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Jacobson J, Fabri L, Osowicki J, Shanthikumar S, Costa AM, Ortika B, Wee-Hee A, Pragassen M, Gatt C, Gonis G, Nguyen C, Rozen T, Teague W, Buttery J, Clifford V, Mulholland K, Steer A, Ranganathan S, Daley A, Dunne E, Satzke C. Evaluation of a multiplex-qPCR for paediatric pleural empyema-An observational study in hospitalised children. PLoS One 2024; 19:e0304861. [PMID: 38917227 PMCID: PMC11198775 DOI: 10.1371/journal.pone.0304861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/20/2024] [Indexed: 06/27/2024] Open
Abstract
Pleural empyema is a serious complication of pneumonia in children. Negative bacterial cultures commonly impede optimal antibiotic therapy. To improve bacterial identification, we developed a molecular assay and evaluated its performance compared with bacterial culture. Our multiplex-quantitative PCR to detect Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus and Haemophilus influenzae was assessed using bacterial genomic DNA and laboratory-prepared samples (n = 267). To evaluate clinical performance, we conducted the Molecular Assessment of Thoracic Empyema (MATE) observational study, enrolling children hospitalised with empyema. Pleural fluids were tested by bacterial culture and multiplex-qPCR, and performance determined using a study gold standard. We determined clinical sensitivity and time-to-organism-identification to assess the potential of the multiplex-qPCR to reduce the duration of empiric untargeted antibiotic therapy. Using spiked samples, the multiplex-qPCR demonstrated 213/215 (99.1%) sensitivity and 52/52 (100%) specificity for all organisms. During May 2019-March 2023, 100 children were enrolled in the MATE study; median age was 3.9 years (IQR 2-5.6). A bacterial pathogen was identified in 90/100 (90%) specimens by multiplex-qPCR, and 24/100 (24%) by bacterial culture (P <0.001). Multiplex-qPCR identified a bacterial cause in 68/76 (90%) culture-negative specimens. S. pneumoniae was the most common pathogen, identified in 67/100 (67%) specimens. We estimate our multiplex-qPCR would have reduced the duration of untargeted antibiotic therapy in 61% of cases by a median 20 days (IQR 17.5-23, range 1-55). Multiplex-qPCR significantly increased pathogen detection compared with culture and may allow for reducing the duration of untargeted antibiotic therapy.
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Affiliation(s)
- Jonathan Jacobson
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Loraine Fabri
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
- Paediatric Department, Academic Children Hospital Queen Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Joshua Osowicki
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Infectious Diseases Unit, Department of General Medicine, The Royal Children’s Hospital Parkville, Parkville, Victoria, Australia
| | - Shivanthan Shanthikumar
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Respiratory and Sleep Medicine, The Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Anna-Maria Costa
- Department of Microbiology, The Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Belinda Ortika
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Ashleigh Wee-Hee
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Michelle Pragassen
- Complex Care Hub, The Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Cassandra Gatt
- Department of Microbiology, The Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Gena Gonis
- Department of Microbiology, The Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Cattram Nguyen
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Clinical and Epidemiology Biostatistics Unit, Murdoch Children’s Research Institute and The Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Thomas Rozen
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Infectious Diseases Unit, Department of General Medicine, The Royal Children’s Hospital Parkville, Parkville, Victoria, Australia
| | - Warwick Teague
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Paediatric Surgery, The Royal Children’s Hospital, Parkville, Victoria, Australia
- Surgical Research Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Jim Buttery
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Infectious Diseases Unit, Department of General Medicine, The Royal Children’s Hospital Parkville, Parkville, Victoria, Australia
