sharon sanders
Editor-in-Chief & President
http://www.cidrap.umn.edu/news-perspective/2019/09/stewardship-resistance-scan-sep-27-2019
[h=3]Rapid test for bloodstream infections tied to faster optimal antibiotics[/h] Use of a rapid molecular identification test on positive blood cultures from critically ill patients with bloodstream infections was associated with significantly reduced time to optimal antibiotic treatment, Belgian researchers reported yesterday in PLOS One.
In a study conducted in the intensive care unit (ICU) of a Belgian tertiary hospital, the researchers compared two methods of blood culture management in patients who had positive blood cultures. In the 8-month pre-intervention period (P0), they performed standard blood culture management, including Gram stain, matrix-assisted laser desorption ionization time-of-flight mass spectrometry identification, and antimicrobial susceptibility testing. In the intervention period (P1), standard blood culture management was completed with the BioFire FilmArray blood culture identification (FA-BCID) panel, which can identify 24 microorganisms and three antibiotic resistance genes from whole blood in just over an hour. The primary outcome was median time to optimal antibiotic treatment.
Outcome analysis was performed on 110 bloodstream infections both in P0 and P1. Time to optimal antimicrobial treatment in P0 was 14 hour and 41 minutes, compared with 4 hours and 39 minutes in P1. FA-BCID test results led to a treatment adjustment in 35 (31.8%) of 110 P1 episodes, including 26 in which the adjustment was the optimal antimicrobial treatment. With regard to microbiologic performance, FA-BCID testing identified 96.2% of the on-panel microorganisms, thereby covering 85.2% of the ICU-strain epidemiology. Time to identification with FA-BCID testing was calculated at 1 hour and 35 minutes. Resistance detection was in complete concordance with routine results.
The authors of the study conclude that FA-BCID could be a beneficial add-on identification tool for diagnosing bloodstream infections in critically ill patients, but they add that further studies are needed in settings with high proportions of multidrug-resistant infections.
Sep 26 PLOS One study
[h=3]Rapid molecular TB test shows promise in comparative study[/h] A multicenter study by an international team has found that an automated molecular assay that rapidly detects tuberculosis (TB) and genetic mutations associated with multidrug resistance had comparable sensitivity and specificity to a widely used rapid molecular test.
In a prospective study published today in Clinical Infectious Diseases, researchers assessed the accuracy of the BD MAX MDR-TB assay performed on sputum, which was then processed for mycobacterial culture and phenotypic drug testing. The Xpert MTB/RIF assay, a rapid molecular test endorsed by the World Health Organization for use in TB-endemic countries, was also performed for comparison. Participants with TB symptoms were recruited and enrolled from study sites in Uganda, South Africa, India, and Peru from May 2017 through March 2018.
Of the 1,102 patients screened, 1,053 met the enrollment criteria. In patients with microbiologically confirmed Mycobacterium tuberculosis (MTB), BD MAX sensitivity was 93% (262 of 282; 95% confidence interval [CI], 89% to 95%), while specificity was 97% (593/610; 95% CI, 96% to 98%) among participants with negative cultures on raw sputa. BD MAX sensitivity was 100% (175/175; 98% to 100%) for smear-positive samples (fluorescence smear-microscopy), and 81% (87/107; 73% to 88%) in smear-negative samples. When both BD MAX and Xpert were compared, sensitivity was 91% (249/274; 87% to 94%) for BD MAX and 90% (246/274; 86% to 93%) for Xpert on processed sputa.
Sensitivity and specificity for rifampicin resistance compared with phenotypic drug susceptibility testing was 90% (9/10; 60% to 98%) and 95% (211/222; 91% to 97%), respectively. Sensitivity and specificity for detection of isoniazid resistance was 82% (22/27; 63% to 92%) and 100% (205/205; 98% to 100%), respectively.
The authors say new TB diagnostic tools are needed and underscore the ability of BD MAX to process more samples simultaneously than the Xpert assay. They write, "For many high-burden settings with a high-volume of testing, the BD MAX assay may represent an important automated tool for rapid detection of both MTB and drug resistance." They add that Xpert can test only for resistance mutations associated with rifampicin.
The study was sponsored by BD MAX developer Becton, Dickinson and Company.
