Harry Perkins Institute of Medical Research, 6 Verdun Street, Nedlands, WA 6009, Australia; School of Medicine, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia.
Harry Perkins Institute of Medical Research, 6 Verdun Street, Nedlands, WA 6009, Australia.
EBioMedicine. 2022 Aug;82:104145. doi: 10.1016/j.ebiom.2022.104145. Epub 2022 Jul 19.
The annual mortality burden of antimicrobial resistant infections exceeds 1.27 million/year. With serious infections, every hour without effective antimicrobial therapy results in a 6.7% increased risk of death. New technology that delivers actionable pathology results in clinically-relevant timeframes is an urgent priority. We present the development and validation of an acoustic-enhanced flow cytometric (AFC) workflow that provides same-day confirmation of infection and antimicrobial susceptibility, using peritoneal dialysis (PD)-associated peritonitis as a demonstrative example.
In this cohort study, we analysed peritoneal dialysis effluent specimens using AFC to confirm the presence of infection and antimicrobial susceptibility of identified organisms. The primary outcome was the performance of the assay compared to conventional microbiology performed by the clinical laboratory. A secondary outcome was time to result.
AFC confirmed infection from primary specimens (n=116), with a sensitivity of 86% and specificity of 94% in ≤ one hour from arrival, including confirmation of infecting organisms in culture-negative cases. Combined with flow-cytometry-assisted antimicrobial susceptibility testing (FAST), we demonstrate same-day antimicrobial susceptibility profiles with an accuracy equivalent to conventional laboratory-based tests.
Application of AFC based assays to confirm infection and predict antimicrobial susceptibility can deliver actionable results with a performance that meets or exceeds currently utilised microbiological tests in clinically meaningful timeframes, as demonstrated for PD peritonitis. This technology shows potential for broad applicability to other time-critical serious infections.
Government of Western Australia (Department of Health), Government of Australia (National Health and Medical Research Council) and the Forrest Research Foundation.
抗菌药物耐药感染的年死亡率超过 127 万/年。对于严重感染，如果没有有效的抗菌治疗，每延误 1 小时，死亡风险就会增加 6.7%。能够在临床相关时间内提供可采取行动的病理学结果的新技术是当务之急。我们介绍了一种声增强流式细胞术（AFC）工作流程的开发和验证，该流程可在临床相关时间内提供当日确认感染和抗菌药物敏感性的结果，以腹膜透析（PD）相关性腹膜炎为例。
在这项队列研究中，我们使用 AFC 分析腹膜透析流出液标本，以确认感染的存在和鉴定出的病原体的抗菌药物敏感性。主要结局是该检测方法与临床实验室进行的常规微生物学检测的性能比较。次要结局是结果获得时间。
AFC 在 1 小时内从标本中确认了感染（n=116），其敏感性为 86%，特异性为 94%，包括对培养阴性病例中感染病原体的确认。结合流式细胞术辅助抗菌药物敏感性检测（FAST），我们展示了与传统基于实验室的检测相当的当日抗菌药物敏感性谱，其准确性可达到或超过目前在临床上有意义的时间框架内使用的微生物学检测。
基于 AFC 的检测方法用于确认感染和预测抗菌药物敏感性，可以提供可采取行动的结果，其性能在临床上有意义的时间内与目前使用的微生物学检测相当，如 PD 相关性腹膜炎所示。这项技术具有广泛应用于其他时间关键的严重感染的潜力。
西澳大利亚州政府（卫生部）、澳大利亚政府（国家卫生和医学研究委员会）和福雷斯特研究基金会。