- Infection and Immunity, Monash Children’s Hospital, Clayton, Victoria, Australia
- Department of Paediatrics & Monash Centre for Health Care Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Vanessa Clifford
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Microbiology, The Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Kim Mulholland
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Infectious Diseases Unit, Department of General Medicine, The Royal Children’s Hospital Parkville, Parkville, Victoria, Australia
| | - Andrew Steer
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Infectious Diseases Unit, Department of General Medicine, The Royal Children’s Hospital Parkville, Parkville, Victoria, Australia
| | - Sarath Ranganathan
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Respiratory and Sleep Medicine, The Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Andrew Daley
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Microbiology, The Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Eileen Dunne
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Catherine Satzke
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, Parkville, Victoria, Australia
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Cox CR, Weghorn KN, Ruger K, Powers-Fletcher MV, Powell EA, Mortensen JE. Clinical utility of multiplex PCR in the detection of pathogens from sterile body fluids. J Clin Microbiol 2024; 62:e0161123. [PMID: 38470149 PMCID: PMC11005351 DOI: 10.1128/jcm.01611-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/21/2024] [Indexed: 03/13/2024] Open
Abstract
Rapid identification of pathogens in normally sterile body fluid (NSBF) is essential for appropriate patient management, specifically antimicrobial therapy. Limited sensitivity and increased time to detection of traditional culture prompted us to evaluate additional testing to contribute to the diagnosis of infection. The purpose of this study was to evaluate the GenMark Dx ePlex Blood Culture Identification (BCID) Panels on positive body fluids inoculated into blood culture bottles for the detection of microorganisms. A total of 88 positive body fluids from blood culture bottles were analyzed using a Gram-Positive, Gram-Negative, and/or Fungal pathogen BCID Panel based on the Gram stain result. Each result was compared to routine culture performed from the positive bottle. When using culture as a reference standard, we found the ePlex multiplex panel performed with a positive percent agreement of 96.5% and a negative percent agreement of 99.8%. The use of multiplex PCR may be a useful supplement to routine culture for NSBF in blood culture bottles. IMPORTANCE The identification of pathogens in normally sterile body fluid (NSBF) is performed using routine culture, the current gold standard. Limitations of this method include sensitivity and increased turnaround times which could potentially delay vital patient care, especially antimicrobial therapy. Adaptations of NSBF in blood culture bottles prompted us to consider the utility of additional methods to bridge the gap in diagnostic challenges for these life-threatening infections. Multiplex molecular panels have been manufactured for use with multiple specimen types including blood, cerebral spinal fluid, stool, and respiratory. Therefore, the purpose of this study was to evaluate the off-label use of ePlex Blood Culture Identification Panels on positive body fluids grown in blood culture bottles for the detection of microorganisms for research purposes.
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Affiliation(s)
- Christina R. Cox
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kristin N. Weghorn
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Katie Ruger
- Department of Pathology and Laboratory Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Margaret V. Powers-Fletcher
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Eleanor A. Powell
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Joel E. Mortensen
- Department of Pathology and Laboratory Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
