Rapid Detection of Bacterial and Fungal Pathogens Using the T2MR versus Blood Culture in Patients with Severe COVID-19

Seitz, Tamara; Holbik, Johannes; Hind, Julian; Gibas, Georg; Karolyi, Mario; Pawelka, Erich; Traugott, Marianna; Wenisch, Christoph; Zoufaly, Alexander

doi:10.1128/spectrum.00140-22

Cited by 9 publications

(8 citation statements)

References 29 publications

(42 reference statements)

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“…In addition, the time to antifungal administration was considerably shorter in the T2MR group than in the BC group (4 hours vs. 37) [ 122 ]. Other authors report similar results [ 123 , 128 - 130 ].…”

Section: What Is the Performance Of T2 Magnetic Resonance (T2mr) Cand...supporting

confidence: 78%

Unresolved issues in the diagnosis of catheter related candidemia: A position paper

Soriano-Martín,

Muñoz,

García-Rodríguez

et al. 2023

Rev Esp Quimioter

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The incidence and recent trends of candidemia and the contribution of the COVID-19 pandemic to its evolution are not well documented. The catheter is a major focus of Candida spp. infections, but the methods used to confirm the origin of candidemia are still based on the data generated for bacterial infection. The presence of Candida spp. on the tip of a removed catheter is the gold standard for confirmation but it is not always possible to remove it. Conservative methods, without catheter removal, have not been specifically studied for microorganisms whose times of growth are different from those of bacteria and therefore these results are not applicable to candidemia. The different Candida species do not have a particular tropism for catheter colonization and fungal biomarkers have not yet been able to contribute to the determination of the origin of candidemia. Techniques such Candida T2 Magnetic Resonance (T2MR) has not yet been applied for this purpose. Finally, there is not yet a consensus of how to proceed when Candida spp. is isolated from an extracted catheter and blood cultures obtained from simultaneous peripheral veins are negative. In this lack of firm data, a group of experts has formulated a series of questions trying to answer them based on the literature, indicating the current deficiencies and offering their own opinion. All authors agree with the conclusions of the manuscript and offer it as a position and discussion paper.

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Section: What Is the Performance Of T2 Magnetic Resonance (T2mr) Cand...supporting

confidence: 78%

Unresolved issues in the diagnosis of catheter related candidemia: A position paper

Soriano-Martín,

Muñoz,

García-Rodríguez

et al. 2023

Rev Esp Quimioter

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“…With the advent of patients suffering from severe COVID-19, the need for rapid diagnosis of sepsis and accurate detection of resistant pathogens causing BSIs has become particularly paramount ( 22 ). An Austrian-based study ( 23 ), which investigated the expanded T2B Panel ( Escherichia coli , Staphylococcus aureus , Klebsiella pneumoniae , Pseudomonas aeruginosa , Enterococcus faecium, and Acinetobacter baumannii ) and T2Candida in patients with severe COVID-19 identified T2MR detected targeted bacterial pathogens in 9 (10.6%) of 85 samples in comparison to parallel BCs detecting in 3 (3.5%) of 85 samples. T2Candida also was more sensitive in detection of candidemia than BCs [7 (8.2%) of 85 versus 1 (1.2%) of 85, respectively].…”

Section: Discussionmentioning

confidence: 99%

Prospective observational pilot study of the T2Resistance panel in the T2Dx system for detection of resistance genes in bacterial bloodstream infections

