scholarly journals Impact of Short-Incubation MALDI-TOF MS on Rapid Identification of Pathogens and Antibiotic Therapy

2021 ◽  
Vol 14 (9) ◽  
Author(s):  
Qianqian Chen ◽  
Anran Zhang ◽  
Haifang Kong ◽  
Zhidong Hu
Keyword(s):  
Antibiotic Therapy ◽  
Antimicrobial Susceptibility ◽  
Rapid Identification ◽  
Blood Cultures ◽  
Empirical Antibiotic Therapy ◽  
Coincidence Rate ◽  
Pathogen Identification ◽  
Identification Method ◽  
Identification Time ◽  
Maldi Tof

Background: It can be a critical point for reducing pathogen identification time and accurate antibiotic treatment for patients with blood circulation infection since it causes high mortality. Objective: The objectives of this study were to evaluate the time differences between conventional identification and MALDI-TOF conventional identification and short-incubation MALDI-TOF identification for positive blood cultures, and to explore the impact of short-incubation MALDI-TOF identification on empirical antibiotic therapy. Methods: Positive blood cultures were collected in our hospital from 2017 to 2019, clinical data were collected from the medical records, which were analyzed retrospectively to determine the empirical antibiotic therapy. Results: Compared with the conventional identification method, the short-incubation MALDI-TOF identification time to initial identification of Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumannii, Staphylococcus aureus, Enterococcus faecium, and E. faecalis decreased by 22.28 h, 22 h, 23.59 h, 23.63 h, 22.63 h, 23.92 h, and 21.59 h, respectively (P < 0.05). The time to final reporting was decreased by 48.85 h, 47.99 h, 55.40 h, 51.07 h, 49.60 h, 51.78h, and 51.73h, respectively (P < 0.05). However, the antimicrobial susceptibility test time of E. coli, A. baumannii, and S. aureus increased to 2.02 h, 2.19 h, and 3.86 h, respectively (P < 0.05). The coincidence rate of antimicrobial susceptibility was 98.48% between short-incubation MALDI-TOF identification and conventional identification method of all Gram-negative bacilli, and there were no extremely major errors or major errors. The coincidence rate of antimicrobial susceptibility of Gram-positive cocci was 99.53%, one strain of E. faecium and S. aureus had major errors. Patients received earlier correct empirical antibiotic 19.89 h earlier by short-incubation MALDI-TOF identification than the conventional identification method (P < 0.001). Conclusions: The short-incubation MALDI-TOF identification significantly shortens the pathogen identification time and the final report time, it is a reliable method for rapid identification of positive blood cultures; the results of antimicrobial susceptibility are highly consistent, which significantly lead to earlier appropriate empirical therapy of bacteremia.

scholarly journals Direct Rapid Identification from Positive Blood Cultures by MALDI-TOF MS: Specific Focus on Turnaround Times

2021 ◽  
Author(s):  
Hazan Zengin Canalp ◽  
Banu Bayraktar
Keyword(s):  
Blood Culture ◽  
Rapid Identification ◽  
Blood Cultures ◽  
Pathogen Identification ◽  
Short Term ◽  
Maldi Tof Ms ◽  
Maldi Tof ◽  
Solid Media ◽  
Time Required ◽  
Tof Ms

Using MALDI-TOF MS directly from blood culture bottles reduces the time required for pathogen identification, and the turnaround times for final identification have been compared with overnight incubation from solid media in previous studies. However, identification from a short incubation of agar plates has been increasingly accepted and successfully implemented in routine laboratories, but there is no data comparing direct MALDI-TOF MS with the short-term, incubated agar plates.

scholarly journals A Prospective Evaluation of Two Rapid Phenotypical Antimicrobial Susceptibility Technologies for the Diagnostic Stewardship of Sepsis

2018 ◽  
Vol 2018 ◽  
pp. 1-13 ◽  
Author(s):  
Cesira Giordano ◽  
Elena Piccoli ◽  
Veronica Brucculeri ◽  
Simona Barnini
Keyword(s):  
Antimicrobial Susceptibility ◽  
Multidrug Resistant ◽  
Rapid Identification ◽  
Blood Cultures ◽  
Gram Positive ◽  
Gram Negative ◽  
Maldi Tof Ms ◽  
Gram Positive Bacteria ◽  
Maldi Tof ◽  
Tof Ms

Rapid identification of bloodstream pathogens by MALDI-TOF MS and the recently introduced rapid antimicrobial susceptibility testing (rAST) directly from positive blood cultures allow clinicians to promptly achieve a targeted therapy, especially for multidrug resistant microorganisms. In the present study, we propose a comparison between phenotypical rASTs performed in light-scattering technology (Alfred 60AST, Alifax®) and fluorescencein situhybridization (Pheno™, Accelerate) directly from positive blood cultures, providing results in 4–7 hours. Blood samples from 67 patients admitted to the Azienda Ospedaliero-Universitaria Pisana were analyzed. After the direct MALDI-TOF MS identification, the rAST was performed at the same time both on Alfred 60AST and Pheno. Alfred 60AST provided qualitative results, interpreted in terms of clinical categories (SIR). Pheno provided identification and MIC values for each antibiotic tested. Results were compared to the broth microdilution assay (SensiTitre™, Thermo Fisher Scientific), according to EUCAST rules. Using Alfred 60AST, an agreement was reached, 91.1% for Gram-negative and 95.7% for Gram-positive bacteria, while using Pheno, the agreement was 90.6% for Gram-negative and 100% for Gram-positive bacteria. Both methods provided reliable results; Alfred 60AST combined with MALDI-TOF MS proved itself faster and cheaper. Pheno provided identification and MIC determination in a single test and, although more expensive, may be useful whenever MIC value is necessary and where MALDI-TOF MS is not present.

