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  • 1 Otto-von-Guericke University Institute of Medical Microbiology, Infection Control and Prevention Leipziger Str. 44 39120 Magdeburg Germany
  • 2 Helmholtz-Zentrum für Infektionsforschung Braunschweig Germany
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Sepsis represents a life-threatening infection requiring the immediate start of antibacterial treatment to reduce morbidity. Thus, laboratories use direct antimicrobial susceptibility testing (AST) to rapidly generate preliminary results from positive blood cultures. As the direct AST has not yet been published to be evaluated with EUCAST breakpoints, the purpose of the study was to investigate the reliability of the direct agar diffusion test to correctly produce AST results from positive monobacterial blood cultures compared with the VITEK2-based definitive AST, when current EUCAST breakpoints were used.A total of 428 isolates from unselected monobacterial routine blood cultures and 110 challenge strains were included. Direct agar diffusion-based and standard VITEK2-based AST of 2803 bacterium-drug combinations yielded a total clinical category agreement of 95.47% with 1.28% very major errors and 3.42% combined major and minor errors. On the species level, very major errors were observed in the species-drug combinations Enterococcus spp.-high-level gentamicin (10.87%) and Staphylococcus spp.-rifampicin (5%), only. No very major errors occurred with Enterobacteriaceae and Pseudomonas aeruginosa.In most species-drug combinations, the direct agar diffusion test using EUCAST breakpoints precisely predicted the result of the definitive antibiotic susceptibility test and, thus, it can be used to optimize empiric antibiotic therapy until definitive results are available.

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  • Weinstein MP, Murphy JR, Reller LB, Lichtenstein KA: The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults. II. Clinical observations, with special reference to factors influencing prognosis. Rev Infect Dis 5, 54–70 (1983)

    Lichtenstein KA , 'The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults. II. Clinical observations, with special reference to factors influencing prognosis ' (1983 ) 5 Rev Infect Dis : 54 -70.

    • Search Google Scholar
  • Ibrahim EH, Sherman G, Ward S, Fraser VJ, Kollef MH: The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest 118, 146–155 (2000)

    Kollef MH , 'The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting ' (2000 ) 118 Chest : 146 -155.

    • Search Google Scholar
  • MacArthur RD, Miller M, Albertson T, Panacek E, Johnson D, Teoh L, Barchuk W: Adequacy of early empiric antibiotic treatment and survival in severe sepsis: experience from the MONARCS trial. Clin Infect Dis 38, 284–288 (2004)

    Barchuk W , 'Adequacy of early empiric antibiotic treatment and survival in severe sepsis: experience from the MONARCS trial ' (2004 ) 38 Clin Infect Dis : 284 -288.

    • Search Google Scholar
  • Jordana-Lluch E, Gimenez M, Quesada MD, Ausina V, Martro E: Improving the diagnosis of bloodstream infections: PCR coupled with mass spectrometry. Biomed Res Int 2014, 1–8 (2014)

    Martro E , 'Improving the diagnosis of bloodstream infections: PCR coupled with mass spectrometry ' (2014 ) 2014 Biomed Res Int : 1 -8.

    • Search Google Scholar
  • Funke G, Funke-Kissling P: Use of the BD PHOENIX Automated Microbiology System for direct identification and susceptibility testing of gram-negative rods from positive blood cultures in a three-phase trial. J Clin Microbiol 42, 1466–1470 (2004)

    Funke-Kissling P , 'Use of the BD PHOENIX Automated Microbiology System for direct identification and susceptibility testing of gram-negative rods from positive blood cultures in a three-phase trial ' (2004 ) 42 J Clin Microbiol : 1466 -1470.

    • Search Google Scholar
  • Lupetti A, Barnini S, Castagna B, Nibbering PH, Campa M: Rapid identification and antimicrobial susceptibility testing of Gram-positive cocci in blood cultures by direct inoculation into the BD Phoenix system. Clin Microbiol Infect 16, 986–991 (2010)

    Campa M , 'Rapid identification and antimicrobial susceptibility testing of Gram-positive cocci in blood cultures by direct inoculation into the BD Phoenix system ' (2010 ) 16 Clin Microbiol Infect : 986 -991.

    • Search Google Scholar
  • Edelmann A, Pietzcker T, Wellinghausen N: Comparison of direct disk diffusion and standard microtitre broth dilution susceptibility testing of blood culture isolates. J Med Microbiol 56, 202–207 (2007)

    Wellinghausen N , 'Comparison of direct disk diffusion and standard microtitre broth dilution susceptibility testing of blood culture isolates ' (2007 ) 56 J Med Microbiol : 202 -207.

