Direct Identification of Gram-Positive Cocci from Routine Blood Cultures by Using AccuProbe Tests

Lindholm, Laura; Sarkkinen, Hannu

doi:10.1128/jcm.42.12.5609-5613.2004

Cited by 32 publications

(15 citation statements)

References 22 publications

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“…However, with the S. aureus probe, although the specificity was very high (99.8%) the sensitivity was quite low (72.4%). The cut-off values were adjusted and the performance of the tests, especially that for S. aureus, was significantly improved [61].…”

Section: Hybridization Techniques For Positive Blood Culturesmentioning

confidence: 99%

Conventional and molecular techniques for the early diagnosis of bacteraemia

Paolucci

Landini

Sambri

2010

International Journal of Antimicrobial Agents

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Bloodstream infections account for 30-40% of all cases of severe sepsis and septic shock, and are major causes of morbidity and mortality. Diagnosis of bloodstream infections must be performed promptly so that adequate antimicrobial therapy can be started and patient outcome improved. An ideal diagnostic technology would identify the infecting organism(s) and their determinants of antibiotic resistance, in a timely manner, so that appropriate pathogen-driven therapy could begin promptly. Unfortunately, despite the essential information it provides, blood culture, the gold standard, largely fails in this purpose because time is lost waiting for bacterial or fungal growth. Several efforts have been made to optimize the performance of blood culture, such as the development of technologies to obtain rapid detection of microorganism(s) directly in blood samples or in a positive blood culture. The ideal molecular method would analyze a patient's blood sample and provide all the information needed to immediately direct optimal antimicrobial therapy for bacterial or fungal infections. Furthermore, it would provide data to assess the effectiveness of the therapy by measuring the clearance of microbial nucleic acids from the blood over time. None of the currently available molecular methods is sufficiently rapid, accurate or informative to achieve this. This review examines the principal advantages and limitations of some traditional and molecular methods commercially available to help the microbiologist and the clinician in the management of bloodstream infections.

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Section: Hybridization Techniques For Positive Blood Culturesmentioning

confidence: 99%

Conventional and molecular techniques for the early diagnosis of bacteraemia

Paolucci

Landini

Sambri

2010

International Journal of Antimicrobial Agents

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“…Recent improvements in blood culture processing have been made through the molecular detection of staphylococci, enabling rapid recognition of meticillin-resistant Staphylococcus aureus (Fujita et al, 2005). Broader-ranging molecular identification systems, such as gene hybridization and PCR-based probes, have been used to identify bacteria from machine-positive cultures, but these have yet to improve patient outcomes (Lindholm & Sarkkinen, 2004;Wellinghausen et al, 2004). Other developments in laboratory medicine such as increased reliance on digital reporting or telephone reports from a centralized diagnostic laboratory reduce the direct contact with the patient's attending physician and thus opportunities for result interpretation.…”

Section: Introductionmentioning

confidence: 99%

A hospital-wide study of the impact of introducing a personal data assistant-augmented blood culture round

Inglis

Hodge

Ketharanathan

2008

Journal of Medical Microbiology

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Blood culture is the cornerstone of an established aetiological diagnosis of septicaemia. The automated blood culture systems used for this purpose have changed little in the last decade, and the clinical value of results depends on a variety of factors, including pre-and post-analytical variables. Growing scepticism over the value of blood culture results and pressure for the introduction of molecular detection systems have prompted a critical path analysis of pre-, peri-and post-analytical stages in the generation of positive blood culture results. The impact of a positive blood culture was studied in a teaching hospital for 12 months before and 12 months after the introduction of a microbiologist's blood culture round. Active culture reporting via a blood culture ward round was supported by a personal data assistant database of contemporaneous laboratory and clinical data. Hospital occupancy and death register records were subsequently obtained through the State Government data linkage project. There was no evidence that faster laboratory generation of positive blood culture results, faster reporting of results or direct clinical interaction with the patient's primary medical team reduced the risk of death in hospital. However, there was a threefold increase in the rate of death in hospital following a 1 day delay in collection of blood cultures after hospital admission (P50.0010). The overall duration of hospital stay for patients with a positive blood culture fell by 2.5 days compared with the previous 12 month period (P50.0003). The interval between the initial positive culture result and patient discharge fell by 2 days (P50.0010). This difference was attributed to shorter overall admissions and shorter intervals between positive cultures containing Gram-positive cocci and subsequent patient discharge (P50.0018). An increased mortality rate from community-acquired bacteraemic infections was associated with delayed culture collection, but not with a prolonged laboratory processing interval. Thus, the speed of conventional blood culture analysis and the form of clinical reporting have little direct effect on the clinical outcome of bacteraemia, but may contribute to a reduction in the length of hospital admission. Introduction of molecular identification tests, such as multiplex PCR methods, at the Gram-stain stage of blood culture is unlikely to affect the rate of death in hospital, but may reduce the length of hospital admission.

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“…Both studies report specificity of 100% but one center reported an accuracy of only 80.8% [120] compared with 99.8% in the other center [120]. The reasons for the differences are not clear and neither study reported outcome data associated with assay performance in their respective centers [120,121].…”

Section: Molecular Non-amplifiedmentioning

confidence: 95%

“…Two published studies on its use on positive BCs are available but with vastly different results [120,121]. Both studies report specificity of 100% but one center reported an accuracy of only 80.8% [120] compared with 99.8% in the other center [120].…”

Section: Molecular Non-amplifiedmentioning

confidence: 98%