Evaluation of the Accelerate Pheno System for Fast Identification and Antimicrobial Susceptibility Testing from Positive Blood Cultures in Bloodstream Infections Caused by Gram-Negative Pathogens

Bloodstream infections (BSI) are an important cause of morbidity and mortality. Increasing rates of antimicrobial-resistant pathogens limit treatment options, prompting an empirical use of broad-range antibiotics. Fast and reliable diagnostic tools are needed to provide adequate therapy in a timely...

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Published in:	Journal of clinical microbiology Vol. 55; no. 7; pp. 2116 - 2126
Main Authors:	Marschal, Matthias, Bachmaier, Johanna, Autenrieth, Ingo, Oberhettinger, Philipp, Willmann, Matthias, Peter, Silke
Format:	Journal Article
Language:	English
Published:	United States American Society for Microbiology 01-07-2017
Subjects:	Automation, Laboratory - methods Bacteriological Techniques - methods Bacteriology Blood - microbiology Gram-Negative Bacteria - classification Gram-Negative Bacteria - drug effects Gram-Negative Bacteria - isolation & purification Gram-Negative Bacterial Infections - diagnosis Humans Sensitivity and Specificity Sepsis - diagnosis Time Factors bloodstream infections antimicrobial susceptibility testing rapid tests
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Summary:	Bloodstream infections (BSI) are an important cause of morbidity and mortality. Increasing rates of antimicrobial-resistant pathogens limit treatment options, prompting an empirical use of broad-range antibiotics. Fast and reliable diagnostic tools are needed to provide adequate therapy in a timely manner and to enable a de-escalation of treatment. The Accelerate Pheno system (Accelerate Diagnostics, USA) is a fully automated test system that performs both identification and antimicrobial susceptibility testing (AST) directly from positive blood cultures within approximately 7 h. In total, 115 episodes of BSI with Gram-negative bacteria were included in our study and compared to conventional culture-based methods. The Accelerate Pheno system correctly identified 88.7% (102 of 115) of all BSI episodes and 97.1% (102 of 105) of isolates that are covered by the system's identification panel. The Accelerate Pheno system generated an AST result for 91.3% (95 of 104) samples in which the Accelerate Pheno system identified a Gram-negative pathogen. The overall category agreement between the Accelerate Pheno system and culture-based AST was 96.4%, the rates for minor discrepancies 1.4%, major discrepancies 2.3%, and very major discrepancies 1.0%. Of note, ceftriaxone, piperacillin-tazobactam, and carbapenem resistance was correctly detected in blood culture specimens with extended-spectrum beta-lactamase-producing ( = 7) and multidrug-resistant ( = 3) strains. The utilization of the Accelerate Pheno system reduced the time to result for identification by 27.49 h ( < 0.0001) and for AST by 40.39 h ( < 0.0001) compared to culture-based methods in our laboratory setting. In conclusion, the Accelerate Pheno system provided fast, reliable results while significantly improving turnaround time in blood culture diagnostics of Gram-negative BSI.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Citation Marschal M, Bachmaier J, Autenrieth I, Oberhettinger P, Willmann M, Peter S. 2017. Evaluation of the Accelerate Pheno system for fast identification and antimicrobial susceptibility testing from positive blood cultures in bloodstream infections caused by gram-negative pathogens. J Clin Microbiol 55:2116–2126. https://doi.org/10.1128/JCM.00181-17.
ISSN:	0095-1137 1098-660X
DOI:	10.1128/JCM.00181-17