von Laer Anja, N'Guessan Micheline Ahou, Touré Fidèle Sounan, Nowak Kathrin, Groeschner Karin, Ignatius Ralf, Friesen Johannes, Tomczyk Sara, Leendertz Fabian H, Eckmanns Tim, Akoua-Koffi Chantal
Postgraduate Training for Applied Epidemiology, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
Front Med (Lausanne). 2021 May 21;8:627513. doi: 10.3389/fmed.2021.627513. eCollection 2021.
Blood cultures (BC) have a high clinical relevance and are a priority specimen for surveillance of antimicrobial resistance. Manual BC are still most frequently used in resource-limited settings. Data on automated BC performance in Africa are scarce. We implemented automated BC at a surveillance site of the (ANDEMIA). Between June 2017 and January 2018, pairs of automated BC (BacT/ALERTFA Plus) and manual BC (brain-heart infusion broth) were compared at a University hospital in Bouaké, Côte d'Ivoire. BC were inoculated each with a target blood volume of 10 ml from the same venipuncture. Automated BC were incubated for up to 5 days, manual BC for up to 10 days. Terminal subcultures were performed for manual BC only. The two systems were compared regarding yield, contamination, and turnaround time. For quality assurance, isolates were retested in a German routine microbiological laboratory. BC sampling was increased from on average 24 BC to 63 BC per month. A total of 337 matched pairs of BC were included. Automated BC was positive in 36.5%, manual BC in 24.0% (-value < 0.01), proportion of contamination was 47.9 and 43.8%, respectively (-value = 1.0). Turnaround time of positive BC was shortened by 2.5 days with automated compared to manual BC ( < 0.01). Most common detected pathogens in both systems were spp. (26.0%) and (18.2%). Most contaminants were members of the skin flora. Retesting of 162 isolates was concordant in 79.6% on family level. Implementing automated BC in a resource-limited setting is possible and improves microbiological diagnostic performance. Automated BC increased yield and shortened turnaround times. Regular training and mentorship of clinicians has to be intensified to increase number and quality of BC. Pre-analytical training to improve diagnostic stewardship is essential when implementing a new microbiological method. Retesting highlighted that manual identification and antimicrobial susceptibility testing can be of good quality and sustainable. The implementation of automated tools should be decided individually according to economic considerations, number of samples, stable supply chain of consumables, and technical sustainability.
血培养（BC）具有很高的临床相关性，是监测抗菌药物耐药性的优先标本。在资源有限的环境中，手工血培养仍是最常用的方法。非洲关于自动化血培养性能的数据很少。我们在（ANDEMIA）的一个监测点实施了自动化血培养。2017年6月至2018年1月期间，在科特迪瓦布瓦凯的一家大学医院对自动化血培养（BacT/ALERT FA Plus）和手工血培养（脑心浸液肉汤）进行了比较。每次血培养均从同一静脉穿刺采集10ml目标血量进行接种。自动化血培养孵育长达5天，手工血培养孵育长达10天。仅对手工血培养进行终末传代培养。比较了两种系统在产量、污染率和周转时间方面的差异。为确保质量，分离株在德国常规微生物实验室进行了重新检测。血培养样本量从平均每月24份增加到63份。共纳入337对匹配的血培养样本。自动化血培养的阳性率为36.5%，手工血培养为24.0%（P值<0.01），污染率分别为47.9%和43.8%（P值=1.0）。与手工血培养相比，自动化血培养阳性结果的周转时间缩短了2.5天（P<0.01）。两种系统中最常检测到的病原体是葡萄球菌属（26.0%）和大肠埃希菌（18.2%）。大多数污染物是皮肤菌群成员。162株分离株在属水平上的重新检测一致性为79.6%。在资源有限的环境中实施自动化血培养是可行的，并可提高微生物诊断性能。自动化血培养提高了产量并缩短了周转时间。必须加强对临床医生的定期培训和指导，以增加血培养的数量和质量。实施新的微生物学方法时，进行分析前培训以改善诊断管理至关重要。重新检测表明，手工鉴定和抗菌药物敏感性试验可以具有良好的质量和可持续性。应根据经济因素、样本数量、耗材稳定的供应链以及技术可持续性等因素，单独决定是否实施自动化工具。
