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Performance of a MALDI-TOF mass spectrometry-based method for rapid detection of third-generation oxymino-cephalosporin-resistant Escherichia coli and Klebsiella spp. from blood cultures

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Abstract

We optimized and prospectively evaluated a simple MALDI-TOF MS-based method for direct detection of third-generation oxymino-cephalosporin resistance (3rd CephR) in Escherichia coli and Klebsiella spp. from blood cultures (BC). In addition, we assessed the performance of a lateral flow immunochromatographic assay (LFIC) for detecting extended-spectrum β-lactamases (ESBL) (NG-Test CTX-M MULTI assay) using bacterial pellets from BC. A total of 168 BCs from unique patients were included. A pre-established volume of BC flagged as positive was transferred in brain heart infusion with or without ceftriaxone (2 mg/ml). After 2-h incubation, intact bacterial pellets were used for MALDI-TOF MS testing. Identification of bacterial species (index score > 2) in the presence of CRO was considered marker of 3rd CephR. The LFIC assay was evaluated in 141 BC. Bacteremia episodes were caused by E. coli (n = 115) or Klebsiella spp. (n = 53). A total of 49 strains were 3rd CephR by broth microdilution, of which 41 were ESBL producers, seven expressed ESBL and OXA-48 type D carbapenemase, and one harbored a plasmid-mediated AmpC. The MALDI-TOF MS method yielded four very major errors (false susceptibility) and two major errors (false resistance). The overall sensitivity of the assay was 91.8% and the specificity 98.3%. Concordance between the LFIC assay and the MALDI-TOF MS method for detection of ESBL-mediated 3rd CephR was 100%. Both evaluated methods may prove useful for early adjustment of empirical therapy in patients with E. coli and Klebsiella spp. bloodstream infections. Whether their use has a beneficial impact on patient outcomes is currently under investigation.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

E.G holds a Juan Rodés research contract (JR18/00053) from the ISCIII (Carlos III Health Institute, Instituto de Salud Carlos III in the original Spanish). E.A. holds a Río Hortega research contract from the Carlos III Health Institute (Ref. CM18/00221).

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Authors and Affiliations

  1. Microbiology Service, Hospital Clínico Universitario, Instituto de Investigación INCLIVA, Valencia, Spain

    Ignacio Torres, Eliseo Albert, Estela Giménez, Beatriz Olea, Arantxa Valdivia, Tania Pascual, Dixie Huntley, David Sánchez, Rosa María Costa, Javier Colomina & David Navarro

  2. Infectious Diseases Unit, Hospital Clínico Universitario, Instituto de Investigación INCLIVA, Valencia, Spain

    Carolina Pinto & Rosa Oltra

  3. Department of Microbiology, School of Medicine, University of Valencia, Av. Blasco Ibáñez 17, 46010, Valencia, Spain

    David Navarro

Authors
  1. Ignacio Torres
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  2. Eliseo Albert
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  3. Estela Giménez
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  4. Beatriz Olea
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  6. Tania Pascual
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  7. Dixie Huntley
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  8. David Sánchez
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  9. Rosa María Costa
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  10. Carolina Pinto
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  11. Rosa Oltra
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  12. Javier Colomina
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  13. David Navarro
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Contributions

IT, EA, EG, JC: conceptualization, methodology, analysis of data, validation, review and editing; BG, AV, TP, DH, DS, RMC: methodology, review and editing; CP, RO: clinical management of patients; DN: conceptualization, supervision, writing the original draft.

Corresponding author

Correspondence to David Navarro.

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Ethical statement

The current study was approved by the Research Ethics Committee of Hospital Clínico Universitario INCLIVA (September, 2019).

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The authors declare no competing interests.

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Torres, I., Albert, E., Giménez, E. et al. Performance of a MALDI-TOF mass spectrometry-based method for rapid detection of third-generation oxymino-cephalosporin-resistant Escherichia coli and Klebsiella spp. from blood cultures. Eur J Clin Microbiol Infect Dis 40, 1925–1932 (2021). https://doi.org/10.1007/s10096-021-04251-0

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  • DOI: https://doi.org/10.1007/s10096-021-04251-0

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