Fast track SSTI management program based on a rapid molecular test (GeneXpert® MRSA/SA SSTI) and antimicrobial stewardship

Bouza, Emilio; Onori, Raffaella; Semiglia-Chong, María Auxiliadora; Álvarez‐Uría, Ana; Alcalá, Luís; Burillo, Almudena

doi:10.1016/j.jmii.2018.07.008

Cited by 20 publications

(15 citation statements)

References 30 publications

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“…The dataset includes 20 different authors from Asia (n = 13), Africa (n = 5), Europe (n = 1) and America (n = 1). A total of 20 studies were included in this synthesis: seven studies employed polymerase chain reaction (PCR) for diagnosing MRSA ( 6 , 9 , 10 , 12 , 13 , 19 , 22 ), one study employed deoxyribonucleic acid (DNA) Microarray ( 7 ), two studies used DNA sequencing ( 2 , 14 ), Xpert MRSA/SA BC assay (n = 2) ( 8 , 17 ), matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF; n = 2) ( 11 , 18 ), multilocus sequence typing (MLST; n = 4) ( 15 , 20 , 23 , 24 ), GENECUBE (n = 1) ( 21 ) and staphylococcal cassette chromosome mec (SCC mec ) typing (n = 1) ( 16 ). Figure 1 is the diagrammatic flow of the study selection and list of techniques appraised in this review.…”

Section: Resultsmentioning

confidence: 99%

Current molecular approach for diagnosis of MRSA: a meta-narrative review

Sim

Lee

Abushelaibi

et al. 2022

dti

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Introduction: Detection and diagnosis of MRSA are important in ensuring a correct and effective treatment, further reducing its spread. There are a wide range of molecular approaches for the diagnosis of AMR in MRSA, including PCR, MLST and SCCmec. This review aims to study and appraise current molecular diagnostic methods used for the detection of MRSA. Method: This narrative review was performed by searching the PubMed using the following search terms: (molecular diagnosis) AND (antimicrobial resistance) NOT (review [publication type)) NOT (systematic review [publication type)) NOT (meta-analysis[publication type)) AND (methicillin-resistant staphylococcus aureus). Studies using molecular diagnostic techniques for the detection of MRSA were included, while non-English language, duplicates, and non-article studies were excluded. After reviewing the libraries and a further manual search, 20 studies were included in this paper. RAMESES publication standard for narrative reviews was used for this synthesis. Results: Of the 20 studies included, 11 studies employed PCR for diagnosing MRSA , 2 studies on DNA Microarray, Xpert MRSA/SA BC assay (n=1), MALDI-TOF (n=2), MLST (n=5) and SCCMec typing (n=1). Discussion: Different diagnostic methods used for the diagnosis of MRSA have been studied in this review. Each diagnostic technique have its benefits and drawbacks, however, this study concludes that PCR has been extensively used due to its increased sensitivity and cost-effectiveness.

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Section: Resultsmentioning

confidence: 99%

Current molecular approach for diagnosis of MRSA: a meta-narrative review

Sim

Lee

Abushelaibi

et al. 2022

dti

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“…The extended ID and AST coverage of the RP is a major advantage in comparison to other commercially available tests, such as those based on molecular methods [6, 23–25]. MALDI-TOF MS library ensures a coverage of >2000 different species and ALFRED60AST allows antimicrobial panels customization based on user’s needs, such as the isolated pathogen, when known, or the local epidemiology.…”

Section: Discussionmentioning

confidence: 99%

Light Scattering Technology and MALDI-TOF MS in the microbiological fast-track of bloodstream infections: potential impact on antimicrobial treatment choices in a real-life setting

