Evaluation of EUCAST rapid antimicrobial susceptibility testing (RAST) for positive blood cultures in clinical practice using a total lab automation
Evaluation of EUCAST rapid antimicrobial susceptibility testing (RAST) for positive blood cultures in clinical practice using a total lab automation
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DOI：
10.1007/s10096-020-03846-3
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发表时间：
2020-02-28
影响因子：
4.5
通讯作者：
Burckhardt, Irene
中科院分区：
文献类型：
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作者：
Jasuja, Jasmin Kaur;Zimmermann, Stefan;Burckhardt, Irene
我们的目标是评估EUCAST的“快速抗菌敏感性试验”（RAST），直接从阳性血培养中获得金黄色葡萄球菌、肠球菌、大肠杆菌、肺炎克雷伯菌和铜绿假单胞菌的抗菌结果，在6小时内提供抗菌结果，使用完全实验室自动化。比较了RAST测得的区域直径。此外，还研究了其对报告时间的影响。对所有阳性好氧和厌氧血培养瓶进行RAST继代培养，即在miller - hinton琼脂上进行继代培养，并添加6个抗生素盘，覆盖革兰氏阴性和革兰氏阳性治疗（头孢西丁、氨苄西林、万古霉素、哌拉西林/他唑巴坦、美罗培南和环丙沙星）。6小时后自动成像RAST。使用TLA软件工具测量区域大小，并根据EUCAST临床断点进行解释。细菌鉴定采用MALDI-TOF质谱，MIC结果采用Vitek2检测板。琼脂扩散和MIC结果之间的分类一致性进行了调查。此外，还比较了100株分离株（每种20株）的RAST时间和Vitek时间。2018年11月至2019年4月，共收集到3313瓶阳性单细菌血培养瓶，其中894瓶经rast验证菌种。在这些瓶子中，2029个单独的抗生素测量值与Vitek2的MIC结果进行了比较，发现14个非常严重，28个严重和12个轻微错误。观察到报告时间中位数减少了17:30小时。引入具有自动TLA成像功能的RAST，可将报告时间缩短至17:30 h。区域直径与MIC结果吻合良好，尤其是头孢西丁、万古霉素和美罗布南，但由于ATU而存在缺陷。
Our objective was to evaluate EUCAST's 'rapid antimicrobial susceptibility testing' (RAST) directly from positive blood culture that delivers antimicrobial results within 6 h for Staphylococcus aureus, Enterococcus spp., Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa, using total lab automation. Zone diameters from RAST were compared with MIC results. Furthermore, its influence on time to report was investigated. RAST was performed to all positive aerobic and anaerobic blood culture bottles by subculturing them, i.e. onto Mueller-Hinton agar and adding six antibiotic discs covering Gram-negative and Gram-positive therapy (cefoxitin, ampicillin, vancomycin, piperacillin/tazobactam, meropenem and ciprofloxacin). RAST was automatically imaged after 6 h. Zone sizes were measured using a TLA software tool and interpreted according to EUCAST clinical breakpoints. Bacteria were identified using MALDI-TOF MS and MIC results were determined using Vitek2 panels. Categorial agreement between agar diffusion and MIC results was investigated. Additionally, time to RAST and time to Vitek were compared for 100 isolates (20 per species). Between November 2018 and April 2019, 3313 positive mono-bacterial blood culture bottles were collected of which 894 bottles with RAST-validated species were investigated. Among these bottles, 2029 individual antibiotic measurements were compared with MIC results from Vitek2 and 14 very major, 28 major and 12 minor errors were found. A median reduction of 17:30 h in time to report was observed. Introduction of RAST with automatic TLA imaging function could reduce time to report by 17:30 h. Excellent accordance between zone diameter and MIC results, particularly for cefoxitin, vancomycin and meropenem, was observed, but drawbacks due to ATU were seen.