scholarly journals 653. Direct Identification of Microorganisms in Positive Blood Cultures by the BioFire® FilmArray® Blood Culture Identification Panel Leads to Faster Optimal Antibiotic Therapy: A Before–After Study

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S428-S429
Author(s):  
Jessica Agnetti ◽  
Andrea C Büchler ◽  
Michael Osthoff ◽  
Fabrice Helfenstein ◽  
Vladimira Hinic ◽  
...  
Keyword(s):  
Blood Culture ◽  
Antibiotic Therapy ◽  
Censored Data ◽  
Blood Cultures ◽  
Empiric Antibiotic Therapy ◽  
Study Endpoint ◽  
Pathogen Identification ◽  
Optimal Therapy ◽  
Identification Method ◽  
Culture Identification

Abstract Background Rapid pathogen identification from positive blood cultures may help optimize empiric antibiotic therapy quickly by reducing unnecessary broad spectrum antibiotic use and may improve patient outcomes. The BioFire® FilmArray® Blood Culture Identification Panel 1 (BF-FA-BCIP) identifies 24 pathogens directly from positive blood cultures without subculture. 3 resistance genes are included. We aimed to compare the time to optimal antibiotic therapy between BF-FA-BCIP and conventional identification. Methods We performed a single-center retrospective case-control before-after study of 386 cases (November 2018 to October 2019) with BF-FA-BCIP compared to 414 controls (August 2017 to July 2018) with conventional identification. The primary study endpoint was the time from blood sampling to implementation of optimal antimicrobial therapy. Secondary endpoints were time to effective therapy, length of hospital stay, and in-hospital and 30-day mortality. Outcomes were assessed using cause-specific Cox Proportional Hazard models and logistic regressions. Results We included 800 patients with comparable baseline characteristics. Main sources of blood stream infection (BSI) were urinary tract infection and intra-abdominal infection (19.2% vs. 22.0% and 16.8% vs. 15.7% for case and control groups, respectively). Overall, 212 positive blood cultures were considered as contaminations. Identification results were available after a median of 21.9 hours by the BF-FA-BCIP and 44.3 hours by the conventional method. Patients with BF-FA-BCIP received the optimal therapy after a median of 25.5 hours (95%CI 21.0 - 31.2) as compared to 45.7 hours (95%CI 37.7 - 51.2) in the control group (Figure 1). We found no effect of the identification method on secondary outcomes. Kaplan-Meier curve representing the probability of implementing the optimal therapy at any given time according to the identification method (Standard vs. BF-FA-BCIP). Shaded ribbons represent the 95 % confidence interval (CI). The vertical dashes represent censored data. The vertical dotted lines represent the median time, i.e. the time at which 50 % of the patients obtained the optimal therapy, for the two methods. Median (95 % CI) time to optimal therapy is 45.7 (37.7 - 51.4) hours with the Standard method and 25.5 (21.0- 31.2) hours with Biofire. The tables below the curves present the numbers expecting optimal therapy according to the bacteria identification method, as well as the number of censored data in parenthesis. Panel A shows data from 0 to 900 hours. Panel B shows the data from 0 to 90 hours to better visualize how the probability to implement optimal therapy varies in the first 72 hours. Conclusion In conclusion, rapid pathogen identification by BF-FA-BCIP was associated with an almost 24h earlier initiation of the optimal antibiotic therapy in BSI. However, the overall benefit for individual patients seems to be limited. Future studies should assess the cost-effectiveness and impact on the prevention of antibiotic resistance using this diagnostic approach. Disclosures All Authors: No reported disclosures

scholarly journals The Use of Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) for the Identification of Pathogens Causing Sepsis

2019 ◽  
Vol 3 (4) ◽  
pp. 675-685 ◽  
Author(s):  
Paul M Luethy ◽  
J Kristie Johnson
Keyword(s):  
Antibiotic Therapy ◽  
Patient Outcomes ◽  
Rapid Identification ◽  
Blood Cultures ◽  
Clinical Microbiology Laboratory ◽  
Microbiology Laboratory ◽  
Labor Costs ◽  
Maldi Tof Ms ◽  
Maldi Tof ◽  
Tof Ms

