Journal of Clinical Microbiology最新文献

{"title":"Comparative performances of the Qvella FAST system and conventional methods for rapid identification and antibiotic susceptibility testing on monomicrobial positive blood cultures.","authors":"Malo Penven, Manon Louazon, Charlotte Freret, Alexandra Sauron, Meghane Pilard, Elisa Creignou, Ophélie Gardan, Maryne Haumont, Asma Zouari, Stéphane Lorre, Vincent Cattoir","doi":"10.1128/jcm.01332-24","DOIUrl":"https://doi.org/10.1128/jcm.01332-24","url":null,"abstract":"<p><p>Rapid and accurate diagnosis of sepsis is of paramount importance to reduce associated morbidity and mortality. The Qvella FAST System is a new instrument that concentrates and purifies bacteria from positive-flagged blood culture bottles (PFBCBs) to produce a \"liquid\" colony comparable to a subcultured colony in less than 40 min for rapid ID and calibrated antibiotic susceptibility testing (AST). In this study, we evaluated performances of the FAST System workflow and our rapid routine manual workflow (bacterial pellet obtained after lysis, cleaning, washing, and centrifugation for ID; AST by disc diffusion by direct inoculation after dilution) by comparison to the reference method based on 24-h bacterial subcultures. Two panels of PFBCBs were studied: panel A (including 107 prospective BCs from septic patients, October-November 2022) and panel B (including 102 BCs spiked with difficult-to-identify bacteria [mostly streptococci] and multidrug-resistant isolates), resulting in a total of 209 evaluable samples. The FAST System provided a correct ID to the species level in 178/209 (85.2%) of cases. For AST, the categorical agreement (CA) of the FAST System was 99.4%, with rates of very major (VME), major (ME), and minor (mE) errors of 0.59%, 0.20%, and 0.26%, respectively. Our rapid routine workflow based on manual methods show similar results for ID (86.2%) and AST (CA, 99.6%; VME, 0.50%; ME, 0.16%; mE, 0.13%). In conclusion, the Qvella FAST system, a promising tool that can reduce diagnostic time by approximately 1 day, shows excellent performances for rapid ID and AST.</p>","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0133224"},"PeriodicalIF":6.1,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of voriconazole to predict susceptibility and resistance to isavuconazole for <i>Aspergillus fumigatus</i> using CLSI methods and interpretive criteria.","authors":"Marisa L Winkler, Paul R Rhomberg, Kelley A Fedler, Michael D Huband, Maura Karr, John H Kimbrough, Mariana Castanheira","doi":"10.1128/jcm.01207-24","DOIUrl":"https://doi.org/10.1128/jcm.01207-24","url":null,"abstract":"<p><p><i>Aspergillus fumigatus</i> is a common cause of pulmonary and invasive mold infections among immunocompromised hosts. Mortality in immunocompromised hosts with invasive <i>Aspergillus</i> infections (IAI) has been reported to be as high as 80%. Therefore, appropriate therapy is essential in treating IAI. Both isavuconazole and voriconazole are first-line agents in treatment guidelines for IAI, but isavuconazole has favorable properties, often leading it to be preferred over voriconazole, given the lengthy duration of treatment. It is difficult to perform mold antifungal susceptibility testing, which often requires a reference lab and several weeks to determine results. Therefore, use of surrogate markers can be helpful to infer susceptibility when testing is not possible or delayed. We performed isavuconazole and voriconazole broth microdilution susceptibility testing by the Clinical and Laboratory Standards Institute (CLSI) method on a collection of 976 non-duplicate <i>A. fumigatus</i> isolates from a global surveillance program between 2017 and 2022. We found that voriconazole and isavuconazole have a very high essential agreement within two doubling dilutions at 99.9% and a categorical agreement of 92.7% with no very major errors, one major error (0.11%), and <10% minor errors. Many of the minor errors were in the setting of voriconazole testing at a MIC of 0.5 mg/L (susceptible) but isavuconazole at 2 mg/L (intermediate). Genetic analysis of <i>cyp51</i> genes confirmed that isavuconazole and voriconazole susceptibility testing identified isolates with <i>cyp51A</i> and <i>cyp51B</i> mutations. Voriconazole can be used to predict the isavuconazole susceptibility testing result when <i>A. fumigatus</i> is tested by CLSI broth microdilution methodology.