Skip to main content
Erschienen in: Wiener klinisches Magazin 5/2017

14.09.2017 | Mikrobiologie

Neue mikrobiologische Diagnostikverfahren

Chancen und Limitierungen

verfasst von: Dr. Florian P. Maurer, Dr. Moritz Hentschke, Prof. Dr. Holger Rohde

Erschienen in: Wiener klinisches Magazin | Ausgabe 5/2017

Einloggen, um Zugang zu erhalten

Zusammenfassung

Auch aufgrund der Ausbreitung multiresistenter Erreger gewinnt eine rasche und zuverlässige mikrobiologische Diagnostik an Bedeutung. Der zeitnahe Erregernachweis und die zugehörige Empfindlichkeitsprüfung sind nicht nur entscheidende Basis zur optimalen Behandlung bei Vorliegen komplexer Resistenzmechanismen, sondern auch notwendige Voraussetzung zur Deeskalation kalkulierter Therapieregime. Somit ist die Mikrobiologie auch integraler Bestandteil von Antibiotic-Stewardship(ABS)-Programmen. Traditionelle Ansätze mikrobiologischer Diagnostik sind durch eine methodeninhärente Langsamkeit gekennzeichnet. Die Zeitspanne bis zum Vorliegen von aussagekräftigen Resultaten beträgt 48 h oder sogar länger und dies beeinflusst schließlich auch die Dauer nichtindizierter oder ungeeigneter Antibiotikatherapien. Die fortlaufende Verbesserung verfügbarer Methoden sowie die Implementierung völlig neuartiger Technologien haben in den vergangenen Jahren zu einer fundamentalen Veränderung mikrobiologischer Analytik geführt. Diese Methoden verbessern nicht nur Sensitivität und Spezifität, sondern führen auch zu einer deutlich schnelleren Verfügbarkeit von Ergebnissen. Diese neuen diagnostischen Methoden sollen hier hinsichtlich ihrer potenziellen Bedeutung für die klinische Infektiologie kritisch beleuchtet werden.
Literatur
1.
Zurück zum Zitat Shorr AF, Micek ST, Welch EC, Doherty JA, Reichley RM, Kollef MH (2011) Inappropriate antibiotic therapy in Gram-negative sepsis increases hospital length of stay. Crit Care Med 39(1):46–51CrossRefPubMed Shorr AF, Micek ST, Welch EC, Doherty JA, Reichley RM, Kollef MH (2011) Inappropriate antibiotic therapy in Gram-negative sepsis increases hospital length of stay. Crit Care Med 39(1):46–51CrossRefPubMed
2.
Zurück zum Zitat Garcia-Vazquez E, Moral-Escudero E, Hernandez-Torres A, Canteras M, Gomez J, Ruiz J (2013) What is the impact of a rapid diagnostic E‑test in the treatment of patients with Gram-negative bacteraemia? Scand J Infect Dis 45(8):623–628CrossRefPubMed Garcia-Vazquez E, Moral-Escudero E, Hernandez-Torres A, Canteras M, Gomez J, Ruiz J (2013) What is the impact of a rapid diagnostic E‑test in the treatment of patients with Gram-negative bacteraemia? Scand J Infect Dis 45(8):623–628CrossRefPubMed
3.
Zurück zum Zitat Kumar A, Ellis P, Arabi Y et al (2009) Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest 136(5):1237–1248CrossRefPubMed Kumar A, Ellis P, Arabi Y et al (2009) Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest 136(5):1237–1248CrossRefPubMed
4.
Zurück zum Zitat Harris PN, Ferguson JK (2012) Antibiotic therapy for inducible AmpC beta-lactamase-producing Gram-negative bacilli: what are the alternatives to carbapenems, quinolones and aminoglycosides? Int J Antimicrob Agents 40(4):297–305CrossRefPubMed Harris PN, Ferguson JK (2012) Antibiotic therapy for inducible AmpC beta-lactamase-producing Gram-negative bacilli: what are the alternatives to carbapenems, quinolones and aminoglycosides? Int J Antimicrob Agents 40(4):297–305CrossRefPubMed
6.
