A Critique of Semiautomated Susceptibility Systems

Ce, Cherubin; R, Erg; Appleman, M

doi:10.1093/clinids/9.3.655

Cited by 12 publications

(4 citation statements)

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“…A shortcoming of rapid susceptibility testing by the current and previously marketed instruments has been some difficulty in detection of inducible antimicrobial resistance in a consistent manner (256,257). In some instances, a short incubation period of 4 -6 hrs was not sufficient for induction of an enzyme (e.g., some ␤-lactamases) that would destroy the antibiotic being tested (258).…”

Section: Short-incubation Automated Instrument Systemsmentioning

confidence: 99%

Diagnosis of infection in sepsis: An evidence-based review

Cohen

Brun‐Buisson

Torres

et al. 2004

Critical Care Medicine

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Obtaining a precise bacteriological diagnosis before starting antibiotic therapy is, when possible, of paramount importance for the success of therapeutic strategy during sepsis. Two to three blood cultures should be performed, preferably from a peripheral vein, without interval between samples to avoid delaying therapy. A quantitative approach is preferred in most cases when possible, in particular for catheter-related infections and ventilator-associated pneumonia. Diagnosing community-acquired pneumonia is complex, and a diagnostic algorithm is proposed. Appropriate samples are indicated during soft tissue and intraabdominal infections, but cultures obtained through the drains are discouraged.

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Section: Short-incubation Automated Instrument Systemsmentioning

confidence: 99%

Diagnosis of infection in sepsis: An evidence-based review

Cohen

Brun‐Buisson

Torres

et al. 2004

Critical Care Medicine

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“…It has been observed (2, 10) that MICs determined after short incubation periods differ from those obtained after incubation for 15 to 18 h. Mixed infections are undoubtedly a problem in direct-inoculation susceptibility testing. Several studies have revealed major discrepancies between susceptibility test results obtained by direct inoculation and those obtained after culturing each bacterial strain and testing it separately (1,3,7). Although the clinical significance of both short-incubation MICs and mixed-culture direct susceptibility test MICs has been questioned, others have emphasized both the need for and the feasibility of developing such methods (1,3,7,11).…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have revealed major discrepancies between susceptibility test results obtained by direct inoculation and those obtained after culturing each bacterial strain and testing it separately (1,3,7). Although the clinical significance of both short-incubation MICs and mixed-culture direct susceptibility test MICs has been questioned, others have emphasized both the need for and the feasibility of developing such methods (1,3,7,11). Methods such as the one described here may allow the rapid initiation of effective treatment against the major infecting organism and monitoring of the patient's condition at short intervals with adjustment of the treatment if other strains multiply.…”

Section: Discussionmentioning

confidence: 99%

Rapid flow cytometric bacterial detection and determination of susceptibility to amikacin in body fluids and exudates

Cohen

Sahar

1989

J Clin Microbiol

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A flow cytometry-based method for rapid and quantitative detection of bacteria in various clinical specimens and for rapid determination of antibiotic effect is described. Achieving such a measurement with high sensitivity required discrimination between bacteria and other particles which were often present in clinical samples in high concentrations. This discrimination was facilitated by detecting the bacterial characteristic light scatter and fluorescence signals following staining, e.g., with the fluorescent nucleic acid-binding dye ethidium bromide, as well as by measuring bacterial proliferation during short time intervals. Antibiotic susceptibility was measured by observing the inhibition of such proliferation. The method was applied to 43 clinical specimens from various sources, such as wound exudates, bile, serous cavity fluids, and bronchial lavage. Bacterial detection, achieved in less than 2 h, agreed with results of conventional methods with a sensitivity of 74% and a specificity of 88%. Susceptibility to amikacin was detected in l h in 92% of 13 positive specimens.

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“…Most of these systems are highly automated, particularly for MIC determinations and interpretations. The final report should offer an acceptable accuracy and should reproduce the values obtained by reference methods (4,7,9).…”

mentioning

confidence: 90%

Evaluation of the Wider System, a New Computer-Assisted Image-Processing Device for Bacterial Identification and Susceptibility Testing

et al. 2000

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The Wider system is a newly developed computer-assisted image-processing device for both bacterial identification and antimicrobial susceptibility testing. It has been adapted to be able to read and interpret commercial MicroScan panels. Two hundred forty-four fresh consecutive clinical isolates (138 isolates of the familyEnterobacteriaceae, 25 nonfermentative gram-negative rods [NFGNRs], and 81 gram-positive cocci) were tested. In addition, 100 enterobacterial strains with known β-lactam resistance mechanisms (22 strains with chromosomal AmpC β-lactamase, 8 strains with chromosomal class A β-lactamase, 21 broad-spectrum and IRT β-lactamase-producing strains, 41 extended-spectrum β-lactamase-producing strains, and 8 permeability mutants) were tested. API galleries and National Committee for Clinical Laboratory Standards (NCCLS) microdilution methods were used as reference methods. The Wider system correctly identified 97.5% of the clinical isolates at the species level. Overall essential agreement (±1 log2dilution for 3,719 organism-antimicrobial drug combinations) was 95.6% (isolates of the family Enterobacteriaceae, 96.6%; NFGNRs, 88.0%; gram-positive cocci, 95.6%). The lowest essential agreement was observed with Enterobacteriaceae versus imipenem (84.0%), NFGNR versus piperacillin (88.0%) and cefepime (88.0%), and gram-positive isolates versus penicillin (80.4%). The category error rate (NCCLS criteria) was 4.2% (2.0% very major errors, 0.6% major errors, and 1.5% minor errors). Essential agreement and interpretive error rates for eight β-lactam antibiotics against isolates of the family Enterobacteriaceae with known β-lactam resistance mechanisms were 94.8 and 5.4%, respectively. Interestingly, the very major error rate was only 0.8%. Minor errors (3.6%) were mainly observed with amoxicillin-clavulanate and cefepime against extended-spectrum β-lactamase-producing isolates. The Wider system is a new reliable tool which applies the image-processing technology to the reading of commercial trays for both bacterial identification and susceptibility testing.

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A Critique of Semiautomated Susceptibility Systems

Cited by 12 publications

References 0 publications

Diagnosis of infection in sepsis: An evidence-based review

Diagnosis of infection in sepsis: An evidence-based review

Rapid flow cytometric bacterial detection and determination of susceptibility to amikacin in body fluids and exudates

Evaluation of the Wider System, a New Computer-Assisted Image-Processing Device for Bacterial Identification and Susceptibility Testing

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