CAN RAPID DIRECT DISK DIFFUSION ANTIMICROBIAL SUSCEPTIBILITY TESTING FROM POSITIVE BLOOD CULTURES IN SEPSIS HELP IN EARLY THERAPEUTIC DECISION-MAKING
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Abstract
Sepsis is a life-threatening condition that requires prompt initiation of effective antimicrobial therapy to improve patient outcomes. Delayed antimicrobial susceptibility results often hinder timely treatment decisions, increasing the risk of morbidity and mortality. Conventional antimicrobial susceptibility testing (AST) methods typically require 24 to 48 hours following blood culture positivity, limiting rapid therapeutic intervention. Direct disk diffusion (dDD) performed directly from positively flagged blood culture broths offers a potential solution by providing susceptibility results 24 hours earlier. This study aims to evaluate the performance of direct disk diffusion testing for rapid antimicrobial susceptibility results in sepsis patients, comparing its accuracy to the reference disk diffusion while assessing error rates such as very major errors (VME), major errors (ME), and minor errors (mE).
Aim: To evaluate the performance of direct disk diffusion (dDD) for rapid antimicrobial susceptibility testing from positively flagged blood culture broths in sepsis patients and compare its accuracy with the reference disk diffusion method by assessing error rates (VME, ME, and mE).
Materials and Methods- A cross-sectional study was conducted in the Department of Microbiology, MMIMSR, Mullana, to assess the performance of direct disk diffusion testing directly from positively flagged blood culture broths. A total of 100 positively flagged blood culture bottles identified through an automated blood culture system were included. All positively flagged blood culture bottles were included in the study, while those containing multiple bacterial species or budding yeast cells, as confirmed by Gram staining, along with all negative blood culture bottles, were excluded from the analysis.
Results- Of 1167 blood cultures processed, 30.67% (358/1167) were positive, with 100 included in the study. Among these, 53% were Gram-positive cocci, predominantly Staphylococcus aureus (38/53; 71.69%), and 47% were Gram-negative bacilli, primarily Escherichia coli (23/47; 48.94%) and Klebsiella spp. (12/47; 25.53%). The overall categorical agreement between direct disk diffusion and the reference method was 91.07%. Minor errors (2.94%), major errors (2.72%), and very major errors (2.13%) were observed. The highest minor error rate was in Acinetobacter spp. (2.5%), while major errors were most frequent in Acinetobacter spp. (5.83%) and Enterobacteriaceae (4%). Staphylococcus spp. showed the highest very major error rate (2.93%). The average reporting time for direct disk diffusion was 24 hours, with 60% of reports available 24 hours earlier than the reference method.
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Mr. Rakesh Kumar
Tutor, Department of Microbiology, SKS Medical College and Research Centre, Mathura,
Uttar Pradesh, India
Snehil Singh
Research Scholar, Department of Microbiology, Integral Institute of Medical Sciences Research, Integral University, Lucknow, Uttar Pradesh, India
Rajat Prakash
Assistant Professor, Department of Microbiology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
Dr. Ritu Garg
Professor, Dr. Ritu Garg, Department of Microbiology, Dr. B.R. Ambedkar State Institute of Medical Sciences, Mohali, Punjab, India.