Pediatric multicenter evaluation of the Verigene gram-negative blood culture test for rapid detection of inpatient bacteremia involving gram-negative organisms, extended-spectrum beta-lactamases, and carbapenemases.
We evaluated the investigational use only (IUO) version of the rapid Verigene Gram-negative blood culture test (BC-GN), a microarray that detects 9 genus/species targets (Acinetobacter spp., Citrobacter spp., Enterobacter spp., Escherichia coli/Shigella spp., Klebsiella oxytoca, Klebsiella pneumoniae, Proteus spp., Pseudomonas aeruginosa, and Serratia marcescens) and 6 antimicrobial resistance determinants (blaCTX-M, blaKPC, blaNDM, blaVIM, blaIMP, and blaOXA) directly from positive blood cultures. BC-GN was performed on positive BacT/Alert Pediatric FAN and Bactec Peds Plus blood cultures with Gram-negative organisms at two tertiary pediatric centers. Vitek MS (bioMérieux, Durham, NC) was used to assign gold standard organism identification. The Check MDR CT-102 microarray (Check Points B.V., Wageningen, Netherlands) was used as an alternative method for detecting resistance determinants. In total, 104 organisms were isolated from 97 clinical blood cultures. BC-GN correctly detected 26/26 cultures with Acinetobacter spp., P. aeruginosa, and S. marcescens, 5/6 with Citrobacter spp., 13/14 with Enterobacter spp., 23/24 with E. coli, 2/3 with K. oxytoca, 16/17 with K. pneumoniae, and 0/1 with Proteus spp. BC-GN appropriately reported negative BC-GN results in 8/13 blood cultures that grew organisms that were not represented on the microarray but failed to detect targets in 3/5 cultures that grew multiple Gram-negative organisms. BC-GN detected 5/5 and 1/1 clinical blood cultures with blaCTX-M and blaVIM. All 6 results were corroborated by Check MDR CT-102 microarray testing. The Verigene BC-GN test has the potential to expedite therapeutic decision making in pediatric patients with Gram-negative bacteremia. Sensitivity was satisfactory but may be suboptimal in mixed Gram-negative blood cultures.
The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA otak@email.chop.edu.
K V
KV
Sullivan
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
B
B
Deburger
The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
S S
SS
Roundtree
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
C A
CA
Ventrola
The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
D L
DL
Blecker-Shelly
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA University of Cincinnati, Cincinnati, Ohio, USA.
J E
JE
Mortensen
D016470:Bacteremia / Q000175:diagnosis* / Q000382:microbiology; D060085:Coinfection / Q000175:diagnosis / Q000382:microbiology; D003428:Cross Infection / Q000175:diagnosis* / Q000382:microbiology; D003951:Diagnostic Errors; D006090:Gram-Negative Bacteria / Q000145:classification* / Q000201:enzymology / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis* / Q000382:microbiology; D006776:Hospitals, Pediatric; D006801:Humans; D007297:Inpatients; D012680:Sensitivity and Specificity; D001618:beta-Lactamases / Q000378:metabolism*
D001618:beta-Lactamases