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Fast-track identification of CTX-M-extended-spectrum-[beta]-lactamase- and carbapenemase-producing Enterobacterales in bloodstream infections: implications on the likelihood of deduction of antibiotic susceptibility in emergency and internal medicine departments

Keywords: Bloodstream infection; CTX-M; Carbapenemase; Fast microbiology diagnostics; Enterobacterales; Antimicrobial stewardship This study aims at presenting a reliable fast-track diagnostics for the detection of CTX-M ESBL- (CTX-M-p) and carbapenemase-producers (CA-p) directly from blood cultures... Full description

Journal Title: European journal of clinical microbiology & infectious diseases 2021-07-01, Vol.40 (7), p.1495
Main Author: Boattini, Matteo
Other Authors: Bianco, Gabriele , Iannaccone, Marco , Ghibaudo, Davide , Almeida, André , Cavallo, Rossana , Costa, Cristina
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: Springer
ID: ISSN: 0934-9723
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title: Fast-track identification of CTX-M-extended-spectrum-[beta]-lactamase- and carbapenemase-producing Enterobacterales in bloodstream infections: implications on the likelihood of deduction of antibiotic susceptibility in emergency and internal medicine departments
format: Article
creator:
  • Boattini, Matteo
  • Bianco, Gabriele
  • Iannaccone, Marco
  • Ghibaudo, Davide
  • Almeida, André
  • Cavallo, Rossana
  • Costa, Cristina
subjects:
  • Bacterial pneumonia
  • Beta lactamases
  • Blood
  • Epidemiology
  • Escherichia coli
  • Health aspects
  • Medical examination
  • Pneumonia
  • Tazobactam
ispartof: European journal of clinical microbiology & infectious diseases, 2021-07-01, Vol.40 (7), p.1495
description: Keywords: Bloodstream infection; CTX-M; Carbapenemase; Fast microbiology diagnostics; Enterobacterales; Antimicrobial stewardship This study aims at presenting a reliable fast-track diagnostics for the detection of CTX-M ESBL- (CTX-M-p) and carbapenemase-producers (CA-p) directly from blood cultures (BCs) of patients with Enterobacterales (EB) bloodstream infections (BSIs) admitted in emergency and internal medicine departments and its contribution in estimation of in vitro antibiotic susceptibility. A fast-track workflow including MALDI-TOF species identification and two lateral flow immunochromatographic assays for the detection of CTX-M-p and CA-p directly from BCs was performed in parallel with conventional routine, and results were compared. A total of 236 BCs of patients suffering from EB BSI were included. Accuracy of the fast-track workflow ranged from 99.6 to 100%. Among E. coli isolates, CTX-M-p (20.5%) were susceptible to ceftolozane-tazobactam (C/T, 97%), ceftazidime-avibactam (CZA, 100%), and piperacillin-tazobactam (TZP, 84.8%), whereas CTX-M-and-main-carbapenemases-non-producer (CTX-M-CA-np, 79.5%) isolates were susceptible to all the antibiotics tested. Among K. pneumoniae isolates, CTX-M-p (23.3%) were poorly susceptible to TZP (40%) but widely susceptible to C/T (90%), CZA (100%), and amikacin (90%), whereas CTX-M-CA-np (55.8%) were also susceptible to cefepime. CA-p K. pneumoniae (20.9%) were susceptible to CZA (88.9%). All the species other than E. coli and K. pneumoniae were CTX-M-CA-np and were widely susceptible to the antibiotics tested except for isolates of the inducible and derepressed AmpC- or AmpC/ESBL-p species. Rapid identification of species and phenotype together with knowledge of local epidemiology may be crucial to determine the likelihood of deduction of in vitro antibiotic susceptibility on the same day of positive BC processing. Author Affiliation: (1) Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy (2) Department of Internal Medicine 4, Hospital de Santa Marta, Central Lisbon Hospital Centre, Lisbon, Portugal (3) NOVA Medical School, Universidade Nova de Lisboa, Campo dos Mártires da Pátria 130, 1169-056, Lisbon, Portugal (a) matteo.boattini@unito.it Article History: Registration Date: 02/10/2021 Received Date: 09/28/2020 Accepted Date: 02/09/2021 Online Date: 02/17/2021 Byline:
language: eng
source:
identifier: ISSN: 0934-9723
fulltext: no_fulltext
issn:
  • 0934-9723
  • 1435-4373
url: Link