Abstract Background Sepsis is a life-threatening condition with high rates of morbidity and mortality; effective and appropriate antibiotic therapy is essential for ensuring patient improvement. To aid in the diagnosis of sepsis, blood cultures are drawn and sent to the microbiology laboratory for pathogen growth, identification, and susceptibility testing. The clinical microbiology laboratory can assist the medical team by providing timely identification of the pathogen(s) causing the bloodstream infection through the use of rapid diagnostic technology. One of these rapid diagnostic technologies, MALDI-TOF MS, has been proven to reduce the time required for appropriate antibiotic therapy when used to identify pathogens grown in culture. This technology has also been used to identify pathogens directly from the positive blood cultures with great success. Content In this minireview, we summarize the different methods that have been developed to directly identify pathogens from positive blood cultures by use of MALDI-TOF MS and the effect of this technology on patient outcomes. Additionally, we touch on current research in the field, including the identification of antimicrobial resistance directly from positive blood cultures by MALDI-TOF MS. Summary Rapid identification of pathogens is important in the survival of patients undergoing a septic event. MALDI-TOF MS technology has played an important role in rapid identification, which has led to a reduction in the time to appropriate antibiotic therapy and contributed to the improvement of patient outcomes. The high sensitivity and specificity of MALDI-TOF MS identification, in combination with MALDI-TOF's rapid function and reduced labor costs, make this technology an attractive choice for clinical laboratories.

Facile syringe filter-enabled bacteria separation, enrichment, and buffer exchange for clinical isolation-free digital detection and characterization of bacterial pathogens in urine

The Analyst ◽  
2021 ◽  
Author(s):  
Pengfei Zhang ◽  
Aniruddha Kaushik ◽  
Kathleen E Mach ◽  
Kuangwen Hsieh ◽  
Joseph C. Liao ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Antibiotic Therapy ◽  
Broad Spectrum ◽  
Antimicrobial Susceptibility ◽  
Susceptibility Testing ◽  
Evidence Based ◽  
Pathogen Identification ◽  
Accelerated Methods ◽  
Syringe Filter

The development of accelerated methods for pathogen identification (ID) and antimicrobial susceptibility testing (AST) for infectious diseases is necessary to facilitate evidence-based antibiotic therapy and reduce clinical overreliance on broad-spectrum...

scholarly journals 12. Evaluation of Rapid Phenotypic Testing for KPC Carbapenemase Producing klebsiella Pneumoniae Directly from Positive Blood Cultures by Use of “Hot Chocolate” Plates

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S7-S7
Author(s):  
Alexander Lawandi ◽  
Gleice C Leite ◽  
Brigitte Lefebvre ◽  
Jean Longtin ◽  
Todd C Lee
Keyword(s):  
Klebsiella Pneumoniae ◽  
Carbapenem Resistance ◽  
Empiric Therapy ◽  
Turnaround Time ◽  
Rapid Identification ◽  
Blood Cultures ◽  
Minimal Growth ◽  
Maldi Tof ◽  
Considerable Morbidity ◽  
Hot Chocolate

Abstract Background Invasive infections with Carbapenemase Producing Enterobacterales are associated with considerable morbidity and mortality, in part due to the risk of inappropriate empiric therapy. Consequently, the rapid identification of carbapenem resistance is crucial to the management of these infections. We sought to evaluate possible reductions in turnaround time to identification of this resistance in blood cultures growing these organisms by applying rapid phenotypic test kits to growth from “hot chocolate” plates. Methods 30 blood cultures, spiked with carbapenem resistant Klebsiella pneumoniae isolates or susceptible controls, were inoculated onto chocolate agars that had pre-warmed at 37°C. These plates were incubated at 37ºC for 3.5 hours. The resulting minimal growth was then identified using MALDI-TOF and underwent rapid phenotypic testing using three commercially available products (β-lacta and β-carba, from Bio-Rad, Marnes-la-Coquette, France, and Carba-NP, from bioMérieux, Durham, NC). The time to identification of carbapenem resistance using this method was then compared to that of the conventional laboratory workup. Results The identification was 100% accurate to the species level using MALDI-TOF paired to the 3.5 hour growth on the “hot choocolate” plates. The β-lacta kit identified resistance to 3rd generation cephalosporins for all ESBL and carbapenemase producing Klebsiella pneumoniae isolates, while the β-carba and Carba-NP kits identified carbapenem resistance only in the carbapenemase producers. The sensitivity of all assays was 100% (95% CI 0.87–1.0) and the specificity of carbapenemase detection was 100% (97.5% one-sided CI 0.4–1.0). The corresponding sensitivities and specificities of direct disc diffusion for ertapenem resistance detection were 88.5% (95% CI 0.70–0.98) and 100% (95%CI 0.40–1.0) respectively. The turnaround time for the rapid kits coupled to the “hot chocolate” plates was 4.25 to 5.1 hours as compared to 16 hours for the conventional workup. Conclusion Rapid phenotypic tests performed after inoculation of “hot chocolate” plates are highly sensitive for the presence of carbapenemase production and can be incorporated into the laboratory workflow for Klebisella pneumoniae with important reductions in turnaround time. Disclosures All Authors: No reported disclosures

Sign in / Sign up

Export Citation Format

Share Document