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Pangonis SF, Schaffzin JK, Claes D, Mortenson JE, Nehus E. An initiative to improve effluent culture detection among pediatric patients undergoing peritoneal dialysis through process improvement. Pediatr Nephrol 2023; 38:211-218. [PMID: 35445978 PMCID: PMC9021362 DOI: 10.1007/s00467-022-05533-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/18/2022] [Accepted: 03/09/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Peritonitis is a significant cause of morbidity and healthcare cost among pediatric patients undergoing peritoneal dialysis. Culture-negative peritonitis has been associated with an increased risk of technique failure. Known risk factors for culture-negative peritonitis are related to the process of collection and sample processing for culture, but additional studies are needed. A culture detection rate of 16.7% was identified among our patients undergoing peritoneal dialysis, which is below the national benchmark of ≥ 85%. Our primary objective of this quality improvement project was to improve culture detection rates. METHODS Interventions were developed aimed at standardizing the process of effluent collection and laboratory processing, timely collection and processing of samples, and addressing other modifying risk factors for lack of bacterial growth from culture. These interventions included direct inoculation of effluent into blood culture bottles at bedside and use of an automated blood culture system. Two Plan-Do-Study-Act cycles were completed prior to moving to the sustain phase. RESULTS The culture detection rate improved from 16.7% (pre-intervention) to 100% (post-intervention). A decrease in the median process time also occurred from 83 min (pre-intervention) to 53 min (post-intervention). An individual and moving range chart identified a decrease in both the centerline (mean) and upper control limit, indicating that the process became more reliable during the sustain phase. CONCLUSIONS An improvement in process time and culture positivity rate occurred following standardization of our PD fluid culture process. Future studies should be aimed at the impact of the components of collection and processing methods on the effluent culture yield. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Scott F. Pangonis
- Department of Pediatrics, Children’s Medical Center of Akron, Akron, OH 44308 USA
| | - Joshua K. Schaffzin
- grid.24827.3b0000 0001 2179 9593Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229 USA
| | - Donna Claes
- grid.24827.3b0000 0001 2179 9593Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229 USA
| | - Joel E. Mortenson
- grid.24827.3b0000 0001 2179 9593Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229 USA
| | - Edward Nehus
- grid.36425.360000 0001 2216 9681Department of Pediatrics, Marshall University Joan C Edwards School of Medicine, Huntington, WV 25701 USA
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Li Z, Liu S, Chen H, Zhang X, Ling Y, Zhang N, Hou T. Comparative evaluation of BACTEC FX, BacT/ALERT 3D, and BacT/ALERT VIRTUO automated blood culture systems using simulated blood cultures. Acta Clin Belg 2022; 77:71-78. [PMID: 32723037 DOI: 10.1080/17843286.2020.1797343] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND To evaluate the performance of BACTEC FX, BacT/ALERT 3D, and VIRTUO systems using simulated blood culture (BC). METHODS Two experimental designs based on 'with' or 'without' added trough antibiotic concentrations in bottles were implemented. RESULTS For the experiment A, A shorter time to detection (TTD) was observed for most of organisms (17/22) in VIRTUO system. VIRTUO system was also faster than 3D and FX systems no matter in aerobic and anaerobic bottles. The anaerobic bottles had faster detection than aerobic bottles in 3D system (13.68 h vs 15.36 h, P < 0.001) and VIRTUO system (10.30 h vs 12.46 h, P = 0.001) but not in FX system (P = 0.38). When antibiotics were present, the bacterial recovery rate (RR) of FX, 3D and VIRTUO systems were 64.10% (50/78), 58.97% (46/78) and 43.59% (34/78), respectively (P = 0.027). the bacterial RR of various bottles were as follows: BPA vs. FA vs. SA [84.44%(38/45) vs. 55.56%(25/45) vs. 42.22(19/45), P < 0.001]; BFN vs. FN vs. SN [36.36%(12/33) vs. 63.64%(21/33) vs.45.45%(15/33), P = 0.078]. CONCLUSIONS The VIRTUO system allowed faster growth detection for most of organisms compared with FX and 3D systems. When antibiotics were present, the bottles containing antibiotic-binding agent showed better bacterial RR, especially in BACTEC Plus Aerobic/F bottles.
