Impact of the beta-lacta test on the management of urinary tract infections at the emergency department.

INTRODUCTION: Rapid detection of extended-spectrum ß-lactamases is essential. In this study, we evaluated the potential impact of ß-lacta test on both the times to appropriate antibiotic therapy and to the implementation of patient isolation measures. PATIENTS AND METHODS: We included prospectively all the patients admitted to the emergency department for clinical suspicion of urinary tract infection. Compared with physician's decision, we analysed the potential impact of ß-lacta test on the initial antibiotic therapy and on the implementation of hygiene measures. This study has been registered under number NCT02897609. RESULTS: We included 203 patients, 43% with acute pyelonephritis and 21% with acute prostatitis. The ß-lacta test had a 95.2% sensitivity and a 99.5% specificity to detect extended-spectrum ß-lactamases. Taking the ß-lacta test results into account would have decreased significantly both the times to appropriate therapy and to isolation measures from 54 to 2.7 h and from 55.2 to 2.6 h, respectively. CONCLUSION: The ß-lacta test could reduce significantly the times to appropriate therapy and implementation of isolations measures.

A rapid and inexpensive protocol to screen for third generation cephalosporin-resistant and non-fermenting Gram-negative rods directly in positive blood cultures.

Third generation cephalosporins are frequently used in the first-line treatment of Gram-negative rod (GNR) bacteremia but are unsuitable in the case of extended-spectrum-beta-lactamase-producing Enterobacterales (ESBL-E) or non-fermenting GNR infections. The aim of this study was to develop and evaluate a simple and rapid two-test protocol involving oxidase and ß-Lacta tests performed directly on positive blood culture broth as a preliminary screen for non-fermenting or third generation cephalosporins-resistant GNR. The diagnostic performance of this approach was evaluated on 294 bottles for the oxidase test and 267 bottles for the ß-Lacta Test. The sensitivity and specificity of the oxidase test were respectively 93.1% and 100%, and the sensitivity of the ß-Lacta Test for ESBL-E was 100% and the specificity 99.5%. This simple protocol, which can be implemented in all laboratories and performed in only 20 min, may be a valuable tool to optimize first-line antibiotic therapy for bacteremia.