First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
J Hosp Infect. 2023 Sep;139:240-248. doi: 10.1016/j.jhin.2023.06.021. Epub 2023 Jun 29.
Novel molecular diagnostic methods are being evaluated in order to expedite pathogen identification in patients with bacteraemia.
To evaluate the feasibility and diagnostic accuracy of the T2 magnetic resonance (T2MR) assays - T2 Bacteria (T2B) and T2 Resistance (T2R) - as point-of-care tests in the intensive care unit compared with blood-culture-based tests.
Prospective cross-sectional study of consecutive patients with suspected bacteraemia. Diagnostic accuracy was evaluated using blood culture as the reference method.
In total, 208 cases were included in the study. The mean time from sampling to report was lower for the T2MR assays compared with blood-culture-based methods (P<0.001). The rate of invalid reports was 6.73% for the T2B assay and 9.9% for the T2R assay. For the T2B assay, overall positive percentage agreement (PPA) was 84.6% [95% confidence interval (CI) 71.9-93.1%], negative percentage agreement (NPA) was 64.3% (95% CI 55.4-72.6%), positive predictive value (PPV) was 48.9% (95% CI 42.5-55.3%) and negative predictive value (NPV) was 91.2% (95% CI 84.4-95.2%). Cohen's kappa coefficient was 0.402. For the T2R assay, overall PPA was 80% (95% CI 51.9-95.7%), NPA was 69.2% (95% CI 54.9-81.3%), PPV was 42.9% (95% CI 31.7-54.8%) and NPV was 92.3% (95% CI 81.1-97.1%). Cohen's kappa coefficient was 0.376.
T2MR assays have high NPV for rapid exclusion of bacteraemia, and could potentially assist with antimicrobial stewardship when applied as point-of-care diagnostic tests in the intensive care unit.
为了加快血培养患者的病原体鉴定，正在评估新型分子诊断方法。
评估 T2 磁共振（T2MR）检测——T2 细菌（T2B）和 T2 耐药性（T2R）——作为床边即时检测在重症监护病房的可行性和诊断准确性，与血培养为基础的检测方法进行比较。
对连续疑似菌血症患者进行前瞻性横断面研究。使用血培养作为参考方法评估诊断准确性。
共有 208 例患者纳入研究。与血培养为基础的方法相比，T2MR 检测的采样至报告时间更短（P<0.001）。T2B 检测的无效报告率为 6.73%，T2R 检测的报告率为 9.9%。对于 T2B 检测，总阳性百分比一致性（PPA）为 84.6%（95%可信区间 71.9%-93.1%），阴性百分比一致性（NPA）为 64.3%（95%可信区间 55.4%-72.6%），阳性预测值（PPV）为 48.9%（95%可信区间 42.5%-55.3%），阴性预测值（NPV）为 91.2%（95%可信区间 84.4%-95.2%）。Cohen's kappa 系数为 0.402。对于 T2R 检测，总 PPA 为 80%（95%可信区间 51.9%-95.7%），NPA 为 69.2%（95%可信区间 54.9%-81.3%），PPV 为 42.9%（95%可信区间 31.7%-54.8%），NPV 为 92.3%（95%可信区间 81.1%-97.1%）。Cohen's kappa 系数为 0.376。
T2MR 检测具有高阴性预测值，可快速排除菌血症，当作为重症监护病房的床边即时诊断检测方法应用时，可能有助于抗菌药物管理。
