sequencing method. The results indicate that the iC-GPC Assay together with the iCubate system is an accurate and reliable tool for the detection of the five most common Gram-positive bacteria and their resistance markers responsible for bloodstream infections.

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Evaluation of Rapid Sepsityper® protocol and specific MBT-Sepsityper module (Bruker Daltonics) for the rapid diagnosis of bacteremia and fungemia by MALDI-TOF-MS

Annals of Clinical Microbiology and Antimicrobials ◽

10.1186/s12941-020-00403-w ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Léa Ponderand ◽

Patricia Pavese ◽

Danièle Maubon ◽

Emmanuelle Giraudon ◽

Thomas Girard ◽

...

Keyword(s):

Formic Acid ◽

Bloodstream Infections ◽

Rapid Identification ◽

Rapid Diagnosis ◽

Blood Cultures ◽

Acid Extraction ◽

Gram Negative Bacteria ◽

Reliable Identification ◽

Extraction Step ◽

Bruker Daltonics

AbstractDuring bloodstream infections, rapid adaptation of empirical treatment according to the microorganism identified is essential to decrease mortality. The aim of the present study was to assess the microbiological performances of a new rapid version of the Sepsityper® kit (Bruker Daltonics) allowing identification of bacteria and yeast by MALDI-TOF mass spectrometry directly from positive blood cultures in 10 min and of the specific MBT-Sepsityper module for spectra analysis, designed to increase identification performance. Identification rates were determined prospectively on 350 bacterial and 29 fungal positive blood cultures, and compared to conventional diagnostic method. Our rapid diagnosis strategy (Rapid Sepsityper® protocol: one spot with and one without formic acid extraction step) combined to MBT-Sepsityper module provided 65.4%, 78.9% and 62% reliable identification to the species level of monomicrobial positive blood cultures growing respectively Gram-positive, Gram-negative bacteria or yeast. Importantly, identification rates of Gram-positive bacteria were higher in anaerobic than in aerobic bottles (77.8% vs 22.2%; p = 0.004), if formic acid extraction step was performed (60.8% vs 39.2%; p = 1.8e−6) and if specific MBT-Sepsityper module was used (76.2% vs 61.9%, p = 0.041) while no significant differences were observed for Gram-negative bacteria. For yeasts identification, formic acid extraction step improved rapid identification rate by 37.9% while the specific MBT-Sepsityper module increased overall performances by 38%, providing up to 89.7% reliable identification if associated with the standard Sepsityper® protocol. These performances, associated with a reduce turnaround time, may help to implement a rapid identification strategy of bloodstream infections in the routine workflow of microbiology laboratories.

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ATG Use Is Associated with Frequent Occurrence of Positive Blood Cultures in Patients in the Early Phase After Hematopoietic Stem Cell Transplantation

Blood ◽

10.1182/blood.v118.21.4564.4564 ◽

2011 ◽

Vol 118 (21) ◽

pp. 4564-4564

Author(s):

Marek Seweryn ◽

Urszula Jarosz ◽

Malgorzata Krawczyk-Kulis ◽

Miroslaw Markiewicz ◽

Grzegorz Helbig ◽

...

Keyword(s):