</p>","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0120724"},"PeriodicalIF":6.1,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of digital images captured after 4 h of incubation on a microbiology laboratory automation system in guiding the work-up of subcultures from positive blood cultures.","authors":"Melvilí Cintrón, Brenden Clark, Edwin Miranda, N Esther Babady","doi":"10.1128/jcm.01320-24","DOIUrl":"https://doi.org/10.1128/jcm.01320-24","url":null,"abstract":"<p><p>Initial workup [e.g., identification (ID) and/or antimicrobial susceptibility testing (AST)] of bacterial growth on solid media traditionally occurs 16-24 h after sub-culturing of positive blood cultures (BC). Early ID and AST can be facilitated by reviewing digital images captured using a Microbiology Laboratory Automation (MLA) system. The goal of this study was to evaluate the utility of images captured at 4 h on the WASPLab MLA system for rapid bacterial ID and AST. Retrospective review of all positive BCs results between 1 January 2021 and 31 July 2022 was performed. WASPLab App data were extracted to determine the decision (e.g., perform ID and/or AST or re-incubate plates) made from the 4 h image. Culture results were extracted from the laboratory information system (LIS). A total of 6,845 BCs flagged positive during the study period. The 4 h images for 1,476 cultures (21.6%) were reviewed: 1,200 cultures were re-incubated due to insufficient growth and 276 cultures (4.0%) were sent for ID and/or AST. ID by mass spectrometry was in 100% agreement with that of the molecular BC identification panels. Overall categorical agreement between AST results from the 4 h and overnight growth was 98%. The 4 h images for the remaining 5,369 cultures (78.4%) were not available for review during the day shift. Implementing early reading times for BCs on MLA allows for rapid and accurate ID and AST results. However, optimization of the reading schedule to align with the laboratory's operation schedule is key to realizing the full potential of early reading times.</p><p><strong>Importance: </strong>In recent years, an increasing number of clinical microbiology laboratories have adopted laboratory automation for processing and incubation of specimens submitted for bacterial culture. At our institution, we implemented the Copan WASPLab in 2018 for all cultures, including positive blood cultures. Given that positive blood cultures start with a higher biomass of organisms, the first image capture was set up to occur after 4 h of incubation. In this study, we investigated the utility of this early 4 h image by capturing and calculating the percentage of useful actions taken based on growth identified on the image and the yield of both new identification by MALDI-TOF MS and valid and accurate antimicrobial susceptibility testing (AST) results. We found that while the 4-hour time point provided accurate, early identification and AST results, the overall yield was minimal. From a practical standpoint, this review prompted us to discontinue capture and review of this time point. While our staffing model is likely responsible for this low yield, we hope that our experience would help other laboratories decide how to implement WASPLab workflow for positive blood cultures. Thus, we believe that this information will be of interest to the readers of JCM.</p>","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0132024"},"PeriodicalIF":6.1,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low concordance between QIAreach QuantiFERON-TB, a novel interferon-gamma release assay, and QuantiFERON-TB Gold Plus, in a population-based survey in Blantyre, Malawi.","authors":"Hannah M Rickman, Mphatso D Phiri, Hannah Mbale, Katherine C Horton, Marc Y R Henrion, Emily S Nightingale, James A Seddon, Elizabeth L Corbett, Peter MacPherson","doi":"10.1128/jcm.01323-24","DOIUrl":"https://doi.org/10.1128/jcm.01323-24","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Urgent improvements in the diagnosis and management of &lt;i&gt;Mycobacterium tuberculosis&lt;/i&gt; infection are required to reach End TB goals. Conventional interferon-gamma release assays (IGRAs), such as QuantiFERON-TB Gold Plus (QFT-Plus), require substantial laboratory infrastructure and large blood volumes, limiting use in high-burden settings. The QIAreach QuantiFERON-TB (QIAreach QFT) was developed to overcome these challenges but has not previously been evaluated in field conditions in a low-income, high-burden country, or at scale in children. We performed a diagnostic evaluation of QIAreach QFT against QFT-Plus, in a cross-sectional IGRA survey in Blantyre, Malawi. We recruited a population-representative sample of children aged 1-4 years and adolescents and adults aged 10-40 years, from households and primary care. We calculated sensitivity, specificity, and Cohen's kappa for QIAreach QFT against QFT-Plus, and constructed Bayesian hurdle-categorical models to compare quantitative test results. A total of 1,049 participants were recruited (64%: 1-4 years; 13%: 10-19 years; and 23%: 20-40 years). More participants had a positive QIAreach QFT result (32%) compared to QFT-Plus (15%). Over half of positive QIAreach QFT results had time-to-positivity of exactly 20 min, the assay cutoff. There was minimal agreement between QFT-Plus and QIAreach QFT results (&lt;i&gt;κ&lt;/i&gt; = 0.26), which was lowest in children aged 1-4 years (&lt;i&gt;κ&lt;/i&gt; = 0.13). Sensitivity and specificity of QIAreach QFT relative to QFT-Plus were 62% and 74%, respectively, with poor correlation between quantitative results. The suboptimal performance of QIAreach QFT, particularly in young children, suggests that it cannot currently be recommended for wider use and that the urgent need for an accessible test of Mtb infection remains unmet.