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Title: Comprehensive evaluation of the MBT STAR-BL module for simultaneous bacterial identification and β-lactamase-mediated resistance detection in Gram-negative rods from cultured isolates and positive blood cultures
Authors: Lee, AWT 
Lam, JKS
Lam, RKW
Ng, WH
Lee, ENL 
Lee, VTY
Sze, PP 
Rajwani, R 
Fung, KSC
To, WK
Lee, RA
Tsang, DNC
Siu, GKH 
Keywords: Bacterial
Blood culture
Drug hydrolysis test
Drug resistance
Issue Date: Feb-2018
Publisher: Frontiers Research Foundation
Source: Frontiers in microbiology, Feb. 2018, v. 9, 334 How to cite?
Journal: Frontiers in microbiology 
Abstract: Objective: This study evaluated the capability of a MALDI Biotyper system equipped with the newly introduced MBT STAR-BL module to simultaneously perform species identification and β-lactamase-mediated resistance detection in bacteremia -causing bacteria isolated from cultured isolates and patient-derived blood cultures (BCs). Methods: Two hundred retrospective cultured isolates and 153 prospective BCs containing Gram-negative rods (GNR) were collected and subjected to direct bacterial identification, followed by the measurement of β-lactamase activities against ampicillin, piperacillin, cefotaxime, ceftazidime, and meropenem using the MBT STAR-BL module. The results and turnaround times were compared with those of routine microbiological processing. All strains were also characterized by beta-lactamase PCR and sequencing. Results: Using the saponin-based extraction method, MALDI-TOF MS correctly identified bacteria in 116/134 (86.6%) monomicrobial BCs. The detection sensitivities for β-lactamase activities against ampicillin, piperacillin, third-generation cephalosporin and meropenem were 91.3, 100, 97.9, and 100% for cultured isolates, and 80.4, 100, 68.8, and 40% for monomicrobial BCs (n = 134) respectively. The overall specificities ranged from 91.5 to 100%. Furthermore, the MBT STAR-BL and conventional drug susceptibility test results were concordant in 14/19 (73.7%) polymicrobial cultures. Reducing the logRQ cut-offvalue from 0.4 to 0.2 increased the direct detection sensitivities for β-lactamase activities against ampicillin, cefotaxime and meropenem in BCs to 85.7, 87.5, and 100% respectively. The MBT STAR-BL test enabled the reporting of β-lactamase-producing GNR at 14.16 and 47.64 h before the interim and final reports of routine BCs processing, respectively, were available. Conclusion: The MALDI Biotyper system equipped with the MBT STAR-BL module enables the simultaneous rapid identification of bacterial species and β-lactamase-mediated resistance from BCs and cultured isolates. Adjustment of the logRQ cut-offvalue to 0.2 significantly increased the detection sensitivities for clinically important drug-resistant pathogens.
ISSN: 1664-302X
DOI: 10.3389/fmicb.2018.00334
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