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Affiliation(s)
- Zhengkang Li
- Department of Clinical Laboratory, Guangdong Academy of Medicine Science and Guangdong Provincial People’s Hospital, Guangzhou, China
| | - Suling Liu
- Department of Clinical Laboratory, Guangdong Academy of Medicine Science and Guangdong Provincial People’s Hospital, Guangzhou, China
| | - Huimin Chen
- Department of Clinical Laboratory, Guangdong Academy of Medicine Science and Guangdong Provincial People’s Hospital, Guangzhou, China
| | - Xinqiang Zhang
- Department of Clinical Laboratory, Guangdong Academy of Medicine Science and Guangdong Provincial People’s Hospital, Guangzhou, China
| | - Yong Ling
- Department of Clinical Laboratory, Guangdong Academy of Medicine Science and Guangdong Provincial People’s Hospital, Guangzhou, China
| | - Ni Zhang
- Department of Clinical Laboratory, Guangdong Academy of Medicine Science and Guangdong Provincial People’s Hospital, Guangzhou, China
| | - Tieying Hou
- Department of Clinical Laboratory, Guangdong Academy of Medicine Science and Guangdong Provincial People’s Hospital, Guangzhou, China
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5
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Chen S, Shi J, Chen M, Ma J, Zeng Z, Wang R, Cui Y, Gao X. Characteristics of and risk factors for biliary pathogen infection in patients with acute pancreatitis. BMC Microbiol 2021; 21:269. [PMID: 34610799 PMCID: PMC8493750 DOI: 10.1186/s12866-021-02332-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 09/28/2021] [Indexed: 02/02/2023] Open
Abstract
Background Infection in patients with acute pancreatitis, especially severe acute pancreatitis patients, is a common and important phenomenon, and the distributions and drug resistance profiles of bacteria causing biliary infection and related risk factors are dynamic. We conducted this study to explore the characteristics of and risk factors for bacterial infection in the biliary tract to understand antimicrobial susceptibility, promote the rational use of antibiotics, control multidrug-resistant bacterial infections and provide guidance for the treatment of acute pancreatitis caused by drug-resistant bacteria. Methods The distribution of 132 strains of biliary pathogenic bacteria in patients with acute pancreatitis from January 2016 to December 2020 were analyzed. We assessed drug resistance in the dominant Gram-negative bacteria and studied the drug resistance profiles of multidrug-resistant bacteria by classifying Enterobacteriaceae and nonfermentative bacteria. We then retrospectively analyzed the clinical data and risk factors associated with 72 strains of Gram-negative bacilli, which were divided into multidrug-resistant bacteria (50 cases) and non-multidrug-resistant bacteria (22 cases). Results The main bacteria were Escherichia coli, Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa. Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli had a 66.67% detection rate. Acinetobacter baumannii had more than 50.00% drug resistance to carbapenems, ESBL-producing Klebsiella pneumoniae had 100.00% drug resistance, and Pseudomonas aeruginosa had 66.67% resistance to carbapenems. Multivariate logistic regression analysis suggested that the administration of third- or fourth-generation cephalosporins was an independent risk factor for Gram-negative multidrug-resistant biliary bacterial infection in acute pancreatitis patients. Conclusion Drug resistance among biliary pathogens in acute pancreatitis patients remains high; therefore, rational antimicrobial drug use and control measures should be carried out considering associated risk factors to improve diagnosis and treatment quality in acute pancreatitis patients.
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Affiliation(s)
- Shayan Chen
- Department of Laboratory Science, Tianjin Medical University NanKai Hospital, Tianjin, 300100, China.,Tianjin Key Laboratory of Acute Abdomen Disease Associated Organ Injury and ITCWM Repair, Tianjin Medical University NanKai Hospital, Tianjin, 300100, China
| | - Jiyu Shi
- Tianjin Medical University, Tianjin, 300070, China
| | - Minghui Chen
- Department of Laboratory Science, Tianjin Medical University NanKai Hospital, Tianjin, 300100, China
| | - Jun Ma
- Department of Laboratory Science, Tianjin Medical University NanKai Hospital, Tianjin, 300100, China
| | - Zhaowei Zeng
- Department of Laboratory Science, Tianjin Medical University NanKai Hospital, Tianjin, 300100, China
| | - Rui Wang
- Department of Laboratory Science, Tianjin Medical University NanKai Hospital, Tianjin, 300100, China
| | - Yunfeng Cui
- Department of Surgery, Tianjin Medical University NanKai Hospital, 122 Sanwei Road, Nankai District, Tianjin, 300100, China.
| | - Xue Gao
- Binzhou Medical University, Yantai City, 264003, Shandong, China.
