scholarly journals Performance and impact of a multiplex PCR in ICU patients with ventilator-associated pneumonia or ventilated hospital-acquired pneumonia

2020 ◽  
Author(s):  
Nathan Peiffer-Smadja ◽  
Lila BOUADMA ◽  
Vincent MATHY ◽  
Kahina ALLOUCHE ◽  
Juliette PATRIER ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Multiplex Pcr ◽  
Antimicrobial Therapy ◽  
Bacterial Resistance ◽  
Clinical Samples ◽  
Gram Positive ◽  
Icu Patients ◽  
Gram Negative ◽  
Surgical Icu ◽  
Gram Positive Cocci

Abstract Background: Early appropriate antibiotic therapy reduces morbidity and mortality of severe pneumonia. However, the emergence of bacterial resistance requires the earliest use of antibiotics with the narrowest possible spectrum. The Unyvero Hospitalized Pneumonia (HPN, Curetis) test is a multiplex PCR (M-PCR) system detecting 21 bacteria and 19 resistance genes on respiratory samples within 5 hours. We assessed the performance and the potential impact of the M-PCR on the antibiotic therapy of ICU patients. Methods: In this prospective study we performed a M-PCR on bronchoalveolar lavage (BAL) or plugged telescoping catheters (PTC) samples of patients with ventilated HAP or VAP with Gram-negative bacilli or clustered Gram-positive cocci. This study was conducted in 3 ICUs in a French academic hospital; the medical and infectious diseases ICU, the surgical ICU and the cardio-surgical ICU. A multidisciplinary expert panel simulated the antibiotics changes they would have made if the M-PCR results had been available. Results We analyzed 95 clinical samples of ventilated HAP or VAP (72 BAL and 23 PTC) from 85 patients (62 males, median age 64 years). The median turnaround time of the M-PCR was 4.6 hours (IQR 4.4-5). A total of 90/112 bacteria were detected by the M-PCR system with a global sensitivity of 80% (95%CI, 73-88%) and specificity of 99% (95%CI 99-100). The sensitivity was better for Gram-negative bacteria (90%) than for Gram-positive cocci (62%) (p=0.005). Moreover, 5/8 extended-spectrum beta-lactamases (CTX-M gene) and 4/4 carbapenemases genes (3 NDM, one oxa-48) were detected. The M-PCR could have led to the earlier initiation of an effective antibiotic in 20/95 patients (21%) and to early de-escalation in 37 patients (39%) but could also have led to one (1%) inadequate antimicrobial therapy. Among 17 empiric antibiotic treatments with carbapenems, 10 could have been de-escalated in the following hours according to the M-PCR results. The M-PCR also led to 2 unexpected diagnosis of severe legionellosis confirmed by culture methods. Conclusions: Our results suggest that the use of a M-PCR system for respiratory samples of patients with VAP and ventilated HAP could improve empirical antimicrobial therapy and reduce the use of broad-spectrum antibiotics.

scholarly journals Performance and impact of a multiplex PCR in ICU patients with ventilator-associated pneumonia or ventilated hospital-acquired pneumonia

2020 ◽  
Author(s):  
Nathan Peiffer-Smadja ◽  
Lila BOUADMA ◽  
Vincent MATHY ◽  
Kahina ALLOUCHE ◽  
Juliette PATRIER ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Multiplex Pcr ◽  
Antimicrobial Therapy ◽  
Bacterial Resistance ◽  
Clinical Samples ◽  
Gram Positive ◽  
Icu Patients ◽  
Gram Negative ◽  
Surgical Icu ◽  
Gram Positive Cocci

