Abstract
BackgroundResults of blood culture (BC) diagnostics should be swiftly available to guide treatment of critically ill patients. Conventional BC diagnostics usually performs species identification of microorganisms from mature solid medium colonies. Species identification might be speed up by using matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) mass spectrometry (MS) of biomass from shortly incubated solid media.MethodsThis single-center analysis compared the applicability of MALDI-TOF-based species identification from shortly incubated cultures in laboratory routine vs. conventional diagnostics and assessed its effects of on empiric antibiotic therapy.ResultsMedian time between detection of BCs as “positive” by incubators and further processing (e.g. microscopy) was 6 h 21 min. Median time between microscopy and result reporting to the ward was 15 min. Including 193 BCs, MALDI-TOF from shortly incubated biomass resulted in significantly faster (p > 0.001) species identification. Species results became available for clinicians after a median of 188 min (231 min for Gram-positive bacteria, 151 min for Gram-negative bacteria) compared to 909 min (n = 192 BCs) when conventional diagnostics was used. For 152/179 bacteremia episodes (85%) empiric antibiotic therapy had already been started when the microscopy result was reported to the ward; microscopy led to changes of therapies in 14/179 (8%). In contrast, reporting the bacterial species (without antibiogram) resulted in therapeutic adjustments in 36/179 (20%). Evaluating these changes revealed improved therapies in 26/36 cases (72%).ConclusionsSpecies identification by MALDI-TOF MS from shortly incubated subcultures resulted in adjustments of empiric antibiotic therapies and might improve the clinical outcome of septic patients.
Highlights
Results of blood culture (BC) diagnostics should be swiftly available to guide treatment of critically ill patients
A disadvantage associated with culture-based BC diagnostics is that it follows the “biological” clock rate of microbial growth but not the clock speed determined by the clinical progress of a severe infection
The median time between bacterial growth reported by the BC incubation system and microscopy was 381 min
Summary
Results of blood culture (BC) diagnostics should be swiftly available to guide treatment of critically ill patients. A disadvantage associated with culture-based BC diagnostics is that it follows the “biological” clock rate of microbial growth but not the clock speed determined by the clinical progress of a severe infection This hampers early adjustment of empiric antimicrobial therapies to diagnostic findings and leads to, first, increased morbidity or mortality of severely ill patients, and second, an extended empiric use of broad-spectrum antibiotics [4]. An alternative is to conventionally incubate BC bottles in an automated system and use matrix-assisted laser desorption ionization time-of-flight mass-spectrometry (MALDI-TOF MS) directly from BC bottles in which microbial growth was indicated by the automated system [13] This approach is valuable, but requires more laborious and costly processing of the BC in the microbiological laboratory
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