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Almost a quarter of the world's population has evidence of &lt;i&gt;Mycobacterium tuberculosis&lt;/i&gt; (Mtb) infection. Monitoring and addressing this substantial burden of so-called \"latent\" tuberculosis (TB) infection will be critical to reach End TB targets. However, current interferon-gamma release assays (IGRAs) for Mtb infection are costly, and require a large volume of venous blood and significant laboratory processing, which are major barriers to their wider use in low-income countries. The novel QIAreach QuantiFERON-TB (QIAreach) assay has been designed as a more accessible alternative. We sought to evaluate it against a reference standard of QuantiFERON-TB Gold Plus, in a large cross-sectional survey in Blantyre, Malawi. To our knowledge, this is the first diagnostic evaluation of QIAreach QFT to be performed in a population-based survey in a low-income high-incidence setting, and to specifically focus on young children (a priority group for interventions targeting Mtb infection). In contrast to previous studies in other settings, we observed poor performance of QIAreach QFT, particularly in young children where there","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0132324"},"PeriodicalIF":6.1,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a new protocol for rapid identification of <i>Streptococcus pneumoniae</i> in blood cultures using the modified bile solubility test: Gram staining is still standing.","authors":"Antoine Aupaix, Alexia Verroken, Hector Rodriguez-Villalobos","doi":"10.1128/jcm.01222-24","DOIUrl":"https://doi.org/10.1128/jcm.01222-24","url":null,"abstract":"<p><p>This study aimed to evaluate a new protocol of the bile solubility test performed directly on the blood from positive blood culture bottles to identify <i>Streptococcus pneumoniae</i> rapidly. Seventy-five positive blood cultures (PBC) showing Gram-positive cocci in pairs or chains on Gram stain, including 32 <i>S. pneumoniae</i> isolates and three reference American Type Culture Collection (ATCC) isolates were included to evaluate the performance of a modified bile solubility test (MBST). One milliliter of blood from the PBC bottle was mixed with 0.5 mL of 10% desoxycholate or a saline solution. Both suspensions were analyzed after 10 min of incubation through a Gram stain to detect solubilization. This technique was compared with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry identification, performed on PBC following extraction or on colonies after short or standard incubation, and the optochin susceptibility test on colonies. The capsular serotypes were determined for all <i>S. pneumoniae</i>, and the Belgian National Reference Center confirmed the identification. All 32 clinical isolates and the ATCC isolate of <i>S. pneumoniae</i> were solubilized on the desoxycholate-treated slides, while the other species tested remained visually unchanged on both, the test and control slides. The MBST test demonstrated a 100% sensitivity and specificity with a mean turnaround time (TAT) of just 39 min, making it 14 h and 56 min faster than the optochin susceptibility test. This rapid variant of the bile solubility test appears to be a reliable method to identify <i>S. pneumoniae</i> directly from positive blood culture bottles, with a TAT of 39 min. It is a cost-effective, easy-to-perform, and time-efficient technique. Negative results should be interpreted cautiously, as they may result from mixed infections with <i>S. pneumoniae</i> and other Gram-positive cocci.