Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May 3;76(9):1550-1558.
doi: 10.1093/cid/ciac952.

Reporting of Antimicrobial Resistance from Blood Cultures, an Antibacterial Resistance Leadership Group Survey Summary: Resistance Marker Reporting Practices from Positive Blood Cultures

Patricia J Simner  1   2 , Jennifer Dien Bard  3 , Christopher Doern  4 , J Kristie Johnson  5 , Lars Westblade  6   7 , Gayane Yenokyan  8 , Robin Patel  9   10 , Kimberly E Hanson  11   12 ; Antibacterial Resistance Leadership Group
Affiliations

Reporting of Antimicrobial Resistance from Blood Cultures, an Antibacterial Resistance Leadership Group Survey Summary: Resistance Marker Reporting Practices from Positive Blood Cultures

Patricia J Simner et al. Clin Infect Dis. .

Abstract

Background: We assessed how laboratories use and handle reporting of results of rapid diagnostics performed on positive blood culture broths, with a focus on antimicrobial resistance (AMR) markers.

Methods: A survey assembled by the Antibacterial Resistance Leadership Group Diagnostics Committee was circulated from December 2020 to May 2021. The survey was sent to local hospitals, shared on the ClinMicroNet and Division C listservs, and included in a College of American Pathologists proficiency testing survey.

Results: Ninety-six laboratories of various sizes across the United States (95%) and outside of the United States (5%) participated. Of the laboratories that had at least 1 rapid diagnostic in place (94%), significant heterogeneity in methods used and reporting practices was found across community (52%) and academic (40%) laboratories serving hospitals of various sizes. Respondents had implemented 1 to 6 different panels/platforms for a total of 31 permutations. Methods of reporting rapid organism identification and AMR results varied from listing all targets as "detected"/"not detected" (16-22%) without interpretive guidance, to interpreting results (23-42%), or providing therapeutic guidance comments to patient-facing healthcare teams (3-17%).

Conclusions: Current approaches to reporting molecular AMR test results from positive blood culture vary significantly across clinical laboratories. Providing interpretative comments with therapeutic guidance alongside results reported may assist clinicians who are not well-versed in genetic mechanisms of AMR. However, this is currently not being done in all clinical laboratories. Standardized strategies for AMR gene result reporting are needed.

