早期生长分离株自动和人工微量肉汤稀释抗菌素敏感性试验的性能评价。

IF 5.4 2区 医学 Q1 MICROBIOLOGY
Journal of Clinical Microbiology Pub Date : 2025-08-13 Epub Date: 2025-06-30 DOI:10.1128/jcm.00236-25
Lucas J Osborn, Lindsay Osborn, Irvin Ibarra-Flores, Marisol Garcia, Kaitlyn Perez, Ali Farhadiayoubloo, Melissa Mitrou, Cristina Costales, Jennifer Dien Bard
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引用次数: 0

摘要

延长的周转时间(TAT)是当前自动药敏试验系统和人工药敏试验方法(如肉汤微量稀释)的主要限制。因此,针对患者的靶向治疗可能会延迟,预示着不理想的临床结果。一个影响因素是临床实验室标准协会(CLSI)和一些自动化抗菌素敏感性试验制造商建议在进行抗菌素敏感性试验(AST)之前进行18-24小时的孵育。本研究通过人工肉汤微量稀释(Thermo Fisher Sensititre)和自动AST系统(BD Phoenix)对培养6 h(早期生长AST, egAST)和18-24 h(标准生长AST, sast)的分离株进行了AST性能的比较。在使用Sensititre和Phoenix之前,对革兰氏阴性(n = 5)和革兰氏阳性(n = 2)质量控制菌株进行了6或24小时的初步概念验证研究,结果显示100%基本一致。随后,我们评估了egAST对革兰氏阳性(n = 49, Phoenix;n = 46 sensitivity)和革兰氏阴性(n = 81 Phoenix;(n = 61)患者来源的分离株与sast相比具有不同的耐药谱。Sensititre共检测了1,666种生物-药物组合(560种革兰氏阳性和1,106种革兰氏阴性),Phoenix检测了1,927种(409种革兰氏阳性和1,518种革兰氏阴性)。对于肠杆菌,使用Phoenix的egAST与sast相比,较小错误(MiE)为1.3%,较大错误(ME)为0.17%,非常重大错误(VME)为1.1%。凤凰对铜绿假单胞菌的egAST性能为0.18% MiE,无ME和VME。同样,用Sensititre法测定肠杆菌的egAST结果显示,MiE为1.5%,无ME或VME,而铜绿假单胞菌的MiE为2.8%,ME为6.6%,无VME。葡萄球菌和肠球菌在Phoenix系统中未检测到MiE、ME和VME,而葡萄球菌在早期生长敏感性试验中检测到MiE为3.14%、ME为0.3%、VME为2.99%,肠球菌在早期生长敏感性试验中检测到MiE为6.8%、ME为0.09%、VME为无。这些数据表明,egAST是一种可行的策略,可以减少CLSI目前推荐的延长潜伏期,并在不产生任何额外成本的情况下选择自动化AST制造商指南,同时保持与参考标准方法的高度一致性。传统的抗菌素敏感性试验(AST)方法通常从生物分离开始持续数天。大部分时间都花在等待培养的分离物在AST前1天孵育上。由于各种快速方法已被证明可以减少对选择抗菌素耐药性的广谱抗生素的暴露,缩短住院时间并改善临床结果,因此对更快速的AST的需求尚未得到满足。同时,有必要确保快速AST方法在临床微生物学实验室中容易实施,几乎没有增加财政负担。该研究展示了一种考虑成本和实用的方法,通过使用早期生长分离物与两种商业AST系统相结合,将AST周转时间缩短了18小时。这项研究的发现补充了以前的报告,这些报告描述了使用早期生长分离物进行磁盘扩散的基本可接受的性能。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Performance evaluation of early growth isolates for automated and manual broth microdilution antimicrobial-susceptibility testing.

Prolonged turnaround times (TAT) represent a major limitation to current automated susceptibility testing systems and manual susceptibility-testing methods such as broth microdilution. As a result, targeted therapy for patients may be delayed, portending suboptimal clinical outcomes. One contributing factor is the 18-24 h of incubation prior to antimicrobial-susceptibility testing (AST) recommended by the Clinical Laboratory Standards Institute (CLSI) and some automated AST manufacturers. This study evaluates the performance of AST by manual broth microdilution (Thermo Fisher Sensititre) and an automated AST system (BD Phoenix) on isolates incubated for 6 h (early growth AST, egAST) compared with 18-24 h (standard growth AST, sgAST). An initial proof-of-concept study conducted on gram-negative (n = 5) and gram-positive (n = 2) quality control strains incubated for 6 or 24 h prior to Sensititre and Phoenix demonstrated 100% essential agreement. Subsequently, we evaluated the performance of egAST on gram-positive (n = 49, Phoenix; n = 46 Sensititre) and gram-negative (n = 81 Phoenix; n = 61 Sensititre) patient-derived isolates with diverse resistance profiles compared with sgAST. In total, 1,666 organism-drug combinations were tested by Sensititre (560 gram-positive and 1,106 gram-negative) and 1,927 by Phoenix (409 gram-positive and 1,518 gram-negative). For Enterobacterales, egAST using Phoenix revealed 1.3% minor errors (MiE), 0.17% major errors (ME), and 1.1% very major errors (VME) compared with sgAST. Phoenix egAST performance for Pseudomonas aeruginosa revealed 0.18% MiE and no ME or VME. Similarly, egAST of Enterobacterales by Sensititre revealed 1.5% MiE and no ME or VME, whereas 2.8% MiE, 6.6% ME, and no VME were observed for P. aeruginosa. For Staphylococcus spp. and Enterococcus spp., there were no MiE, ME, or VME on the Phoenix system, whereas early growth Sensititre showed 3.14% MiE, 0.3% ME, and 2.99% VME for Staphylococcus spp. and 6.8% MiE, 0.09% ME, and no VME for Enterococcus spp. Taken together, these data suggest that egAST represents a viable strategy to reduce the prolonged incubation period currently recommended by CLSI and select automated AST manufacturer guidelines without incurring any additional costs while simultaneously maintaining high concordance with reference standard methods.IMPORTANCETraditional antimicrobial-susceptibility testing (AST) methods typically span several days from the time of organism isolation. The majority of this time is spent waiting for a cultured isolate to incubate up to 1 day prior to AST. There exists an unmet need to provide more rapid AST as various rapid methods have been shown to reduce exposure to broad-spectrum antibiotics that select for antimicrobial resistance, shorten hospital stays, and improve clinical outcomes. Simultaneously, there is a need to ensure that rapid AST approaches are readily implemented in the clinical microbiology laboratory, with little to no added financial burden. This study demonstrates a cost-considerate and practical approach to reduce AST turnaround times by up to 18 h through the use of early growth isolates in combination with two commercial AST systems. The findings from this study complement those of previous reports describing the largely acceptable performance of disk diffusion using early growth isolates.

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来源期刊
Journal of Clinical Microbiology
Journal of Clinical Microbiology 医学-微生物学
CiteScore
17.10
自引率
4.30%
发文量
347
审稿时长
3 months
期刊介绍: The Journal of Clinical Microbiology® disseminates the latest research concerning the laboratory diagnosis of human and animal infections, along with the laboratory's role in epidemiology and the management of infectious diseases.
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