Institut National de la Santé et de la Recherche Médicale, U1047, Université de Montpellier, UFR de Médecine, Nîmes, France.
Service de Microbiologie, CHU Carémeau, Nîmes, France.
J Antimicrob Chemother. 2018 Jun 1;73(6):1546-1552. doi: 10.1093/jac/dky032.
To evaluate the performance of the Accelerate Pheno™ system for the identification and antimicrobial susceptibility testing (AST) of a panel of Gram-negative bacilli (GNB) with different resistance profiles (e.g. penicillinases, ESBLs, cephalosporinase overproduction, carbapenemases, impermeability) directly from positive blood cultures in <7 h.
A panel of 105 clinical strains previously characterized for the presence of β-lactamase-encoding genes was tested. Approximately 100 cfu of each isolate was inoculated into sterile blood culture bottles and incubated in a BD BACTEC™ FX automated system (Becton Dickinson, USA). Positive blood cultures were subjected to parallel testing using the Accelerate Pheno™ system and conventional culture methods [identification of isolated colonies by MALDI-TOF and VITEK® 2 system (bioMérieux, France), and AST by disc diffusion and Etest following EUCAST recommendations].
The overall identification agreement between the Accelerate Pheno™ system and conventional culture methods was 100% (105/105). The overall categorical agreement between the system and culture-based AST was 94.9% (1169/1232), with rates for minor errors of 4.1% (51/1232), major errors 0.3% (4/1232) and very major errors 0.7% (8/1232). The Accelerate Pheno™ system produced AST results indicative of third-generation cephalosporinases (26/26) and carbapenem-resistant strains (52/55).
The Accelerate Pheno™ system is an accurate, sensitive and easy-to-use test for the rapid identification and AST of MDR GNB in bloodstream infections. Given the burden of multidrug resistance, its implementation in the microbiology laboratory could be a useful tool for prompt management of sepsis.
评估 Accelerate Pheno™ 系统在<7 小时内直接从阳性血培养物中鉴定和进行不同耐药谱（如青霉素酶、ESBLs、头孢菌素酶过度产生、碳青霉烯酶、通透性）革兰氏阴性杆菌（GNB）的表型和药敏试验（AST）的性能。
对一组 105 株先前具有β-内酰胺酶编码基因的临床分离株进行了检测。将每个分离株的约 100 个菌落接种到无菌血培养瓶中，并在 BD BACTEC™ FX 自动化系统（Becton Dickinson，美国）中孵育。将阳性血培养物进行平行检测，使用 Accelerate Pheno™ 系统和常规培养方法[通过 MALDI-TOF 和 VITEK® 2 系统（bioMérieux，法国）鉴定分离株的菌落，根据 EUCAST 建议通过纸片扩散和 Etest 进行 AST]。
Accelerate Pheno™ 系统与常规培养方法之间的总体鉴定一致性为 100%（105/105）。系统与基于培养的 AST 的总体分类一致性为 94.9%（1169/1232），次要错误率为 4.1%（51/1232），主要错误率为 0.3%（4/1232），非常大错误率为 0.7%（8/1232）。Accelerate Pheno™ 系统产生了第三代头孢菌素酶（26/26）和耐碳青霉烯菌株（52/55）的 AST 结果。
Accelerate Pheno™ 系统是一种快速、准确、敏感且易于使用的测试方法，可用于快速鉴定血流感染中的 MDR GNB 并进行 AST。鉴于多药耐药性的负担，在微生物学实验室中实施该方法可能是及时管理败血症的有用工具。