Sep 27 Clin Infect Dis abstract
[h=3]European report highlights spread of carbapenem-resistant pathogens[/h] The European Centre for Disease Prevention and Control (ECDC) today issued an updated rapid risk assessment for carbapenem-resistant Enterobacteriaceae (CRE).
According to the assessment, data from the European Antimicrobial Resistance Surveillance Network (EARS-Net) for 2017 show a large variability in national percentages of carbapenem-resistant Klebsiella pneumoniae in European Union/European Economic Area (EU/EEA) countries, ranging from 0% to 64%, and a statistically insignificant drop in the population-weighted mean percentage for the EU/EEA overall, from 7.3% in 2014 to 7.2% in 2017. For carbapenem-resistant Escherichia coli, national percentages ranged from 0% to 1.6% in 2017, with a slightly decreasing trend observed for the EU/EEA overall from 2014 through 2017.
Despite the low percentages of CRE isolates in many European countries, however, the ECDC reports that a national self-assessment of epidemiologic stages conducted in 2018 documented an evolving pattern of spread of carbapenemase-producing CRE (CP-CRE) in Europe, with 16 of 37 countries (43%) reporting regional or interregional spread of CP-CRE and 4 other countries reporting an endemic situation. In addition, there have been large CRE outbreaks in healthcare settings in several EU states, including some with low CRE rates. Finally, the report notes that introduction of CRE via cross-border patient transfers and travelers from high-prevalence countries might significantly contribute to the spread of these bacteria into countries with a low prevalence.
To guard against the spread of CRE, the assessment recommends that hospitals implement and adhere to infection control measures, including hand hygiene, contact precautions, and cleaning and disinfecting patient rooms; screen patients at high risk for digestive tract CRE carriage; consider enhanced control measures such as patient isolation and cohorting and dedicated nurses; and implement antimicrobial stewardship programs to curb unnecessary use of carbapenems.
In addition, the ECDC encourages hospitals involved in cross-border patient transfers to consider taking a detailed history of travels and hospitalization for every patient at hospital admission and performing pre-emptive isolation and screening in patients who've been transferred from or hospitalized in countries that have a high CRE prevalence.
Sep 27 ECDC rapid risk assessment
[h=3]Rapid test for bloodstream infections tied to faster optimal antibiotics[/h] Use of a rapid molecular identification test on positive blood cultures from critically ill patients with bloodstream infections was associated with significantly reduced time to optimal antibiotic treatment, Belgian researchers reported yesterday in PLOS One.
In a study conducted in the intensive care unit (ICU) of a Belgian tertiary hospital, the researchers compared two methods of blood culture management in patients who had positive blood cultures. In the 8-month pre-intervention period (P0), they performed standard blood culture management, including Gram stain, matrix-assisted laser desorption ionization time-of-flight mass spectrometry identification, and antimicrobial susceptibility testing. In the intervention period (P1), standard blood culture management was completed with the BioFire FilmArray blood culture identification (FA-BCID) panel, which can identify 24 microorganisms and three antibiotic resistance genes from whole blood in just over an hour. The primary outcome was median time to optimal antibiotic treatment.
Outcome analysis was performed on 110 bloodstream infections both in P0 and P1. Time to optimal antimicrobial treatment in P0 was 14 hour and 41 minutes, compared with 4 hours and 39 minutes in P1. FA-BCID test results led to a treatment adjustment in 35 (31.8%) of 110 P1 episodes, including 26 in which the adjustment was the optimal antimicrobial treatment. With regard to microbiologic performance, FA-BCID testing identified 96.2% of the on-panel microorganisms, thereby covering 85.2% of the ICU-strain epidemiology. Time to identification with FA-BCID testing was calculated at 1 hour and 35 minutes. Resistance detection was in complete concordance with routine results.
The authors of the study conclude that FA-BCID could be a beneficial add-on identification tool for diagnosing bloodstream infections in critically ill patients, but they add that further studies are needed in settings with high proportions of multidrug-resistant infections.
Sep 26 PLOS One study
[h=3]Rapid molecular TB test shows promise in comparative study[/h] A multicenter study by an international team has found that an automated molecular assay that rapidly detects tuberculosis (TB) and genetic mutations associated with multidrug resistance had comparable sensitivity and specificity to a widely used rapid molecular test.