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Comparison of Microorganism Detection and Time to Positivity in Pediatric and Standard Media from Three Major Commercial Continuously Monitored Blood Culture Systems. J Clin Microbiol 2021; 59:e0042921. [PMID: 33910963 DOI: 10.1128/jcm.00429-21] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
New blood culture instrumentation and medium formulations have led to improved time to positivity (TTP) for positive blood cultures. Data regarding the necessity of pediatric blood culture bottles with contemporary blood culture systems are sparse. We compared performance of three commercial blood culture systems, evaluating impact of blood volumes in standard and pediatric blood culture media across systems. Simulated blood cultures with packed red blood cells (PRBCs) and three Gram-positive, four Gram-negative, and one anaerobic organism (final concentrations ranging from 0.5 to 19 CFU/ml blood) on the Virtuo, VersaTrek, and Bactec FX instruments were evaluated with FAN Plus, Redox, and Bactec Plus media, respectively. For each medium/instrument/organism combination, 1-, 3-, 5-, and 10-ml blood volumes were evaluated in triplicate. Detection rate was not affected by blood volume. Aerobic organisms that demonstrated variable rates of detection were Kingella kingae, Haemophilus influenzae, and Neisseria meningitidis. Bacteroides fragilis was detected in 83%, 100%, and 100% of Virtuo, VersaTrek, and Bactec anaerobic bottles, respectively. The average TTP of standard medium for aerobic organisms detected on Virtuo was decreased compared to those for VersaTrek (-2.3 h) and Bactec (-4.9 h). Compared to standard medium, detection rate and TTP were unchanged on Virtuo, while TTP was reduced with pediatric medium for 2/8 organisms tested on Bactec and 7/8 organisms on VersaTrek, illustrating the potential benefit of pediatric medium on VersaTrek or Bactec when low blood volumes (<5 ml) are collected. These results demonstrate that TTP is decreased on the Virtuo compared to VersaTrek and Bactec for many microorganisms associated with bloodstream infection (BSI) but may have species-specific limitations.
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Evaluation of Optimal Blood Culture Incubation Time To Maximize Clinically Relevant Results from a Contemporary Blood Culture Instrument and Media System. J Clin Microbiol 2021; 59:JCM.02459-20. [PMID: 33239377 PMCID: PMC8106720 DOI: 10.1128/jcm.02459-20] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/23/2020] [Indexed: 12/11/2022] Open
Abstract
Timely diagnosis of microorganisms in blood cultures is necessary to optimize therapy. Although blood culture media and systems have evolved for decades, the standard interval for incubation prior to being discarded as negative has remained 5 days. Here, we evaluated the optimal incubation time for the BacT/Alert Virtuo blood culture detection system (bioMérieux) using FA Plus (aerobic) and FN Plus (anaerobic) resin culture bottles in routine clinical use. Timely diagnosis of microorganisms in blood cultures is necessary to optimize therapy. Although blood culture media and systems have evolved for decades, the standard interval for incubation prior to being discarded as negative has remained 5 days. Here, we evaluated the optimal incubation time for the BacT/Alert Virtuo blood culture detection system (bioMérieux) using FA Plus (aerobic) and FN Plus (anaerobic) resin culture bottles in routine clinical use. Following institutional review board (IRB) approval, a retrospective review evaluated the outcomes of 158,710 bottles collected between November 2018 and October 2019. The number of positive blood bottles was 13,592 (8.6%); 99% of positive aerobic and anaerobic bottles flagged positive by 91.5 and 108 h, respectively. The mean (median) times to positivity were 18.4 h (15.6 h) for Staphylococcus aureus, 12.3 h (9.5 h) for Escherichia coli, 22.2 h (15.9 h) for Pseudomonas aeruginosa, and 48.9 h (42.9 h) for Candida spp. Only 175 bottles (0.1% of all bottles) flagged positive after 4 days of incubation; 89 (51%) of these bottles grew Cutibacterium (Propionibacterium) species. Chart review of blood cultures positive after 4 days (96 h) rarely had a clinical impact and sometimes had a negative impact on patient care. Finally, a seeded study of the HACEK group (i.e., Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, and Kingella), historically associated with delayed blood culture positivity, demonstrated no benefit to extended incubation beyond 4 days. Collectively, these findings demonstrated that a 4-day incubation time was sufficient for the Virtuo system and media. Implementation of the 4-day incubation time could enhance clinically relevant results by reducing recovery of contaminants and finalizing blood cultures 1 day earlier.
