Background. A bloodstream infection (BSI) presents a complex and serious health problem, a problem that is being exacerbated by increasing antimicrobial resistance (AMR). Gap Statement. The current turnaround times (TATs) for most antimicrobial susceptibility testing (AST) methods offer results retrospective of treatment decisions, and this limits the impact AST can have on antibiotic prescribing and patient care. Progress must be made towards rapid BSI diagnosis and AST to improve antimicrobial stewardship and reduce preventable deaths from BSIs. To support the successful implementation of rapid AST (rAST) in hospital settings, a rAST method that is affordable, is sustainable and offers comprehensive AMR detection is needed. Aim. To evaluate a scattered light-integrated collection (SLIC) device against standard of care (SOC) to determine whether SLIC could accelerate the current TATs with actionable, accurate rAST results for Gram-negative BSIs. Methods. Positive blood cultures from a tertiary referral hospital were studied prospectively. Flagged positive Gram-negative blood cultures were confirmed by Gram staining and analysed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, Vitek 2, disc diffusion (ceftriaxone susceptibility only) and an SLIC device. Susceptibility to a panel of five antibiotics, as defined by European Committee on Antimicrobial Susceptibility Testing breakpoints, was examined using SLIC. Results. A total of 505 bacterial–antimicrobial combinations were analysed. A categorical agreement of 95.5 % (482/505) was achieved between SLIC and SOC. The 23 discrepancies that occurred were further investigated by the broth microdilution method, with 10 AST results in agreement with SLIC and 13 in agreement with SOC. The mean time for AST was 10.53±0.46 h and 1.94±0.02 h for Vitek 2 and SLIC, respectively. SLIC saved 23.96±1.47 h from positive blood culture to AST result. Conclusion. SLIC has the capacity to provide accurate AST 1 day earlier from flagged positive blood cultures than SOC. This significant time saving could accelerate time to optimal antimicrobial therapy, improving antimicrobial stewardship and management of BSIs.

中文翻译：

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使用散射光集成收集装置快速测定临床血培养物中革兰氏阴性菌的抗菌敏感性

背景。血流感染 (BSI) 是一个复杂而严重的健康问题，而抗菌素耐药性 (AMR) 的增加会加剧这一问题。 差距声明。大多数抗菌药物敏感性测试 (AST) 方法的当前周转时间 (TAT) 提供了治疗决策的回顾性结果，这限制了 AST 对抗生素处方和患者护理的影响。必须在快速 BSI 诊断和 AST 方面取得进展，以改善抗菌药物管理并减少 BSI 造成的可预防死亡。为了支持在医院环境中成功实施快速 AST (rAST)，需要一种经济实惠、可持续且提供全面 AMR 检测的 rAST 方法。 目的。根据护理标准 (SOC) 评估散射光集成收集 (SLIC) 装置，以确定 SLIC 是否可以通过针对革兰氏阴性 BSI 的可操作、准确的 rAST 结果来加速当前的 TAT。 方法。对来自三级转诊医院的阳性血培养物进行了前瞻性研究。标记的阳性革兰氏阴性血培养物通过革兰氏染色进行确认，并通过基质辅助激光解吸/电离飞行时间质谱、Vitek 2、纸片扩散（仅限头孢曲松敏感性）和 SLIC 装置进行分析。使用 SLIC 检查对欧洲抗菌药物敏感性测试断点委员会定义的五种抗生素的敏感性。 结果。总共分析了 505 种细菌-抗菌药物组合。SLIC 和 SOC 之间达到了 95.5% (482/505) 的绝对一致性。通过肉汤微量稀释法进一步研究了出现的 23 个差异，其中 10 个 AST 结果与 SLIC 一致，13 个与 SOC 一致。Vitek 2 和 SLIC 的 AST 平均时间分别为 10.53±0.46 小时和 1.94±0.02 小时。从血培养阳性到 AST 结果，SLIC 节省了 23.96±1.47 小时。 结论。SLIC 能够比 SOC 早 1 天从标记的阳性血培养中提供准确的 AST。这种显着的时间节省可以加快最佳抗菌治疗的速度，改善抗菌药物管理和 BSI 的管理。