Multicenter assessment of the rapid Unyvero Blood Culture molecular assay Open Access

Abstract

Purpose. Bloodstream infections remain an important cause of morbidity and mortality. Rapid diagnosis can reduce the time from empiric antimicrobial therapy to targeted therapy and improve patient outcomes.

Methodology. The fully automated Unyvero Blood Culture (BCU) Application (Curetis GmbH) can identify a broad panel of pathogens (36 analytes covering over 50 pathogens) and 16 antibiotic resistance gene markers simultaneously in about 5 h. The assay was evaluated in three clinical laboratories in comparison to routine microbiological procedures.

Results. A total of 207 blood cultures were included in the study, and 90.5 % of the species identified by culture were covered by the Unyvero BCU panel with an overall sensitivity of 96.8 % and specificity of 99.8 %. The time to result was reduced on average by about 34 h. The assay accurately identified 95 % of the species, including 158/164 monomicrobial and 7/9 polymicrobial cultures. The Unyvero BCU Cartridge detected a large number of resistance markers including mecA (n=57), aac(6)aph(2′′) (n=40), one vanB resistance gene, and six instances of bla CTX-M.

Conclusion. The Unyvero BCU Application provided fast, reliable results, while significantly improving turnaround time in blood culture diagnostics.

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2018-07-27
2024-03-29
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References

