The EUCAST rapid disc diffusion method for antimicrobial susceptibility testing directly from positive blood culture bottles
The EUCAST rapid disc diffusion method for antimicrobial susceptibility testing directly from positive blood culture bottles
复制标题
DOI：
10.1093/jac/dkz548
复制
发表时间：
2020-04-01
影响因子：
5.2
通讯作者：
Kahlmeter, Gunnar
中科院分区：
文献类型：
--
作者：
Jonasson, Emma;Matuschek, Erika;Kahlmeter, Gunnar
目的：随着耐药性的增加，快速抗菌药物敏感性测试（RAST）变得重要，特别是在血流感染患者中。EUCAST决定开发一种标准化的快速方法，基于EUCAST纸片扩散，在4-8小时内提供阳性血培养（BC）的敏感性报告。方法：BC瓶加标临床分离株（n = 332）的7个最相关的脓毒症病原体与各种耐药机制。直接从瓶中进行RAST，并在4、6和8小时后读取区域。几个变量进行了研究，包括使用不同的BC瓶和0-18 h的延迟之间的积极信号和RAST.Results的性能的影响：对于五个物种，大多数抑制区可以在4 h后读取。可以解释的结果比例从4 h时的75%增加到8 h后的84%。与参考方法的分类一致性良好，在4、6和8 h时假敏感性的误差率分别为0.2%、0.2%和0.2%，在4、6和8 h时假耐药性的误差率分别为1.2%、0.2%和0.1%。使用EUCAST RAST方法，可以在BC瓶对七种重要的血流感染病原体呈阳性的4-8小时内提供可靠的AST结果。为了减少错误的发生并吸收因使用非标准化接种物、来自不同制造商的材料和与工作流程相关的延迟而导致的变异性，我们引入了一个不允许解释的区域，即技术不确定性区域。
Objectives: With increasing antimicrobial resistance, rapid antimicrobial susceptibility testing (RAST) becomes important, especially in patients with bloodstream infections. EUCAST decided to develop a standardized rapid method, based on EUCAST disc diffusion, to offer susceptibility reports within 4-8 h of a positive blood culture (BC).Methods: BC bottles were spiked with clinical isolates (n = 332) of the seven most relevant sepsis pathogens with a variety of resistance mechanisms. RAST was performed directly from the bottle and zones read after 4, 6 and 8 h. Several variables were investigated, including the effect of using different BC bottles and of a 0-18 h delay between a positive signal and the performance of RAST.Results: For five species, most inhibition zones could be read after 4 h. The proportion of results that could be interpreted increased from 75% at 4 h to 84% after 8 h. Categorical agreement against the reference method was good, with error rates of false susceptibility of 0.2%, 0.2% and 0.2% at 4, 6 and 8 h and false resistance of 1.2%, 0.2% and 0.1% at 4, 6 and 8 h, respectively.Conclusions: With the EUCAST RAST method, reliable AST results can be delivered within 4-8 h of positivity of BC bottles for seven important bloodstream infection pathogens. To reduce the occurrence of errors and to absorb the variability caused by using a non-standardized inoculum, material from different manufacturers and workflow-related delays, we have introduced an area in which interpretation is not permitted, the Area of Technical Uncertainty.