    • Search Google Scholar
  • Endtz HP, Van den Braak N, Van Belkum A, Goessens WH, Kreft D, Stroebel AB, Verbrugh HA: Comparison of eight methods to detect vancomycin resistance in enterococci. J Clin Microbiol 36, 592–594 (1998)

    Verbrugh HA , 'Comparison of eight methods to detect vancomycin resistance in enterococci ' (1998 ) 36 J Clin Microbiol : 592 -594.

    • Search Google Scholar
  • Klare I, Fleige C, Geringer U, Witte W, Werner G: Performance of three chromogenic VRE screening agars, two Etest((R)) vancomycin protocols, and different microdilution methods in detecting vanB genotype Enterococcus faecium with varying vancomycin MICs. Diagn Microbiol Infect Dis 74, 171–176 (2012)

    Werner G , 'Performance of three chromogenic VRE screening agars, two Etest((R)) vancomycin protocols, and different microdilution methods in detecting vanB genotype Enterococcus faecium with varying vancomycin MICs ' (2012 ) 74 Diagn Microbiol Infect Dis : 171 -176.

    • Search Google Scholar
  • Chapin KC, Musgnug MC: Direct susceptibility testing of positive blood cultures by using Sensititre broth microdilution plates. J Clin Microbiol 41, 4751–4754 (2003)

    Musgnug MC , 'Direct susceptibility testing of positive blood cultures by using Sensititre broth microdilution plates ' (2003 ) 41 J Clin Microbiol : 4751 -4754.

    • Search Google Scholar
  • Wellinghausen N, Pietzcker T, Poppert S, Belak S, Fieser N, Bartel M, Essig A: Evaluation of the Merlin MICRONAUT system for rapid direct susceptibility testing of gram-positive cocci and gram-negative bacilli from positive blood cultures. J Clin Microbiol 45, 789–795 (2007)

    Essig A , 'Evaluation of the Merlin MICRONAUT system for rapid direct susceptibility testing of gram-positive cocci and gram-negative bacilli from positive blood cultures ' (2007 ) 45 J Clin Microbiol : 789 -795.

    • Search Google Scholar
  • Gherardi G, Angeletti S, Panitti M, Pompilio A, Di Bonaventura G, Crea F, Avola A, Fico L, Palazzo C, Sapia GF, Visaggio D, Dicuonzo G: Comparative evaluation of the Vitek-2 Compact and Phoenix systems for rapid identification and antibiotic susceptibility testing directly from blood cultures of Gram-negative and Gram-positive isolates. Diagn Microbiol Infect Dis 72, 20–31 (2012)

    Dicuonzo G , 'Comparative evaluation of the Vitek-2 Compact and Phoenix systems for rapid identification and antibiotic susceptibility testing directly from blood cultures of Gram-negative and Gram-positive isolates ' (2012 ) 72 Diagn Microbiol Infect Dis : 20 -31.

    • Search Google Scholar
  • European Committee on Antimicrobial Susceptibility Testing (EUCAST): http://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Breakpoint_tables/Breakpoint_table_v_2.0_120221.pdf. (last access 25.01.2015)

  • Jorgensen JH: Selection criteria for an antimicrobial susceptibility testing system. J Clin Microbiol 31, 2841–2844 (1993)

    Jorgensen JH , 'Selection criteria for an antimicrobial susceptibility testing system ' (1993 ) 31 J Clin Microbiol : 2841 -2844.

    • Search Google Scholar
  • Thornsberry C, Anhalt JP, Washington JA, McCarthy LR, Schoenknecht FD, Sherris JC, Spencer HJ: Clinical laboratory evaluation of the Abbott MS-2 automated antimicrobial susceptibility testing system: report of a collaborative study. J Clin Microbiol 12, 375–390 (1980)

    Spencer HJ , 'Clinical laboratory evaluation of the Abbott MS-2 automated antimicrobial susceptibility testing system: report of a collaborative study ' (1980 ) 12 J Clin Microbiol : 375 -390.

