Evaluation of the Reveal® AST (SPECIFIC) for Antimicrobial Susceptibility Testing from Positive Blood Culture Spiked with Carbapenem-Resistant Isolates

• Published in: Pathogens (Basel) Vol. 13; no. 9; p. 722
• Main Authors: Girlich, Delphine, Jousset, Agnès B., Emeraud, Cécile, Rezzoug, Inès, Burwell, Reece, Singh, Pragya, Rhodes, Paul A., Naas, Thierry, Bonnin, Rémy A., Dortet, Laurent
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 27.08.2024; MDPI
• Subjects: Anti-Bacterial Agents - pharmacology; antibiotic resistance; Antibiotics; Antimicrobial agents; Automation; Bacterial Proteins; beta-lactamase; beta-Lactamases - metabolism; Blood; Blood culture; Blood Culture - methods; blood flow; Blood levels; carbapenem-resistant Enterobacterales; Carbapenem-Resistant Enterobacteriaceae - drug effects; Carbapenem-Resistant Enterobacteriaceae - isolation & purification; Carbapenemase; Carbapenems; Carbapenems - pharmacology; Classification; Diffusion rate; disk diffusion antimicrobial test; Drug resistance; E coli; Enterobacterales; Enterobacteriaceae - drug effects; Enterobacteriaceae - isolation & purification; Enterobacteriaceae Infections - drug therapy; Enterobacteriaceae Infections - microbiology; Epidemiology; Errors; Humans; Imipenem; Imipenem - pharmacology; Medical examination; Microbial Sensitivity Tests - methods; minimum inhibitory concentration; mortality; patients; phenotypic antimicrobial susceptibility testing; rapid diagnostic; Sensors; Sepsis; Septic shock; Shock resistance; therapeutics; VOCs; Volatile organic compounds; β Lactamase; France; blood culture; phenotypic antimicrobial susceptibility testing; carbapenem-resistant Enterobacterales; rapid diagnostic
• ISSN: 2076-0817; 2076-0817
• DOI: 10.3390/pathogens13090722

As bloodstream infections and associated septic shock are common causes of mortality in hospitals, rapid antibiotic susceptibility testing (AST) performed directly on positive blood cultures is needed to implement an efficient therapy in clinical settings. We evaluated the Reveal® rapid AST system on a collection of 197 fully characterized carbapenem-resistant Enterobacterales, including 177 carbapenemase producers (CPE) spiked in blood culture bottles. The clinical categorization based on the Minimal Inhibitory Concentration (MIC) determination of eighteen antimicrobial molecules was compared to the clinical categorization based on the disk diffusion assay as a reference. The Reveal AST system provided results within a mean time to result of 5 h. Overall, the categorical agreement (CA) between the two techniques was 94.1%. The rates of very major errors (VMEs), major errors (MEs) and minor errors (mEs) were 3.8%, 3.7% and 5.6%, respectively. Imipenem was the antimicrobial with the lowest CA rate (78.7%), with rates of 15% VMEs and 10.7% MEs, but the performances were better when considering only the non-CPE category (CA of 89%). On this resistant collection of Enterobacterales with numerous acquired β-lactamases, the Specific Reveal assay proved to be useful for a rapid determination of AST compatible with a quick adaptation of the patient’s antimicrobial treatment.