The detection of carbapenemase extended-spectrum β-lactamase (ESBL)-producing Enterobacterales (EB) has become a major issue among critically ill patients, especially due to their impact on appropriate antimicrobial therapy. This study aimed at evaluating the potential contribution of molecular assays to early optimization of empirical antibiotic therapy among critically ill patients with carbapenemase- and/or CTX-M-producing EB pneumonia. The CRE and ESBL ELITe MGB^® assays were evaluated directly on 197 bronchoalveolar lavage (BAL) samples obtained from 120 patients. Molecular results were then compared to routine culture-based diagnostic results, and a retrospective analysis of the therapeutic antimicrobial management was performed. Among the 197 clinical specimens, bla_KPC-like and bla_CTX-M-like were detected in 20 (10.2%) and 12 (6.1%) specimens belonging to 15 and 11 patients, respectively. Positive predictive value (PPV) and negative predictive value (NPV) of the CRE ELITe MGB Kit were 85% [95% confidence interval [CI]: 64.9–94.6] and 100%, respectively. PPV and NPV of the ESBL ELITe MGB Kit were 75% [95% CI: 49.4–90.2] and 100%, respectively. Retrospective analysis of the therapeutic antimicrobial management at the time of BAL collection showed that in ∼50% of patients with carbapenemase- and CTX-M-producing EB pneumonia empirical antibiotic therapy could have been optimized at least 48–72 hr earlier if positive molecular data had been used. The CRE and ESBL ELITe MGB assays might be an interesting tool for expediting optimization of empirical antibiotic therapy in critically ill patients with pneumonia, depending on local epidemiology of antibiotic resistance, patient risk stratification for EB infection, and availability of an antimicrobial stewardship team.

中文翻译：

---

使用 CRE 和 ESBL ELITe MGB 检测直接从支气管肺泡灌洗液中检测碳青霉烯酶和 CTX-M 编码基因：迈向肺炎重症患者的早期和最佳抗生素治疗管理

产碳青霉烯酶超广谱β-内酰胺酶（ESBL）肠杆菌（EB）的检测已成为危重患者的一个主要问题，尤其是由于它们对适当的抗菌治疗的影响。本研究旨在评估分子检测对产碳青霉烯酶和/或 CTX-M EB 肺炎危重患者经验性抗生素治疗早期优化的潜在贡献。CRE 和 ESBL ELITe MGB ^®检测直接对从 120 名患者获得的 197 个支气管肺泡灌洗 (BAL) 样本进行评估。然后将分子结果与常规基于培养的诊断结果进行比较，并对治疗性抗菌管理进行回顾性分析。在 197 份临床标本中，bla_KPC-like和bla _CTX-M-like分别在 15 名和 11 名患者的 20 份（10.2%）和 12 份（6.1%）标本中检测到。CRE ELITe MGB 试剂盒的阳性预测值 (PPV) 和阴性预测值 (NPV) 分别为 85% [95% 置信区间 [CI]：64.9–94.6] 和 100%。ESBL ELITe MGB 试剂盒的 PPV 和 NPV 分别为 75% [95% CI：49.4–90.2] 和 100%。收集 BAL 时对治疗性抗菌药物管理的回顾性分析表明，在约 50% 的产碳青霉烯酶和 CTX-M 的 EB 肺炎患者中，如果分子数据呈阳性，经验性抗生素治疗可以至少提前 48-72 小时优化已被使用。CRE 和 ESBL ELITe MGB 检测可能是一种有趣的工具，可用于加速优化重症肺炎患者的经验性抗生素治疗，