Zurück zum Zitat Novais A, Brilhante M, Pires J, Peixe L (2015) Evaluation of the recently launched rapid carb blue kit for detection of carbapenemase-producing gram-negative bacteria. J Clin Microbiol 53(9):3105–3107CrossRefPubMedPubMedCentral Novais A, Brilhante M, Pires J, Peixe L (2015) Evaluation of the recently launched rapid carb blue kit for detection of carbapenemase-producing gram-negative bacteria. J Clin Microbiol 53(9):3105–3107CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat Matsumoto Y, Sakakihara S, Grushnikov A et al (2016) A microfluidic channel method for rapid drug-susceptibility testing of Pseudomonas aeruginosa. PLOS ONE 11(2):e0148797CrossRefPubMedPubMedCentral Matsumoto Y, Sakakihara S, Grushnikov A et al (2016) A microfluidic channel method for rapid drug-susceptibility testing of Pseudomonas aeruginosa. PLOS ONE 11(2):e0148797CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Mezger A, Gullberg E, Goransson J et al (2015) A general method for rapid determination of antibiotic susceptibility and species in bacterial infections. J Clin Microbiol 53(2):425–432CrossRefPubMedPubMedCentral Mezger A, Gullberg E, Goransson J et al (2015) A general method for rapid determination of antibiotic susceptibility and species in bacterial infections. J Clin Microbiol 53(2):425–432CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Parcina M, Bartonickova L, Vojvoda V et al (2015) Performance characteristics of the new accelerate ID/AST system for antibiotic susceptibility testing of enterobacteriaceae clinical isolates, compared to IVD routine laboratory AST systems. ICAAC, San Diego Parcina M, Bartonickova L, Vojvoda V et al (2015) Performance characteristics of the new accelerate ID/AST system for antibiotic susceptibility testing of enterobacteriaceae clinical isolates, compared to IVD routine laboratory AST systems. ICAAC, San Diego
11.
Zurück zum Zitat Patel R (2015) MALDI-TOF MS for the diagnosis of infectious diseases. Clin Chem 61(1):100–111CrossRefPubMed Patel R (2015) MALDI-TOF MS for the diagnosis of infectious diseases. Clin Chem 61(1):100–111CrossRefPubMed
12.
Zurück zum Zitat Clerc O, Prod’hom G, Vogne C, Bizzini A, Calandra T, Greub G (2013) Impact of matrix-assisted laser desorption ionization time-of-flight mass spectrometry on the clinical management of patients with Gram-negative bacteremia: a prospective observational study. Clin Infect Dis 56(8):1101–1107CrossRefPubMed Clerc O, Prod’hom G, Vogne C, Bizzini A, Calandra T, Greub G (2013) Impact of matrix-assisted laser desorption ionization time-of-flight mass spectrometry on the clinical management of patients with Gram-negative bacteremia: a prospective observational study. Clin Infect Dis 56(8):1101–1107CrossRefPubMed
13.
Zurück zum Zitat Huang AM, Newton D, Kunapuli A et al (2013) Impact of rapid organism identification via matrix-assisted laser desorption/ionization time-of-flight combined with antimicrobial stewardship team intervention in adult patients with bacteremia and candidemia. Clin Infect Dis 57(9):1237–1245CrossRefPubMed Huang AM, Newton D, Kunapuli A et al (2013) Impact of rapid organism identification via matrix-assisted laser desorption/ionization time-of-flight combined with antimicrobial stewardship team intervention in adult patients with bacteremia and candidemia. Clin Infect Dis 57(9):1237–1245CrossRefPubMed
14.
Zurück zum Zitat Wenzler E, Goff DA, Mangino JE, Reed EE, Wehr A, Bauer KA (2016) Impact of rapid identification of Acinetobacter baumannii via matrix-assisted laser desorption ionization time-of-flight mass spectrometry combined with antimicrobial stewardship in patients with pneumonia and/or bacteremia. Diagn Microbiol Infect Dis 84(1):63–68CrossRefPubMed Wenzler E, Goff DA, Mangino JE, Reed EE, Wehr A, Bauer KA (2016) Impact of rapid identification of Acinetobacter baumannii via matrix-assisted laser desorption ionization time-of-flight mass spectrometry combined with antimicrobial stewardship in patients with pneumonia and/or bacteremia. Diagn Microbiol Infect Dis 84(1):63–68CrossRefPubMed
