Skip to main content
SpringerLink
Log in

Rapid antibiotic susceptibility testing in blood culture diagnostics performed by direct inoculation using the VITEK®-2 and BD Phoenix™ platforms

  • Original Article
  • Published:
European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

Early availability of microbiological results can improve treatment decisions of patients suffering from bloodstream infections. Direct inoculation of automated susceptibility testing (AST) platforms is an approach to shorten time-to-result in blood culture diagnostics. We performed a comparative evaluation of the two commercial AST systems VITEK®-2 and BD Phoenix™ for the direct inoculation with blood culture samples. Furthermore, two different methods of sample preparation were compared in this study. Positive blood cultures were prepared for direct inoculation by use of serum separator tubes and twofold centrifugation. AST was performed with the VITEK®-2 and the BD Phoenix™ system by the standard method according to the manufacturer’s recommendations using subcultures on solid media and by direct inoculation of blood culture samples. A hundred clinical samples from blood cultures were included in this study. Rapid AST by direct inoculation showed inter-test agreement rates ranging from 92.45 to 97.7%. Comparing both AST platforms, the VITEK®-2 system demonstrated a higher test accuracy for direct inoculation. No relevant difference was observed for the two different sample preparation methods. Direct inoculation is an easy and inexpensive approach to obtain early full panel phenotypic AST results in blood culture diagnostics. Sample preparation is sufficiently performed by a simple centrifugation method. Both commercial platforms, the VITEK®-2 and the BD Phoenix™, have proven suitable for the use of direct inoculation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Fleischmann C, Thomas-Rueddel DO, Hartmann M, Hartog CS, Welte T, Heublein S et al (2016) Hospital incidence and mortality rates of sepsis. Dtsch Arztebl Int 113(10):159–166

    PubMed  PubMed Central  Google Scholar 

  2. Martin GS (2012) Sepsis, severe sepsis and septic shock: changes in incidence, pathogens and outcomes. Expert Rev Anti-Infect Ther 10(6):701–706

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Kumar A, Ellis P, Arabi Y, Roberts D, Light B, Parrillo JE et al (2009) Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest 136(5):1237–1248

    Article  PubMed  Google Scholar 

  4. Garnacho-Montero J, Gutierrez-Pizarraya A, Escoresca-Ortega A, Fernandez-Delgado E, Lopez-Sanchez JM (2015) Adequate antibiotic therapy prior to ICU admission in patients with severe sepsis and septic shock reduces hospital mortality. Crit Care 19:302

    Article  PubMed  PubMed Central  Google Scholar 

  5. Ferrer R, Martin-Loeches I, Phillips G, Osborn TM, Townsend S, Dellinger RP et al (2014) Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program. Crit Care Med 42(8):1749–1755

    Article  CAS  PubMed  Google Scholar 

  6. Tabak YP, Vankeepuram L, Ye G, Jeffers K, Gupta V, Murray PR (2018) Blood culture turnaround time in US acute care hospitals and implications for laboratory process optimization. J Clin Microbiol 56(12). https://doi.org/10.1128/JCM.00500-18

  7. Liesenfeld O, Lehman L, Hunfeld KP, Kost G (2014) Molecular diagnosis of sepsis: new aspects and recent developments. Eur J Microbiol Immunol (Bp) 4(1):1–25

    Article  CAS  Google Scholar 

  8. Sinha M, Jupe J, Mack H, Coleman TP, Lawrence SM, Fraley SI (2018) Emerging technologies for molecular diagnosis of sepsis. Clin Microbiol Rev 31(2). https://doi.org/10.1128/CMR.00089-17

  9. Tan KE, Ellis BC, Lee R, Stamper PD, Zhang SX, Carroll KC (2012) Prospective evaluation of a matrix-assisted laser desorption ionization-time of flight mass spectrometry system in a hospital clinical microbiology laboratory for identification of bacteria and yeasts: a bench-by-bench study for assessing the impact on time to identification and cost-effectiveness. J Clin Microbiol 50(10):3301–3308

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Maelegheer K, Nulens E (2017) Same-day identification and antibiotic susceptibility testing on positive blood cultures: a simple and inexpensive procedure. Eur J Clin Microbiol Infect Dis 36(4):681–687

    Article  CAS  PubMed  Google Scholar 

  11. Munoz-Davila MJ, Yague G, Albert M, Garcia-Lucas T (2012) Comparative evaluation of Vitek 2 identification and susceptibility testing of Gram-negative rods directly and isolated from BacT/ALERT-positive blood culture bottles. Eur J Clin Microbiol Infect Dis 31(5):663–669

    Article  CAS  PubMed  Google Scholar 

  12. Lupetti A, Barnini S, Castagna B, Capria AL, Nibbering PH (2010) Rapid identification and antimicrobial susceptibility profiling of Gram-positive cocci in blood cultures with the Vitek 2 system. Eur J Clin Microbiol Infect Dis 29(1):89–95

    Article  CAS  PubMed  Google Scholar 

  13. Wattal C, Oberoi JK (2016) Microbial identification and automated antibiotic susceptibility testing directly from positive blood cultures using MALDI-TOF MS and VITEK 2. Eur J Clin Microbiol Infect Dis 35(1):75–82

    Article  CAS  PubMed  Google Scholar 

  14. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R et al (2017) Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med 45(3):486–552

    Article  PubMed  Google Scholar 

  15. Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F et al (2015) 2015 ESC guidelines for the management of infective endocarditis: the task force for the management of infective endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 36(44):3075–3128

    Article  PubMed  Google Scholar 

  16. Jorgensen JH (1993) Selection criteria for an antimicrobial susceptibility testing system. J Clin Microbiol 31(11):2841–2844

