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1.
J Antimicrob Chemother ; 74(Suppl 1): i16-i23, 2019 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-30690542

RESUMEN

Objectives: We evaluated the performance and time to result for pathogen identification (ID) and antimicrobial susceptibility testing (AST) of the Accelerate Pheno™ system (AXDX) compared with standard of care (SOC) methods. We also assessed the hypothetical improvement in antibiotic utilization if AXDX had been implemented. Methods: Clinical samples from patients with monomicrobial Gram-negative bacteraemia were tested and compared between AXDX and the SOC methods of the VERIGENE® and Bruker MALDI Biotyper® systems for ID and the VITEK® 2 system for AST. Additionally, charts were reviewed to calculate theoretical times to antibiotic de-escalation, escalation and active and optimal therapy. Results: ID mean time was 21 h for MALDI-TOF MS, 4.4 h for VERIGENE® and 3.7 h for AXDX. AST mean time was 35 h for VITEK® 2 and 9.0 h for AXDX. For ID, positive percentage agreement was 95.9% and negative percentage agreement was 99.9%. For AST, essential agreement was 94.5% and categorical agreement was 93.5%. If AXDX results had been available to inform patient care, 25% of patients could have been put on active therapy sooner, while 78% of patients who had therapy optimized during hospitalization could have had therapy optimized sooner. Additionally, AXDX could have reduced time to de-escalation (16 versus 31 h) and escalation (19 versus 31 h) compared with SOC. Conclusions: By providing fast and reliable ID and AST results, AXDX has the potential to improve antimicrobial utilization and enhance antimicrobial stewardship.


Asunto(s)
Antibacterianos/farmacología , Bacteriemia/microbiología , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Gramnegativas/aislamiento & purificación , Infecciones por Bacterias Gramnegativas/microbiología , Pruebas de Sensibilidad Microbiana/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos , Cultivo de Sangre/métodos , Cultivo de Sangre/normas , Niño , Preescolar , Técnicas de Laboratorio Clínico/métodos , Técnicas de Laboratorio Clínico/normas , Femenino , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Humanos , Hibridación Fluorescente in Situ/métodos , Hibridación Fluorescente in Situ/normas , Lactante , Masculino , Pruebas de Sensibilidad Microbiana/normas , Persona de Mediana Edad , Fenotipo , Estudios Prospectivos , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción/métodos , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción/normas , Adulto Joven
2.
Diagn Microbiol Infect Dis ; 95(3): 114841, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31422873

RESUMEN

OBJECTIVES: To compare the performance and time-to-result (TTR) for antimicrobial susceptibility testing (AST) of positive blood cultures (PBC) using the Accelerate Pheno™ system (AXDX) and both a direct VITEK® 2 card inoculation workflow (DV2) and traditional FDA-approved VITEK® 2 workflow using subcultured isolates (V2). METHODS: Patient samples with monomicrobial Gram-negative rod bacteremia were tested on AXDX and DV2 in tandem and compared to V2 AST results. Categorical agreement (CA) errors were adjudicated using broth microdilution. Instrumentation times and AST TTR were compared. RESULTS: AXDX and DV2 had a CA of 93.4% and 97.4%, respectively, compared to V2. Postadjudication, AXDX, DV2, and V2 had CA of 94.7%, 95.7%, and 96.5%, respectively. Instrument run times were 6.6 h, 9.4 h, and 9.2 h, and AST TTR were 8.9 h, 12.9 h and 35.5 h, respectively. CONCLUSIONS: AXDX and DV2 ASTs are fast and reliable, which may have significant antimicrobial stewardship implications.


Asunto(s)
Cultivo de Sangre , Pruebas Diagnósticas de Rutina/métodos , Pruebas de Sensibilidad Microbiana/métodos , Programas de Optimización del Uso de los Antimicrobianos , Bacteriemia/microbiología , Pruebas Diagnósticas de Rutina/instrumentación , Pruebas Diagnósticas de Rutina/normas , Bacterias Gramnegativas/aislamiento & purificación , Bacterias Gramnegativas/metabolismo , Infecciones por Bacterias Gramnegativas/microbiología , Humanos , Pruebas de Sensibilidad Microbiana/instrumentación , Pruebas de Sensibilidad Microbiana/normas , Estudios Prospectivos , Factores de Tiempo , Flujo de Trabajo , beta-Lactamasas/biosíntesis
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