15.
Zurück zum Zitat Nagel JL, Huang AM, Kunapuli A et al (2014) Impact of antimicrobial stewardship intervention on coagulase-negative Staphylococcus blood cultures in conjunction with rapid diagnostic testing. J Clin Microbiol 52(8):2849–2854CrossRefPubMedPubMedCentral Nagel JL, Huang AM, Kunapuli A et al (2014) Impact of antimicrobial stewardship intervention on coagulase-negative Staphylococcus blood cultures in conjunction with rapid diagnostic testing. J Clin Microbiol 52(8):2849–2854CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Martiny D, Debaugnies F, Gateff D et al (2013) Impact of rapid microbial identification directly from positive blood cultures using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry on patient management. Clin Microbiol Infect 19(12):E568–E581CrossRefPubMed Martiny D, Debaugnies F, Gateff D et al (2013) Impact of rapid microbial identification directly from positive blood cultures using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry on patient management. Clin Microbiol Infect 19(12):E568–E581CrossRefPubMed
17.
Zurück zum Zitat Christner M, Rohde H, Wolters M, Sobottka I, Wegscheider K, Aepfelbacher M (2010) Rapid identification of bacteria from positive blood culture bottles by use of matrix-assisted laser desorption-ionization time of flight mass spectrometry fingerprinting. J Clin Microbiol 48(5):1584–1591CrossRefPubMedPubMedCentral Christner M, Rohde H, Wolters M, Sobottka I, Wegscheider K, Aepfelbacher M (2010) Rapid identification of bacteria from positive blood culture bottles by use of matrix-assisted laser desorption-ionization time of flight mass spectrometry fingerprinting. J Clin Microbiol 48(5):1584–1591CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Burrer A, Findeisen P, Jager E et al (2015) Rapid detection of cefotaxime-resistant Escherichia coli by LC-MS. Int J Med Microbiol 305(8):860–864CrossRefPubMed Burrer A, Findeisen P, Jager E et al (2015) Rapid detection of cefotaxime-resistant Escherichia coli by LC-MS. Int J Med Microbiol 305(8):860–864CrossRefPubMed
19.
Zurück zum Zitat Lasserre C, De Saint ML, Cuzon G et al (2015) Efficient detection of carbapenemase activity in Enterobacteriaceae by matrix-assisted laser desorption ionization-time of flight mass spectrometry in less than 30 minutes. J Clin Microbiol 53(7):2163–2171CrossRefPubMedPubMedCentral Lasserre C, De Saint ML, Cuzon G et al (2015) Efficient detection of carbapenemase activity in Enterobacteriaceae by matrix-assisted laser desorption ionization-time of flight mass spectrometry in less than 30 minutes. J Clin Microbiol 53(7):2163–2171CrossRefPubMedPubMedCentral
20.
21.
Zurück zum Zitat Blanc DS, Basset P, Nahimana-Tessemo I, Jaton K, Greub G, Zanetti G (2011) High proportion of wrongly identified methicillin-resistant Staphylococcus aureus carriers by use of a rapid commercial PCR assay due to presence of staphylococcal cassette chromosome element lacking the mecA gene. J Clin Microbiol 49(2):722–724CrossRefPubMedPubMedCentral Blanc DS, Basset P, Nahimana-Tessemo I, Jaton K, Greub G, Zanetti G (2011) High proportion of wrongly identified methicillin-resistant Staphylococcus aureus carriers by use of a rapid commercial PCR assay due to presence of staphylococcal cassette chromosome element lacking the mecA