Abstract Background: Early appropriate antibiotic therapy reduces morbidity and mortality of severe pneumonia. However, the emergence of bacterial resistance requires the earliest use of antibiotics with the narrowest possible spectrum. The Unyvero Hospitalized Pneumonia (HPN, Curetis) test is a multiplex PCR (M-PCR) system detecting 21 bacteria and 19 resistance genes on respiratory samples within 5 hours. We assessed the performance and the potential impact of the M-PCR on the antibiotic therapy of ICU patients. Methods: In this prospective study we performed a M-PCR on bronchoalveolar lavage (BAL) or plugged telescoping catheters (PTC) samples of patients with ventilated HAP or VAP with Gram-negative bacilli or clustered Gram-positive cocci. This study was conducted in 3 ICUs in a French academic hospital; the medical and infectious diseases ICU, the surgical ICU and the cardio-surgical ICU. A multidisciplinary expert panel simulated the antibiotics changes they would have made if the M-PCR results had been available. Results We analyzed 95 clinical samples of ventilated HAP or VAP (72 BAL and 23 PTC) from 85 patients (62 males, median age 64 years). The median turnaround time of the M-PCR was 4.6 hours (IQR 4.4-5). A total of 90/112 bacteria were detected by the M-PCR system with a global sensitivity of 80% (95%CI, 73-88%) and specificity of 99% (95%CI 99-100). The sensitivity was better for Gram-negative bacteria (90%) than for Gram-positive cocci (62%) (p=0.005). Moreover, 5/8 extended-spectrum beta-lactamases (CTX-M gene) and 4/4 carbapenemases genes (3 NDM, one oxa-48) were detected. The M-PCR could have led to the earlier initiation of an effective antibiotic in 20/95 patients (21%) and to early de-escalation in 37 patients (39%) but could also have led to one (1%) inadequate antimicrobial therapy. Among 17 empiric antibiotic treatments with carbapenems, 10 could have been de-escalated in the following hours according to the M-PCR results. The M-PCR also led to 2 unexpected diagnosis of severe legionellosis confirmed by culture methods. Conclusions: Our results suggest that the use of a M-PCR system for respiratory samples of patients with VAP and ventilated HAP could improve empirical antimicrobial therapy and reduce the use of broad-spectrum antibiotics.

scholarly journals Culturing Periprosthetic Tissues in BacT/Alert® Virtuo Blood Culture Bottles for a Short Duration of Post-operative Empirical Antibiotic Therapy

2020 ◽  
Vol 5 (3) ◽  
pp. 145-150
Author(s):  
Claire Duployez ◽  
Frédéric Wallet ◽  
Henri Migaud ◽  
Eric Senneville ◽  
Caroline Loiez
Keyword(s):  
Blood Culture ◽  
Antibiotic Therapy ◽  
Joint Infection ◽  
Length Of Hospital Stay ◽  
Empirical Antibiotic Therapy ◽  
Gram Positive ◽  
Gram Negative ◽  
Surgical Interventions ◽  
Joint Infections ◽  
Gram Positive Cocci

Abstract. Introduction: A post-operative empirical antibiotic therapy (PEAT) is required in periprosthetic joint infections. It commonly uses broad-spectrum antibiotics to cover most Gram-positive cocci and Gram-negative bacilli. It is currently continued until first microbiological results are available, no less than five days later.Methods: We performed a retrospective study in order to evaluate duration of incubation required for surgical samples using the BacT/Alert® Virtuo blood culture bottles system.Results: Among 216 surgical interventions and 199 clinical strains (53.8% staphylococci, 22,1% streptococci and enterococci, 14,6% Gram-negative bacilli, 5,5% anaerobes), 90.5% of the strains were detected between day 0 and day 2; 15 infective strains are cultured from day 3 including 8 Cutibacterium sp., 4 staphylococci, 2 streptococci and 1 Enterococcus.Conclusions: We suggest that the duration of PEAT in patients operated for a periprosthetic joint infection may be shortened to three days as Gram-negative rods are unlikely to grow after three days of culture by using BacT/Alert® Virtuo blood culture bottles. This is likely to shorten the overall length of hospital stay, to diminish the occurrence of adverse side effects, and the emergence of antimicrobial resistance. However, coverage of Gram-positive cocci should be maintained for 14 days until the definite culture results are available.

