Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
Department of Pathology, Emory University School of Medicine, Atlanta, Georgia, USA.
J Clin Microbiol. 2018 Mar 26;56(4). doi: 10.1128/JCM.01672-17. Print 2018 Apr.
Rapid diagnostic tests are needed to improve patient care and to combat the problem of antimicrobial resistance. The Accelerate Pheno system (Accelerate Diagnostics, Tucson, AZ) is a new diagnostic device that can provide rapid bacterial identification and antimicrobial susceptibility test (AST) results directly from a positive blood culture. The device was compared to the standard of care at two academic medical centers. There were 298 blood cultures included in the study, and the Accelerate Pheno system provided a definitive identification result in 218 instances (73.2%). The Accelerate Pheno system provided a definitive and correct result for 173 runs (58.1%). The Accelerate Pheno system demonstrated an overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 94.7%, 98.9%, 83.7%, and 99.7%, respectively. An AST result was available for analysis in 146 instances. The overall category agreement was 94.1% with 12 very major errors, 5 major errors, and 55 minor errors. After a discrepancy analysis, there were 5 very major errors and 4 major errors. The Accelerate Pheno system provided an identification result in 1.4 h and an AST result in 6.6 h; the identification and AST results were 41.5 h and 48.4 h faster than those with the standard of care, respectively. This study demonstrated that the Accelerate Pheno system is able to provide fast and accurate organism identification and AST data. A limitation is the frequency with which cultures required the use of alternative identification and AST methods.
快速诊断测试对于改善患者护理和应对抗菌药物耐药性问题至关重要。Accelerate Pheno 系统（Accelerate Diagnostics，图森，亚利桑那州）是一种新的诊断设备，可直接从阳性血培养物中提供快速的细菌鉴定和抗菌药物敏感性测试（AST）结果。该设备在两个学术医疗中心与标准护理进行了比较。研究共纳入 298 份血培养物，Accelerate Pheno 系统在 218 例（73.2%）中提供了明确的鉴定结果。Accelerate Pheno 系统在 173 次运行中提供了明确且正确的结果（58.1%）。Accelerate Pheno 系统的总体敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为 94.7%、98.9%、83.7%和 99.7%。有 146 份 AST 结果可用于分析。总体类别一致性为 94.1%，有 12 个非常大的错误、5 个大错误和 55 个小错误。经过差异分析，有 5 个非常大的错误和 4 个大错误。Accelerate Pheno 系统在 1.4 小时内提供鉴定结果，在 6.6 小时内提供 AST 结果；与标准护理相比，鉴定和 AST 结果分别快了 41.5 小时和 48.4 小时。这项研究表明，Accelerate Pheno 系统能够提供快速准确的微生物鉴定和 AST 数据。一个限制是培养物需要使用替代鉴定和 AST 方法的频率。
