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Burillo A, de Egea V, Onori R, Martín-Rabadán P, Cercenado E, Jiménez-Navarro L, Muñoz P, Bouza E. Gradient diffusion antibiogram used directly on bronchial aspirates for a rapid diagnosis of ventilator-associated pneumonia. Antimicrob Resist Infect Control 2019; 8:176. [PMID: 31807286 PMCID: PMC6857332 DOI: 10.1186/s13756-019-0640-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 11/01/2019] [Indexed: 11/10/2022] Open
Abstract
Background In patients with suspected ventilator-associated pneumonia, a rapid etiological diagnosis is crucial as incorrect or delayed treatment in the first few hours leads to a worse prognosis and a higher mortality rate. This study examines the efficacy of a rapid antibiogram on bronchial aspirates in patients with suspected ventilator-associated pneumonia (VAP). Methods The direct gradient diffusion susceptibility testing method (GDM) on respiratory samples was compared with a standard broth microdilution method (BMD) after quantitative cultures in patients with suspicion of VAP. Samples were preselected by Gram staining (for good quality microbiological samples with a predominant single bacterial morphotype). The antibiotics tested were ceftazidime, ceftobiprole, ceftolozane-tazobactam, meropenem, doripenem, and tedizolid. Results Over a 16-month study period, 445 bronchial aspirate samples were selected from 1376 samples received at our laboratory from 672 adult patients. By direct plating on Mueller-Hinton agar, we recovered 504 (95.5%) of the 528 microorganisms identified by the standard semiquantitative method. Antimicrobial susceptibility testing by GDM was compared with the BMD method in 472 strains (216 Enterobacteriaceae, 138 P. aeruginosa and 118 S. aureus.) and 1652 individual microorganism-antimicrobial agent combinations. There was total agreement between both methods in 98% of combinations. The Kappa index between both techniques was excellent (over 80%). There was only one potential major error for P. aeruginosa susceptibility to ceftazidime. Conclusions The six GDM strips directly placed on plated bronchial aspirates obtained from patients with a suspicion of VAP provided accurate and reliable susceptibility results within 24 h.
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Affiliation(s)
- Almudena Burillo
- 1Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain.,2Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Ciudad Universitaria, 28040 Madrid, Spain.,3Instituto de Investigación Sanitaria, Hospital Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Viviana de Egea
- 1Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain.,3Instituto de Investigación Sanitaria, Hospital Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Raffaella Onori
- 1Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain.,3Instituto de Investigación Sanitaria, Hospital Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Pablo Martín-Rabadán
- 1Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain.,3Instituto de Investigación Sanitaria, Hospital Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain.,4CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Servicio Madrileño de Salud, Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Emilia Cercenado
- 1Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain.,2Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Ciudad Universitaria, 28040 Madrid, Spain.,3Instituto de Investigación Sanitaria, Hospital Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain.,4CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Servicio Madrileño de Salud, Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Laura Jiménez-Navarro
- 1Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain.,3Instituto de Investigación Sanitaria, Hospital Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Patricia Muñoz
- 1Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain.,2Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Ciudad Universitaria, 28040 Madrid, Spain.,3Instituto de Investigación Sanitaria, Hospital Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain.,4CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Servicio Madrileño de Salud, Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Emilio Bouza
- 1Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain.,2Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Ciudad Universitaria, 28040 Madrid, Spain.,3Instituto de Investigación Sanitaria, Hospital Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain.,4CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Servicio Madrileño de Salud, Doctor Esquerdo 46, 28007 Madrid, Spain
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Le Dorze M, Gault N, Foucrier A, Ruppé E, Mourvillier B, Woerther PL, Birgand G, Montravers P, Dilly MP, Tubach F, Andremont A, Timsit JF, Wolff M, Armand-Lefèvre L. Performance and impact of a rapid method combining mass spectrometry and direct antimicrobial susceptibility testing on treatment adequacy of patients with ventilator-associated pneumonia. Clin Microbiol Infect 2014; 21:468.e1-6. [PMID: 25656626 DOI: 10.1016/j.cmi.2014.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/17/2014] [Accepted: 12/18/2014] [Indexed: 11/29/2022]
Abstract
Inappropriate antibiotic therapy in ventilator-associated pneumonia (VAP) is associated with increased mortality. Using broad-spectrum antibiotics for 48 h until the results of conventional cultures and antimicrobial susceptibility testing (AST) are available, may promote the emergence of drug-resistant bacteria. Performing AST directly on clinical respiratory samples would hasten the process by at least 24 h. Here, we analysed the diagnostic performance of a rapid method combining mass spectrometry and direct AST (DAST), and compared it with the conventional method (mass spectrometry with conventional AST (CAST)). Additionally, we assessed its potential impact on antimicrobial use in patients. Over a period of 18 months, the two methods were performed on 85 bronchoalveolar lavages obtained from intensive care unit patients with suspected VAP, and in which Gram-negative bacilli were observed on direct examination. Only the CAST results were reported to the clinicians. DAST produced useable results in 85.9% of the patients. The sensitivity and negative predictive values of DAST were 100% for all antibiotics tested, except gentamicin (97.1%, (95% CI 93.3-101) and 97.4% (93.7-101), respectively) and amikacin (88.9% (81.7-96.1) and 96.4% (92.1-100.7), respectively), compared with CAST. Specificity and positive predictive values ranged from 82.9 (74.2-91.5) to 100%, and from 86.4 (78.5-94.2) to 100%, respectively. If the DAST results had been reported to the clinicians, treatment could have been optimized 24 h earlier in 35/85 (41.2%) patients, with 17 carbapenem patient-days saved. Overall, routine use of the DAST method could help optimize earlier antibiotic treatment in patients with suspected VAP.
