Universidade de São Paulo, Instituto de Ciências Biomédicas II, São Paulo, Brazil.
Hospital de Clínicas da Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Campinas, Brazil.
Diagn Microbiol Infect Dis. 2024 Jun;109(2):116247. doi: 10.1016/j.diagmicrobio.2024.116247. Epub 2024 Mar 8.
In this study, rapid diagnostic of multidrug-resistant (MDR) sepsis pathogens, directly from positive blood culture (BC) bottles, was evaluated by combining MALDI-TOF and the EUCAST Rapid Antimicrobial Susceptibility Testing (RAST). Carbapenemase production in Escherichia coli and Klebsiella pneumoniae isolates was also evaluated by RAST. From 171 positive BC bottles analyzed, 79 (46 %) MDR species, including E. coli (4/34, 12 %), K. pneumoniae (33/48, 69 %), Pseudomonas aeruginosa (12/12, 100 %), Acinetobacter baumannii (15/15, 100 %), and Staphylococcus aureus (14/37, 38 %) displaying resistance to beta-lactams, fluoroquinolones, aminoglycosides, and/or trimethoprim/sulphamethoxazole, were identified. In this regard, turnaround time of direct MALDI-TOF identification and RAST was < 7 h, which was significantly (p< 0.05) lower than our routine method. Carbapenemase detection by RAST displayed 100% sensitivity and 88.7 % specificity at 8 h. This protocol could offer advantages for the treatment and clinical outcomes of septic patients, improving the rapid diagnostic of sepsis by MDR pathogens.
本研究旨在通过 MALDI-TOF 与 EUCAST 快速药敏试验（RAST）相结合，直接从阳性血培养瓶中快速诊断多重耐药（MDR）败血症病原体。还通过 RAST 评估了大肠杆菌和肺炎克雷伯菌分离株中产碳青霉烯酶的情况。在分析的 171 个阳性 BC 瓶中，鉴定出 79 种（46%）MDR 物种，包括大肠杆菌（4/34，12%）、肺炎克雷伯菌（33/48，69%）、铜绿假单胞菌（12/12，100%）、鲍曼不动杆菌（15/15，100%）和金黄色葡萄球菌（14/37，38%），它们对β-内酰胺类、氟喹诺酮类、氨基糖苷类和/或复方磺胺甲噁唑表现出耐药性。在这方面，直接 MALDI-TOF 鉴定和 RAST 的周转时间<7 小时，明显低于我们的常规方法（p<0.05）。RAST 在 8 小时时对碳青霉烯酶的检测显示出 100%的灵敏度和 88.7%的特异性。该方案可能为败血症患者的治疗和临床结果带来优势，通过 MDR 病原体提高败血症的快速诊断。