Keywords: AMR marker reporting; antimicrobial resistance test result reporting; blood cultures; multiplex molecular panels.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest. P. J. S. reports grants and personal fees from Accelerate Diagnostics, OpGen Inc, bioMérieux Inc, BD Diagnostics, and Qiagen Sciences Inc; grants from Affinity Biosensors, Qiagen, Hardy Diagnostics, and T2 Diagnostics; personal fees from Roche Diagnostics, Shionogi, and GeneCapture; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from GenMark Dx, OpGen Inc, and BD Diagnostics; a leadership or fiduciary role on the Antibacterial Resistance Leadership Group Diagnostics Committee, CLSI AST Subcommittee, and CAP Microbiology Committee; stock options from GeneCapture, outside the submitted work. K. E. H. reports grants from BioFire Diagnostics and roles on the Infectious Diseases Society of America Board of Directors (CLIS Antifungal Susceptibility Committee), Clinical Infectious Diseases deputy editor, and JCM editor, outside the submitted work. R. P. reports grants from ContraFect, TenNor Therapeutics Limited, BioFire, and Adaptive Phage Therapeutics (paid to institution); is a consultant to Curetis, PathoQuest, Selux Diagnostics, 1928 Diagnostics, PhAST, Torus Biosystems, Day Zero Diagnostics, Mammoth Biosciences, HealthTrackRx, and Qvella (monies paid to Mayo Clinic; Mayo Clinic and R. P. have a relationship with Pathogenomix); has research supported by Adaptive Phage Therapeutics (Mayo Clinic has a royalty-bearing know-how agreement and equity in Adaptive Phage Therapeutics); is a consultant to Netflix, Abbott Laboratories, and CARB-X; has a patent on Bordetella pertussis/parapertussis PCR issued, a patent on a device/method for sonication with royalties paid by Samsung to Mayo Clinic, and a patent on an anti-biofilm substance issued; receives honoraria from the NBME, Up-to-Date, and the Infectious Diseases Board Review Course; reports travel reimbursement to author from ASM; and has a volunteer role on the Governance Committee of ASM. J. D. B. reports grants from Luminex Corporation, Abbott Molecular, Chromacode, and BioFire Diagnostics; is a consultant for Roche Diagnostics/GenMark, bioMérieux Inc, BioFire Diagnostics, and Qiagen; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Thermo Fisher Scientific and Qiagen; payment for expert testimony from Lewis Rice; support for attending meetings and/or travel from Thermo Fisher Scientific; and a leadership or fiduciary role in other board, society, committee, or advocacy groups, paid or unpaid, with ASM and AMP. J. K. J. reports personal fees as speaker from BioFire Diagnostics. C. D. is a scientific advisor for GeneCapture and Quidel; is on the Shionogi speaker's bureau; has received travel funds from ASM; receives honoraria for editorial work performed for the Clinical Microbiology Newsletter; reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from ASM and NYASM; reports consulting fees from Quidel, Shionogi, Cepheid, and BD; and receipt of equipment, materials, drugs, medical writing, gifts, or other services from Accelerate. L. W. has received consulting fees from Roche Molecular Systems, Shionogi, and Talis Biomedical; research funding from Accelerate Diagnostics, bioMérieux Inc/BioFire Diagnostics, Hardy Diagnostics, and Roche Molecular Systems; and support for attending meetings and/or travel from the American Society for Microbiology (budget for speaking). G. Y. reports grants or contracts paid to institution from the Agency for Healthcare Research and Quality. All remaining authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Breakdown of different combinations of rapid molecular and/or phenotypic panels/platforms performed for testing positive blood culture broths at participating laboratories. Length of bar reflects the number of laboratories performing the combinations of rapid molecular and/or phenotypic tests. Numbers of panels/platforms used by laboratories: light blue, 1; orange, 2; red, 3; green, 4; dark blue, 5; and purple, 6. MALDI-TOF MS directly from positive blood culture broths (e.g., SepsiTyper). Abbreviations:BC, blood culture; BCID, blood culture identification; FP, fungal panel; GN, Gram-negative; GP, Gram-positive; MALDI-TOF MS, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry; MRSA, methicillin-resistant Staphylococcus aureus; PCR, polymerase chain reaction; SA: Staphylococcus aureus.
Figure 2.
Figure 2.
Reporting strategies used by laboratories (N = 90) applying rapid molecular diagnostics from positive blood culture broths. Three scenarios were provided and responses were tabulated for the following: Staphylococcus aureus and mecA were both detected (interpreted as MRSA; blue bars); S. aureus was detected but mecA was not (interpreted as MSSA; orange bars); and Escherichia coli and blaCTX-M were both detected (CTX-M) interpreted as extended-spectrum β-lactamase-producing E. coli; gray bars). See Supplementary Materials for details on the survey questions. Abbreviations: MRSA, methicillin-resistant Staphylococcus aureus; MSSA, methicillin-susceptible Staphylococcus aureus.
See this image and copyright information in PMC

References

    1. Goto M, Al-Hasan MN. Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe. Clin Microbiol Infect 2013; 19:501–9. - PubMed
    1. Seymour CW, Gesten F, Prescott HC, et al. . Time to treatment and mortality during mandated emergency care for sepsis. N Engl J Med 2017; 376:2235–44. - PMC - PubMed
    1. Arroyo MA, Denys GA. Parallel evaluation of the MALDI Sepsityper and Verigene BC-GN assays for rapid identification of gram-negative bacilli from positive blood cultures. J Clin Microbiol 2017; 55:2708–18. - PMC - PubMed
    1. Faron ML, Buchan BW, Ledeboer NA. Matrix-assisted laser desorption ionization-time of flight mass spectrometry for use with positive blood cultures: methodology, performance, and optimization. J Clin Microbiol 2017; 55:3328–38. - PMC - PubMed
    1. Kayin M, Mert B, Aydemir S, Ozenci V. Comparison of rapid BACpro® II, Sepsityper® kit and in-house preparation methods for direct identification of bacteria from blood cultures by MALDI-TOF MS with and without Sepsityper® module analysis. Eur J Clin Microbiol Infect Dis 2019; 38:2133–43. - PMC - PubMed

Publication types

Substances