Use of Cepheid Xpert Carba-R® for Rapid Detection of Carbapenemase-Producing Bacteria in Abdominal Septic Patients Admitted to Intensive Care Unit
Early institution of effective antibiotic therapy and source control are pivotal to improve survival of abdominal septic patients. Xpert® Carba-R is a real time polymerase chain reaction assay for rapid detection and differentiation of five genes (blaKPC, blaVIM, blaOXA-48, blaIMP-1, blaNDM) respons...
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| Veröffentlicht in: | PloS one 2016-08, Vol.11 (8), p.e0160643-e0160643 |
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| creator | Cortegiani, Andrea Russotto, Vincenzo Graziano, Giorgio Geraci, Daniela Saporito, Laura Cocorullo, Gianfranco Raineri, Santi Maurizio Mammina, Caterina Giarratano, Antonino |
| description | Early institution of effective antibiotic therapy and source control are pivotal to improve survival of abdominal septic patients. Xpert® Carba-R is a real time polymerase chain reaction assay for rapid detection and differentiation of five genes (blaKPC, blaVIM, blaOXA-48, blaIMP-1, blaNDM) responsible for carbapenem resistance. We performed an observational study investigating the clinical usefulness and applicability of Xpert® Carba-R to detect carbapenem resistance in abdominal septic patients admitted to intensive care unit. We compared the results of Xpert® Carba-R with standard microbiological culture. We collected a set of two rectal/stomia swabs and two swabs from abdominal drainage fluid for each patient. We included 20 patients for a total of 45 comparisons between the two methods. In our clinical setting, the overall performance of Xpert® Carba-R for detection of carbapenem resistance in the presence of genes detectable and non-detectable by the method was: sensitivity 50% (95% CI 24.6-75.3); specificity 93.1% (95% CI 77.2-99.1); positive predictive value (PPV) 80% (95% CI 44.4-97.5); negative predictive value (NPV) 77.1% (95% CI 56.9-89.6). The inter-rater agreement was 0.47 (SE 0.14; 95% CI 0.20-0.74). When considering the only 5 mechanisms of resistance detected by both methods, the overall diagnostic performance was: sensitivity 100% (95% CI 69.1-100), specificity 94.2 (95% CI 80.8-99.3), PPV 83.3 (95% CI 59.6-97.9) and NPV 100% (95% CI 89.4-100). The inter-rater agreement was 0.88 (SE 0.08; 95% CI 0.71-1). Xpert® Carba-R may be considered an additional diagnostic tool for early diagnosis of carbapenem resistance in abdominal septic patients. Clinicians should be aware of their epidemiology before its introduction in the diagnostic protocol of their intensive care units. |
| doi_str_mv | 10.1371/journal.pone.0160643 |
| format | Article |
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Xpert® Carba-R is a real time polymerase chain reaction assay for rapid detection and differentiation of five genes (blaKPC, blaVIM, blaOXA-48, blaIMP-1, blaNDM) responsible for carbapenem resistance. We performed an observational study investigating the clinical usefulness and applicability of Xpert® Carba-R to detect carbapenem resistance in abdominal septic patients admitted to intensive care unit. We compared the results of Xpert® Carba-R with standard microbiological culture. We collected a set of two rectal/stomia swabs and two swabs from abdominal drainage fluid for each patient. We included 20 patients for a total of 45 comparisons between the two methods. In our clinical setting, the overall performance of Xpert® Carba-R for detection of carbapenem resistance in the presence of genes detectable and non-detectable by the method was: sensitivity 50% (95% CI 24.6-75.3); specificity 93.1% (95% CI 77.2-99.1); positive predictive value (PPV) 80% (95% CI 44.4-97.5); negative predictive value (NPV) 77.1% (95% CI 56.9-89.6). The inter-rater