Evaluation of rapid phenotypic identification and antimicrobial susceptibility testing in a pediatric oncology center

Cardenas, Jessica N Brazelton de; Su, Yin; Rodríguez, Alicia; Hewitt, C.; Li, Tang; Garner, Cherilyn D.; Hayden, Randall T.

doi:10.1016/j.diagmicrobio.2017.06.014

Cited by 30 publications

(23 citation statements)

References 27 publications

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“…In our study, the average hands-on time per specimen was not different from routine testing, however the time to deliver susceptibility results has been significantly reduced compared to routine standard automated system (BD Phoenix™). The times to AST results were similar to the times noted in a previous study using the Alfred 60 AST™ system and other the Accelerate Pheno TM system (Accelerate Diagnostics, USA) (Barnini, 2016) (Descours, 2018) (Lutgring, 2018) (Brazelton de Cardenas, 2017). Given high categorical agreement between the BD Phoenix™ and Alfred 60 AST™ and the 16 hour reduction in time to results there are compelling clinical benefits of the Alfred AST 60™.…”

Section: Discussionsupporting

confidence: 81%

Evaluation of a new Rapid Antimicrobial Susceptibility system for Gram-negative and Gram-positive bloodstream infections: Speed and accuracy of Alfred 60 AST

Antón-Vázquez

Samuel

Cristina

et al. 2019

Preprint

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Background: Blood stream infections (BSIs) are a major cause of morbidity and mortality. The time from taking blood cultures to obtain results of antibiotic sensitivity can be up to five days which impacts patient care. The Alfred 60 AST™ can reduce laboratory time from positive culture bottle to susceptibility results from 16-25 hours to 5-6 hours, transforming patient care. Objective: To evaluate the diagnostic accuracy of a rapid antimicrobial susceptibility system, the Alfred 60 AST™, in clinical isolates from patients with BSIs and confirm time to results. Methods: 301 Gram-negative and 86 Gram-positive isolates were analysed directly from positive blood culture bottles following Gram staining. Antimicrobial susceptibility results and time-to-results obtained by rapid Alfred 60 AST system and BD Phoenix were compared . Results : A total of 2,196 antimicrobial susceptibility test results (AST) were performed: 1,863 Gram-negative and 333 Gram-positive. AST categorical agreement (CA) for Alfred 60 AST™ was 95% (1772/1863) for Gram-negative and 89% (295/333) for Gram-positive isolates. Gram-negative CA: ampicillin 96% (290/301); ciprofloxacin 95% (283/297); ceftriaxone 96% (75/78); meropenem 97% (288/297); piperacillin-tazobactam 95% (280/295); gentamicin 94% (279/297) and amikacin 93% (277/298). The median time to susceptibility resultsfrom blood culture flagging positive was 6.3 h vs 20 h ( p<0.01 ) for Alfred system vs BD Phoenix™. Conclusion: Alfred 60 AST system greatly reduced time to antimicrobial susceptibility results in Gram-negative and Gram-positive BSIs with good performance and cost, particularly for Gram-negative bacteraemia. Keywords: Rapid diagnostics. Bloodstream infection. Bacteraemia. Antimicrobial susceptibility testing. Gram-negative bacteria. Gram-positive bacteria

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Section: Discussionsupporting

confidence: 81%

Evaluation of a new Rapid Antimicrobial Susceptibility system for Gram-negative and Gram-positive bloodstream infections: Speed and accuracy of Alfred 60 AST

Antón-Vázquez

Samuel

Cristina

et al. 2019

Preprint

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“…Manufacturer-provided interpretative ranges for procalcitonin.Manufacturer-provided interpretative ranges for procalcitonin(45) are listed in the table above, and normal ranges of procalcitonin in newborns based on age in hours are depicted below in the bar graph.…”