scholarly journals Comparative study on the changes of bacterial species and severity of antimicrobial resistance during 13 years

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256375
Author(s):  
Huili Zhang ◽  
Kairui Zhou ◽  
Xinglong He ◽  
Xin Yuan
Keyword(s):  
Drug Resistance ◽  
Drug Sensitivity ◽  
Bacterial Resistance ◽  
Bacterial Species ◽  
Mass Spectrometry Analysis ◽  
Gram Positive ◽  
Gram Negative ◽  
The Past ◽  
Dominant Bacteria ◽  
Gram Positive Cocci

Background With the widespread use of broad-spectrum antibiotics, the problem of bacterial resistance has become a global crisis. To monitor bacterial resistance in our hospital, the distribution of specimens, the detection of pathogens and their drug resistance from July 2005 to June 2007 (13 years ago) and July 2018 to June 2020 were compared and analyzed. Methods Ordinary specimens (such as sputum, urine, feces, and secretion) were inoculated in blood AGAR media, MacConkey medium, chocolate medium, double SS medium and selective culture medium. Blood, cerebrospinal fluid, pleural effusion, joint cavity effusion and other sterile body fluid samples were inoculated in aerobic and anaerobic blood culture flasks. Automatic microbial identification, drug sensitivity analysis and mass spectrometry analysis were used to determine their drug sensitivity. Results Compared with the results obtained 13 years ago, the number of specimens submitted for inspection in the past two years has increased significantly, exhibiting a growth rate of 283%. The changes in the pathogen species were obvious. Gram-positive cocci were the dominant bacteria 13 years ago, and Gram-negative bacilli were the dominant bacteria in the past two years. In addition, the resistance of several major Gram-negative bacilli to piperacillin/tazobactam, cefoperazone/sulbactam, meropenem and imipenem all showed an increasing trend. Conclusion The variety of pathogenic bacteria in our hospital has changed significantly in the past two years compared with that 13 years ago, and the clinical isolates of Gram-negative bacilli have increased significantly compared with Gram-positive cocci. In the clinical treatment of anti-infective diseases, antimicrobial agents should be selected according to the bacterial distribution characteristics and drug resistance in each hospital.

scholarly journals Five-year period evaluation of isolated agents and their resistance profiles in intensive care unit patients with malignancy

2020 ◽  
Vol 14 (08) ◽  
pp. 918-923
Author(s):  
Duygu Mert ◽  
Selda Muslu ◽  
Alparslan Merdin ◽  
Arif Timuroğlu ◽  
Ece Dirim ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Samples ◽  
Gram Negative Bacteria ◽  
Hospital Infections ◽  
Gram Positive ◽  
Icu Patients ◽  
Gram Negative ◽  
Gram Positive Bacteria ◽  
Acinetobacter Spp

Introduction: Patients treated in the intensive care unit (ICU) are usually patients who deteriorated health condition and could have longer hospital stay compared to other patients. Hospital infections are more common in ICU patients. The aim of this study was to evaluate the bacteria and treatment resistance profiles isolated from clinical specimens sent for hospital infections in ICU patients between January 1, 2014 and December 31, 2018. Methodology: Bacteria isolated from various clinical samples sent for hospital infections in hospitalized patients in the Anesthesia and Reanimation Intensive Care Unit were retrospectively analyzed. Results: Culture positivity was detected in 547 of the sent clinical samples. Eighty Gram-positive bacteria, 389 Gram-negative bacteria and 78 fungi infection were identified in a total of 547 positive cultures. In Gram-positive bacteria, 4 MRSA, 6 VRE and 30 MRCoNS were identified as resistant strains. In Gram-negative bacteria, Acinetobacter spp. was the most culture positive strain with the number of 223. Carbapenem resistance was found in 258 of the Gram-negative bacteria and ESBL positivity was found in 44 of the Gram-negative bacteria strains. Conclusions: Gram-negative bacteria were the most frequently isolated strain in samples. Recently, colistin resistance has been increasing in Acinetobacter spp. and the increase in carbapenemase enzyme in Escherichia coli, Pseudomonas and Klebsiella species has increased resistance to carbapenems. Knowing the microorganisms that grow in ICUs and their antibiotic resistance patterns may help to prevent contamination of resistant microorganisms by both appropriate empirical antibiotic treatment and more isolation as well as general hygiene standard precautions.