Stem Cell ◽

Hematopoietic Stem Cell Transplantation ◽

Blood Culture ◽

Stem Cell Transplantation ◽

Positive Blood Culture ◽

Blood Cultures ◽

Gram Negative Bacteria ◽

Hematopoietic Stem ◽

Gram Negative ◽

Gram Positive Bacteria

Abstract Abstract 4564 Background: Infectious complications remain an important cause of morbidity and mortality in the early phase after hematopoietic stem cell transplantation (HSCT). Aim: The aim of this study was to assess the frequency of positive blood cultures and its potential correlation with different studied parameters in large patient population studied in the first 30 days after HSCT. Material and methods: 431 patients at median age of 47 years (range 18–85) transplanted between 2009–2011 for hematological and non-hematological malignancies were included in our analysis. There were 242 males and 189 females. Results: The indications for autologous and allogeneic HSCT were following: AML – 105 (24%), NHL – 86 (20%), MM – 75 (17,5%), HL – 48 (11%), ALL – 40 (9%), MDS – 17 (4%), AA – 15 (3,5%), CML – 12 (2,8%), PNH – 11 (2,6%), connective tissue diseases – 5 (1,2%), CLL – 3 (0,7%) and other – 14 (3,2%). The following transplant procedures were performed: ABCT – 213 (49%), ABMT – 3 (0,7%), alloBCT – 56 (13%), alloBMT – 21 (5%), URDBCT – 87 (20%), URDBMT – 51 (12%). Pre-transplant ATG and anti-CD52 antibody were used in 142 (33%) and 5 (1.2%) patients, respectively. Amongst 431 transplanted patients, 495 blood cultures were collected; range 0–8 (median 1). Eighty seven blood samples were positive (17,6%). The following pathogens were detected: gram-positive bacteria in 48% (n=42), gram-negative bacteria in 38% (n=33), fungi in 1% (n=1) and both G(+) and G(−) bacteria in 13%(n=11). The gram-positive bacteria included: Staphylococcus epidermidis: 21 (50%), Micrococcus spp: 4 (9%), Enterococcus faecium: 3 (7%), Enterococcus faecalis: 3 (7%), Streptococcus haemolyticus: 3 (7%). The following gram-negative bacteria were found: Enterobacter cloacae: 10 (30%), Escherichia coli: 7 (21%), Pseudomonas aeruginosa: 5 (15%), Klebsiella pneumonia: 5 (15%). Candida albicans was detected only in one case. The use of ATG was associated with higher number of total blood draw and positive blood cultures. No significant correlation was found between the specific pathogen and the use of ATG. Male gender was associated with significantly higher number of blood sampling and with tendency to higher number of positive blood cultures. The type of conditioning regimen, the source of stem cell and the donor origin (auto vs sibling vs unrelated) did not influence the number of positive blood culture. There was tendency to higher number of blood intake, but not positive blood culture in patients transplanted in NR if compared to PR or CR. Conclusions: Positive blood cultures were positive in about 20% of patients after HSCT. Only pre-transplant ATG use was associated with the higher number of positive blood culture. Disclosures: No relevant conflicts of interest to declare.

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Trends of Bloodstream Infections in a University Greek Hospital during a Three-Year Period: Incidence of Multidrug-Resistant Bacteria and Seasonality in Gram-negative Predominance

Polish Journal of Microbiology ◽

10.5604/01.3001.0010.7834 ◽

2017 ◽

Vol 66 (2) ◽

pp. 171-180 ◽

Cited By ~ 14

Author(s):

Fevronia Kolonitsiou ◽

Matthaios Papadimitriou-Olivgeris ◽

Anastasia Spiliopoulou ◽

Vasiliki Stamouli ◽

Vasileios Papakostas ◽

...

Keyword(s):

Bloodstream Infections ◽

Multidrug Resistant ◽

Blood Cultures ◽

Diffusion Method ◽

Resistant Bacteria ◽

Gram Negative Bacteria ◽

Multidrug Resistant Bacteria ◽

Gram Positive ◽

Gram Negative ◽

Carbapenem Resistant

The aim of the study was to assess the epidemiology, the incidence of multidrug-resistant bacteria and bloodstream infections’ (BSIs) seasonality in a university hospital. This retrospective study was carried out in the University General Hospital of Patras, Greece, during 2011–13 y. Blood cultures from patients with clinical presentation suggestive of bloodstream infection were performed by the BacT/ALERT System. Isolates were identified by Vitek 2 Advanced Expert System. Antibiotic susceptibility testing was performed by the disk diffusion method and E-test. Resistance genes (mecA in staphylococci; vanA/vanB/vanC in enterococci; blaKPC/blaVIM/blaNDM in Klebsiella spp.) were detected by PCR. In total, 4607 (9.7%) blood cultures were positive from 47451 sets sent to Department of Microbiology, representing 1732 BSIs. Gram-negative bacteria (52.3%) were the most commonly isolated, followed by Gram-positive (39.5%), fungi (6.6%) and anaerobes bacteria (1.8%). The highest contamination rate was observed among Gram-positive bacteria (42.3%). Among 330 CNS and 150 Staphylococcus aureus, 281 (85.2%) and 60 (40.0%) were mecA-positive, respectively. From 113 enterococci, eight were vanA, two vanB and two vanC-positives. Of the total 207 carbapenem-resistant Klebsiella pneumoniae (73.4%), 202 carried blaKPC, four blaKPC and blaVIM and one blaVIM. A significant increase in monthly BSIs’ incidence was shown (R2: 0.449), which may be attributed to a rise of Gram-positive BSIs (R2: 0.337). Gram-positive BSIs were less frequent in spring (P < 0.001), summer (P < 0.001), and autumn (P < 0.001), as compared to winter months, while Gram-negative bacteria (P < 0.001) and fungi (P < 0.001) were more frequent in summer months. BSIs due to methicillin resistant S. aureus and carbapenem-resistant Gram-negative bacteria increased during the study period. The increasing incidence of BSIs can be attributed to an increase of Gram-positive BSI incidence, even though Gram-negative bacteria remained the predominant ones. Seasonality may play a role in the predominance of Gram-negative’s BSI.