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8
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Zhou F, Sun S, Sun X, Chen Y, Yang X. Rapid and sensitive identification of pleural and peritoneal infections by droplet digital PCR. Folia Microbiol (Praha) 2020; 66:213-219. [PMID: 33159654 PMCID: PMC7648221 DOI: 10.1007/s12223-020-00834-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 10/19/2020] [Indexed: 01/08/2023]
Abstract
Pleural and peritoneal infections cause substantial morbidity and mortality. Traditional diagnostic methods rely on the cultivation of clinical samples, which usually takes days to obtain report and holds a low detection sensitivity. In this study, we evaluated a 5-fluorescent-channel droplet digital PCR (ddPCR) system and 5 assay panels for culture-independent rapid pathogen detections directly from pleural and peritoneal fluid samples. Traditional culture of the same sample was used as reference. A total of 40 pleural fluid samples and 19 peritoneal fluid samples were tested in this study. Twenty-five positives including 4 polymicrobial infections by culture and 26 positives including 11 polymicrobial infections by ddPCR were detected for pleural fluid samples; 14 positives including 2 polymicrobial infections by culture and 15 positives including 3 polymicrobial infections by ddPCR were detected for peritoneal fluid samples. Klebsiella pneumoniae was the most common bacterium detected both in pleural and in peritoneal fluid samples. The sensitivity of the ddPCR assay for pleural and peritoneal fluid samples was 96% (95% confidence interval (CI) = 79.65 to 99.90%) and 92.86% (95% CI = 66.13 to 99.82%), respectively. The turnaround time of the ddPCR assay was approximately 3 h comparing with 38.30 ± 22.44 h for culture-based identifications. Our results demonstrated that the ddPCR assay is a rapid and sensitive method for identifying pathogens responsible for pleural and peritoneal infections and would be a promising approach for early diagnosis and optimizing treatment of infections.
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Affiliation(s)
- Fangmei Zhou
- College of Medical Technology, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, People's Republic of China
| | - Shoudong Sun
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Hangzhou, 310006, Zhejiang, People's Republic of China.,The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, People's Republic of China
| | - Xiling Sun
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Hangzhou, 310006, Zhejiang, People's Republic of China
| | - Ye Chen
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Hangzhou, 310006, Zhejiang, People's Republic of China.,The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, People's Republic of China
| | - Xuejing Yang
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Hangzhou, 310006, Zhejiang, People's Republic of China.