  1. Laupland KB, Zygun DA, Doig CJ, Bagshaw SM, Svenson LW et al. One-year mortality of bloodstream infection-associated sepsis and septic shock among patients presenting to a regional critical care system. Intensive Care Med 2005; 31:213–219 [View Article][PubMed]
    [Google Scholar]
  2. Mayr FB, Yende S, Angus DC. Epidemiology of severe sepsis. Virulence 2014; 5:4–11 [View Article][PubMed]
    [Google Scholar]
  3. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J et al. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001; 29:1303–1310 [View Article][PubMed]
    [Google Scholar]
  4. Goto M, Al-Hasan MN. Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe. Clin Microbiol Infect 2013; 19:501–509 [View Article][PubMed]
    [Google Scholar]
  5. Hall MJ, Williams SN, Defrances CJ, Golosinskiy A. Inpatient care for septicemia or sepsis: a challenge for patients and hospitals. NCHS Data Brief 2011; 62:1–8
    [Google Scholar]
  6. Gaieski DF, Mikkelsen ME, Band RA, Pines JM, Massone R et al. Impact of time to antibiotics on survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department. Crit Care Med 2010; 38:1045–1053 [View Article][PubMed]
    [Google Scholar]
  7. Harbarth S, Garbino J, Pugin J, Romand JA, Lew D et al. Inappropriate initial antimicrobial therapy and its effect on survival in a clinical trial of immunomodulating therapy for severe sepsis. Am J Med 2003; 115:529–535 [View Article][PubMed]
    [Google Scholar]
  8. Ibrahim EH, Sherman G, Ward S, Fraser VJ, Kollef MH. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest 2000; 118:146–155 [View Article][PubMed]
    [Google Scholar]
  9. 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]
  10. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med 2017; 43:304–377 [View Article][PubMed]
    [Google Scholar]
  11. Hartmann H, Stender H, Schäfer A, Autenrieth IB, Kempf VA. Rapid identification of Staphylococcus aureus in blood cultures by a combination of fluorescence in situ hybridization using peptide nucleic acid probes and flow cytometry. J Clin Microbiol 2005; 43:4855–4857 [View Article][PubMed]
    [Google Scholar]
  12. Jeng K, Gaydos CA, Blyn LB, Yang S, Won H et al. Comparative analysis of two broad-range PCR assays for pathogen detection in positive-blood-culture bottles: PCR-high-resolution melting analysis versus PCR-mass spectrometry. J Clin Microbiol 2012; 50:3287–3292 [View Article][PubMed]
    [Google Scholar]
  13. Patel P. [MALDI-TOFF mass spectrometry: transformative proteomics in clinical microbiology]. Klin Lab Diagn 2014; 59:8–10[PubMed]
    [Google Scholar]
  14. Patel R. MALDI-TOF MS for the diagnosis of infectious diseases. Clin Chem 2015; 61:100–111 [View Article][PubMed]
    [Google Scholar]
  15. Selva L, Esteva C, Gené A, de Sevilla MF, Hernandez-Bou S et al. Direct detection of Streptococcus pneumoniae in positive blood cultures by real-time polymerase chain reaction. Diagn Microbiol Infect Dis 2010; 66:204–206 [View Article][PubMed]
    [Google Scholar]
  16. Thomin J, Aubin GG, Foubert F, Corvec S. Assessment of four protocols for rapid bacterial identification from positive blood culture pellets by matrix-assisted laser desorption ionization-time of flight mass spectrometry (Vitek® MS). J Microbiol Methods 2015; 115:54–56 [View Article][PubMed]
    [Google Scholar]
  17. Beal SG, Ciurca J, Smith G, John J, Lee F et al. Evaluation of the nanosphere verigene gram-positive blood culture assay with the VersaTREK blood culture system and assessment of possible impact on selected patients. J Clin Microbiol 2013; 51:3988–3992 [View Article][PubMed]
    [Google Scholar]
  18. Blaschke AJ, Heyrend C, Byington CL, Fisher MA, Barker E et al. Rapid identification of pathogens from positive blood cultures by multiplex polymerase chain reaction using the FilmArray system. Diagn Microbiol Infect Dis 2012; 74:349–355 [View Article][PubMed]
    [Google Scholar]
  19. Bauer KA, West JE, Balada-Llasat JM, Pancholi P, Stevenson KB et al. An antimicrobial stewardship program's impact with rapid polymerase chain reaction methicillin-resistant Staphylococcus aureus/S. aureus blood culture test in patients with S. aureus bacteremia. Clin Infect Dis 2010; 51:1074–1080 [View Article][PubMed]
    [Google Scholar]
  20. Huang AM, Newton D, Kunapuli A, Gandhi TN, Washer LL et al. Impact of rapid organism identification via matrix-assisted laser desorption/ionization time-of-flight combined with antimicrobial stewardship team intervention in adult patients with bacteremia and candidemia. Clin Infect Dis 2013; 57:1237–1245 [View Article][PubMed]
    [Google Scholar]
  21. Wong JR, Bauer KA, Mangino JE, Goff DA. Antimicrobial stewardship pharmacist interventions for coagulase-negative staphylococci positive blood cultures using rapid polymerase chain reaction. Ann Pharmacother 2012; 46:1484–1490 [View Article][PubMed]
    [Google Scholar]
  22. Kumar A, Ellis P, Arabi Y, Roberts D, Light B et al. Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest 2009; 136:1237–1248 [View Article][PubMed]
    [Google Scholar]
  23. Garnacho-Montero J, Ortiz-Leyba C, Herrera-Melero I, Aldabó-Pallás T, Cayuela-Dominguez A et al. Mortality and morbidity attributable to inadequate empirical antimicrobial therapy in patients admitted to the ICU with sepsis: a matched cohort study. J Antimicrob Chemother 2008; 61:436–441 [View Article][PubMed]
    [Google Scholar]
  24. Lagacé-Wiens PR, Adam HJ, Karlowsky JA, Nichol KA, Pang PF et al. Identification of blood culture isolates directly from positive blood cultures by use of matrix-assisted laser desorption ionization-time of flight mass spectrometry and a commercial extraction system: analysis of performance, cost, and turnaround time. J Clin Microbiol 2012; 50:3324–3328 [View Article][PubMed]
    [Google Scholar]
  25. Verroken A, Defourny L, Lechgar L, Magnette A, Delmée M et al. Reducing time to identification of positive blood cultures with MALDI-TOF MS analysis after a 5-h subculture. Eur J Clin Microbiol Infect Dis 2015; 34:405–413 [View Article][PubMed]
    [Google Scholar]
  26. Lin JN, Lai CH, Chen YH, Chang LL, Lu PL et al. Characteristics and outcomes of polymicrobial bloodstream infections in the emergency department: a matched case-control study. Acad Emerg Med 2010; 17:1072–1079 [View Article][PubMed]
    [Google Scholar]
  27. Pammi M, Zhong D, Johnson Y, Revell P, Versalovic J. Polymicrobial bloodstream infections in the neonatal intensive care unit are associated with increased mortality: a case-control study. BMC Infect Dis 2014; 14:390 [View Article][PubMed]
    [Google Scholar]
  28. Hall KK, Lyman JA. Updated review of blood culture contamination. Clin Microbiol Rev 2006; 19:788–802 [View Article][PubMed]
    [Google Scholar]
  29. Lee A, Mirrett S, Reller LB, Weinstein MP. Detection of bloodstream infections in adults: how many blood cultures are needed?. J Clin Microbiol 2007; 45:3546–3548 [View Article][PubMed]
    [Google Scholar]
  30. Ruiz-Giardín JM, Martin-Díaz RM, Jaqueti-Aroca J, Garcia-Arata I, San Martín-López JV et al. Diagnosis of bacteraemia and growth times. Int J Infect Dis 2015; 41:6–10 [View Article][PubMed]
    [Google Scholar]
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