gene. J Clin Microbiol 49(2):722–724CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat Marner ES, Wolk DM, Carr J et al (2011) Diagnostic accuracy of the Cepheid GeneXpert vanA/vanB assay ver. 1.0 to detect the vanA and vanB vancomycin resistance genes in Enterococcus from perianal specimens. Diagn Microbiol Infect Dis 69(4):382–389CrossRefPubMed Marner ES, Wolk DM, Carr J et al (2011) Diagnostic accuracy of the Cepheid GeneXpert vanA/vanB assay ver. 1.0 to detect the vanA and vanB vancomycin resistance genes in Enterococcus from perianal specimens. Diagn Microbiol Infect Dis 69(4):382–389CrossRefPubMed
23.
Zurück zum Zitat Crobach MJ, Terveer EM, Kuijper EJ (2016) Effect of detecting and isolating asymptomatic Clostridium difficile carriers. JAMA Intern Med 176(10):1572–1573CrossRefPubMed Crobach MJ, Terveer EM, Kuijper EJ (2016) Effect of detecting and isolating asymptomatic Clostridium difficile carriers. JAMA Intern Med 176(10):1572–1573CrossRefPubMed
24.
26.
Zurück zum Zitat Meyer T, Franke G, Polywka SK et al (2014) Improved detection of bacterial central nervous system infections by use of a broad-range PCR assay. J Clin Microbiol 52(5):1751–1753CrossRefPubMedPubMedCentral Meyer T, Franke G, Polywka SK et al (2014) Improved detection of bacterial central nervous system infections by use of a broad-range PCR assay. J Clin Microbiol 52(5):1751–1753CrossRefPubMedPubMedCentral
27.
Zurück zum Zitat Binnicker MJ (2015) Multiplex molecular panels for diagnosis of gastrointestinal infection: performance, result interpretation, and cost-effectiveness. J Clin Microbiol 53(12):3723–3728CrossRefPubMedPubMedCentral Binnicker MJ (2015) Multiplex molecular panels for diagnosis of gastrointestinal infection: performance, result interpretation, and cost-effectiveness. J Clin Microbiol 53(12):3723–3728CrossRefPubMedPubMedCentral
28.
Zurück zum Zitat Krause JC, Panning M, Hengel H, Henneke P (2014) The role of multiplex PCR in respiratory tract infections in children. Dtsch Arztebl Int 111(38):639–645PubMedPubMedCentral Krause JC, Panning M, Hengel H, Henneke P (2014) The role of multiplex PCR in respiratory tract infections in children. Dtsch Arztebl Int 111(38):639–645PubMedPubMedCentral
29.
Zurück zum Zitat Timbrook T, Maxam M, Bosso J (2015) Antibiotic discontinuation rates associated with positive respiratory viral panel and low procalcitonin results in proven or suspected respiratory infections. Infect Dis Ther 4(3):297–306CrossRefPubMedPubMedCentral Timbrook T, Maxam M, Bosso J (2015) Antibiotic discontinuation rates associated with positive respiratory viral panel and low procalcitonin results in proven or suspected respiratory infections. Infect Dis Ther 4(3):297–306CrossRefPubMedPubMedCentral
30.
Zurück zum Zitat Yee C, Suarthana E, Dendukuri N, Nicolau I, Semret M, Frenette C (2016) Evaluating the impact of the multiplex respiratory virus panel polymerase chain reaction test on the clinical management of suspected respiratory viral infections in adult patients in a hospital setting. Am J Infect Control 44(11):1396–1398CrossRefPubMed Yee C, Suarthana E, Dendukuri N, Nicolau I, Semret M, Frenette C (2016) Evaluating the impact of the multiplex respiratory virus panel polymerase chain reaction test on the clinical management of suspected respiratory viral infections in adult patients in a hospital setting. Am J Infect Control 44(11):1396–1398CrossRefPubMed
31.
