In the microbiological diagnosis of bloodstream infections (BSI), blood culture (BC) is considered the gold standard test despite its limitations such as low sensitivity and slow turnaround time. A new FDA-cleared and CE-marked platform utilizing magnetic resonance to detect amplified DNA of the six most common and/or problematic BSI pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Escherichia coli; referred to as ESKAPEc) is available and may shorten the time to diagnosis and potentially improve antimicrobial utilization. Whole blood samples from hospitalized patients with clinical signs of sepsis were analyzed using the T2Bacteria Panel (T2Biosystems) and compared to simultaneously collected BC. Discrepant results were evaluated based on clinical infection criteria, combining supporting culture results and the opinion of treating physicians. A total of 55 samples from 53 patients were evaluated. The sensitivity and specificity of the T2Bacteria panel was 94% (16 out of 17 detections of T2Bacteria-targeted organisms) and 100%, respectively, with 36.4% (8 of 22) causes of BSI detected only by this method. The T2Bacteria Panel detected pathogens on average 55 hours faster than standard BC. In our study, 9 of 15 patients with positive T2Bacteria Panel results received early-targeted antibiotic therapy and/or modification of antimicrobial treatment based on T2Bacteria Panel findings. Given the high reliability, faster time to detection, and easy workflow, the technique qualifies as a point-of-care testing approach.

Department of Anesthesiology and ICM 2nd Faculty of Medicine Charles University Motol University Hospital Prague Czech Republic

Department of Internal Medicine 1st Faculty of Medicine Charles University Prague Motol University Hospital Prague Czech Republic

Department of Medical Microbiology 2nd Faculty of Medicine Charles University Motol University Hospital Prague Czech Republic

Department of Rehabilitation and Sports Medicine 2nd Faculty of Medicine Charles University Motol University Hospital Prague Czech Republic

Department of Surgery Faculty of Medicine Charles University Motol University Hospital Prague Czech Republic

Zobrazit více v PubMed

Beganovic, M. , Costello, M. , & Wieczorkiewicz, S. M. (2017). Effect of Matrix‐Assisted Laser Desorption Ionization‐Time of Flight Mass Spectrometry (MALDI‐TOF MS) alone versus MALDI‐TOF MS combined with Real‐Time antimicrobial stewardship interventions on time to optimal antimicrobial therapy in patients with positive blood cultures. Journal of Clinical Microbiology, 55, 1437–1445. PubMed PMC

Bookstaver, P. B , Nimmich, E. B , Smith, T. J , Justo, J. A , Kohn, J. , Hammer, K. l , Troficanto, C. , Albrecht, H. A , & Al‐Hasan, M.N . (2017). Cumulative effect of an antimicrobial stewardship and rapid diagnostic testing bundle on early streamlining of antimicrobial therapy in gram‐negative bloodstream infections. Antimicrobial Agents and Chemotherapy, 61, e00189. 10.1128/AAC.00189-17 PubMed DOI PMC

Buehler, S. S. , Madison, B. , Snyder, S. R. , Derzon, J. H. , Cornish, N. E. , Saubolle, M. A. , Weissfeld, A. S. , Weinstein, M. P. , Liebow, E. B. , & Wolk, D. M. (2016). Effectiveness of practices to increase timeliness of providing targeted therapy for inpatients with bloodstream infections: a laboratory medicine best practices systematic review and meta‐analysis. Clinical Microbiology Reviews, 29, 59–103. PubMed PMC

Cheng, M. P. , Stenstrom, R. , Paquette, K. , Stabler, S. N. , Akhter, M. , Davidson, A. C. , Gavric, M. , Lawandi, A. , Jinah, R. , Saeed, Z. , Demir, K. , Huang, K. , Mahpour, A. , Shamatutu, C. , Caya, C. , Troquet, J. M. , Clark, G. , Yansouni, C. P. , Sweet, D. , & Investigators, F. (2019). Blood culture results before and after antimicrobial administration in patients with severe manifestations of sepsis: A diagnostic study. Annals of Internal Medicine, 171, 547–554. PubMed

De Angelis, G. , Posteraro, B. , De Carolis, E. , Menchinelli, G. , Franceschi, F. , Tumbarello, M. , De Pascale, G. , Spanu, T. , & Sanguinetti, M. (2018). T2Bacteria magnetic resonance assay for the rapid detection of ESKAPEc pathogens directly in whole blood. Journal of Antimicrobial Chemotherapy, 73, iv20–iv26. 10.1093/jac/dky049 PubMed DOI

Farrell, J. J. , Hujer, A. M. , Sampath, R. , & Bonomo, R. A. (2015). Salvage microbiology: opportunities and challenges in the detection of bacterial pathogens following initiation of antimicrobial treatment. Expert Rev Mol Diagn, 15, 349–360. PubMed PMC

Idelevich, E. A. , Seifert, H. , Sundqvist, M. , Scudeller, L. , Amit, S. , Balode, A. , Bilozor, A. , Drevinek, P. , Kocak Tufan, Z. , Koraqi, A. , Lamy, B. , Marekovic, I. , Miciuleviciene, J. , Muller Premru, M. , Pascual, A. , Pournaras, S. , Saegeman, V. , Schonheyder, H. C. , Schrenzel, J. , … Becker, K. (2019). Escmid Study Group for Bloodstream Infections, E.; Sepsis. Microbiological diagnostics of bloodstream infections in Europe‐an ESGBIES survey. Clinical Microbiology & Infection, 25, 1399–1407. PubMed

Kumar, A. , Roberts, D. , Wood, K. E. , Light, B. , Parrillo, J. E. , Sharma, S. , Suppes, R. , Feinstein, D. , Zanotti, S. , Taiberg, L. , Gurka, D. , Kumar, A. , & Cheang, M. (2006). Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Critical Care Medicine, 34, 1589–1596. PubMed

