Abstract
BackgroundA multicenter study was conducted to evaluate the diagnostic performance and the time to identifcation of the Verigene Blood Culture Test, the BC-GP and BC-GN assays, to identify both Gram-positive and Gram-negative bacteria and their drug resistance determinants directly from positive blood cultures collected in Hong Kong.Methods and ResultsA total of 364 blood cultures were prospectively collected from four public hospitals, in which 114 and 250 cultures yielded Gram-positive and Gram-negative bacteria, and were tested with the BC-GP and BC-GN assay respectively. The overall identification agreement for Gram-positive and Gram-negative bacteria were 89.6% and 90.5% in monomicrobial cultures and 62.5% and 53.6% in polymicrobial cultures, respectively. The sensitivities for most genus/species achieved at least 80% except Enterococcus spp. (60%), K.oxytoca (0%), K.pneumoniae (69.2%), whereas the specificities for all targets ranged from 98.9% to 100%. Of note, 50% (7/14) cultures containing K.pneumoniae that were missed by the BC-GN assay were subsequently identified as K.variicola. Approximately 5.5% (20/364) cultures contained non-target organisms, of which Aeromonas spp. accounted for 25% and are of particular concern. For drug resistance determination, the Verigene test showed 100% sensitivity for identification of MRSA, VRE and carbapenem resistant Acinetobacter, and 84.4% for ESBL-producing Enterobacteriaceae based on the positive detection of mecA, vanA, bla OXA and bla CTXM respectively.ConclusionOverall, the Verigene test provided acceptable accuracy for identification of bacteria and resistance markers with a range of turnaround time 40.5 to 99.2 h faster than conventional methods in our region.
Highlights
Sepsis is the ninth leading cause of mortality in Hong Kong, accounting for nearly 900 deaths in 2014 [1]
In Hong Kong, about 30% of E.coli isolated from blood culture were positive for extended-spectrum beta-lactamase (ESBL) and more than 50% of patients infected with these resistant strains were prescribed with inappropriate empirical treatment [9, 10]
We investigated the diagnostic accuracy of the Verigene BC-GP ad BC-GN assays to identify bacteria and their resistance determinants directly from positive blood culture broths collected from four public hospitals serving different district areas in Hong Kong
Summary
Sepsis is the ninth leading cause of mortality in Hong Kong, accounting for nearly 900 deaths in 2014 [1] It is initially caused by bloodstream infections (BSI) with pathogenic bacteria, due to Enterobacteriaceae members and Staphylococcus spp. being the predominant etiological agents [2, 3]. In Hong Kong, about 30% of E.coli isolated from blood culture were positive for extended-spectrum beta-lactamase (ESBL) and more than 50% of patients infected with these resistant strains were prescribed with inappropriate empirical treatment [9, 10]. Rapid microbiological methods that can shorten the turnaround time for bacterial identification and antimicrobial susceptibility tests will definitely facilitate early clinical management, reducing the mortality and relieving the corresponding financial burden. A multicenter study was conducted to evaluate the diagnostic performance and the time to identifcation of the Verigene Blood Culture Test, the BC-GP and BC-GN assays, to identify both Gram-positive and Gram-negative bacteria and their drug resistance determinants directly from positive blood cultures collected in Hong Kong
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