</p>","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0122224"},"PeriodicalIF":6.1,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two-transcript signature for differentiation and clinical outcomes in severe fever with thrombocytopenia syndrome (SFTS) patients: a double-blind, multicenter, validation study.","authors":"Nannan Xu, Sai Wen, Yongyuan Yao, Yanyan Guan, Lianhui Zhao, Lulu Yang, Hui Yang, Yishan He, Gang Wang","doi":"10.1128/jcm.01282-24","DOIUrl":"https://doi.org/10.1128/jcm.01282-24","url":null,"abstract":"<p><p>Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease with a high mortality rate that is often underdiagnosed due to the limitations of current laboratory testing. Timely diagnosis and early identification of severe cases are crucial to improving patient outcomes and overall survival rates. This study aimed to evaluate the efficacy of two transcripts, IFI44L and PI3, in the early differentiation between SFTS virus (SFTSV) infection and bacterial sepsis, as well as in the prompt identification of severe cases during epidemic seasons. In a prospective study conducted between 1 May 2021 and 30 September 2022, we enrolled 225 patients who presented with acute fever and thrombocytopenia at four hospitals in Shandong Province, China. The two-transcript signature provided a clear distinction between SFTS and bacterial infection, achieving an area under the receiver operating characteristic curve of 0.961 (95% confidence interval [95% CI] 0.916-0.986), outperforming C-reactive protein (0.810 [95% CI 0.738-0.870]) and procalcitonin (0.764 [95% CI 0.687-0.830]). Importantly, the relative expression of the IFI44L gene was significantly elevated in fatal SFTS cases, with an area under the curve (AUC) of 0.820 (95% CI 0.727-0.914), indicating its potential as an early prognostic marker. Additionally, IFI44L and PI3 were identified as potential biomarkers for distinguishing SFTS patients with and without invasive pulmonary aspergillosis, with AUC values of 0.817 and 0.753, respectively. Our findings demonstrate that the two-transcript signature effectively distinguishes SFTSV infection from bacterial sepsis and helps identify high-risk individuals, guiding appropriate treatment during SFTS outbreak.</p>","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0128224"},"PeriodicalIF":6.1,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142836577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Excellent capability for molecular detection of <i>Aedes</i>-borne dengue, Zika, and chikungunya viruses but with a need for increased capacity for yellow fever and Japanese encephalitis viruses: an external quality assessment in 36 European laboratories.","authors":"Lance D Presser, Cécile Baronti, Ramona Moegling, Laura Pezzi, Yaniv Lustig, Céline M Gossner, Chantal B E M Reusken, Rémi N Charrel","doi":"10.1128/jcm.00910-24","DOIUrl":"https://doi.org/10.1128/jcm.00910-24","url":null,"abstract":"<p><p>Mosquito-borne viruses represent a large global health burden. With geographic expansion of competent vectors for chikungunya virus (CHIKV), dengue virus (DENV), and Zika virus (ZIKV) in Europe, it is anticipated that the number of autochthonous cases of these tropical viruses in Europe will increase. Therefore, regular assessment of diagnostic capabilities in Europe is important. Our aim was to evaluate the mosquito-borne virus molecular detection capability of expert European laboratories by conducting an external quality assessment in October 2023. Molecular panels included 12 plasma samples: one alphavirus (CHIKV), four orthoflaviviruses (ZIKV, yellow fever virus [YFV], DENV, and Japanese encephalitis virus [JEV]), and two negative control samples. Mosquito-borne virus detection was assessed among 36 laboratories in 24 European countries. Adequate capabilities were lacking for YFV and JEV. Many laboratories relied on a mix of laboratory-developed tests (some of which were pan-orthoflavivirus or pan-alphavirus in combination with sequencing) and commercial assays. 47.2% of laboratories characterized all external quality assessment (EQA) samples correctly. Correct result rates were 100% for CHIKV and ZIKV and >99% for DENV, but laboratories lacked capacity, specificity, and sensitivity for JEV and YFV. Three of the viruses in this panel emerged and transiently circulated in Europe: CHIKV, ZIKV, and DENV. Molecular detection was excellent for those viruses, but <50% is accurate for the remainder of the panel. With the possibility or continuation of imported cases and a growing global concern about climate change and vector expansion, progress toward rapid, accurate mosquito-borne virus diagnostics in Europe is recommended, as well as regular EQAs to monitor it.IMPORTANCEThe external quality assessment (EQA) focused on <i>Aedes</i>-borne viruses: chikungunya virus (CHIKV), dengue virus (DENV), Zika virus (ZIKV), and yellow fever virus (YFV). Japanese encephalitis virus, an orthoflavivirus that is spread by mosquito species belonging to the genus <i>Culex</i>, was included in the quality assessment as well. CHIKV, DENV, and ZIKV have proven potential for transient and limited circulation in Europe upon introduction of viremic travelers returning to <i>Aedes albopictus</i>-endemic regions. Results of this EQA were excellent for those viruses, but <50% is accurate for the remainder of the panel (YFV and Japanese encephalitis virus). Considering imported cases and the threat of climate change and competent vector expansion, progress toward rapid, accurate mosquito-borne virus diagnostics in Europe is recommended.