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Tian Y, Zheng B, Wang B, Lin Y, Li M (2016) Rapid identification and multiple susceptibility testing of pathogens from positive-culture sterile body fluids by a combined MALDI-TOF mass spectrometry and Vitek susceptibility system. Front Microbiol 7:523

    PubMed  PubMed Central  Google Scholar 

  18. Bruins MJ, Bloembergen P, Ruijs GJ, Wolfhagen MJ (2004) Identification and susceptibility testing of Enterobacteriaceae and Pseudomonas aeruginosa by direct inoculation from positive BACTEC blood culture bottles into Vitek 2. J Clin Microbiol 42(1):7–11

    Article  PubMed  PubMed Central  Google Scholar 

  19. Quesada MD, Gimenez M, Molinos S, Fernandez G, Sanchez MD, Rivelo R et al (2010) Performance of VITEK-2 Compact and overnight MicroScan panels for direct identification and susceptibility testing of Gram-negative bacilli from positive FAN BacT/ALERT blood culture bottles. Clin Microbiol Infect 16(2):137–140

    Article  CAS  PubMed  Google Scholar 

  20. Gherardi G, Angeletti S, Panitti M, Pompilio A, Di Bonaventura G, Crea F et al (2012) Comparative evaluation of the Vitek-2 Compact and Phoenix systems for rapid identification and antibiotic susceptibility testing directly from blood cultures of Gram-negative and Gram-positive isolates. Diagn Microbiol Infect Dis 72(1):20–31

    Article  CAS  PubMed  Google Scholar 

  21. Funke G, Funke-Kissling P (2004) Use of the BD PHOENIX Automated Microbiology System for direct identification and susceptibility testing of gram-negative rods from positive blood cultures in a three-phase trial. J Clin Microbiol 42(4):1466–1470

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Wimmer JL, Long SW, Cernoch P, Land GA, Davis JR, Musser JM et al (2012) Strategy for rapid identification and antibiotic susceptibility testing of gram-negative bacteria directly recovered from positive blood cultures using the Bruker MALDI Biotyper and the BD Phoenix system. J Clin Microbiol 50(7):2452–2454

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Prod’hom G, Durussel C, Greub G (2013) A simple blood-culture bacterial pellet preparation for faster accurate direct bacterial identification and antibiotic susceptibility testing with the VITEK 2 system. J Med Microbiol 62(Pt 5):773–777

    Article  CAS  PubMed  Google Scholar 

  24. Machen A, Drake T, Wang YF (2014) Same day identification and full panel antimicrobial susceptibility testing of bacteria from positive blood culture bottles made possible by a combined lysis-filtration method with MALDI-TOF VITEK mass spectrometry and the VITEK2 system. PLoS One 9(2):e87870

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Romero-Gomez MP, Gomez-Gil R, Pano-Pardo JR, Mingorance J (2012) Identification and susceptibility testing of microorganism by direct inoculation from positive blood culture bottles by combining MALDI-TOF and Vitek-2 Compact is rapid and effective. J Inf Secur 65(6):513–520

    Google Scholar 

  26. Ling TK, Liu ZK, Cheng AF (2003) Evaluation of the VITEK 2 system for rapid direct identification and susceptibility testing of gram-negative bacilli from positive blood cultures. J Clin Microbiol 41(10):4705–4707

    Article  PubMed  PubMed Central  Google Scholar 

  27. Lupetti A, Barnini S, Castagna B, Nibbering PH, Campa M (2010) Rapid identification and antimicrobial susceptibility testing of Gram-positive cocci in blood cultures by direct inoculation into the BD Phoenix system. Clin Microbiol Infect 16(7):986–991

    Article  CAS  PubMed  Google Scholar 

  28. Wisplinghoff H, Seifert H, Wenzel RP, Edmond MB (2003) Current trends in the epidemiology of nosocomial bloodstream infections in patients with hematological malignancies and solid neoplasms in hospitals in the United States. Clin Infect Dis 36(9):1103–1110

    Article  PubMed  Google Scholar 

  29. Karlowsky JA, Jones ME, Draghi DC, Thornsberry C, Sahm DF, Volturo GA (2004) Prevalence and antimicrobial susceptibilities of bacteria isolated from blood cultures of hospitalized patients in the United States in 2002. Ann Clin Microbiol Antimicrob 3:7

    Article  PubMed  PubMed Central  Google Scholar 

  30. Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB (2004) Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis 39(3):309–317

    Article  PubMed  Google Scholar 

  31. Fritzenwanker M, Imirzalioglu C, Herold S, Wagenlehner FM, Zimmer KP, Chakraborty T (2018) Treatment options for carbapenem- resistant gram-negative infections. Dtsch Arztebl Int 115(20–21):345–352

    PubMed  PubMed Central  Google Scholar 

Download references

Funding

The study was financed by internal funding.

Author information

Authors and Affiliations

  1. Institute of Medical Microbiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany

    Steffen Höring, Alain Sami Massarani, Bettina Löffler & Jürgen Rödel

Authors
  1. Steffen Höring
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alain Sami Massarani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bettina Löffler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jürgen Rödel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Steffen Höring.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study has been approved by the local research ethics committee (5358-11/17).

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Höring, S., Massarani, A.S., Löffler, B. et al. Rapid antibiotic susceptibility testing in blood culture diagnostics performed by direct inoculation using the VITEK®-2 and BD Phoenix™ platforms. Eur J Clin Microbiol Infect Dis 38, 471–478 (2019). https://doi.org/10.1007/s10096-018-03445-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-018-03445-3

Search

Navigation