Implementing EUCAST rapid antimicrobial susceptibility testing method for sepsis: lessons learned in a tertiary care center
Introduction: We prospectively evaluated EUCAST rapid antimicrobial susceptibility testing methodology for susceptibility testing directly from blood culture bottles in comparison to CLSI disk-diffusion method. Methodology: During May-November 2019, positively flagged blood culture bottles showi...
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The Journal of Infection in Developing Countries
2021-06-01
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| author | Mohammad Aadam Bin Najeeb Ayush Gupta Shashank Purwar Vishnu Teja Nallapati Jogender Yadav Farha Siddiqui |
| author_facet | Mohammad Aadam Bin Najeeb Ayush Gupta Shashank Purwar Vishnu Teja Nallapati Jogender Yadav Farha Siddiqui |
| author_sort | Mohammad Aadam Bin Najeeb |
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Introduction: We prospectively evaluated EUCAST rapid antimicrobial susceptibility testing methodology for susceptibility testing directly from blood culture bottles in comparison to CLSI disk-diffusion method.
Methodology: During May-November 2019, positively flagged blood culture bottles showing Gram-negative micro-organisms were simultaneously processed by rapid antimicrobial susceptibility testing and CLSI methodology. Antibiotics tested were cefotaxime, ceftazidime, piperacillin-tazobactam, imipenem, meropenem, gentamicin, tobramycin and trimethoprim-sulphamethoxazole.
Results: Overall, 80 isolates identified as Escherichia coli (n = 24, 30%), Klebsiella pneumoniae (n = 15, 18.7%), Pseudomonas aeruginosa (n = 16, 20%) and Acinetobacter baumannii (n = 25, 31.2%) were included. Categorical agreements of rapid antimicrobial susceptibility testing at 4-, 6- and 8-hour reading times were 88.1% (304/345), 90.8% (425/468) and 92.3% (467/506), respectively. Major Error rates were 14% (21/150), 4.9% (10/206) and 4/236 (1.7%), whereas Very Major Error rates were 1.1% (2/177), 1.3% (3/232) and 3.3% (8/243), respectively. Results categorized as “Area of Technical Uncertainty” were significantly lower at 8-hour {10.2% (39/384) vs 5.2% (28/534), 4- vs 8-hour, p = 0.003, Fischer’s exact test}.
Conclusions: Except for a slightly higher Very major error rate, rapid antimicrobial susceptibility testing at 8-hour is equivalent to Disk-diffusion method (CLSI-M100) using CLSI-M52 criteria for equivalence: (Categorical agreement ≥ 90%, Very major error ≤ 1.5% and Major error ≤ 3%). Poor Categorical agreements at all reading times were noted for piperacillin-tazobactam, ciprofloxacin and E. coli. Performance of rapid antimicrobial susceptibility testing methodology in resource limited settings brings unique challenge of identifying micro-organisms within 8 hours. We suggest reading and reporting of results at a single time point using rapid antimicrobial susceptibility testing method i.e. at 8-hour.
