1887

Abstract

The direct rapid antibiotic susceptibility test (dRAST), based on analysing changes in bacterial micro-colonies under antibiotic conditions, detects antibiotic resistance within 6 h of direct smear examination results. This study aimed to assess the accuracy of dRAST and evaluate its potential usefulness for improving selection of appropriate antibiotic in real clinical practice settings.

We evaluated the accuracy of dRAST by comparing the antibiotic treatments that should have been administered based on dRAST results and the broth microdilution (BMD) test and its potential usefulness via simulation.

For 49/52 (94.2 %) patients with Gram-positive bacteraemia and 66/67 (98.5 %) patients with Gram-negative bacteraemia, antibiotics indicated by dRAST results were the same as those indicated by the BMD test. Among 34 patients with ineffective and suboptimal treatment, 19 (55.9 %) of patients could have received optimal treatment 1 to 2 days earlier with dRAST results. Among 33 patients given unnecessary broad-spectrum antibiotics, 1 to 2 days earlier de-escalation could have been possible for 27 (81.8 %) patients based on dRAST results.

The introduction of dRAST could increase the use of optimal antibiotics and reduce unnecessary broad-spectrum antibiotic use in the early period of bacteraemia.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.000678
2018-03-01
2024-10-05
Loading full text...

Full text loading...

/deliver/fulltext/jmm/67/3/325.html?itemId=/content/journal/jmm/10.1099/jmm.0.000678&mimeType=html&fmt=ahah

References

  1. Kumar A, Roberts D, Wood KE, Light B, Parrillo JE et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006; 34:1589–1596 [View Article][PubMed]
    [Google Scholar]
  2. Tenover FC. The best of times, the worst of times. The global challenge of antimicrobial resistance. Pharm World Sci 1995; 17:149–151[PubMed] [Crossref]
    [Google Scholar]
  3. Howard SJ, Hopwood S, Davies SC. Antimicrobial resistance: a global challenge. Sci Transl Med 2014; 6:236ed10 [View Article][PubMed]
    [Google Scholar]
  4. Pulido MR, García-Quintanilla M, Martín-Peña R, Cisneros JM, McConnell MJ. Progress on the development of rapid methods for antimicrobial susceptibility testing. J Antimicrob Chemother 2013; 68:2710–2717 [View Article][PubMed]
    [Google Scholar]
  5. Barenfanger J, Drake C, Kacich G. Clinical and financial benefits of rapid bacterial identification and antimicrobial susceptibility testing. J Clin Microbiol 1999; 37:1415–1418[PubMed]
    [Google Scholar]
  6. Doern GV, Vautour R, Gaudet M, Levy B. Clinical impact of rapid in vitro susceptibility testing and bacterial identification. J Clin Microbiol 1994; 32:1757–1762[PubMed]
    [Google Scholar]
  7. Choi J, Yoo J, Lee M, Kim EG, Lee JS et al. A rapid antimicrobial susceptibility test based on single-cell morphological analysis. Sci Transl Med 2014; 6:267ra174 [View Article][PubMed]
    [Google Scholar]
  8. Choi J, Jeong HY, Lee GY, Han S, Han S et al. Direct, rapid antimicrobial susceptibility test from positive blood cultures based on microscopic imaging analysis. Sci Rep 2017; 7:1148 [View Article][PubMed]
    [Google Scholar]
  9. FDA 2009; Class II Special Controls Guidance Document: Antimicrobial Susceptibility Test (AST) Systems. Available from www.fda.gov/RegulatoryInformation/Guidances/ucm080564.htm
  10. Wieser A, Schneider L, Jung J, Schubert S. MALDI-TOF MS in microbiological diagnostics-identification of microorganisms and beyond (mini review). Appl Microbiol Biotechnol 2012; 93:965–974 [View Article][PubMed]
    [Google Scholar]
  11. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988; 16:128–140 [View Article][PubMed]
    [Google Scholar]
  12. Chow JW, Yu VL. Combination antibiotic therapy versus monotherapy for gram-negative bacteraemia: a commentary. Int J Antimicrob Agents 1999; 11:7–12 [View Article][PubMed]
    [Google Scholar]
  13. Weber Z, Ariano R, Lagacé-Wiens P, Zelenitsky S. Multifaceted antibiotic treatment analysis of methicillin-sensitive Staphylococcus aureus bloodstream infections. Int J Antimicrob Agents 2016; 48:674–679 [View Article][PubMed]
    [Google Scholar]
  14. Frye AM, Baker CA, Rustvold DL, Heath KA, Hunt J et al. Clinical impact of a real-time PCR assay for rapid identification of staphylococcal bacteremia. J Clin Microbiol 2012; 50:127–133 [View Article][PubMed]
    [Google Scholar]
  15. Le Dorze M, Gault N, Foucrier A, Ruppé E, Mourvillier B et al. Performance and impact of a rapid method combining mass spectrometry and direct antimicrobial susceptibility testing on treatment adequacy of patients with ventilator-associated pneumonia. Clin Microbiol Infect 2015; 21:468.e1–468.e6 [View Article][PubMed]
    [Google Scholar]
  16. Leekha S, Terrell CL, Edson RS. General principles of antimicrobial therapy. Mayo Clin Proc 2011; 86:156–167 [View Article][PubMed]
    [Google Scholar]
  17. Gaynes R, Edwards JR. National Nosocomial Infections Surveillance System Overview of nosocomial infections caused by gram-negative bacilli. Clin Infect Dis 2005; 41:848–854 [View Article][PubMed]
    [Google Scholar]
  18. Klevens RM, Edwards JR, Tenover FC, McDonald LC, Horan T et al. Changes in the epidemiology of methicillin-resistant Staphylococcus aureus in intensive care units in US hospitals, 1992–2003. Clin Infect Dis 2006; 42:389–391 [View Article][PubMed]
    [Google Scholar]
  19. Ramsey AM, Zilberberg MD. Secular trends of hospitalization with vancomycin-resistant enterococcus infection in the United States, 2000–2006. Infect Control Hosp Epidemiol 2009; 30:184–186 [View Article][PubMed]
    [Google Scholar]
  20. Armand-Lefèvre L, Angebault C, Barbier F, Hamelet E, Defrance G et al. Emergence of imipenem-resistant gram-negative bacilli in intestinal flora of intensive care patients. Antimicrob Agents Chemother 2013; 57:1488–1495 [View Article][PubMed]
    [Google Scholar]
/content/journal/jmm/10.1099/jmm.0.000678
Loading
/content/journal/jmm/10.1099/jmm.0.000678
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error