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9
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Jeverica S, El Sayed F, Čamernik P, Kocjančič B, Sluga B, Rottman M, Papst L. Growth detection of Cutibacterium acnes from orthopaedic implant-associated infections in anaerobic bottles from BACTEC and BacT/ALERT blood culture systems and comparison with conventional culture media. Anaerobe 2019; 61:102133. [PMID: 31813852 DOI: 10.1016/j.anaerobe.2019.102133] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 11/25/2019] [Accepted: 11/29/2019] [Indexed: 12/19/2022]
Abstract
Cutibacterium acnes is a major etiologic agent of orthopaedic implant-associated infections (IAIs) and requires up to 14 days of incubation in an anaerobic atmosphere for growth detection. As blood culture (BC) systems are increasingly being used to monitor the growth of IAI specimens, we compared different BC media for growth detection of C. acnes. Non-duplicate C. acnes isolates (n = 99) obtained from sonicate-fluid cultures of orthopaedic IAIs from Slovenia (n = 54), conventional tissue samples of monomicrobial orthopaedic IAIs from France (n = 43) and two reference strains were inoculated to anaerobic BC bottles of two major BC systems and 3 conventional culture media types (thioglycolate broth, Schaedler and chocolate agar). Growth and time-to-detection (TTD) were recorded. Only Lytic (BACTEC) and SN (BacT/ALERT) bottles consistently detected growth of C. acnes within 14 days with 94% (n = 93) and 92% (n = 91) detection rates, respectively (p = 0.79). Lytic was superior to Plus BACTEC medium (p < 0.001), while SN was superior to all other BacT/ALERT media (p < 0.001). Mean TTD was 128 ± 43 h (61-336 h) for Lytic and 158 ± 65 h (77-336 h) for SN medium. Among the conventional media, 99% (n = 98) of the isolates grew on Schaedler agar, 96% (n = 95) in thioglycolate broth and 74% (n = 73) on chocolate agar. Inconsistent growth of C. acnes in different BC media can critically influence the detection of this major IAI pathogen. Only Lytic (BACTEC) and SN (BacT/ALERT) BC media types were consistently able to detect C. acnes within 14 days of incubation. However, visible growth was observed faster in thioglycolate broth and Schaedler agar media.
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Affiliation(s)
- Samo Jeverica
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| | - Faten El Sayed
- Microbiology Laboratory, Raymond Poincaré Hospital, Garches, France
| | - Petra Čamernik
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Boštjan Kocjančič
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Boštjan Sluga
- Department of Traumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Martin Rottman
- Microbiology Laboratory, Raymond Poincaré Hospital, Garches, France
| | - Lea Papst
- Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Kim SC, Lee S, Kim S, Cho OH, Park H, Yu SM. Comparison of Clinical Performance Between BacT/Alert Virtuo and BacT/Alert 3D Blood Culture Systems. Ann Lab Med 2019; 39:278-283. [PMID: 30623614 PMCID: PMC6340844 DOI: 10.3343/alm.2019.39.3.278] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/02/2018] [Accepted: 12/16/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND BacT/Alert Virtuo (BioMérieux, Durham, NC, USA) is a recently developed blood culture system that includes functions of automatic registration, loading, and unloading of the blood culture bottles, as well as measurement of blood volume. We compared the performances between the BacT/Alert Virtuo and 3D (BioMérieux) blood culture systems. METHODS A total of 952 patients (1,904 sets) visiting an university-affiliated hospital in Korea for blood cultures were enrolled. Five milliliters of blood was added into each of the two aerobic (FA Plus) and two anaerobic (FN Plus) bottles of the Virtuo and 3D systems for a single set. Positive rate and time to detection (TTD) were compared between the two systems. RESULTS The positive rates were 8.3% and 8.4% in FA Plus bottles and 7.8% and 8.3% in FN Plus bottles, in the Virtuo and 3D systems, respectively (P>0.05). Median TTDs were shorter in the Virtuo than in the 3D system for all isolates (11.5 hours [N=305] vs 11.8 hours [N=318], P<0.001), Staphylococcus aureus (N=38; 14.3 hours vs 16.0 hours, P=0.021), and Escherichia coli (N=117; 10.4 hours vs 11.0 hours, P<0.001). CONCLUSIONS The Virtuo has the potential to detect pathogens early in all bottle types. This might improve the prognosis of sepsis by allowing for implementation of expeditious management.
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Affiliation(s)
- Seong Chun Kim
- Department of Emergency Medicine, Institute of Health Sciences, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Seungjun Lee
- Department of Laboratory Medicine, Institute of Health Sciences, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Sunjoo Kim
- Department of Laboratory Medicine, Institute of Health Sciences, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea.
| | - Oh Hyun Cho
- Department of Internal Medicine, Institute of Health Sciences, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Hyunwoong Park
- Department of Laboratory Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Seong Mi Yu
- Division of Nursing, Gwangju Health University, Gwangju, Korea
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