Walsh,

Mencacci,

Paggi

et al. 2024

J Clin Microbiol

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Early initiation of antimicrobial therapy targeting resistant bacterial pathogens causing sepsis and bloodstream infections (BSIs) is critical for a successful outcome. The T2Resistance Panel (T2R) detects the following resistance genes within organisms that commonly cause BSIs directly from patient blood samples: bla KPC , bla CTXM-14/15 , bla NDM /bla /IMP /bla VIM , bla AmpC , bla OXA , vanA , vanB , and mec A/ mec C. We conducted a prospective study in two major medical centers for the detection of circulating resistance genes by T2R in patients with BSIs. T2R reports were compared to antimicrobial susceptibility testing (AST), phenotypic identification, and standard molecular detection assays. Among 59 enrolled patients, 25 resistance genes were identified: bla KPC ( n = 10), bla NDM /bla /IMP /bla VIM ( n = 5), bla CTXM-14/15 ( n = 4), bla AmpC ( n = 2), and mec A/ mec C ( n = 4). Median time-to-positive-T2R in both hospitals was 4.4 hours [interquartile range (IQR): 3.65–4.97 hours] in comparison to that for positive blood cultures with final reporting of AST of 58.34 h (IQR: 45.51–111.2 hours; P < 0.0001). The sensitivity of T2R to detect the following genes in comparison to AST was 100% for bla CTXM-14/15 , bla NDM /bla / IMP /bla VIM , bla AmpC , mec A/ mec C and 87.5% for bla KPC . When monitored for the impact of significant antimicrobial changes, there were 32 events of discontinuation of unnecessary antibiotics and 17 events of escalation of antibiotics, including initiation of ceftazidime/avibactam in six patients in response to positive T2R results for bla KPC . In summary, T2R markers were highly sensitive for the detection of drug resistance genes in patients with bacterial BSIs, when compared with standard molecular resistance detection systems and phenotypic identification assays while significantly reducing by approximately 90% the time to detection of resistance compared to standard methodology and impacting clinical decisions for antimicrobial therapy. IMPORTANCE This is the first reported study to our knowledge to identify key bacterial resistance genes directly from the bloodstream within 3 to 5 hours in patients with bloodstream infections and sepsis. The study further demonstrated a direct effect in modifying initial empirical antibacterial therapy in response to T2R signal to treat resistant bacteria causing bloodstream infections and sepsis.

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“…To conclude, the emergence of multidrug-resistant bacteria necessitates the development and integration of rapid and reliable bacterial identification methods such as the T2MR, which provides identification within 6 h [ 27 ], and most importantly phenotypic AST methods like MAPt, which are crucial for swift determination of bacterial susceptibility. While further research is needed to address potential limitations and optimize its implementation, MAPt’s speed, accuracy and broad-spectrum coverage suggest its significant potential as a valuable tool for optimizing antimicrobial therapy, improving patient outcomes and curbing the spread of antibiotic resistance.…”

Section: Discussionmentioning

confidence: 99%

Rapid Phenotypic Antibiotic Susceptibility Profiling of Clinical Escherichia coli and Klebsiella pneumoniae Blood Cultures

Hefetz,

Bardenstein,

Rotem

et al. 2024

Antibiotics

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Bloodstream infections (BSI) are defined by the presence of viable bacteria or fungi, accompanied by systemic signs of infection. Choosing empirical therapy based solely on patient risk factors and prior antibiotic susceptibility test (AST) may lead to either ineffective treatment or unnecessarily broad-spectrum antibiotic exposure. In general, Clinical & Laboratory Standards Institute guideline-approved ASTs have a turnaround time of 48–72 h from sample to answer, a period that may result in a critical delay in the appropriate selection of therapy. Therefore, reducing the time required for AST is highly advantageous. We have previously shown that our novel rapid AST method, MAPt (Micro-Agar-PCR-test), accurately identifies susceptibility profiles for spiked bioterrorism agents like Bacillus anthracis, Yersinia pestis and Francisella tularensis directly from whole-blood and blood culture samples, even at low bacterial levels (500 CFU/mL). This study evaluated the performance of MAPt on routine bloodstream infection (BSI), focusing on Escherichia coli and Klebsiella pneumoniae isolates from clinical cultures, including resistant strains to some of the six tested antibiotics. Notably, MAPt yielded results exceeding 95% agreement with the standard hospital method within a significantly shorter timeframe of 6 h. These findings suggest significant potential for MAPt as a rapid and reliable BSI management tool.

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Rapid Detection of Bacterial and Fungal Pathogens Using the T2MR versus Blood Culture in Patients with Severe COVID-19

Abstract: Coronavirus disease 2019 (COVID-19) has led to a high number of deaths since the beginning of the pandemic worldwide. One of the reasons is the high number of bacterial and fungal superinfections in patients suffering from critical disease.

Cited by 9 publications

References 29 publications

Unresolved issues in the diagnosis of catheter related candidemia: A position paper

Unresolved issues in the diagnosis of catheter related candidemia: A position paper

Prospective observational pilot study of the T2Resistance panel in the T2Dx system for detection of resistance genes in bacterial bloodstream infections

Rapid Phenotypic Antibiotic Susceptibility Profiling of Clinical Escherichia coli and Klebsiella pneumoniae Blood Cultures

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