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| format | Article |
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| institution | DOAJ |
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| publishDate | 2021-06-01 |
| publisher | The Journal of Infection in Developing Countries |
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| spelling | doaj-art-715f0cb89e1844fb8e185eae31c606ce2025-08-20T02:57:18ZengThe Journal of Infection in Developing CountriesJournal of Infection in Developing Countries1972-26802021-06-01150610.3855/jidc.13799Implementing EUCAST rapid antimicrobial susceptibility testing method for sepsis: lessons learned in a tertiary care centerMohammad Aadam Bin Najeeb0Ayush Gupta1Shashank Purwar2Vishnu Teja Nallapati3Jogender Yadav4Farha Siddiqui5Department of Microbiology, NAMO Medical Education and Research Institute, Silvassa, Dadra and Nagar Haveli, IndiaDepartment of Microbiology, All India Institute of Medical Science (AIIMS), Bhopal, IndiaDepartment of Microbiology, All India Institute of Medical Science (AIIMS), Bhopal, IndiaDepartment of Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, IndiaDepartment of Microbiology, All India Institute of Medical Science (AIIMS), Bhopal, IndiaDepartment of Microbiology, All India Institute of Medical Science (AIIMS), Bhopal, India Introduction: We prospectively evaluated EUCAST rapid antimicrobial susceptibility testing methodology for susceptibility testing directly from blood culture bottles in comparison to CLSI disk-diffusion method. Methodology: During May-November 2019, positively flagged blood culture bottles showing Gram-negative micro-organisms were simultaneously processed by rapid antimicrobial susceptibility testing and CLSI methodology. Antibiotics tested were cefotaxime, ceftazidime, piperacillin-tazobactam, imipenem, meropenem, gentamicin, tobramycin and trimethoprim-sulphamethoxazole. Results: Overall, 80 isolates identified as Escherichia coli (n = 24, 30%), Klebsiella pneumoniae (n = 15, 18.7%), Pseudomonas aeruginosa (n = 16, 20%) and Acinetobacter baumannii (n = 25, 31.2%) were included. Categorical agreements of rapid antimicrobial susceptibility testing at 4-, 6- and 8-hour reading times were 88.1% (304/345), 90.8% (425/468) and 92.3% (467/506), respectively. Major Error rates were 14% (21/150), 4.9% (10/206) and 4/236 (1.7%), whereas Very Major Error rates were 1.1% (2/177), 1.3% (3/232) and 3.3% (8/243), respectively. Results categorized as “Area of Technical Uncertainty” were significantly lower at 8-hour {10.2% (39/384) vs 5.2% (28/534), 4- vs 8-hour, p = 0.003, Fischer’s exact test}. Conclusions: Except for a slightly higher Very major error rate, rapid antimicrobial susceptibility testing at 8-hour is equivalent to Disk-diffusion method (CLSI-M100) using CLSI-M52 criteria for equivalence: (Categorical agreement ≥ 90%, Very major error ≤ 1.5% and Major error ≤ 3%). Poor Categorical agreements at all reading times were noted for piperacillin-tazobactam, ciprofloxacin and E. coli. Performance of rapid antimicrobial susceptibility testing methodology in resource limited settings brings unique challenge of identifying micro-organisms within 8 hours. We suggest reading and reporting of results at a single time point using rapid antimicrobial susceptibility testing method i.e. at 8-hour. https://jidc.org/index.php/journal/article/view/13799RASTEUCASTsepsisantimicrobial susceptibility testingantimicrobial stewardship |
| spellingShingle | Mohammad Aadam Bin Najeeb Ayush Gupta Shashank Purwar Vishnu Teja Nallapati Jogender Yadav Farha Siddiqui Implementing EUCAST rapid antimicrobial susceptibility testing method for sepsis: lessons learned in a tertiary care center Journal of Infection in Developing Countries RAST EUCAST sepsis antimicrobial susceptibility testing antimicrobial stewardship |
| title | Implementing EUCAST rapid antimicrobial susceptibility testing method for sepsis: lessons learned in a tertiary care center |
| title_full | Implementing EUCAST rapid antimicrobial susceptibility testing method for sepsis: lessons learned in a tertiary care center |
| title_fullStr | Implementing EUCAST rapid antimicrobial susceptibility testing method for sepsis: lessons learned in a tertiary care center |
| title_full_unstemmed | Implementing EUCAST rapid antimicrobial susceptibility testing method for sepsis: lessons learned in a tertiary care center |
| title_short | Implementing EUCAST rapid antimicrobial susceptibility testing method for sepsis: lessons learned in a tertiary care center |
| title_sort | implementing eucast rapid antimicrobial susceptibility testing method for sepsis lessons learned in a tertiary care center |
| topic | RAST EUCAST sepsis antimicrobial susceptibility testing antimicrobial stewardship |
| url | https://jidc.org/index.php/journal/article/view/13799 |
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