title: Value of integron detection for predicting antibiotic resistance in patients with Gram-negative septicaemia.
abstract: Multidrug-resistant Enterobacteriaceae are a major public health threat and complicate the choice of drugs for empirical antibiotic therapy, especially in sepsis patients who require rapid, appropriate treatment. The objective of this study was to examine the value of integrons as a global predictive marker of acquired antibiotic resistance in septicaemia-causing Enterobacteriaceae by direct detection in positive blood cultures. The integron genetic marker can be detected in a single test, whereas multiple PCRs are needed to detect the hundreds of known antibiotic resistance genes. A total of 166 positive blood cultures were included in the study, and integrons were detected with a quantitative PCR method both in positive blood cultures and isolated Enterobacteriaceae. The results of integron detection directly on positive blood cultures were consistent in 98.8% of cases with integron detection in isolated Enterobacteriaceae. Negative predictive values (NPVs) were >90% for resistance to third-generation cephalosporins, aminoglycosides, ciprofloxacin and trimethoprim/sulfamethoxazole. In the current context of antibiotic stewardship, these good NPVs indicate that this method might be useful for preserving broad-spectrum antibiotics. The results of this proof-of-concept study must be confirmed in order to demonstrate the clinical relevance of integron detection, not only in positive blood cultures but also, to gain time, in raw biological samples.
authors.affiliation: INSERM, U1092, Limoges F-87000, France; Université de Limoges, UMR-S1092, Faculté de Médecine, 2 rue du Dr Marcland, Limoges F-87025, France; CHU Limoges, Laboratoire de Bactériologie-Virologie-Hygiène, 2 Av. Martin Luther King, Limoges F-87042, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Barraud
authors.affiliation: INSERM, U1092, Limoges F-87000, France; Université de Limoges, UMR-S1092, Faculté de Médecine, 2 rue du Dr Marcland, Limoges F-87025, France; CHU Limoges, CIC-1435, 2 Av. Martin Luther King, Limoges F-87042, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: François
authors.affiliation: INSERM, U1092, Limoges F-87000, France; Université de Limoges, UMR-S1092, Faculté de Médecine, 2 rue du Dr Marcland, Limoges F-87025, France; CHU Limoges, Laboratoire de Bactériologie-Virologie-Hygiène, 2 Av. Martin Luther King, Limoges F-87042, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Chainier
authors.affiliation: CHU Limoges, Laboratoire de Bactériologie-Virologie-Hygiène, 2 Av. Martin Luther King, Limoges F-87042, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Vignaud
authors.affiliation: INSERM, U1092, Limoges F-87000, France; Université de Limoges, UMR-S1092, Faculté de Médecine, 2 rue du Dr Marcland, Limoges F-87025, France; CHU Limoges, Laboratoire de Bactériologie-Virologie-Hygiène, 2 Av. Martin Luther King, Limoges F-87042, France. Electronic address: marie-cecile.ploy@unilim.fr.
authors.forename: Marie-Cécile
authors.initials: MC
authors.lastname: Ploy
mesh_terms: D001769:Blood / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D004755:Enterobacteriaceae / Q000235:genetics* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000382:microbiology*; D060005:Genotyping Techniques / Q000379:methods*; D006801:Humans; D032023:Integrons; D008826:Microbial Sensitivity Tests / Q000379:methods*; D011237:Predictive Value of Tests; D060888:Real-Time Polymerase Chain Reaction / Q000379:methods; D018805:Sepsis / Q000382:microbiology*
keywords: Antibiotic resistance; Blood culture; Enterobacteriaceae; Genetic marker; Integron