Evaluation of two rapid molecular test systems to establish an algorithm for fast identification of bacterial pathogens
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ORIGINAL ARTICLE
Evaluation of two rapid molecular test systems to establish an algorithm for fast identification of bacterial pathogens from positive blood cultures Philipp Oberhettinger 1,2 & Jan Zieger 1,2 & Ingo Autenrieth 1,2 & Matthias Marschal 1,2 & Silke Peter 1,2 Received: 17 October 2019 / Accepted: 22 January 2020 # The Author(s) 2020
Abstract Fast identification of pathogens directly from positive blood cultures is of highest importance to supply an adequate therapy of bloodstream infections (BSI). There are several platforms providing molecular-based identification, detection of antimicrobial resistance genes, or even a full antimicrobial susceptibility testing (AST). Two of such test systems allowing rapid diagnostics were assessed in this study: The Biofire FilmArray® and the Genmark ePlex®, both fully automated test system with a minimum of hands-on time. Overall 137 BSI episodes were included in our study and compared to conventional culture–based reference methods. The FilmArray® is using one catridge including a panel for the most common bacterial and fungal BSI pathogens as well as selected resistance markers. The ePlex® offers three different cartridges for detection of Gram-positives, Gram-negatives, and fungi resulting in a broader panel including also rare pathogens, putative contaminants, and more genetic resistance markers. The FilmArray® and ePlex® were evaluated for all 137 BSI episodes with FilmArray® detecting 119 and ePlex® detecting 128 of these. For targets on the respective panel of the system, the FilmArray® generated a sensitivity of 98.9% with 100% specificity on Gram-positive isolates. The ePlex® system generated a sensitivity of 94.7% and a specificity of 90.7% on Gram-positive isolates. In each case, the two systems performed with 100% sensitivity and specificity for the detection of Gram-negative specimens covered by each panel. In summary, both evaluated test systems showed a satisfying overall performance for fast pathogen identification and are beneficial tools for accelerating blood culture diagnostics of sepsis patients. Keywords Bloodstream infection . Molecular identification . Antibiotic resistance . Rapid identification system . GenMark ePlex® . Biofire FilmArray®
Introduction As bacteremia and sepsis are still leading causes of morbidity and mortality [1, 2], fast diagnosis of the causative organism and appropriate antimicrobial therapy are essential for rapid treatment decisions [3]. Worldwide, the incidence of sepsis is about 19 Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10096-020-03828-5) contains supplementary material, which is available to authorized users. * Philipp Oberhettinger [email protected] 1
Institute of Medical Microbiology and Hygiene, University of Tübingen, Elfriede-Aulhorn-Str. 6, 72076 Tübingen, Germany
2
German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany
million per year [4] with a lethality of 20–30% [5, 6]. This emphasizes t
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