</p>","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0091024"},"PeriodicalIF":6.1,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of the detection of antibiotic genotypic resistance with gastric mucosa, gastric fluid, and fecal samples in patients with <i>Helicobacter pylori</i> infection.","authors":"Xinlu Ren, Baojun Suo, Cailing Li, Guangjie Ping, Lingling Ma, Yanyan Shi, Kai Zhou, Yuxin Wang, Xueli Tian, Liya Zhou, Zhiqiang Song","doi":"10.1128/jcm.01034-24","DOIUrl":"https://doi.org/10.1128/jcm.01034-24","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Genotypic methods for detecting antibiotic resistance in &lt;i&gt;Helicobacter pylori&lt;/i&gt; infection offer a rapid, convenient, and accurate approach for tailored therapy. However, existing studies predominantly examine single sample types and lack comparative analyses across different samples. This study comprehensively detects and compares genotypic resistance to clarithromycin and levofloxacin in gastric mucosa, gastric fluid, and fecal samples from the same patients. The study enrolled 183 participants, comprising 124 &lt;i&gt;H&lt;/i&gt;. &lt;i&gt;pylori&lt;/i&gt;-positive and 59 &lt;i&gt;H&lt;/i&gt;. &lt;i&gt;pylori&lt;/i&gt;-negative patients. All participants provided fecal samples and underwent gastroscopy for the collection of gastric mucosa and gastric fluid. Real-time PCR was employed to detect genotypic resistance to clarithromycin and levofloxacin in conjunction with bacterial culture and antibiotic susceptibility testing. Genotypic resistance detection rates for clarithromycin were 100% in gastric mucosa, 99.2% in gastric fluid, and 79.8% in fecal samples. For levofloxacin, detection rates were 97.6%, 96.8%, and 72.6%, respectively. The results showed that PCR detection for clarithromycin exhibited high sensitivity (0.94-0.95) and specificity (0.88-0.89) across all sample types. However, PCR detection for levofloxacin demonstrated slightly lower sensitivity (0.79-0.89) and specificity (0.79-0.83). The comparison of genotypic resistance results by PCR among the three sample types showed that gastric mucosa and gastric juice exhibited higher consistency, while the consistency between feces and both gastric mucosa and gastric juice was lower. This study confirmed good consistency between genotypic and phenotypic resistance in clarithromycin and levofloxacin. While both gastric mucosa and gastric fluid samples demonstrated high detection performance, the efficiency of detecting fecal samples was constrained by challenges in DNA extraction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;This study, with a large sample size, comprehensively tested both &lt;i&gt;Helicobacter&lt;/i&gt; pylori-negative and -positive patients, including rapid urease test, histopathological evaluation and staining, bacterial culture, susceptibility testing, and resistance gene mutation analysis. By simultaneously examining gastric mucosa, gastric juice, and fecal samples from the same individuals, we minimized confounding factors arising from different sample sources, ensuring the reliability of our results. This approach effectively delineated the differences and characteristics in detection performance among different sample types, offering crucial reference data for selecting appropriate detection samples and identifying areas for improvement. The findings revealed robust concordance between genotypic and phenotypic resistance, with both gastric mucosa and gastric juice samples demonstrating excellent detection performance. However, the efficiency of detecting resistance in fecal samples was hampered by challenges in DNA extrac","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0103424"},"PeriodicalIF":6.1,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical significance of toxin EIA positivity in patients with suspected <i>Clostridioides difficile</i> infection: systematic review and meta-analysis.","authors":"Giannoula S Tansarli, Matthew E Falagas, Ferric C Fang","doi":"10.1128/jcm.00977-24","DOIUrl":"https://doi.org/10.1128/jcm.00977-24","url":null,"abstract":"<p><p>The laboratory diagnosis of <i>Clostridioides difficile</i> infection (CDI) is controversial. Nucleic acid amplification tests (NAAT) and toxin enzyme immunoassays (EIA) are most widely used, often in combination. However, the interpretation of a positive NAAT and negative toxin immunoassay (NAAT+/EIA-) is uncertain. PubMed and EMBASE were searched for