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titleFast-track identification of CTX-M-extended-spectrum-[beta]-lactamase- and carbapenemase-producing Enterobacterales in bloodstream infections: implications on the likelihood of deduction of antibiotic susceptibility in emergency and internal medicine departments
creatorBoattini, Matteo ; Bianco, Gabriele ; Iannaccone, Marco ; Ghibaudo, Davide ; Almeida, André ; Cavallo, Rossana ; Costa, Cristina
creatorcontribBoattini, Matteo ; Bianco, Gabriele ; Iannaccone, Marco ; Ghibaudo, Davide ; Almeida, André ; Cavallo, Rossana ; Costa, Cristina
descriptionKeywords: Bloodstream infection; CTX-M; Carbapenemase; Fast microbiology diagnostics; Enterobacterales; Antimicrobial stewardship This study aims at presenting a reliable fast-track diagnostics for the detection of CTX-M ESBL- (CTX-M-p) and carbapenemase-producers (CA-p) directly from blood cultures (BCs) of patients with Enterobacterales (EB) bloodstream infections (BSIs) admitted in emergency and internal medicine departments and its contribution in estimation of in vitro antibiotic susceptibility. A fast-track workflow including MALDI-TOF species identification and two lateral flow immunochromatographic assays for the detection of CTX-M-p and CA-p directly from BCs was performed in parallel with conventional routine, and results were compared. A total of 236 BCs of patients suffering from EB BSI were included. Accuracy of the fast-track workflow ranged from 99.6 to 100%. Among E. coli isolates, CTX-M-p (20.5%) were susceptible to ceftolozane-tazobactam (C/T, 97%), ceftazidime-avibactam (CZA, 100%), and piperacillin-tazobactam (TZP, 84.8%), whereas CTX-M-and-main-carbapenemases-non-producer (CTX-M-CA-np, 79.5%) isolates were susceptible to all the antibiotics tested. Among K. pneumoniae isolates, CTX-M-p (23.3%) were poorly susceptible to TZP (40%) but widely susceptible to C/T (90%), CZA (100%), and amikacin (90%), whereas CTX-M-CA-np (55.8%) were also susceptible to cefepime. CA-p K. pneumoniae (20.9%) were susceptible to CZA (88.9%). All the species other than E. coli and K. pneumoniae were CTX-M-CA-np and were widely susceptible to the antibiotics tested except for isolates of the inducible and derepressed AmpC- or AmpC/ESBL-p species. Rapid identification of species and phenotype together with knowledge of local epidemiology may be crucial to determine the likelihood of deduction of in vitro antibiotic susceptibility on the same day of positive BC processing. Author Affiliation: (1) Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy (2) Department of Internal Medicine 4, Hospital de Santa Marta, Central Lisbon Hospital Centre, Lisbon, Portugal (3) NOVA Medical School, Universidade Nova de Lisboa, Campo dos Mártires da Pátria 130, 1169-056, Lisbon, Portugal (a) matteo.boattini@unito.it Article History: Registration Date: 02/10/2021 Received Date: 09/28/2020 Accepted Date: 02/09/2021 Online Date: 02/17/2021 Byline:
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subjectBacterial pneumonia ; Beta lactamases ; Blood ; Epidemiology ; Escherichia coli ; Health aspects ; Medical examination ; Pneumonia ; Tazobactam
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0Fast-track identification of CTX-M-extended-spectrum-[beta]-lactamase- and carbapenemase-producing Enterobacterales in bloodstream infections: implications on the likelihood of deduction of antibiotic susceptibility in emergency and internal medicine departments
1European journal of clinical microbiology & infectious diseases
descriptionKeywords: Bloodstream infection; CTX-M; Carbapenemase; Fast microbiology diagnostics; Enterobacterales; Antimicrobial stewardship This study aims at presenting a reliable fast-track diagnostics for the detection of CTX-M ESBL- (CTX-M-p) and carbapenemase-producers (CA-p) directly from blood cultures (BCs) of patients with Enterobacterales (EB) bloodstream infections (BSIs) admitted in emergency and internal medicine departments and its contribution in estimation of in vitro antibiotic susceptibility. A fast-track workflow including MALDI-TOF species identification and two lateral flow immunochromatographic assays for the detection of CTX-M-p and CA-p directly from BCs was performed in parallel with conventional routine, and results were compared. A total of 236 BCs of patients suffering from EB BSI were included. Accuracy of the fast-track workflow ranged from 99.6 to 100%. Among E. coli isolates, CTX-M-p (20.5%) were susceptible to ceftolozane-tazobactam (C/T, 97%), ceftazidime-avibactam (CZA, 100%), and piperacillin-tazobactam (TZP, 84.8%), whereas CTX-M-and-main-carbapenemases-non-producer (CTX-M-CA-np, 79.5%) isolates were susceptible to all the antibiotics tested. Among K. pneumoniae isolates, CTX-M-p (23.3%) were poorly susceptible to TZP (40%) but widely susceptible to C/T (90%), CZA (100%), and amikacin (90%), whereas CTX-M-CA-np (55.8%) were also susceptible to cefepime. CA-p K. pneumoniae (20.9%) were susceptible to CZA (88.9%). All the species other than E. coli and K. pneumoniae were CTX-M-CA-np and were widely susceptible to the antibiotics tested except for isolates of the inducible and derepressed AmpC- or AmpC/ESBL-p species. Rapid identification of species and phenotype together with knowledge of local epidemiology may be crucial to determine the likelihood of deduction of in vitro antibiotic susceptibility on the same day of positive BC processing. Author Affiliation: (1) Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy (2) Department of Internal Medicine 4, Hospital de Santa Marta, Central Lisbon Hospital Centre, Lisbon, Portugal (3) NOVA Medical School, Universidade Nova de Lisboa, Campo dos Mártires da Pátria 130, 1169-056, Lisbon, Portugal (a) matteo.boattini@unito.it Article History: Registration Date: 02/10/2021 Received Date: 09/28/2020 Accepted Date: 02/09/2021 Online Date: 02/17/2021 Byline:
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atitleFast-track identification of CTX-M-extended-spectrum-[beta]-lactamase- and carbapenemase-producing Enterobacterales in bloodstream infections: implications on the likelihood of deduction of antibiotic susceptibility in emergency and internal medicine departments
jtitleEuropean journal of clinical microbiology & infectious diseases
date2021-07-01
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issue7
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issn0934-9723
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abstractKeywords: Bloodstream infection; CTX-M; Carbapenemase; Fast microbiology diagnostics; Enterobacterales; Antimicrobial stewardship This study aims at presenting a reliable fast-track diagnostics for the detection of CTX-M ESBL- (CTX-M-p) and carbapenemase-producers (CA-p) directly from blood cultures (BCs) of patients with Enterobacterales (EB) bloodstream infections (BSIs) admitted in emergency and internal medicine departments and its contribution in estimation of in vitro antibiotic susceptibility. A fast-track workflow including MALDI-TOF species identification and two lateral flow immunochromatographic assays for the detection of CTX-M-p and CA-p directly from BCs was performed in parallel with conventional routine, and results were compared. A total of 236 BCs of patients suffering from EB BSI were included. Accuracy of the fast-track workflow ranged from 99.6 to 100%. Among E. coli isolates, CTX-M-p (20.5%) were susceptible to ceftolozane-tazobactam (C/T, 97%), ceftazidime-avibactam (CZA, 100%), and piperacillin-tazobactam (TZP, 84.8%), whereas CTX-M-and-main-carbapenemases-non-producer (CTX-M-CA-np, 79.5%) isolates were susceptible to all the antibiotics tested. Among K. pneumoniae isolates, CTX-M-p (23.3%) were poorly susceptible to TZP (40%) but widely susceptible to C/T (90%), CZA (100%), and amikacin (90%), whereas CTX-M-CA-np (55.8%) were also susceptible to cefepime. CA-p K. pneumoniae (20.9%) were susceptible to CZA (88.9%). All the species other than E. coli and K. pneumoniae were CTX-M-CA-np and were widely susceptible to the antibiotics tested except for isolates of the inducible and derepressed AmpC- or AmpC/ESBL-p species. Rapid identification of species and phenotype together with knowledge of local epidemiology may be crucial to determine the likelihood of deduction of in vitro antibiotic susceptibility on the same day of positive BC processing. Author Affiliation: (1) Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy (2) Department of Internal Medicine 4, Hospital de Santa Marta, Central Lisbon Hospital Centre, Lisbon, Portugal (3) NOVA Medical School, Universidade Nova de Lisboa, Campo dos Mártires da Pátria 130, 1169-056, Lisbon, Portugal (a) matteo.boattini@unito.it Article History: Registration Date: 02/10/2021 Received Date: 09/28/2020 Accepted Date: 02/09/2021 Online Date: 02/17/2021 Byline:
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doi10.1007/s10096-021-04192-8