■在常规药物敏感性测试(DST)可用之前进行快速分子诊断以预测碳青霉烯耐药性,可以在碳青霉烯耐药肠杆菌科(CRE)高发生率的情况下作为抗菌管理工具。
■对XpertCarba-R(FDA批准用于直肠拭子标本)的年龄超过18岁的患者进行的回顾性观察研究,2015年1月至2018年11月期间在印度重症监护病房。与常规DST相比,我们分析了XpertCarba-R的性能。
■从160名患者中分离出164个GNB。肺炎克雷伯菌和大肠埃希菌是主要分离株。在常规DST中,35.36%的样品中Carba-R阳性,45.34%的样品对碳青霉烯耐药(CR)。CR基因的分布为:OXA(50%),NDM(32.7%),其次是OXA和NDM共表达(15.51%)。敏感性,特异性,正似然比,负似然比,正预测值,肠杆菌科细菌的阴性预测值分别为90.74、93.15、13.25、0.10、83.58和96.31%。获得Carba-R报告的中位时间为30小时34分钟,而常规DST为74小时20分钟。根据Carba-R的报告,9.72%的患者出现抗生素升级,27.08%的患者出现抗生素降级。
■XpertCarba-R可作为一种快速诊断工具,用于预测由肠杆菌引起的菌血症的重症监护病房患者的碳青霉烯耐药性。
■RajendranS,GopalakrishnanR,TarigopulaA,KumarDS,NambiPS,SethuramanN,etal.标记血液培养样品的XpertCarba-R测定:肠杆菌科引起菌血症的重症监护病房患者的临床应用。印度J暴击护理中心2023;27(9):655-662。
UNASSIGNED: Rapid molecular diagnostics to predict carbapenem resistance well before the availability of routine drug sensitivity testing (DST) can serve as an antimicrobial stewardship tool in the context of high rates of Carbapenem-resistant Enterobacteriaceae (CRE).
UNASSIGNED: A retrospective observational study of patients more than 18 years of age on whom Xpert Carba-R (FDA approved for rectal swab specimen) was done on gram-negative bacteria (GNB) flagged blood culture samples, in an Indian intensive care unit between January 2015 and November 2018. We analyzed the performance of Xpert Carba-R in comparison with routine DST.
UNASSIGNED: A total of 164 GNBs were isolated from 160 patients. Klebsiella pneumoniae and Escherichia coli were the predominant isolates. Carba-R was positive in 35.36% of samples and 45.34% were carbapenem-resistant (CR) on routine DST. The distribution of the CR gene was: Oxacillinase (OXA) (50%), NDM (32.7%) followed by OXA and NDM co-expression (15.51%). The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, and negative predictive value of Carba-R were 90.74, 93.15, 13.25, 0.10, 83.58 and 96.31% for Enterobacteriaceae. The median time to obtain the Carba-R report was 30 hours 34 minutes vs 74 hours and 20 minutes for routine DST. Based on the Carba-R report, 9.72% of patients had escalation and 27.08% had de-escalation of antibiotics.
UNASSIGNED: Xpert Carba-R serves as a rapid diagnostic tool for predicting carbapenem resistance in intensive care unit patients with bacteremia caused by Enterobacteriaceae.
UNASSIGNED: Rajendran S, Gopalakrishnan R, Tarigopula A, Kumar DS, Nambi PS, Sethuraman N, et al. Xpert Carba-R Assay on Flagged Blood Culture Samples: Clinical Utility in Intensive Care Unit Patients with Bacteremia Caused by Enterobacteriaceae. Indian J Crit Care Med 2023;27(9):655-662.