A rapid and inexpensive protocol to screen for third generation cephalosporin-resistant and non-fermenting Gram-negative rods directly in positive blood cultures

Parmeland, Laurence; Bourru, Thomas; Kyungu, Victoria; Rousseau, Nathalie; Gleize, Marion; Beauvoir, C.; Pecquet, Matthieu

doi:10.1016/j.diagmicrobio.2021.115428

Cited by 3 publications

(3 citation statements)

References 10 publications

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“…The other rapid testing protocol investigated in this study involved multiple rapid tests ( Parmeland et al., 2021 ) with a decision algorithm to select the best possible combination based on Gram-staining results. The GeneXpert MRSA/SA PCR test is a genotypic test able to detect methicillin-resistant Staphylococcus with a sensitivity and specificity close to 100% in blood cultures ( Parta et al., 2009 ; Brown and Paladino, 2010 ; Davies et al., 2012 ).…”

Section: Discussionmentioning

confidence: 99%

“…The oxidase test is also a phenotypic test used to detect gram-negative bacteria producing cytochrome oxidase, typically Pseudomonas species in bacteremia. The performance and utility of this test remains to be established, but its sensitivity and specificity have been found to be around 95% and 100% respectively, when performed on blood cultures ( Sepúlveda et al., 1990 ; Cobos-Triguero et al., 2017 ; Parmeland et al., 2021 ). Neither the β -Lacta test nor the oxidase test require additional sample preparation steps, consumables, or specialist training.…”

Section: Discussionmentioning

confidence: 99%

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Shortening identification times: comparative observational study of three early blood culture testing protocols

Chatelard

Rousseau

Parmeland

et al. 2023

Front. Cell. Infect. Microbiol.

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BackgroundWhile early appropriate antibiotic therapy is a proven means of limiting the progression of infections, especially bacteremia, empirical antibiotic therapy in sepsis is ineffective up to 30%. The aim of this study was to compare early blood culture testing protocols in terms of their ability to shorten the delay between blood sampling and appropriate antibiotic therapy.MethodsIn this french observational study, we compared three blood culture testing protocols. Positive blood cultures were tested using either GenMark ePlex panels (multiplex PCR period), a combination of MRSA/SA PCR, β-Lacta and oxidase tests (multitest period), or conventional identification and susceptibility tests only (reference period). Conventional identification and susceptibility tests were performed in parallel for all samples, as the gold standard.ResultsAmong the 270 patients with positive blood cultures included, early and conventional results were in good agreement, especially for the multitest period. The delay between a blood culture positivity and initial results was 3.8 (2.9–6.9) h in the multiplex PCR period, 2.6 (1.3–4.5) h in the multitest period and 3.7 (1.8–8.2) h in the reference period (p<0.01). Antibiotic therapy was initiated or adjusted in 68 patients based on early analysis results. The proportion of patients receiving appropriate antibiotic therapy within 48 h of blood sampling was higher in the multiplex PCR and multitest periods, (respectively 90% and 88%) than in the reference period (71%).ConclusionThese results suggest rapid bacterial identification and antibiotic resistance tests are feasible, efficient and can expedite appropriate antibiotic therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Shortening identification times: comparative observational study of three early blood culture testing protocols

Chatelard

Rousseau

Parmeland

et al. 2023

Front. Cell. Infect. Microbiol.

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“…Colorimetric methods to detect resistance mechanisms are commercially available as relatively inexpensive benchtop solutions. They identify the presence and type of Extended-spectrum b-lactamase (ESBL) or carbapenemase enzymes in 1-6 h on bacterial colonies isolated from the initial culture with good accuracy [22][23][24][25][26]. Matrix-assisted laser desorption/ ionization-time of flight (MALDI-TOF) mass spectrometry for the identification of microorganisms in positive blood cultures has been compared to conventional methods in the RAPIDO randomized-controlled trial, which did not show an impact on day 28 mortality [27 & ].…”

Section: Key Pointsmentioning

confidence: 99%

Current opinion in management of septic shock due to Gram-negative bacteria

Tabah

Buetti

Barbier³

et al. 2021

Current Opinion in Infectious Diseases

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Purpose of reviewThe COVID-19 pandemic has caused multiple challenges to ICUs, including an increased rate of secondary infections, mostly caused by Gram-negative micro-organisms. Worrying trends of resistance acquisition complicate this picture. We provide a review of the latest evidence to guide management of patients with septic shock because of Gram-negative bacteria. Recent findingsNew laboratory techniques to detect pathogens and specific resistance patterns from the initial culture are available. Those may assist decreasing the time to adequate antimicrobial therapy and avoid unnecessary broad-spectrum antibiotic overuse. New antimicrobials, including b-lactam/b-lactamase inhibitor combinations, such as ceftolozane-tazobactam, imipenem-relebactam or meropenem-vaborbactam and cephalosporins, such as cefiderocol targeted to specific pathogens and resistance patterns are available for use in the clinical setting. Optimization of antibiotic dosing and delivery should follow pharmacokinetic and pharmacodynamic principles and wherever available therapeutic drug monitoring. Management of sepsis has brought capillary refill time back to the spotlight along with more reasoned fluid resuscitation and a moderate approach to timing of dialysis initiation. SummaryNovel rapid diagnostic tests and antimicrobials specifically targeted to Gram-negative pathogens are available and should be used within the principles of antimicrobial stewardship including de-escalation and short duration of antimicrobial therapy.

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Diagnostic bactériologique des bactéries multirésistantes et bactéries hautement résistantes émergentes

Bousquet¹,

Mérens²

2021

Revue Francophone des Laboratoires

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A rapid and inexpensive protocol to screen for third generation cephalosporin-resistant and non-fermenting Gram-negative rods directly in positive blood cultures

Cited by 3 publications

References 10 publications

Shortening identification times: comparative observational study of three early blood culture testing protocols

Shortening identification times: comparative observational study of three early blood culture testing protocols

Current opinion in management of septic shock due to Gram-negative bacteria

Diagnostic bactériologique des bactéries multirésistantes et bactéries hautement résistantes émergentes

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