scholarly journals Profile of pathogens isolated from different clinical samples and their antimicrobial pattern: a retrospective study

2021 ◽  
Author(s):  
M. Anjaneya Swamy ◽  
Jagannath D. Andhale
Keyword(s):  
Escherichia Coli ◽  
Retrospective Study ◽  
Significant Rise ◽  
Diffusion Method ◽  
Clinical Samples ◽  
Resistance Pattern ◽  
Resistant Bacteria ◽  
Gram Positive ◽  
Gram Negative ◽  
Gram Positive Cocci

Background: Since there is a significant rise in resistant bacteria to different antimicrobial agents, there is a need to study the resistance pattern of different isolates from different clinical samples for effective use of available antimicrobials by clinicians. The aim of the present study was to detect the resistance pattern of various antimicrobials against different clinical isolates in hospitalised patients in out setting.Methods: This is a retrospective study involving the collection of the data from the records of microbiology laboratory. All clinical specimens were processed as per standard microbiological procedures. Antibiotic susceptibility testing was performed by Kirby Bauer disc diffusion method on Mueller Hinton agar plate as per CLSI guidelines.Results: A total of 153 isolates were recovered from 219 clinical samples accounting for 69.86% of total positivity. Which includes gram negative bacilli 107/153 (69.93%) gram positive cocci 36/153 (23.53%) and yeast 10/153 (6.54%). Among the total isolates gram negative bacilli account for major number of isolates 69.93% followed by gram positive cocci 23.53% and yeast 6.54%. Gram positive cocci and gram-negative bacilli showed a significant level of antimicrobial resistance. Nitrofurantoin is highly effective against urinary isolates of Escherichia coli. vancomycin and linezolid are most effective antimicrobials against gram positive cocci. Among gram negative bacilli meropenem and amikacin are most effective antimicrobials. Statistical significance of occurrence of Escherichia coli as predominant isolate as compared to other isolates were analysed by chi square test by using GraphPad online calculator. A p value<0.001 was obtained.Conclusions: Significant rise in antimicrobial resistant pathogens were observed. Local antimicrobial policy should be developed for effective selection of available antimicrobials which are the need of the day to reduce the burden of diseases on global health care system.

scholarly journals Clinical Presentation and Bacterial Etiology of Adult Community Acquired Pneumonia

2017 ◽  
Vol 34 (3) ◽  
pp. 128-134
Author(s):  
Md Abdus Salam ◽  
Md Robed Amin ◽  
Quazi Tarikul Islam
Keyword(s):  
Streptococcus Pneumoniae ◽  
Blood Culture ◽  
Mycoplasma Pneumoniae ◽  
Chlamydia Pneumoniae ◽  
Community Acquired Pneumonia ◽  
Sputum Culture ◽  
Gram Positive ◽  
Gram Negative ◽  
The Mean ◽  
Gram Positive Cocci

