Fully automated disc diffusion for rapid antibiotic susceptibility test results: a proof-of-principle study

Hombach, Michael; Jetter, Marion; Blöchliger, Nicolas; Kolesnik-Goldmann, Natalia; Böttger, Erik C.

doi:10.1093/jac/dkx026

Cited by 43 publications

(23 citation statements)

References 22 publications

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“…However, the gradual increase in samples number, limited budget, personal shortage and quality issues as well as laboratories consolidation and liquid-based transport devices have triggered the development and the introduction by different manufacturers of laboratory automation solutions into diagnostic bacteriology laboratories [1] , [2] , [3] , [4] . Several peer-reviewed publications have demonstrated that laboratory automation have the potential to greatly improve the diagnostic processes in bacteriology by increasing the productivity, the quality and the throughput but also by decreasing the time-to results and laboratory cost [1] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] . Even though the indirect impact of lab automation on patient management remained to be demonstrated in objective, comparative and prospective clinical studies performed by independent laboratories, the shortening of time-to results observed after implementation of laboratory automation strongly suggests that automation will positively improve the clinical management of patients suffering from infectious diseases.…”

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confidence: 99%

Towards automated detection, semi-quantification and identification of microbial growth in clinical bacteriology: A proof of concept

et al. 2017

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BackgroundAutomation in microbiology laboratories impacts management, workflow, productivity and quality. Further improvements will be driven by the development of intelligent image analysis allowing automated detection of microbial growth, release of sterile samples, identification and quantification of bacterial colonies and reading of AST disk diffusion assays. We investigated the potential benefit of intelligent imaging analysis by developing algorithms allowing automated detection, semi-quantification and identification of bacterial colonies.MethodsDefined monomicrobial and clinical urine samples were inoculated by the BD Kiestra™ InoqulA™ BT module. Image acquisition of plates was performed with the BD Kiestra™ ImagA BT digital imaging module using the BD Kiestra™ Optis™ imaging software. The algorithms were developed and trained using defined data sets and their performance evaluated on both defined and clinical samples.ResultsThe detection algorithms exhibited 97.1% sensitivity and 93.6% specificity for microbial growth detection. Moreover, quantification accuracy of 80.2% and of 98.6% when accepting a 1 log tolerance was obtained with both defined monomicrobial and clinical urine samples, despite the presence of multiple species in the clinical samples. Automated identification accuracy of microbial colonies growing on chromogenic agar from defined isolates or clinical urine samples ranged from 98.3% to 99.7%, depending on the bacterial species tested.ConclusionThe development of intelligent algorithm represents a major innovation that has the potential to significantly increase laboratory quality and productivity while reducing turn-around-times. Further development and validation with larger numbers of defined and clinical samples should be performed before transferring intelligent imaging analysis into diagnostic laboratories.

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confidence: 99%

Towards automated detection, semi-quantification and identification of microbial growth in clinical bacteriology: A proof of concept

et al. 2017

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“…We recently demonstrated in a proof-of-principle study the feasibility of rAST. 15 E. faecalis , E. faecium , P. aeruginosa and A. baumannii represent a significant part of microorganisms isolated from critically ill patients. We here evaluated whether early reading of disc diffusion can be applied to these pathogens.…”

Section: Discussionmentioning

confidence: 99%

“…13 , 14 In a proof-of-principle study, we recently demonstrated that automated rAST is feasible. 15 We here evaluated whether early reading of disc diffusion is possible for clinical pathogens with a high diversity of intrinsic resistance mechanisms, namely enterococci, P. aeruginosa and A. baumannii . The aims of this study were to examine the feasibility of rAST to discriminate important resistance phenotypes from WT populations and to identify species/drug combinations that need adaptation of clinical breakpoints (CBPs).…”

Section: Introductionmentioning

confidence: 99%

Rapid disc diffusion antibiotic susceptibility testing for Pseudomonas aeruginosa, Acinetobacter baumannii and Enterococcus spp.

Hombach

Jetter

Blöchliger

et al. 2017

Journal of Antimicrobial Chemotherapy

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BackgroundWe investigated the feasibility of rapid disc diffusion antibiotic susceptibility testing (rAST) with reading of inhibition zones after 6 and/or 8 h of incubation for Enterococcus faecalis, Enterococcus faecium, Pseudomonas aeruginosa and Acinetobacter baumannii. In addition, we evaluated discrimination of resistant populations from the WT populations at early timepoints and the requirement for clinical breakpoint adaptations for proper interpretation of rAST data.MethodsIn total, 815 clinical strains [E. faecalis (n = 135), E. faecium (n = 227), P. aeruginosa (n = 295) and A. baumannii (n = 158)] were included in this study. Disc diffusion plates were streaked, incubated and imaged using the WASPLabTM automation system. WT populations and non-WT populations were defined using epidemiological cut-offs.Results and conclusionsrAST at 6 and 8 h was possible for A. baumannii and enterococci with readability of inhibition zones >90%. Overall categorical agreement of rAST at 6 h with AST at 18 h was 97.2%, 97.4% and 95.3% for E. faecalis, E. faecium and A. baumannii, respectively. With few exceptions, major categorization error rates were <1% for A. baumannii, and vancomycin-resistant E. faecium were clearly separated from the WT at 6 h. For P. aeruginosa the average readability of inhibition zones was 68.9% at 8 h and we found an overall categorical agreement of 94.8%. Adaptations of clinical breakpoints and/or introduction of technical buffer zones, preferably based on aggregated population data from various epidemiological settings, are required for proper interpretation of rAST.

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“…Finally, fully automated solutions to disk diffusion testing are emerging, including total laboratory automation systems. These will further simplify the process of disk diffusion testing by automating colony picking, inoculum preparation, incubation, and reading (37). The use of these fully automated disk diffusion solutions will expedite reporting and will fit into today's laboratory workflow.…”

Section: Tools To Aid In Standardization Of Disk Diffusion Testing Inmentioning

confidence: 99%

The Continued Value of Disk Diffusion for Assessing Antimicrobial Susceptibility in Clinical Laboratories: Report from the Clinical and Laboratory Standards Institute Methods Development and Standardization Working Group

et al. 2018

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Expedited pathways to antimicrobial agent approval by the U.S. Food and Drug Administration (FDA) have led to increased delays between drug approval and the availability of FDA-cleared antimicrobial susceptibility testing (AST) devices. Antimicrobial disks for use with disk diffusion testing are among the first AST devices available to clinical laboratories. However, many laboratories are reluctant to implement disk diffusion testing for a variety of reasons, including dwindling proficiency with this method, interruptions of the laboratory workflow, uncertainty surrounding the quality and reliability of disk diffusion tests, and a perceived need to report MIC values to clinicians. This minireview provides a report from the Clinical and Laboratory Standards Institute Methods Development and Standardization Working Group on the current standards and clinical utility of disk diffusion testing.

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Fully automated disc diffusion for rapid antibiotic susceptibility test results: a proof-of-principle study

Cited by 43 publications

References 22 publications

Towards automated detection, semi-quantification and identification of microbial growth in clinical bacteriology: A proof of concept

Towards automated detection, semi-quantification and identification of microbial growth in clinical bacteriology: A proof of concept

Rapid disc diffusion antibiotic susceptibility testing for Pseudomonas aeruginosa, Acinetobacter baumannii and Enterococcus spp.

The Continued Value of Disk Diffusion for Assessing Antimicrobial Susceptibility in Clinical Laboratories: Report from the Clinical and Laboratory Standards Institute Methods Development and Standardization Working Group

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