Zurück zum Zitat Carver PL, Lin SW, DePestel DD, Newton DW (2008) Impact of mecA gene testing and intervention by infectious disease clinical pharmacists on time to optimal antimicrobial therapy for Staphylococcus aureus bacteremia at a University Hospital. J Clin Microbiol 46(7):2381–2383CrossRefPubMedPubMedCentral Carver PL, Lin SW, DePestel DD, Newton DW (2008) Impact of mecA gene testing and intervention by infectious disease clinical pharmacists on time to optimal antimicrobial therapy for Staphylococcus aureus bacteremia at a University Hospital. J Clin Microbiol 46(7):2381–2383CrossRefPubMedPubMedCentral
32.
Zurück zum Zitat Brown J, Paladino JA (2010) Impact of rapid methicillin-resistant Staphylococcus aureus polymerase chain reaction testing on mortality and cost effectiveness in hospitalized patients with bacteraemia: a decision model. Pharmacoeconomics 28(7):567–575PubMed Brown J, Paladino JA (2010) Impact of rapid methicillin-resistant Staphylococcus aureus polymerase chain reaction testing on mortality and cost effectiveness in hospitalized patients with bacteraemia: a decision model. Pharmacoeconomics 28(7):567–575PubMed
33.
Zurück zum Zitat Emonet S, Charles PG, Harbarth S et al (2016) Rapid molecular determination of methicillin resistance in staphylococcal bacteraemia improves early targeted antibiotic prescribing: a randomized clinical trial. Clin Microbiol Infect 27(16):10 Emonet S, Charles PG, Harbarth S et al (2016) Rapid molecular determination of methicillin resistance in staphylococcal bacteraemia improves early targeted antibiotic prescribing: a randomized clinical trial. Clin Microbiol Infect 27(16):10
34.
Zurück zum Zitat Tuite N, Reddington K, Barry T, Zumla A, Enne V (2014) Rapid nucleic acid diagnostics for the detection of antimicrobial resistance in Gram-negative bacteria: is it time for a paradigm shift? J Antimicrob Chemother 69(7):1729–1733CrossRefPubMed Tuite N, Reddington K, Barry T, Zumla A, Enne V (2014) Rapid nucleic acid diagnostics for the detection of antimicrobial resistance in Gram-negative bacteria: is it time for a paradigm shift? J Antimicrob Chemother 69(7):1729–1733CrossRefPubMed
35.
Zurück zum Zitat Dodemont M, De MR, Nonhoff C, Roisin S, Denis O (2014) Performance of the Verigene Gram-negative blood culture assay for rapid detection of bacteria and resistance determinants. J Clin Microbiol 52(8):3085–3087CrossRefPubMedPubMedCentral Dodemont M, De MR, Nonhoff C, Roisin S, Denis O (2014) Performance of the Verigene Gram-negative blood culture assay for rapid detection of bacteria and resistance determinants. J Clin Microbiol 52(8):3085–3087CrossRefPubMedPubMedCentral
36.
Zurück zum Zitat Ward C, Stocker K, Begum J, Wade P, Ebrahimsa U, Goldenberg SD (2015) Performance evaluation of the Verigene(R) (Nanosphere) and FilmArray(R) (BioFire(R)) molecular assays for identification of causative organisms in bacterial bloodstream infections. Eur J Clin Microbiol Infect Dis 34(3):487–496CrossRefPubMed Ward C, Stocker K, Begum J, Wade P, Ebrahimsa U, Goldenberg SD (2015) Performance evaluation of the Verigene(R) (Nanosphere) and FilmArray(R) (BioFire(R)) molecular assays for identification of causative organisms in bacterial bloodstream infections. Eur J Clin Microbiol Infect Dis 34(3):487–496CrossRefPubMed
Metadaten
Titel
Neue mikrobiologische Diagnostikverfahren
Chancen und Limitierungen
verfasst von
Dr. Florian P. Maurer
Dr. Moritz Hentschke
Prof. Dr. Holger Rohde
Publikationsdatum
14.09.2017
Verlag
Springer Vienna
Erschienen in
Wiener klinisches Magazin / Ausgabe 5/2017
Print ISSN: 1869-1757
Elektronische ISSN: 1613-7817
DOI
https://doi.org/10.1007/s00740-017-0193-y

Weitere Artikel der Ausgabe 5/2017

Wiener klinisches Magazin 5/2017 Zur Ausgabe

Panorama

Panorama