β LACTA test performance for detection of extended-spectrum β-lactamase-producing Gram-negative bacilli directly on bronchial aspirates samples: a validation study
| Autor: | J. Tankovic, S. Gallah, Y. Benzerara, H. Bensekri, Jean-Luc Mainardi, Sophie Vimont, Marc Garnier, Guillaume Arlet, P.-L. Woerther |
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| Přispěvatelé: | Centre d'Immunologie et de Maladies Infectieuses (CIMI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS) |
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
0301 basic medicine
Microbiology (medical) Bacilli Klebsiella pneumoniae education 030106 microbiology medicine.disease_cause Sensitivity and Specificity beta-Lactamases Specimen Handling law.invention Microbiology 03 medical and health sciences law Intensive care Gram-Negative Bacteria Bronchopneumonia polycyclic compounds medicine Humans Prospective Studies ComputingMilieux_MISCELLANEOUS biology Pseudomonas aeruginosa business.industry Bacterial pneumonia General Medicine biochemical phenomena metabolism and nutrition bacterial infections and mycoses Antimicrobial medicine.disease biology.organism_classification [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology Body Fluids 3. Good health Stenotrophomonas maltophilia Infectious Diseases Gram staining Gram-Negative Bacterial Infections business |
| Zdroj: | Clinical Microbiology and Infection Clinical Microbiology and Infection, Elsevier for the European Society of Clinical Microbiology and Infectious Diseases, 2018, 24 (4), pp.402-408. ⟨10.1016/j.cmi.2017.07.030⟩ |
| ISSN: | 1198-743X 1469-0691 |
| DOI: | 10.1016/j.cmi.2017.07.030⟩ |
| Popis: | Objectives Incidence of extended-spectrum β-lactamase-producing Gram-negative bacilli (ESBL-PE-GNB)-related infections is worryingly increasing worldwide. ESBL-PE-GNB detection directly on bronchial aspirate samples (BAS) performed for suspected pneumonia may help save empirical carbapenems. Our objectives were to optimize β-LACTA™ test (BLT) realization and evaluate BLT performance for ESBL-PE-GNB detection directly on BAS. Methods We studied BLT technical optimization using BAS of different matrix types spiked with increasing concentrations of CTX-M-15-producing Klebsiella pneumoniae; in vitro validation of BLT diagnostic performance on 17 ESBL enzymes, belonging to CTX-M, SHV, TEM, OXA, GES, VEB and PER groups; and clinical validation of BLT performance on 126 BAS prospectively collected from seven intensive care units. Results After optimization, BLT detected with 100% sensitivity the presence of CTX-M-15-producing K. pneumoniae spiked in sterile BAS for inoculums upon two or more GNB per field upon microscopic Gram staining examination (MGSE). The BLT accurately detected the 17 ESBLs tested at 10 6 CFU/mL and all ESBLs except Pseudomonas aeruginosa –related OXA-14 at 10 4 CFU/mL. Among the 126 BAS of the validation cohort, 21 (17%) gave positive BLT (ten in BAS positive and 11 in BAS negative on MGSE). All BLT-positive BAS grew with ESBL-PE-GNB, including five hyper-L2-producing Stenotrophomonas maltophilia strains. BLT detected ESBL-PE-GNB directly on clinical BAS positive for GNB on MGSE and/or growing with ≥10 4 CFU/mL with 100% sensitivity, specificity, and positive and negative predictive values. Conclusions BLT is an accurate tool for ESBL-PE-GNB detection directly on BAS. Further studies are needed to evaluate the impact of BLT-guided early antimicrobial de-escalation strategies. |
| Databáze: | OpenAIRE |
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