agreement was 0.47 (SE 0.14; 95% CI 0.20-0.74). When considering the only 5 mechanisms of resistance detected by both methods, the overall diagnostic performance was: sensitivity 100% (95% CI 69.1-100), specificity 94.2 (95% CI 80.8-99.3), PPV 83.3 (95% CI 59.6-97.9) and NPV 100% (95% CI 89.4-100). The inter-rater agreement was 0.88 (SE 0.08; 95% CI 0.71-1). Xpert® Carba-R may be considered an additional diagnostic tool for early diagnosis of carbapenem resistance in abdominal septic patients. Clinicians should be aware of their epidemiology before its introduction in the diagnostic protocol of their intensive care units.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0160643</identifier><identifier>PMID: 27490684</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Abdomen ; Abdomen - microbiology ; Abdominal surgery ; Aged ; Antibiotics ; Antimicrobial agents ; Bacteria ; Bacterial Proteins - metabolism ; beta-Lactamases - metabolism ; Biology and Life Sciences ; Carbapenemase ; Carbapenems - pharmacology ; Care and treatment ; Causes of ; Chemotherapy ; Child care ; Critical care ; Diagnostic software ; Diagnostic systems ; DNA, Bacterial - isolation & purification ; DNA, Bacterial - metabolism ; Drug resistance ; Drug Resistance, Bacterial - drug effects ; Drug Resistance, Bacterial - genetics ; Enterobacteriaceae ; Enterobacteriaceae - enzymology ; Enterobacteriaceae - genetics ; Enterobacteriaceae - isolation & purification ; Epidemiology ; Female ; Genes ; Gram-negative bacteria ; Health aspects ; Health promotion ; Hospitals ; Humans ; Infections ; Infectious diseases ; Intensive care ; Intensive Care Units ; Laboratories ; Male ; Medical diagnosis ; Medicine and Health Sciences ; Microbiological culture ; Microbiology ; Microorganisms ; Middle Aged ; Patients ; Polymerase chain reaction ; Reagent Kits, Diagnostic ; Real-Time Polymerase Chain Reaction ; Rectum ; Rectum - microbiology ; Research and Analysis Methods ; Sensitivity ; Sensitivity and Specificity ; Sepsis ; Sepsis - diagnosis ; Sepsis - microbiology</subject><ispartof>PloS one, 2016-08, Vol.11 (8), p.e0160643-e0160643</ispartof><rights>COPYRIGHT 2016 Public Library of Science</rights><rights>2016 Cortegiani et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 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Xpert® Carba-R is a real time polymerase chain reaction assay for rapid detection and differentiation of five genes (blaKPC, blaVIM, blaOXA-48, blaIMP-1, blaNDM) responsible for carbapenem resistance. We performed an observational study investigating the clinical usefulness and applicability of Xpert® Carba-R to detect carbapenem resistance in abdominal septic patients admitted to intensive care unit. We compared the results of Xpert® Carba-R with standard microbiological culture. We collected a set of two rectal/stomia swabs and two swabs from abdominal drainage fluid for each patient. We included 20 patients for a total of 45 comparisons between the two methods. In our clinical setting, the overall performance of Xpert® Carba-R for detection of carbapenem resistance in the presence of genes detectable and non-detectable by the method was: sensitivity 50% (95% CI 24.6-75.3); specificity 93.1% (95% CI 77.2-99.1); positive predictive value (PPV) 80% (95% CI 44.4-97.5); negative predictive value (NPV) 77.1% (95% CI 56.9-89.6). The inter-rater agreement was 0.47 (SE 0.14; 95% CI 0.20-0.74). When considering the only 5 mechanisms of resistance detected by both methods, the overall diagnostic performance was: sensitivity 100% (95% CI 69.1-100), specificity 94.2 (95% CI 80.8-99.3), PPV 83.3 (95% CI 59.6-97.9) and NPV 100% (95% CI 89.4-100). The inter-rater agreement was 0.88 (SE 0.08; 95% CI 0.71-1). Xpert® Carba-R may be considered an additional diagnostic tool for early diagnosis of carbapenem resistance in abdominal septic patients. Clinicians should be aware of their epidemiology before its introduction in the diagnostic protocol of their intensive care units.