Girlich Delphine, Jousset Agnès B, Emeraud Cécile, Rezzoug Inès, Burwell Reece, Singh Pragya, Rhodes Paul A, Naas Thierry, Bonnin Rémy A, Dortet Laurent
Team "Resist" UMR1184 Immunology of Viral, Auto-Immune, Hematological and Bacterial Diseases (IMVA-HB), INSERM, Faculty of Medicine, Paris-Saclay University, 94270 Le Kremlin-Bicêtre, France.
Bacteriology-Hygiene Unit, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, 94270 Le Kremlin-Bicêtre, France.
Pathogens. 2024 Aug 27;13(9):722. doi: 10.3390/pathogens13090722.
As bloodstream infections and associated septic shock are common causes of mortality in hospitals, rapid antibiotic susceptibility testing (AST) performed directly on positive blood cultures is needed to implement an efficient therapy in clinical settings. We evaluated the Reveal rapid AST system on a collection of 197 fully characterized carbapenem-resistant Enterobacterales, including 177 carbapenemase producers (CPE) spiked in blood culture bottles. The clinical categorization based on the Minimal Inhibitory Concentration (MIC) determination of eighteen antimicrobial molecules was compared to the clinical categorization based on the disk diffusion assay as a reference. The Reveal AST system provided results within a mean time to result of 5 h. Overall, the categorical agreement (CA) between the two techniques was 94.1%. The rates of very major errors (VMEs), major errors (MEs) and minor errors (mEs) were 3.8%, 3.7% and 5.6%, respectively. Imipenem was the antimicrobial with the lowest CA rate (78.7%), with rates of 15% VMEs and 10.7% MEs, but the performances were better when considering only the non-CPE category (CA of 89%). On this resistant collection of Enterobacterales with numerous acquired β-lactamases, the Specific Reveal assay proved to be useful for a rapid determination of AST compatible with a quick adaptation of the patient's antimicrobial treatment.
由于血流感染及相关感染性休克是医院死亡的常见原因，因此需要对阳性血培养物直接进行快速抗生素敏感性测试（AST），以便在临床环境中实施有效的治疗。我们在197株特征明确的耐碳青霉烯类肠杆菌中评估了Reveal快速AST系统，其中包括177株添加到血培养瓶中的产碳青霉烯酶菌株（CPE）。将基于18种抗菌分子最低抑菌浓度（MIC）测定的临床分类与基于纸片扩散法作为参考的临床分类进行比较。Reveal AST系统的平均报告时间为5小时。总体而言，两种技术之间的类别一致性（CA）为94.1%。极重大错误（VME）、重大错误（ME）和微小错误（mE）的发生率分别为3.8%、3.7%和5.6%。亚胺培南是CA率最低的抗菌药物（78.7%），VME率为15%，ME率为10.7%，但仅考虑非CPE类别时性能更好（CA为89%）。在这组具有多种获得性β-内酰胺酶的耐药肠杆菌中，特异性Reveal检测方法被证明可用于快速测定AST，有助于快速调整患者的抗菌治疗。