    • Search Google Scholar
  • Lopez-Cerero L, Picon E, Morillo C, Hernandez JR, Docobo F, Pachon J, Rodriguez-Bano J, Pascual A: Comparative assessment of inoculum effects on the antimicrobial activity of amoxycillin–clavulanate and piperacillin–tazobactam with extended-spectrum beta-lactamase-producing and extended-spectrum beta-lactamase-non-producing Escherichia coli isolates. Clin Microbiol Infect 16, 132–136 (2010)

    Pascual A , 'Comparative assessment of inoculum effects on the antimicrobial activity of amoxycillin–clavulanate and piperacillin–tazobactam with extended-spectrum beta-lactamase-producing and extended-spectrum beta-lactamase-non-producing Escherichia coli isolates ' (2010 ) 16 Clin Microbiol Infect : 132 -136.

    • Search Google Scholar
  • Wu N, Chen B, Tian S, Chu Y: The inoculum effect of antibiotics against CTX-M-extended-spectrum beta-lactamase-producing Escherichia coli. Ann Clin Microbiol Antimicrob 13, 45–52 (2014)

    Chu Y , 'The inoculum effect of antibiotics against CTX-M-extended-spectrum beta-lactamase-producing Escherichia coli ' (2014 ) 13 Ann Clin Microbiol Antimicrob : 45 -52.

    • Search Google Scholar
  • Torres E, Villanueva R, Bou G: Comparison of different methods of determining beta-lactam susceptibility in clinical strains of Pseudomonas aeruginosa. J Med Microbiol 58, 625–629 (2009)

    Bou G , 'Comparison of different methods of determining beta-lactam susceptibility in clinical strains of Pseudomonas aeruginosa ' (2009 ) 58 J Med Microbiol : 625 -629.

    • Search Google Scholar
  • Johnson KN, Andreacchio K, Edelstein PH: Detection of methicillin-resistant coagulase-negative staphylococci by the Vitek 2 system. J Clin Microbiol 52, 3196–3199 (2014)

    Edelstein PH , 'Detection of methicillin-resistant coagulase-negative staphylococci by the Vitek 2 system ' (2014 ) 52 J Clin Microbiol : 3196 -3199.

    • Search Google Scholar
  • de Cueto M, Ceballos E, Martinez-Martinez L, Perea EJ, Pascual A: Use of positive blood cultures for direct identification and susceptibility testing with the vitek 2 system. J Clin Microbiol 42, 3734–3738 (2004)

    Pascual A , 'Use of positive blood cultures for direct identification and susceptibility testing with the vitek 2 system ' (2004 ) 42 J Clin Microbiol : 3734 -3738.

    • Search Google Scholar

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Editor(s)-in-Chief: Dunay, Ildiko Rita

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Jeffrey S. Buguliskis (Thomas Jefferson University, USA)

  • Jörn Albring (University of Münster, Germany)
  • Stefan Bereswill (Charité - University Medicine Berlin, Germany)
  • Dunja Bruder (University of Megdeburg, Germany)
  • Jan Buer (University of Duisburg, Germany)
  • Jeff Buguliskis (Thomas Jefferson University, USA)
  • Edit Buzas (Semmelweis University, Hungary)
  • Charles Collyer (University of Sydney, Australia)
  • Renato Damatta (UENF, Brazil)
  • Ivelina Damjanova (Semmelweis University, Hungary)
  • Maria Deli (Biological Research Center, HAS, Hungary)
  • Olgica Djurković-Djaković (University of Belgrade, Serbia)
  • Jean-Dennis Docquier (University of Siena, Italy)
  • Anna Erdei (Eötvös Loránd University, Hungary)
  • Zsuzsanna Fabry (University of Washington, USA)
  • Beniam Ghebremedhin (Witten/Herdecke University, Germany)
  • Nancy Guillen (Institute Pasteur, France)
  • Georgina L. Hold (University of Aberdeen, United Kingdom)
  • Ralf Ignatius (Charité - University Medicine Berlin, Germany)
  • Zsuzsanna Izsvak (MDC-Berlin, Germany)
  • Achim Kaasch (University of Cologne, Germany)
  • Tamás Laskay (University of Lübeck, Germany)
  • Oliver Liesenfeld (Roche, USA)
  • Shreemanta Parida (Vaccine Grand Challenge Program, India)
  • Matyas Sandor (University of Wisconsin, USA)
  • Ulrich Steinhoff (University of Marburg, Germany)
  • Michal Toborek (University of Miami, USA)
  • Mary Jo Wick (University of Gothenburg, Sweden)
  • Susanne A. Wolf (MDC-Berlin, Germany)

 

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Magdeburg, Germany
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