In a prospective study published today in Clinical Infectious Diseases, researchers assessed the accuracy of the BD MAX MDR-TB assay performed on sputum, which was then processed for mycobacterial culture and phenotypic drug testing. The Xpert MTB/RIF assay, a rapid molecular test endorsed by the World Health Organization for use in TB-endemic countries, was also performed for comparison. Participants with TB symptoms were recruited and enrolled from study sites in Uganda, South Africa, India, and Peru from May 2017 through March 2018.
Of the 1,102 patients screened, 1,053 met the enrollment criteria. In patients with microbiologically confirmed Mycobacterium tuberculosis (MTB), BD MAX sensitivity was 93% (262 of 282; 95% confidence interval [CI], 89% to 95%), while specificity was 97% (593/610; 95% CI, 96% to 98%) among participants with negative cultures on raw sputa. BD MAX sensitivity was 100% (175/175; 98% to 100%) for smear-positive samples (fluorescence smear-microscopy), and 81% (87/107; 73% to 88%) in smear-negative samples. When both BD MAX and Xpert were compared, sensitivity was 91% (249/274; 87% to 94%) for BD MAX and 90% (246/274; 86% to 93%) for Xpert on processed sputa.
Sensitivity and specificity for rifampicin resistance compared with phenotypic drug susceptibility testing was 90% (9/10; 60% to 98%) and 95% (211/222; 91% to 97%), respectively. Sensitivity and specificity for detection of isoniazid resistance was 82% (22/27; 63% to 92%) and 100% (205/205; 98% to 100%), respectively.
The authors say new TB diagnostic tools are needed and underscore the ability of BD MAX to process more samples simultaneously than the Xpert assay. They write, "For many high-burden settings with a high-volume of testing, the BD MAX assay may represent an important automated tool for rapid detection of both MTB and drug resistance." They add that Xpert can test only for resistance mutations associated with rifampicin.
The study was sponsored by BD MAX developer Becton, Dickinson and Company.
Sep 27 Clin Infect Dis abstract
[h=3]European report highlights spread of carbapenem-resistant pathogens[/h] The European Centre for Disease Prevention and Control (ECDC) today issued an updated rapid risk assessment for carbapenem-resistant Enterobacteriaceae (CRE).
According to the assessment, data from the European Antimicrobial Resistance Surveillance Network (EARS-Net) for 2017 show a large variability in national percentages of carbapenem-resistant Klebsiella pneumoniae in European Union/European Economic Area (EU/EEA) countries, ranging from 0% to 64%, and a statistically insignificant drop in the population-weighted mean percentage for the EU/EEA overall, from 7.3% in 2014 to 7.2% in 2017. For carbapenem-resistant Escherichia coli, national percentages ranged from 0% to 1.6% in 2017, with a slightly decreasing trend observed for the EU/EEA overall from 2014 through 2017.
Despite the low percentages of CRE isolates in many European countries, however, the ECDC reports that a national self-assessment of epidemiologic stages conducted in 2018 documented an evolving pattern of spread of carbapenemase-producing CRE (CP-CRE) in Europe, with 16 of 37 countries (43%) reporting regional or interregional spread of CP-CRE and 4 other countries reporting an endemic situation. In addition, there have been large CRE outbreaks in healthcare settings in several EU states, including some with low CRE rates. Finally, the report notes that introduction of CRE via cross-border patient transfers and travelers from high-prevalence countries might significantly contribute to the spread of these bacteria into countries with a low prevalence.
To guard against the spread of CRE, the assessment recommends that hospitals implement and adhere to infection control measures, including hand hygiene, contact precautions, and cleaning and disinfecting patient rooms; screen patients at high risk for digestive tract CRE carriage; consider enhanced control measures such as patient isolation and cohorting and dedicated nurses; and implement antimicrobial stewardship programs to curb unnecessary use of carbapenems.
In addition, the ECDC encourages hospitals involved in cross-border patient transfers to consider taking a detailed history of travels and hospitalization for every patient at hospital admission and performing pre-emptive isolation and screening in patients who've been transferred from or hospitalized in countries that have a high CRE prevalence.
Sep 27 ECDC rapid risk assessment