Introduction: Pneumonia is a worldwide, serious threat to health and an enormous socio-economic burden for health care system. According to recent WHO data, each year 3-4 million patients die from pneumonia. The clinical presentations and bacterial agents responsible for community acquired pneumonia (CAP) varies according to geography and culture.Methods: A cross sectional observational study conducted among the 53 consecutive patients with a clinical diagnosis of CAP in admitted patient in the department of Medicine, DMCH, during January 2010 to December 2010. Hematological measurements (TC of WBC, Hb%, ESR, platelet count), blood culture, chest X-ray P/A view, sputum for Gram staining and culture sensitivity, sputum for AFB, blood urea and random blood sugar were done in all cases. ELISA for IgM antibody of Mycoplasma pneumoniae and Chlamydia pneumoniae were done in sputum culture negative cases.Results: The mean (±SD) age was 38.9±17.3 years and Male female ratio was 3:1. Fever, chest pain and productive cough were the most common clinical features. The mean (±SD) respiratory rate was 23.0±2.8 /minute . COPD and DM were found in 17.0% and 5.7% of patients respectively . Blood culture was found positive in only 1.9% of the study patients. Gram positive Cocci 62.26%, Gram negative Bacilli 9.43%, mixed Gram positive cocci and Gram negative bacilli 11.32% and Gram negative Cocco Bacilli 1.9% were observed and in 15.03 % cases, no bacteria could be seen. Sputum culture revealed 53.8% streptococcus pneumoniae, 26.9% Klebsiella pneumonia as predominant organism. Mycoplasma pneumoniae and Chlamydia pneumoniae were found in 7.4% and 3.7% respectively by serological test. For Streptococcus pneumoniae, sensitive antibiotics were Amoxyclav and Levofloxacin. For Gram negative bacilli and coccobacilli, more sensitive antibiotics were Meropenem, Ceftriaxone, and Clarithromycin. The best sensitive drug were found meropenem. The mean (±SD) duration of hospital stay was 5.0±1.7 days with ranging from 3 to 10 days.Conclusion: Region based bacteroiological diagnosis of Cap is important for selecting the best and sensitive drugs for complete cure.J Bangladesh Coll Phys Surg 2016; 34(3): 128-134

scholarly journals Evaluation of MRSASelect™Chromogenic Medium for the Early Detection of Methicillin-ResistantStaphylococcus aureusfrom Blood Cultures

2013 ◽  
Vol 24 (4) ◽  
pp. e113-e116 ◽  
Author(s):  
Kanchana Manickam ◽  
Andrew Walkty ◽  
Philippe RS Lagacé-Wiens ◽  
Heather Adam ◽  
Barbara Swan ◽  
...  
Keyword(s):  
Early Detection ◽  
Antimicrobial Therapy ◽  
Predictive Value ◽  
Turnaround Time ◽  
Blood Cultures ◽  
Gram Stain ◽  
Chromogenic Medium ◽  
Gram Positive ◽  
Microbiological Methods ◽  
Gram Positive Cocci

INTRODUCTION:Staphylococcus aureusbacteremia is associated with considerable morbidity and mortality. In theory, reducing the turnaround time in reporting of methicillin-resistantS aureus(MRSA) among patients with bactermia could assist with the rapid optimization of antimicrobial therapy.OBJECTIVE: To evaluate the sensitivity and specificity of MRSASelect(Bio-Rad Laboratories, USA), a chromogenic medium, in the early detection of MRSA from blood cultures growing Gram-positive cocci in clusters, and to confirm that routine use of this medium would, in fact, reduce turnaround time for MRSA identification.METHODS: The present study was conducted at three microbiology laboratories in Manitoba. Between April 2010 and May 2011, positive blood cultures with Gram-positive cocci in clusters visualized on Gram stain were subcultured to both MRSASelectand routine media. MRSA isolates were identified using conventional microbiological methods from routine media and using growth with the typical colony morphology (pink colony) on MRSASelectmedium.RESULTS: A total of 490 blood cultures demonstrating Gram-positive cocci in clusters on Gram stain were evaluated.S aureuswas recovered from 274 blood cultures, with 51S aureusisolates (51 of 274 [18.6%]) identified as MRSA. MRSASelectmedium had a sensitivity of 98%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 99.8% for the recovery and identification of MRSA directly from positive blood culture bottles. In addition, use of MRSASelectmedium was found to improve turnaround time in the detection of MRSA by almost 24 h relative to conventional methods.DISCUSSION: These data support the utility of MRSASelectmedium for the rapid identification of MRSA from positive blood cultures. Further clinical studies are warranted to determine whether the improvement in turnaround time will result in a measurable reduction in suboptimal antimicrobial therapy and/or improvement in patient outcome.