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

BioMed Research International ◽

10.1155/2016/1081536 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 2

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.

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Early Quantitative Determination of Serum Procalcitonin Can Help Distinguishing Strains of Different Bloodstream Infections in Patients with Hematologic Diseases

Blood ◽

10.1182/blood.v128.22.3703.3703 ◽

2016 ◽

Vol 128 (22) ◽

pp. 3703-3703

Author(s):

Xiaofeng Luo ◽

Jinhua Ren ◽

Zhizhe Chen ◽

Ting Yang ◽

Jianda Hu

Keyword(s):

Quantitative Determination ◽

Bloodstream Infection ◽

Large Population ◽

Bloodstream Infections ◽

Blood Cultures ◽

Gram Negative Bacteria ◽

Gram Positive ◽

Gram Negative ◽

Hematologic Diseases ◽

Fungi Infection

Abstract High procalcitonin (PCT) levels are strongly associated with systemic bacterial infections. PCT is produced in response to bacterial endotoxin and inflammatory cytokines. Few studies are available in the literature on PCT ability to distinguish different strains of bloodstream infections in patients with hematologic diseases. The aim of the present study was to explore the value of determining serum PCT values early, i.e., as soon as blood cultures are positive, in a large population of patients with hematologic diseases. Patients with hematologic diseases admitted to the hematology department of our hospitalfrom January 2013 to March 2016 who had bloodstream infections were retrospectively analyzed. Patients whose blood samples were collected for simultaneous blood culture and PCT test were enrolled in the study, and they were divided into agranulocytosis and non-agranulocytosis groups. Automatic microbial analyzer was used to identify all strains, and PCT levels were analyzed with an automatic electrochemiluminescence system. The relationship between PCT levels and the strains in bloodstream infections was analyzed and compared, and the diagnostic efficacy of PCT was evaluated using the receiver operating characteristic (ROC) curve. A total of 494 bloodstream infection cases that fulfilled the inclusion criteria were included in the study, involving 312 cases of bloodstream infection with single Gram-negative, 146 cases with single Gram-positive, 12 cases with single fungi, 19 cases with polymicrobes, and 5 cases identified as contaminated specimens. Unpaired t-test was used for data analysis. PCT levels for single Gram-negative infection (15.17±2.11 ng/ml) were significantly higher than those for Gram-positive infection (3.30 ± 0.93 ng/ml) (P<0.0001), or those for single fungi infection (0.22 ± 0.04 ng/ml) (P<0.0001). PCT levels for single Gram-positive infection were also significantly higher than those in single fungi infection (P<0.01). In the agranulocytosis group, which included 403 cases, the PCT levels in the single Gram-negative infection (14.14 ± 2.13 ng/ml) were significantly higher than those in single Gram-positive (2.49 ± 0.73 ng/ml) (P<0.0001), or in single fungi infection (0.24 ± 0.04 ng/ml) (P<0.0001). The PCT levels in the single Gram-positive bacterial infection were also significantly higher than those in single fungi infection (P<0.01). In the single Gram-negative bacteria bloodstream infection, we further found that the PCT levels in Enterobacteriaceae infection (17.00 ± 3.04 ng/ml) were significantly higher than those in nonfermentative Gram-negatives infection (6.49 ± 1.50 ng/ml) (P<0.01). ROC analysis was performed on monomicrobial blood cultures. ROC of single Gram-negative and Gram-positive infections revealed that the area under the curve (AUC) was 0.687, the best cut-off value was 0.58 ng/ml, the sensitivity was 60.81% and specificity was 71%. ROC of single Gram-negative and fungi infections revealed that the AUC was 0.795, the best cut-off value was 0.42 ng/ml, the sensitivity was 67% and specificity was 100%. ROC of single Gram-positive and fungi infections revealed that the AUC was 0.6, the best cut-off value was 0.44 ng/ml, the sensitivity was 37% and specificity was 100%. In the non-agranulocytosis group, we only found that the PCT levels in the single Gram-negative infection were significantly higher than those in single Gram-positive infection (P<0.05). In summary, early serum PCT quantitative determination can be used as a routine test to help to distinguish Gram-negative bacteria, Gram-positive bacteria, or fungi bloodstream infections in patients with hematologic diseases. These findings will be of great clinical value to select appropriate antibiotics for patients with hematologic diseases and bloodstream infections. Figure Figure. Disclosures No relevant conflicts of interest to declare.