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Affiliation(s)
- M Le Dorze
- Réanimation médicale et infectieuse, Hôpital Bichat, Paris, France
| | - N Gault
- Département Epidémiologie et Recherche Clinique, AP-HP, Hôpital Bichat, Paris, France; INSERM CIE 801, Paris, France; UMR 1123 ECEVE, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - A Foucrier
- Réanimation médicale et infectieuse, Hôpital Bichat, Paris, France
| | - E Ruppé
- Laboratoire de Bactériologie, AP-HP, Hôpital Bichat, Paris, France; UMR 1137, INSERM, IAME, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - B Mourvillier
- Réanimation médicale et infectieuse, Hôpital Bichat, Paris, France; UMR 1137, INSERM, IAME, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - P L Woerther
- Laboratoire de Bactériologie, AP-HP, Hôpital Bichat, Paris, France
| | - G Birgand
- UMR 1137, INSERM, IAME, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Unité hospitalière de lutte contre les infections nosocomiales, Hôpital Bichat, Paris, France
| | - P Montravers
- Réanimation chirurgicale, Hôpital Bichat, Paris, France
| | - M P Dilly
- Réanimation chirurgicale cardio-vasculaire, AP-HP, Hôpital Bichat, Paris, France
| | - F Tubach
- Département Epidémiologie et Recherche Clinique, AP-HP, Hôpital Bichat, Paris, France; INSERM CIE 801, Paris, France; UMR 1123 ECEVE, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - A Andremont
- Laboratoire de Bactériologie, AP-HP, Hôpital Bichat, Paris, France; UMR 1137, INSERM, IAME, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - J F Timsit
- Réanimation médicale et infectieuse, Hôpital Bichat, Paris, France; UMR 1137, INSERM, IAME, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - M Wolff
- Réanimation médicale et infectieuse, Hôpital Bichat, Paris, France; UMR 1137, INSERM, IAME, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - L Armand-Lefèvre
- Laboratoire de Bactériologie, AP-HP, Hôpital Bichat, Paris, France; UMR 1137, INSERM, IAME, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
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Pailhoriès H, Lemarié C, Kouatchet A, Lasocki S, Sargentini C, Kempf M, Coron N, Mahaza C, Joly-Guillou ML, Eveillard M. The impact of performing bacterial identification and antimicrobial susceptibility testing on bronchoalveolar fluid cultures 24 h a day in a microbiology laboratory. Diagn Microbiol Infect Dis 2014; 80:216-21. [PMID: 25149417 DOI: 10.1016/j.diagmicrobio.2014.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 06/27/2014] [Accepted: 07/22/2014] [Indexed: 10/25/2022]
Abstract
We previously demonstrated the positive impact of performing bacterial identification and antimicrobial susceptibility testing (AST) after day hours (night service [NS]) for certain clinical samples on the treatment of infected patients. Our objective was to evaluate the impact of including positive bronchoalveolar lavage (BAL) cultures in our NS. Two major positive consequences were recorded: initiation of earlier appropriate treatment and earlier change to a reduced-spectrum but still effective regimen. Reductions in delay were defined as the differences between the hours actually spent and hours estimated as though laboratory tests had been performed in the absence of NS. Fifty BALs were included. The NS led to the implementation of earlier appropriate therapy in 10 cases (20%), to earlier de-escalation in 15 cases (30%), and to earlier appropriate therapy and de-escalation in 4 cases (8%). In conclusion, performing bacterial identification and AST for positive BAL after laboratory opening hours could be relevant.
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Affiliation(s)
| | - Carole Lemarié
- CHU d'Angers, Laboratoire de Bactériologie, F-49000 Angers, France
| | - Achille Kouatchet
- CHU d'Angers, Service de Réanimation médicale, F-49000 Angers, France
| | - Sigismond Lasocki
- CHU d'Angers, Service de Réanimation Chirurgicale A, F-49000 Angers, France
| | - Cyril Sargentini
- CHU d'Angers, Service de Réanimation Chirurgicale B, F-49000 Angers, France
| | - Marie Kempf
- CHU d'Angers, Laboratoire de Bactériologie, F-49000 Angers, France
| | - Noémie Coron
- CHU d'Angers, Laboratoire de Bactériologie, F-49000 Angers, France
| | - Chetaou Mahaza
- CHU d'Angers, Laboratoire de Bactériologie, F-49000 Angers, France
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