</description><subject>Abdomen</subject><subject>Abdomen - microbiology</subject><subject>Abdominal surgery</subject><subject>Aged</subject><subject>Antibiotics</subject><subject>Antimicrobial agents</subject><subject>Bacteria</subject><subject>Bacterial Proteins - metabolism</subject><subject>beta-Lactamases - metabolism</subject><subject>Biology and Life Sciences</subject><subject>Carbapenemase</subject><subject>Carbapenems - pharmacology</subject><subject>Care and treatment</subject><subject>Causes of</subject><subject>Chemotherapy</subject><subject>Child care</subject><subject>Critical care</subject><subject>Diagnostic software</subject><subject>Diagnostic systems</subject><subject>DNA, Bacterial - isolation & purification</subject><subject>DNA, Bacterial - metabolism</subject><subject>Drug resistance</subject><subject>Drug Resistance, Bacterial - drug effects</subject><subject>Drug Resistance, Bacterial - 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microbiology</subject><subject>Research and Analysis Methods</subject><subject>Sensitivity</subject><subject>Sensitivity and Specificity</subject><subject>Sepsis</subject><subject>Sepsis - diagnosis</subject><subject>Sepsis - microbiology</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk99u0zAUxiMEYmPwBggsISG4aIljJ3FukEr5V2nSpo4i7izHPmk9JXawnQmeg_fgIXgynLWbWrQL5ItYx7_z-ZwvPknyFKdTTEr85tIOzoh22lsD0xQXaUHJveQYVySbFFlK7u_tj5JH3l-maU5YUTxMjrKSVmnB6HHya-UB2QbNod-AVuhbDy6guXC1mCz__EaNdWgp-njyHgLIoK25xkegBwOd8DA5d1YNUps1eidkAKcF0gbNamU7HUtEF9AHLdG5CBpM8GimOh0CKBQsWpgAxusrGDUBrYwOj5MHjWg9PNl9T5LVxw9f5p8np2efFvPZ6UQWVRYmWVZLVhWprDCtMVEibTBALoCQuoQikw2psWKiKQugkuUNLUVZZ7kkrCaUFeQkeb7V7Vvr-c5Pz3HFSpJnBasisdgSyopL3jvdCfeTW6H5dcC6NRcuttYCr6FiVMlcURnFy1IwmkkpSM4UKJnVUevt7rah7mIoOuFEeyB6eGL0hq_tFadVSWJFUeDVTsDZ7wP4wDvtJbStMGCHWDfDKckJpTSiL_5B7-5uR61FbECbxsZ75SjKZzSvKprjcnRpegcVl4JOy_j4Gh3jBwmvDxIiE-BHWIvBe764WP4_e_b1kH25x25AtGHjbTuMb9IfgnQLSme9d9DcmoxTPs7OjRt8nB2-m52Y9mz_B90m3QwL-QvqjRY0</recordid><startdate>20160804</startdate><enddate>20160804</enddate><creator>Cortegiani, Andrea</creator><creator>Russotto, Vincenzo</creator><creator>Graziano, Giorgio</creator><creator>Geraci, Daniela</creator><creator>Saporito, Laura</creator><creator>Cocorullo, Gianfranco</creator><creator>Raineri, Santi Maurizio</creator><creator>Mammina, Caterina</creator><creator>Giarratano, Antonino</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0003-1416-9993</orcidid></search><sort><creationdate>20160804</creationdate><title>Use of Cepheid Xpert Carba-R® for Rapid Detection of Carbapenemase-Producing Bacteria in Abdominal Septic Patients Admitted to Intensive Care Unit</title><author>Cortegiani, Andrea ; Russotto, Vincenzo ; Graziano, Giorgio ; Geraci, Daniela ; Saporito, Laura ; Cocorullo, Gianfranco ; Raineri, Santi Maurizio ; Mammina, Caterina ; Giarratano, Antonino</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-22bc8960c914b13da0f1ee5ae33b7e62cf3b1d8af76e4c85f47a7b25c38b34863</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Abdomen</topic><topic>Abdomen - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cortegiani, Andrea</au><au>Russotto, Vincenzo</au><au>Graziano, Giorgio</au><au>Geraci, Daniela</au><au>Saporito, Laura</au><au>Cocorullo, Gianfranco</au><au>Raineri, Santi Maurizio</au><au>Mammina, Caterina</au><au>Giarratano, Antonino</au><au>Chaturvedi, Vishnu</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Use of Cepheid Xpert Carba-R® for Rapid Detection of Carbapenemase-Producing Bacteria in Abdominal Septic Patients Admitted to Intensive Care