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Development of the iCubate Molecular Diagnostic Platform Utilizing Amplicon Rescue Multiplex Polymerase Chain Reaction

Journal of Biomedical Nanotechnology ◽

10.1166/jbn.2019.2783 ◽

2019 ◽

Vol 15 (7) ◽

pp. 1598-1608

Author(s):

Hongna Liu ◽

Kathryn Heflin ◽

Jian Han ◽

Matt Conover ◽

Leslie Wagner ◽

...

Keyword(s):

Limit Of Detection ◽

Bacterial Species ◽

Bloodstream Infections ◽

Cross Reactivity ◽

Blood Cultures ◽

Molecular Diagnostic ◽

Gram Positive ◽

Gram Positive Bacteria ◽

High Level

We utilized Amplicon-Rescue Multiplex PCR (ARM-PCR) and microarray hybridization to develop and validate the iC-GPC Assay, a multiplexed, in vitro diagnostic test that identifies five of the most common gram positive bacteria and three clinically relevant resistance markers associated with bloodstream infections (BSI). The iC-GPC Assay is designed for use with the iC-System™, which automates sample preparation, ARM-PCR, and microarray detection within a closed cassette. Herein, we determined the limit of detection for each of the iC-GPC Assay targets to be between 3.0 × 105–1.7 × 107 CFU/mL, well below clinically relevant bacterial levels for positive blood cultures. Additionally, we tested 106 strains for assay inclusivity and observed a target performance of 99.4%. 95 of 96 non-target organisms tested negative for cross-reactivity, thereby assuring a high level of assay specificity. Overall performance above 99% was observed for iC-GPC Assay reproducibility studies across multiple sites, operators and cassette lots. In conclusion, the iC-GPC Assay is capable of accurately and rapidly identifying bacterial species and resistance determinants present in blood cultures containing gram positive bacteria. Utilizing molecular diagnostics like the iC-GPC Assay will decrease time to treatment, healthcare costs, and BSI-related mortality.

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2123. Rapid Phenotypic Detection of Gram-Negative Bacilli-Resistant to Oximinocephalosporins and Carbapenems in Positive Blood Cultures Using a Novel Protocol

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1803 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S718-S718

Author(s):

Diego Josa ◽

Gisell Bustos-Moya ◽

Soad Yusef ◽

Stephanie Crevoisier ◽

Edwin Silva ◽

...

Keyword(s):

Clinical Outcomes ◽

Bloodstream Infections ◽

Blood Cultures ◽

Drug Resistant ◽

Gram Negative ◽

Diagnostic Strategies ◽

Detection Techniques ◽

Reference Hospital ◽

Novel Method

Abstract Background Early and adequate antibiotic treatment are the cornerstones to improve clinical outcomes in patients with Bloodstream infections (BSI). Delays in appropriate antimicrobial therapy have catastrophic consequences for patients with BSI. Microbiological characterization of multi-drug-resistant pathogens (MDRP) allow clinicians to provide appropriate treatments. Current available microbiologic techniques may take-up to 96 hours to identify causative pathogens and its resistant patterns. Therefore, there is an important need to develop rapid diagnostic strategies for MDRP. However, rapid detection techniques are costly and are not widely available. We tested a modified protocol designed to detect Gram-negative bacilli (GNB) resistant to oximinocephalosporins and carbapenems from positive blood cultures. Methods This is a prospective, cohort study of consecutive patients with bacteremia. We developed a modified protocol using HB&L® system to detect MDRP. We then attempted to determine accuracy, concordance and reduction of identification time of this novel method in a reference hospital. Descriptive statistics and logistical regressions were used. Results Ninety-six patients with BSI were included in the study. A total of 161 positive blood cultures were analyzed. Escherichia coli (50%, 81/161) was the most frequently identified pathogen followed by Klebsiella pneumoniae (15%, 24/161) and Pseudomonas aeruginosa (8%, 13/161). 32% of isolations had usual resistance patters. However, in 29/161 (18%) of identified pathogens were producer of carbapenemasases and 21/161 (13%) of extended-spectrum β-lactamases. Concordance among our HB&L® modified protocol and traditional method was 99% (159/161). Finally, identification times were significantly shorter using our HB&L® modified protocol than traditional methods (Mean, hours [SD], 20.8 [6.22] vs. 62.8 [6.22], P < 0.001). Conclusion Here we provided novel evidence that using our HB&L® modified protocol is an effective strategy to reduce the time to MDRP detection/identification; with a great concordance rate when compared with the gold standard. Further studies are needed to confirm these findings and to determine whether this method may improve clinical outcomes. Disclosures All authors: No reported disclosures.

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