A Direct Rapid Phenotypic Antimicrobial Susceptibility Test Enables Early Selection of Optimal Antibiotics to Treat Bacteremia in COVID-19 Patients

Background The rate and composition of bacterial co-infection in patients with coronavirus disease 2019 (COVID-19) were evaluated when microbiological testing was conducted on the majority of patients. We also evaluated whether the use of empirical antibacterials was associated with mortality. Methods In this retrospective study, all of the adult patients with COVID-19 hospitalized in a single tertiary hospital in South Korea between February 2020 and December 2021 were included. Bacterial co-infection was assessed by sputum cultures, blood cultures, and molecular testing, including polymerase chain reaction sputum testing and urinary antigen tests. Mortality was compared between patients who received empirical antibacterials and those who did not. Results Of the 367 adult patients admitted during the study period, 300 (81.7%) had sputum culture results and were included in the analysis. Of these 300 patients, 127 (42.3%) had a history of antibiotic exposure. The co-infection rate within 48 hours was 8.3% (25/300): 6.4% (11/173) of patients without prior antibiotic exposure and 11% (14/127) of patients with prior antibacterial exposure. The co-infected bacteria were different according to antibacterial exposure before admission, and multi-drug resistant pathogens were detected exclusively in the antibacterial exposed group. Among the patients without positive results for the microbiological tests, empirical antibacterials were used in 33.3% of cases (100/300). Empirical antibacterial therapy was not significantly related to the 30-day mortality or in-hospital mortality rates in the study cohort before or after the propensity score-matching. Conclusion In this study including only patients underwent microbiological testing, bacterial co-infection was not frequent, and the co-infected organisms varied depending on previous antibacterial exposures. Given the rarity of co-infection and the lack of potential benefits, empiric antibacterial use in COVID-19 should be an important target of antibiotic stewardship.

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“… 15 28 In particular, an early diagnosis strategy for bacterial co-infection for the appropriate use of antibacterials should be implemented. 29 …”

Section: Discussionmentioning

confidence: 99%

Bacterial Co-Infection and Empirical Antibacterial Therapy in Patients With COVID-19

et al. 2023

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“…Rapid diagnostic testing requires fostering a cooperative relationship between the ASP teams and microbiological laboratories. The sooner culture results are reported, the sooner appropriate antimicrobials can be prescribed [ 71 72 73 74 ]. Rapid diagnostic testing for respiratory viruses or respiratory virus polymerase chain reaction (PCR) can help avoid additional test prescriptions, reduce unnecessary antimicrobial use, and help select appropriate therapeutic agents such as antiviral agents [ 75 76 ].…”

Section: Core Elements Of Aspmentioning

confidence: 99%

Core Elements for Implementing Antimicrobial Stewardship Programs in Korean General Hospitals

et al. 2022

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Currently, antimicrobial resistance (AMR) is a major threat to global public health. The antimicrobial stewardship program (ASP) has been proposed as an important approach to overcome this crisis. ASP supports the optimal use of antimicrobials, including appropriate dosing decisions, administration duration, and administration routes. In Korea, efforts are being made to overcome AMR using ASPs as a national policy. The current study aimed to develop core elements of ASP that could be introduced in domestic medical facilities. A Delphi survey was conducted twice to select the core elements through expert consensus. The core elements for implementing the ASP included (1) leadership commitment, (2) operating system, (3) action, (4) tracking, (5) reporting, and (6) education. To ensure these core elements are present at medical facilities, multiple departments must collaborate as teams for ASP operations. Establishing a reimbursement system and a workforce for ASPs are prerequisites for implementing ASPs. To ensure that ASP core elements are actively implemented in medical facilities, it is necessary to provide financial support for ASPs in medical facilities, nurture the healthcare workforce in performing ASPs, apply the core elements to healthcare accreditation, and provide incentives to medical facilities by quality evaluation criteria.

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“…This time delay is often too long to wait in life-threatening infection 6 , leading clinicians to prescribe empirically and use combinations of broad-spectrum antibiotics. In clinical trials, the use of rapid ASTs improves clinical outcomes, decreases the use of broad-spectrum antibiotics, and shortens the time between sample collection and optimal targeted antibiotic treatment 7,8 .…”

Section: Introductionmentioning

confidence: 99%

Ribosome Phenotypes Enable Rapid Antibiotic Susceptibility Testing inEscherichia coli

Farrar,

Turner,

El Sayyed

et al. 2024

Preprint

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Rapid antibiotic susceptibility tests (ASTs) are an increasingly important part of clinical care as antimicrobial resistance (AMR) becomes more common in bacterial infections. Here, we use the spatial distribution of fluorescently labelled ribosomes to detect intracellular changes associated with antibiotic susceptibility in singleE. colicells using a convolutional neural network (CNN). By using ribosome-targeting probes, a single fluorescence cell image provides data for cell segmentation and susceptibility phenotyping. Using 50,722 images of cells from an antibiotic-susceptible laboratory strain ofE. coli, we showed that antibiotics with different mechanisms of action result in distinct ribosome phenotypes, which can be identified by a CNN with high accuracy (99%, 96%, and 91% for ciprofloxacin, gentamicin, and chloramphenicol). With 6E. colistrains isolated from bloodstream infections, we used 34,205 images of ribosome phenotypes to train a CNN that could classify susceptible cells with 92% accuracy and resistant cells with 99% accuracy. Such accuracies correspond to the ability to differentiate susceptible and resistant samples with 99% confidence with just 2 cells, meaning that this method could eliminate lengthy sample culturing steps and could determine in vitro susceptibility with 30 minutes of antibiotic treatment. Our ribosome phenotype method should also be able to identify phenotypes in other strains and species.

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A Direct Rapid Phenotypic Antimicrobial Susceptibility Test Enables Early Selection of Optimal Antibiotics to Treat Bacteremia in COVID-19 Patients

Cited by 6 publications

References 26 publications

Bacterial Co-Infection and Empirical Antibacterial Therapy in Patients With COVID-19

Bacterial Co-Infection and Empirical Antibacterial Therapy in Patients With COVID-19

Core Elements for Implementing Antimicrobial Stewardship Programs in Korean General Hospitals

Ribosome Phenotypes Enable Rapid Antibiotic Susceptibility Testing inEscherichia coli

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