Unit</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2016-08-04</date><risdate>2016</risdate><volume>11</volume><issue>8</issue><spage>e0160643</spage><epage>e0160643</epage><pages>e0160643-e0160643</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Early institution of effective antibiotic therapy and source control are pivotal to improve survival of abdominal septic patients. Xpert® Carba-R is a real time polymerase chain reaction assay for rapid detection and differentiation of five genes (blaKPC, blaVIM, blaOXA-48, blaIMP-1, blaNDM) responsible for carbapenem resistance. We performed an observational study investigating the clinical usefulness and applicability of Xpert® Carba-R to detect carbapenem resistance in abdominal septic patients admitted to intensive care unit. We compared the results of Xpert® Carba-R with standard microbiological culture. We collected a set of two rectal/stomia swabs and two swabs from abdominal drainage fluid for each patient. We included 20 patients for a total of 45 comparisons between the two methods. In our clinical setting, the overall performance of Xpert® Carba-R for detection of carbapenem resistance in the presence of genes detectable and non-detectable by the method was: sensitivity 50% (95% CI 24.6-75.3); specificity 93.1% (95% CI 77.2-99.1); positive predictive value (PPV) 80% (95% CI 44.4-97.5); negative predictive value (NPV) 77.1% (95% CI 56.9-89.6). The inter-rater agreement was 0.47 (SE 0.14; 95% CI 0.20-0.74). When considering the only 5 mechanisms of resistance detected by both methods, the overall diagnostic performance was: sensitivity 100% (95% CI 69.1-100), specificity 94.2 (95% CI 80.8-99.3), PPV 83.3 (95% CI 59.6-97.9) and NPV 100% (95% CI 89.4-100). The inter-rater agreement was 0.88 (SE 0.08; 95% CI 0.71-1). Xpert® Carba-R may be considered an additional diagnostic tool for early diagnosis of carbapenem resistance in abdominal septic patients. Clinicians should be aware of their epidemiology before its introduction in the diagnostic protocol of their intensive care units.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>27490684</pmid><doi>10.1371/journal.pone.0160643</doi><tpages>e0160643</tpages><orcidid>https://orcid.org/0000-0003-1416-9993</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2016-08, Vol.11 (8), p.e0160643-e0160643 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1987352689 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS); PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Abdomen Abdomen - microbiology Abdominal surgery Aged Antibiotics Antimicrobial agents Bacteria Bacterial Proteins - metabolism beta-Lactamases - metabolism Biology and Life Sciences Carbapenemase Carbapenems - pharmacology Care and treatment Causes of Chemotherapy Child care Critical care Diagnostic software Diagnostic systems DNA, Bacterial - isolation & purification DNA, Bacterial - metabolism Drug resistance Drug Resistance, Bacterial - drug effects Drug Resistance, Bacterial - genetics Enterobacteriaceae Enterobacteriaceae - enzymology Enterobacteriaceae - genetics Enterobacteriaceae - isolation & purification Epidemiology Female Genes Gram-negative bacteria Health aspects Health promotion Hospitals Humans Infections Infectious diseases Intensive care Intensive Care Units Laboratories Male Medical diagnosis Medicine and Health Sciences Microbiological culture Microbiology Microorganisms Middle Aged Patients Polymerase chain reaction Reagent Kits, Diagnostic Real-Time Polymerase Chain Reaction Rectum Rectum - microbiology Research and Analysis Methods Sensitivity Sensitivity and Specificity Sepsis Sepsis - diagnosis Sepsis - microbiology |
| title | Use of Cepheid Xpert Carba-R® for Rapid Detection of Carbapenemase-Producing Bacteria in Abdominal Septic Patients Admitted to Intensive Care Unit |
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