Rapid Testing Using the Verigene Gram-Negative Blood Culture Nucleic Acid Test in Combination with Antimicrobial Stewardship Intervention against Gram-Negative Bacteremia
Rapid Testing Using the Verigene Gram-Negative Blood Culture Nucleic Acid Test in Combination with Antimicrobial Stewardship Intervention against Gram-Negative Bacteremia
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DOI：
10.1128/aac.04259-14
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发表时间：
2015-03-01
影响因子：
4.9
通讯作者：
Johnson, J. Kristie
中科院分区：
文献类型：
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作者：
Bork, Jacqueline T.;Leekha, Surbhi;Johnson, J. Kristie
快速鉴定微生物和耐药性对于严重血流感染（BSI）的靶向治疗至关重要。Verigene革兰氏阴性血培养核酸检测试剂盒（BC-GN）是一种多重、自动化分子诊断检测试剂盒，用于从血培养中鉴定8种革兰氏阴性（GN）微生物和耐药标志物，周转时间约为2小时。本研究纳入了2012年1月1日至2012年6月30日期间马里兰州大学医学中心GN菌血症成人患者的临床分离株。用临床分离株加标血培养瓶，允许孵育，并由BC-GN处理。进行了诊断评价。此外，对至有效和最佳抗生素的时间进行了理论评价，比较了图表审查（“对照”）的实际抗生素给药时间与基于BC-GN报告和抗菌药物管理团队（AST）审查（“干预”）的理论给药时间。对于检测试剂盒检出的微生物，BC-GN正确识别率为95.6%（131/137），灵敏度为97.1%（95%置信区间[CI]，90.7 - 98.4%），特异性为99.5%（95% CI，98.8 - 99.8%）。CTX-M和OXA耐药决定因素均检出。从革兰氏染色到抗生素实施允许12小时，干预组有效（3.3 vs 7.0小时; P < 0.01）和最佳（23.5 vs 41.8小时; P < 0.01）抗生素治疗的持续时间明显更短。AST干预的BC-GN可能会缩短GN BSI中有效和最佳抗生素治疗的时间。
Rapid identification of microorganisms and antimicrobial resistance is paramount for targeted treatment in serious blood-stream infections (BSI). The Verigene Gram-negative blood culture nucleic acid test (BC-GN) is a multiplex, automated molecular diagnostic test for identification of eight Gram-negative (GN) organisms and resistance markers from blood culture with a turnaround time of approximately 2 h. Clinical isolates from adult patients at the University Maryland Medical Center with GN bacteremia from 1 January 2012 to 30 June 2012 were included in this study. Blood culture bottles were spiked with clinical isolates, allowed to incubate, and processed by BC-GN. A diagnostic evaluation was performed. In addition, a theoretical evaluation of time to effective and optimal antibiotic was performed, comparing actual antibiotic administration times from chart review ("control") to theoretical administration times based on BC-GN reporting and antimicrobial stewardship team (AST) review ("intervention"). For organisms detected by the assay, BC-GN correctly identified 95.6% (131/137), with a sensitivity of 97.1% (95% confidence interval [CI], 90.7 to 98.4%) and a specificity of 99.5% (95% CI, 98.8 to 99.8%). CTX-M and OXA resistance determinants were both detected. Allowing 12 h from Gram stain for antibiotic implementation, the intervention group had a significantly shorter duration to both effective (3.3 versus 7.0 h; P < 0.01) and optimal (23.5 versus 41.8 h; P < 0.01) antibiotic therapy. BC-GN with AST intervention can potentially decrease time to both effective and optimal antibiotic therapy in GN BSI.