studies reporting clinical outcomes in NAAT+/EIA- versus NAAT+/EIA+ patients. Forty-six studies comprising 33,959 patients were included in this meta-analysis. All-cause mortality (RR 0.96, 95% CI 0.80-1.15), attributable mortality (RR 0.61, 95% CI 0.20-1.91), fulminant CDI (RR 0.83, 95% CI 0.57-1.20), radiographic evidence of CDI (RR 0.87, 95% CI 0.65-1.16), total CDI complications (RR 0.95, 95% CI 0.59-1.53), colectomies (RR 0.78, 95% CI 0.34-1.79), and ICU admission (RR 1.04, 95% CI 0.84-1.30) did not significantly differ between NAAT+/EIA- and NAAT+/EIA+ patients. However, rates of recurrent (RR 0.62, 95% CI 0.50-0.77) or severe (RR 0.74, 95% CI 0.63-0.88) CDI were significantly lower in NAAT+/EIA- patients than in NAAT+/EIA+ patients. The pooled prevalence of NAAT+/EIA- patients who were treated with antibiotics for CDI was 73.4% (pooled proportion 0.72, 95% CI 0.52-0.88). NAAT+/EIA- patients have lower rates of recurrence and are at reduced risk for severe CDI compared with NAAT+/EIA+ patients but have a risk of CDI-related complications and mortality comparable to that of NAAT+/EIA+ patients. Toxin results cannot rule in or rule out CDI, and the decision whether to treat symptomatic NAAT+/EIA- patients for CDI should be based on clinical presentation and not on the toxin result.IMPORTANCE<i>Clostridioides difficile</i> infection (CDI) is a common cause of healthcare-associated infections and the leading cause of antibiotic-associated diarrhea. However, the laboratory diagnosis of CDI, primarily done by nucleic acid amplification test (NAAT) and enzyme immunoassay (EIA), is controversial, especially in patients who test positive by NAAT but negative by EIA. In this systematic review, we compared the clinical outcomes of NAAT+/EIA- versus NAAT+/EIA+ patients and found that the two groups have similar risk of mortality and CDI-related complications. However, NAAT+/EIA- patients had significantly lower rates of recurrence and severe CDI than NAAT+/EIA+ patients, and most NAAT+/EIA- patients received CDI therapy. Toxin testing can help to predict the likelihood of CDI recurrence or severe infection, but the toxin result should not be a determining factor in the administration of CDI therapy. The decision on whether to treat NAAT+/EIA- patients should be based on clinical assessment.</p>","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0097724"},"PeriodicalIF":6.1,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum antigen tests for the diagnosis of invasive aspergillosis: a retrospective comparison of five <i>Aspergillus</i> antigen assays and one beta-D-glucan assay.","authors":"Thilo Schub, Isabel Klugherz, Johannes Wagener, Juergen Prattes, Martin Hoenigl, Sebastian Suerbaum, Jürgen Held, Karl Dichtl","doi":"10.1128/jcm.00950-24","DOIUrl":"10.1128/jcm.00950-24","url":null,"abstract":"<p><p>Invasive aspergillosis (IA) is a life-threatening infection. Early and specific diagnosis is pivotal to ensure adequate therapy. Antigen testing from blood is a widespread and convenient diagnostic approach. Various tests for the detection of <i>Aspergillus</i> antigen as well as for the panfungal antigen β-1,3-D-glucan (BDG) are available, for which comprehensive comparisons are still lacking. Blood samples of 82 proven/probable (11/71) IA patients and 52 controls were tested using two enzyme-linked immunosorbent assays (ELISAs) (Bio-Rad and Euroimmun), one chemiluminescent immunoassay (CLIA) (Vircell), one BDG assay (Fujifilm Wako), and two point of care (PoC) assays (Immy sōna and OLM). PoC assays were evaluated visually and used automated read out systems. Of the 82 IA patients, 37 had received solid organ transplantation (SOT) and 25 hematopoietic stem cell transplant (HSCT). Sensitivities and specificities for the eight test systems ranged from 27% to 71% and from 64% to 100%. Estimating a 10% prevalence of IA, test performance would have resulted in positive and negative predictive values of 14%-100% and 91%-95%. Areas under the curve (AUCs) for all tests except GM were below 0.7. When the cut-off values for quantitative tests were normalized to a specificity close to 95%, sensitivities ranged from 14% to 40%. The use of automated read out systems for the PoC assays had a significant impact. Combining different tests did not result in better test strategies. Sensitivity of <i>Aspergillus</i> antigen testing from single serum samples is low. Due to specificity issues, the majority of tests is not suited for screening purposes. The different assays can meet different needs in different diagnostic settings.</p>","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0095024"},"PeriodicalIF":6.1,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11633112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}