scholarly journals Comparing the Performance of the New Fully Automated Urine Particle Analyzer UF-5000 with UF-1000i and Gram Stain in Predicting Bacteria Growth Patterns in Women with Uncomplicated Urinary Tract Infections

2020 ◽  
Author(s):  
Stephen Shei-Dei Yang ◽  
Chun-Chun yang ◽  
Yi-Shen Chen ◽  
Shangjen chang
Keyword(s):  
Urinary Tract ◽  
Urine Analysis ◽  
Growth Patterns ◽  
Gram Stain ◽  
Gram Positive ◽  
Gram Negative ◽  
Bacterial Patterns ◽  
Tract Infections ◽  
Sensitivity Specificity ◽  
Gram Positive Cocci

Abstract BackgroudTo compare the performance of the new flow cytometer UF-5000 with UF-1000i (Sysmex, Kobe, Japan) and Gram stain in predicting the bacterial patterns in urine samples MethodsWomen with symptoms suggestive of urinary tract infection were enrolled. Mid-stream urine sample was collected for gram staining, urine analysis and urine culture. Bacterial patterns were classified though UF1000i (none, cocci bacteria or rods/mixed growth), UF-5000 (none, cocci, rods or mixed growth) and Gram stain. Results Among the 102 samples, there were 10 gram-positive cocci, 2 gram-positive bacilli, 66 gram-negative rods, and 24 mixed growth. The sensitivity/specificity of the UF-1000i was 81.8/91.1% for gram-negative rods and 23.5/96.9% for cocci/mixed. The sensitivity/specificity of the UF-5000 was 80.0/88.2% for gram negative rods and 70.0/86.5% for gram-positive cocci.ConclusionsThe UF-5000 demonstrated the good sensitivity and specificity for Gram-negative bacilli bacteria and demonstrated an improved sensitivity for detecting Gram-positive cocci.

scholarly journals PATIENTS' MICROFLORA COMPARATIVE CHARACTERISTICS OF DIFFERENT DEPARTMENTS AT THE NATIONAL HOSPITAL OF PEDIATRICS IN HANOI, VIETNAM

2019 ◽  
pp. 43-48
Author(s):  
L.V. Kataeva ◽  
A.P. Rebeshchenko ◽  
T.F. Stepanova ◽  
O.V. Posoiuznykh ◽  
Le Thanh Hai ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Infectious Diseases ◽  
Hospital Environment ◽  
Clinical Samples ◽  
Gram Negative Bacteria ◽  
National Hospital ◽  
Statistical Research ◽  
Gram Positive ◽  
Gram Negative

We studied the microflora structure and resistance gathered from the biomaterial of patients and the environment objects of various departments at the National hospital of Pediatrics in Hanoi. 140 clinical samples of biomaterials from 74 patients treated in the intensive care unit, the infectious diseases and the gastroenterology departments were studied. A systematic approach including microbiological, epidemiological and statistical research methods was used in carrying out the study. Bacteria of the Enterobacteriaceae family (38.5 per cent) prevailed in the biomaterial of intensive care unit patients. Nonfermentative Gram-negative bacteria (46.5 per cent) occupied the leading positions in the infectious diseases department and Gram-positive bacteria (39.3 per cent) were in the gastroenterology department. Gram-positive flora (60.2 per cent in the intensive care unit and 50.7 per cent in the infectious diseases department) prevailed in the microflora structure gathered from hospital environment objects. We identified the prevalence of bacteria of the genus Enterobacteriaceae and non-fermentative Gram-negative bacteria with a wide spectrum of resistance in the departments of the National Hospital of Pediatrics.

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