Lamy, B. , Dargere, S. , Arendrup, M. C. , Parienti, J. J. , & Tattevin, P. (2016). How to optimize the use of blood cultures for the diagnosis of bloodstream infections? A State‐of‐the Art. Front Microbiol, 7, 697. 10.3389/fmicb.2016.00697. PubMed DOI PMC

Mylonakis, E. , Clancy, C. J. , Ostrosky‐Zeichner, L. , Garey, K. W. , Alangaden, G. J. , Vazquez, J. A. , Groeger, J. S. , Judson, M. A. , Vinagre, Y. M. , Heard, S. O. , Zervou, F. N. , Zacharioudakis, I. M. , Kontoyiannis, D. P. , & Pappas, P. G. (2015). T2 magnetic resonance assay for the rapid diagnosis of candidemia in whole blood: a clinical trial. Clinical Infectious Diseases, 60, 892–899. PubMed

Nguyen, M. H. , Clancy, C. J. , Pasculle, A. W. , Pappas, P. G. , Alangaden, G. , Pankey, G. A. , Schmitt, B. H. , Rasool, A. , Weinstein, M. P. , Widen, R. , Hernandez, D. R. , Wolk, D. M. , Walsh, T. J. , Perfect, J. R. , Wilson, M. N. , & Mylonakis, E. (2019). Performance of the T2bacteria panel for diagnosing bloodstream infections: A diagnostic accuracy study. Annals of Internal Medicine, 170, 845–852. PubMed

Nunvar, J. , & Drevinek, P. (2015). Identification of bacteria from aerobic and anaerobic blood cultures after short cultivation by matrix‐assisted laser desorption/ionization‐time‐of‐flight mass spectrometry. Journal of Medical Microbiology, 64, 1253–1255. 10.1099/jmm.0.000140. PubMed DOI

Peker, N. , Couto, N. , Sinha, B. , & Rossen, J. W. (2018). Diagnosis of bloodstream infections from positive blood cultures and directly from blood samples: recent developments in molecular approaches. Clinical Microbiology & Infection, 24, 944–955. PubMed

Perez, K. K. , Olsen, R. J. , Musick, W. L. , Cernoch, P. L. , Davis, J. R. , Land, G. A. , Peterson, L. E. , & Musser, J. M. (2013). Integrating rapid pathogen identification and antimicrobial stewardship significantly decreases hospital costs. Archives of Pathology and Laboratory Medicine, 137, 1247–1254. PubMed

Perez, K. K. , Olsen, R. J. , Musick, W. L. , Cernoch, P. L. , Davis, J. R. , Peterson, L. E. , & Musser, J. M. (2014). Integrating rapid diagnostics and antimicrobial stewardship improves outcomes in patients with antibiotic‐resistant Gram‐negative bacteremia. Journal of Infection, 69, 216–225. PubMed

Poole, S. , Kidd, S. P. , & Saeed, K. (2018). A review of novel technologies and techniques associated with identification of bloodstream infection etiologies and rapid antimicrobial genotypic and quantitative phenotypic determination. Expert Rev Mol Diagn, 18, 543–555. PubMed

Tabak, Y. P. , Vankeepuram, L. , Ye, G. , Jeffers, K. , Gupta, V. , & Murray, P. R. (2018). Blood culture turnaround time in U.S. Acute care hospitals and implications for laboratory process optimization. Journal of Clinical Microbiology, 56, e00500. 10.1128/JCM.00500-18 PubMed DOI PMC

Timbrook, T. T. , Morton, J. B. , McConeghy, K. W. , Caffrey, A. R. , Mylonakis, E. , & LaPlante, K. L. (2017). The effect of molecular rapid diagnostic testing on clinical outcomes in bloodstream infections: a systematic review and meta‐analysis. Clinical Infectious Diseases, 64, 15–23. PubMed

Tkadlec, J. , Bebrova, E. , Berousek, J. , Vymazal, T. , Adamkova, J. , Martinkova, V. , Moser, C. , Florea, D. , & Drevinek, P. (2020). Limited diagnostic possibilities for bloodstream infections with broad‐range methods: A promising PCR/electrospray ionization‐mass spectrometry platform is no longer available. Microbiologyopen, 9.e1007 10.1002/mbo3.1007 PubMed DOI PMC

Tkadlec, J. , Peckova, M. , Sramkova, L. , Rohn, V. , Jahoda, D. , Raszka, D. , Berousek, J. , Mosna, F. , Vymazal, T. , Kvapil, M. , & Drevinek, P. (2019). The use of broad‐range bacterial PCR in the diagnosis of infectious diseases: a prospective cohort study. Clinical Microbiology & Infection, 25, 747–752. PubMed

Voigt, C. , Silbert, S. , Widen, R. H. , Marturano, J. E. , Lowery, T. J. , Ashcraft, D. , & Pankey, G. (2020). The T2bacteria assay is a sensitive and rapid detector of bacteremia that can be initiated in the emergency department and has potential to favorably influence subsequent therapy. Journal of Emergency Medicine, 58, 785–796. PubMed

Warhurst, G. , Dunn, G. , Chadwick, P. , Blackwood, B. , McAuley, D. , Perkins, G. D. , McMullan, R. , Gates, S. , Bentley, A. , Young, D. , Carlson, G. L. , & Dark, P. (2015). Rapid detection of health‐care‐associated bloodstream infection in critical care using multipathogen real‐time polymerase chain reaction technology: a diagnostic accuracy study and systematic review. Health Technology Assessment, 19, 1–142. PubMed PMC