Abstract
Antimicrobial susceptibility testing (AST) of bacteria isolated in blood cultures is critical for optimal management of patients with sepsis. This review describes new and emerging phenotypic and genotypic AST methods and summarizes the evidence that implementation of these methods can impact clinical outcomes of patients with bloodstream infections.
Highlights
We describe currently available rapid Antimicrobial susceptibility testing (AST) methods along with the data that support their clinical benefit to patients with sepsis and bacteremia
broth microdilution (BMD) is fraught with technical limitations that make these correlations challenging, not the least of which include need for a bacterium isolated in pure culture, use of culture media that are a poor mimic of the physiological environment of the body, and use of an inoculum size that is infrequently observed in clinical specimens [i.e., 108 colonyforming units (CFU)/ml] [27,28,29,30]
More novel approaches include those taken by LifeScale (Affinity Biosensors, Santa Barbara, CA), which measures impact of antimicrobials to bacterial cell mass via a microcantilever [57], Fastinov (Portugal), which evaluates cell by flow cytometry [58], and RevealTM AST (Specific Diagnostics, Mountain View, CA), which utilizes sensor arrays to measure changes to volatile organic compounds emitted during bacterial growth
Summary
Sepsis, defined as an infection with dysregulated host response leading to life-threatening organ dysfunction, occurred in nearly 49 million incident cases and accounted for 19% of all deaths worldwide in 2017 [1, 2]. While standard turnaround time for clinical microbiology laboratories to isolate, identify, and perform antimicrobial susceptibility testing (AST) of bacterial isolates is 48–96 h from the time a blood culture turns positive [23], many rapid testing methods provide results within 6–24 h [24, 25]. These novel diagnostics are routinely used in many hospitals; the clinical benefit of these methods has not been well-quantified. As to date, rapid methods focus on identification of Candida in blood cultures, but not susceptibility testing
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