Performance of Kiestra Total Laboratory Automation Combined with MS in Clinical Microbiology Practice

Abstract

Background: Microbiological laboratories seek technologically innovative solutions to cope with large numbers of samples and limited personnel and financial resources. One platform that has recently become available is the Kiestra Total Laboratory Automation (TLA) system (BD Kiestra B.V., the Netherlands). This fully automated sample processing system, equipped with digital imaging technology, allows superior detection of microbial growth. Combining this approach with matrix-assisted laser desorption ionization time-offlight mass spectrometry (MS) (Bruker Daltonik, Germany) is expected to enable more rapid identification of pathogens.Methods: Early growth detection by digital imaging using Kiestra TLA combined with MS was compared to conventional methods (CM) of detection. Accuracy and time taken for microbial identification were evaluated for the two methods in 219 clinical blood culture isolates. The possible clinical impact of earlier microbial identification was assessed according to antibiotic treatment prescription.Results: Pathogen identification using Kiestra TLA combined with MS resulted in a 30.6 hr time gain per isolate compared to CM. Pathogens were successfully identified in 98.4% (249/253) of all tested isolates. Early microbial identification without susceptibility testing led to an adjustment of antibiotic regimen in 12% (24/200) of patients. Conclusions:The requisite 24 hr incubation time for microbial pathogens to reach sufficient growth for susceptibility testing and identification would be shortened by the implementation of Kiestra TLA in combination with MS, compared to the use of CM. Not only can this method optimize workflow and reduce costs, but it can allow potentially life-saving switches in antibiotic regimen to be initiated sooner.

Minimum requirements in infection control

“…Mass spectrometry might also become useful in the routine detection of bacterial resistance mechanisms in the future [20]. Additionally, the increasing implementation of total laboratory automation systems offers the opportunity to optimize workflows, reduce costs, and further accelerate microbiological diagnostics [21,22]. On the other hand, external or centralized laboratories may negatively affect the relevance of microbiological data for IC activities, because of delays in result reporting and lack of contact with the hospital problems.…”

Real-time video imaging as a new and rapid tool for antibiotic susceptibility testing by the disc diffusion method: A paradigm for evaluating resistance to imipenem and identifying extended-spectrum β-lactamases

“…The first objective is to correctly identify the bacteria to species level, which is now feasible owing to matrix-assisted laser desorption/ionisation time-of-flight (MALDI-TOF) analysis within hours, including identification directly from blood culture bottles [5,6]. Use of MALDI-TOF analysis for identification of bacteria directly from positive blood cultures using automated systems has resulted in a 24-30 h time gain compared with conventional methods [6,7]. It has been demonstrated that early microbial identification by MALDI-TOF even without AST may lead to antimicrobial therapy adjustment in 12% of patients with positive blood culture [7].…”

“…Use of MALDI-TOF analysis for identification of bacteria directly from positive blood cultures using automated systems has resulted in a 24-30 h time gain compared with conventional methods [6,7]. It has been demonstrated that early microbial identification by MALDI-TOF even without AST may lead to antimicrobial therapy adjustment in 12% of patients with positive blood culture [7]. The second objective is to decrease the time required for AST of bacteria, which usually requires an additional overnight subculture of the isolated bacterium.…”

PetriJet Platform Technology: An Automated Platform for Culture Dish Handling and Monitoring of the Contents

“…9 The analysis methods used in large-scale microbiology laboratories and institutes are often rigidly configured, 6 making implementation of a totally automated system for HTS a reasonable goal. 10 In contrast, small-and mid-scale laboratories have a growing demand for automated and adaptable laboratory platform technologies that can be applied in partially automated processes. This is because such laboratories lack the capacity and throughput needed to achieve efficient turnaround times when using totally automated laboratory devices.…”