Curtoni

Ghibaudo

Veglio

et al. 2023

Journal of Medical Microbiology

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Introduction. Rapid identification (ID) and antimicrobial susceptibility testing (AST) of bloodstream infections (BSI) pathogens are fundamental to switch from empirical to targeted antibiotic therapy improving patients outcome and reducing antimicrobial resistance spreading. Hypothesis. The adoption of a rapid microbiological protocol (RP) based on Matrix-Assisted Laser Desorption Ionization-Time Of Flight Mass Spectrometry (MALDI-TOF MS) and Light Scattering Technology (LST) for rapid diagnosis of BSI could positively impact on patients' antimicrobial management. Aim. The study aim was to evaluate a RP for BSI microbiological diagnosis in terms of accuracy, turnaround time (TAT) and potential therapeutic impact. Methodology. A prospective observational study was conducted: monomicrobial bacterial blood cultures of septic patients were analysed in parallel by RP and standard protocol (SP). In RP the combination of MALDI-TOF MS and LST was used for rapid ID and AST assessments, respectively. To determine the potential impact of RP on antimicrobial therapy management, clinicians were interviewed on therapeutic decisions based on RP and SP results. RP accuracy, TAT and impact were evaluated in comparison to SP results. Results. A total of 97 patients were enrolled. ID and AST concordance between RP and SP were 96.9 and 94.7 %, respectively. RP technical and real-life TAT were lower than SP (6.4 h vs. 18.4 h; 9.5 vs. 27.1 h). The agreement between RP- and SP-based therapeutic decisions was 90.7 (90 % CI 84.4–95.1). RP results could produce 24/97 correct antibiotic changes with 18/97 possible de-escalations and 25/97 prompt applications of infection control precautions. Conclusion. With the application of RP in BSI management, about one-fourth of patients may safely benefit from early targeted antibiotic therapy and infection control policies with one working day in advance in comparison to conventional methods. This protocol is feasible for clinical use in microbiology laboratories and potentially helpful for Antimicrobial Stewardship.

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“…Bouza et al evaluated the clinical impacts of a fast track SSTI/ABSSSIs management programme based on the GeneXpert assay performed directly on clinical samples 36 . This rapid molecular method can give information on whether or not S. aureus can be ruled out as a causative agent and its antimicrobial susceptibility using directly skin samples.…”

Section: Role Of the Molecular Techniquesmentioning

confidence: 99%

“…| 169 Bouza et al evaluated the clinical impacts of a fast track SSTI/ABSSSIs management programme based on the GeneXpert assay performed directly on clinical samples. 36 This rapid molecular method can give information on whether or not S. aureus can be ruled out as a causative agent and its antimicrobial susceptibility using directly skin samples. The results of this study indicated that a rapid diagnostic algorithm (Gram staining plus real-time PCR, GeneXpert MRSA/SA) for SSTI/ABSSSIs, within an antimicrobial stewardship programme, could help adjust antibiotic treatment when inappropriate, reducing antibiotic use, hospital costs, length of stay, clostridioides difficile infection and related mortality.…”

Section: The Management Of Bacterial Skin Infectionsmentioning

confidence: 99%

Multidisciplinary panel opinion on the management of bacterial skin infections

Bouza

Rosa

Guzek

et al. 2022

JEADV Clinical Practice

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Eight hot topics regarding the diagnosis and management of bacterial skin infections were selected and reviewed by five experts from different European countries, chosen based on their expertise in microbiology, infectious diseases, and dermatology. As noninfectious skin diseases/conditions such as atopic dermatitis can be complicated by infections, including Acute Bacterial Skin and Skin Structure Infections (ABSSSI), a collaboration between dermatologists and infectious disease specialists can promote a rational approach to diagnosis and a more functional treatment approach, especially for complicated infections. In addition, an important role would be played by microbiologists as they are crucial for the isolation and classification of the bacterial pathogen to guide clinicians toward the most effective antibiotic therapy. Although there are many therapeutic options for the treatment of bacterial skin infections, including those due to methicillin-resistant Staphylococcus aureus, these drugs often require multiple daily administrations leading to patient noncompliance and are associated with gastrointestinal adverse events and drug resistance. With their characteristics of being long-acting, safety and single-dose regimens, long-acting antibiotics, such as dalbavancin and oritavancin, represent an effective alternative that could change the management of these infections with a considerable reduction of hospitalisation costs and risks.

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Fast track SSTI management program based on a rapid molecular test (GeneXpert® MRSA/SA SSTI) and antimicrobial stewardship

Abstract: This type of program could help adjust antibiotic treatment when inappropriate, reducing antibiotic use and costs, length of stay, CDI and related mortality.

Cited by 20 publications

References 30 publications

Current molecular approach for diagnosis of MRSA: a meta-narrative review

Current molecular approach for diagnosis of MRSA: a meta-narrative review

Light Scattering Technology and MALDI-TOF MS in the microbiological fast-track of bloodstream infections: potential impact on antimicrobial treatment choices in a real-life setting

Multidisciplinary panel opinion on the management of bacterial skin infections

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