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confidence: 99%

Diagnostic Challenges and Laboratory Considerations for Pediatric Sepsis

Patel

McElvania

2019

The Journal of Applied Laboratory Medicine

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Background Sepsis is a leading cause of death for children in the US and worldwide. There is a lack of consensus how sepsis is clinically defined, and sepsis definitions and diagnostic guidelines for the pediatric population have remained unchanged for more than a decade now. Current pediatric definitions are largely based on adult guidelines and expert opinion rather than evidence based on outcomes in the pediatric populations. Without a clear definition of sepsis, it is challenging to evaluate the performance of new laboratory tests on the diagnosis and management of sepsis. Content This review provides an overview of common etiologies of sepsis in pediatric populations, challenges in defining and diagnosing pediatric sepsis, and current laboratory tests used to identify and monitor sepsis. Strengths and limitations of emerging diagnostic strategies will also be discussed. Summary Currently there is no single biomarker that can accurately diagnose or predict sepsis. Current biomarkers such as C-reactive protein and lactate are neither sensitive nor specific for diagnosing sepsis. New biomarkers and rapid pathogen identification assays are much needed. Procalcitonin, although having some limitations, has emerged as a biomarker with demonstrated utility in management of sepsis in adults. Parallel studies analyzing the utility of procalcitonin in pediatric populations are lagging but have shown potential to affect sepsis care in pediatric populations. Multibiomarker approaches and stepwise algorithms show promise in the management of pediatric sepsis. However, a major hurdle is the lack of validated clinical criteria for classification of pediatric sepsis, which is necessary for the development of well-designed studies that can assess the clinical impact of these emerging biomarkers.

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“…The Accelerate Pheno system (Accelerate Diagnostics, Tucson, AZ) is a new diagnostic device that can provide rapid bacterial identification and AST results. The device uses a broad panel of fluorescence in situ hybridization assays for microorganism identification and morphokinetic cellular analysis using time-lapse imaging for AST (21)(22)(23)(24)(25). The Accelerate PhenoTest BC kit can identify 16 organisms-6 Gram-positive and 8 Gram-negative bacteria, as well as 2 Candida species-directly from positive blood cultures.…”

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confidence: 99%

Evaluation of the Accelerate Pheno System: Results from Two Academic Medical Centers

et al. 2018

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Rapid diagnostic tests are needed to improve patient care and to combat the problem of antimicrobial resistance. The Accelerate Pheno system (Accelerate Diagnostics, Tucson, AZ) is a new diagnostic device that can provide rapid bacterial identification and antimicrobial susceptibility test (AST) results directly from a positive blood culture. The device was compared to the standard of care at two academic medical centers. There were 298 blood cultures included in the study, and the Accelerate Pheno system provided a definitive identification result in 218 instances (73.2%). The Accelerate Pheno system provided a definitive and correct result for 173 runs (58.1%). The Accelerate Pheno system demonstrated an overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 94.7%, 98.9%, 83.7%, and 99.7%, respectively. An AST result was available for analysis in 146 instances. The overall category agreement was 94.1% with 12 very major errors, 5 major errors, and 55 minor errors. After a discrepancy analysis, there were 5 very major errors and 4 major errors. The Accelerate Pheno system provided an identification result in 1.4 h and an AST result in 6.6 h; the identification and AST results were 41.5 h and 48.4 h faster than those with the standard of care, respectively. This study demonstrated that the Accelerate Pheno system is able to provide fast and accurate organism identification and AST data. A limitation is the frequency with which cultures required the use of alternative identification and AST methods.

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Evaluation of rapid phenotypic identification and antimicrobial susceptibility testing in a pediatric oncology center

Cited by 30 publications

References 27 publications

Evaluation of a new Rapid Antimicrobial Susceptibility system for Gram-negative and Gram-positive bloodstream infections: Speed and accuracy of Alfred 60 AST

Evaluation of a new Rapid Antimicrobial Susceptibility system for Gram-negative and Gram-positive bloodstream infections: Speed and accuracy of Alfred 60 AST

Diagnostic Challenges and Laboratory Considerations for Pediatric Sepsis

Evaluation of the Accelerate Pheno System: Results from Two Academic Medical Centers

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