A randomised controlled trial of matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDITOF-MS) versus conventional microbiological methods for identifying pathogens: Impact on optimal antimicrobial therapy of invasive bacterial and fungal infections in Vietnam
•MALDITOF MS provided more rapid identification of invasive bacterial and fungal pathogens than conventional microbiology.•MALDITOF MS did not increase the proportion of patients on optimal therapy at 24 or 48 hours after positive culture.•MALDITOF MS did not increase the proportion of patients rece...
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Published in | The Journal of infection Vol. 78; no. 6; pp. 454 - 460 |
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Main Authors | , , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
England
Elsevier Ltd
01.06.2019
W.B. Saunders |
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Abstract | •MALDITOF MS provided more rapid identification of invasive bacterial and fungal pathogens than conventional microbiology.•MALDITOF MS did not increase the proportion of patients on optimal therapy at 24 or 48 hours after positive culture.•MALDITOF MS did not increase the proportion of patients receiving adequate therapy at 24 hours after positive culture.•The most common reason for therapy being sub-optimal was use of overly broad spectrum or unnecessary multiple antibiotics.
We assessed the impact of MALDITOF-MS on the timeliness of optimal antimicrobial therapy through a parallel-arm randomised controlled trial in two hospitals in Vietnam.
We recruited patients with a pathogen (bacterial or fungal) cultured from a normally sterile sample. Samples were randomly assigned (1:1) to identification by MALDITOF-MS or conventional diagnostics. The primary outcome was the proportion on optimal antimicrobial therapy within 24 h of positive culture, determined by a blinded independent review committee. Trial registered at ClinicalTrials.gov (NCT02306330).
Among 1005 randomised patients, pathogens were isolated from 628 (326 intervention, 302 control), with 377 excluded as likely contaminants or discharged/died before positive culture. Most isolates were cultured from blood (421/628, 67.0%). The proportion receiving optimal antimicrobial therapy within 24 h (the primary outcome) or 48 h of growth was not significantly different between MALDITOF-MS and control arms (135/326, 41.4% vs 120/302, 39.7%; Adjusted Odds ration (AOR) 1.17, p = 0.40 and 151/326, 46.3% vs 141/302, 46.7%; AOR 1.05 p = 0.79, respectively).
MALDITOF-MS, in the absence of an antimicrobial stewardship programme, did not improve the proportion on optimal antimicrobial therapy at 24 or 48 h after first growth in a lower-middle income setting with high rates of antibiotic resistance. |
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AbstractList | •
MALDITOF MS provided more rapid identification of invasive bacterial and fungal pathogens than conventional microbiology.
•
MALDITOF MS did not increase the proportion of patients on optimal therapy at 24 or 48 hours after positive culture.
•
MALDITOF MS did not increase the proportion of patients receiving adequate therapy at 24 hours after positive culture.
•
The most common reason for therapy being sub-optimal was use of overly broad spectrum or unnecessary multiple antibiotics. OBJECTIVESWe assessed the impact of MALDITOF-MS on the timeliness of optimal antimicrobial therapy through a parallel-arm randomised controlled trial in two hospitals in Vietnam. METHODSWe recruited patients with a pathogen (bacterial or fungal) cultured from a normally sterile sample. Samples were randomly assigned (1:1) to identification by MALDITOF-MS or conventional diagnostics. The primary outcome was the proportion on optimal antimicrobial therapy within 24 h of positive culture, determined by a blinded independent review committee. Trial registered at ClinicalTrials.gov (NCT02306330). RESULTSAmong 1005 randomised patients, pathogens were isolated from 628 (326 intervention, 302 control), with 377 excluded as likely contaminants or discharged/died before positive culture. Most isolates were cultured from blood (421/628, 67.0%). The proportion receiving optimal antimicrobial therapy within 24 h (the primary outcome) or 48 h of growth was not significantly different between MALDITOF-MS and control arms (135/326, 41.4% vs 120/302, 39.7%; Adjusted Odds ration (AOR) 1.17, p = 0.40 and 151/326, 46.3% vs 141/302, 46.7%; AOR 1.05 p = 0.79, respectively). CONCLUSIONSMALDITOF-MS, in the absence of an antimicrobial stewardship programme, did not improve the proportion on optimal antimicrobial therapy at 24 or 48 h after first growth in a lower-middle income setting with high rates of antibiotic resistance. We assessed the impact of MALDITOF-MS on the timeliness of optimal antimicrobial therapy through a parallel-arm randomised controlled trial in two hospitals in Vietnam. We recruited patients with a pathogen (bacterial or fungal) cultured from a normally sterile sample. Samples were randomly assigned (1:1) to identification by MALDITOF-MS or conventional diagnostics. The primary outcome was the proportion on optimal antimicrobial therapy within 24 h of positive culture, determined by a blinded independent review committee. Trial registered at ClinicalTrials.gov (NCT02306330). Among 1005 randomised patients, pathogens were isolated from 628 (326 intervention, 302 control), with 377 excluded as likely contaminants or discharged/died before positive culture. Most isolates were cultured from blood (421/628, 67.0%). The proportion receiving optimal antimicrobial therapy within 24 h (the primary outcome) or 48 h of growth was not significantly different between MALDITOF-MS and control arms (135/326, 41.4% vs 120/302, 39.7%; Adjusted Odds ration (AOR) 1.17, p = 0.40 and 151/326, 46.3% vs 141/302, 46.7%; AOR 1.05 p = 0.79, respectively). MALDITOF-MS, in the absence of an antimicrobial stewardship programme, did not improve the proportion on optimal antimicrobial therapy at 24 or 48 h after first growth in a lower-middle income setting with high rates of antibiotic resistance. •MALDITOF MS provided more rapid identification of invasive bacterial and fungal pathogens than conventional microbiology.•MALDITOF MS did not increase the proportion of patients on optimal therapy at 24 or 48 hours after positive culture.•MALDITOF MS did not increase the proportion of patients receiving adequate therapy at 24 hours after positive culture.•The most common reason for therapy being sub-optimal was use of overly broad spectrum or unnecessary multiple antibiotics. We assessed the impact of MALDITOF-MS on the timeliness of optimal antimicrobial therapy through a parallel-arm randomised controlled trial in two hospitals in Vietnam. We recruited patients with a pathogen (bacterial or fungal) cultured from a normally sterile sample. Samples were randomly assigned (1:1) to identification by MALDITOF-MS or conventional diagnostics. The primary outcome was the proportion on optimal antimicrobial therapy within 24 h of positive culture, determined by a blinded independent review committee. Trial registered at ClinicalTrials.gov (NCT02306330). Among 1005 randomised patients, pathogens were isolated from 628 (326 intervention, 302 control), with 377 excluded as likely contaminants or discharged/died before positive culture. Most isolates were cultured from blood (421/628, 67.0%). The proportion receiving optimal antimicrobial therapy within 24 h (the primary outcome) or 48 h of growth was not significantly different between MALDITOF-MS and control arms (135/326, 41.4% vs 120/302, 39.7%; Adjusted Odds ration (AOR) 1.17, p = 0.40 and 151/326, 46.3% vs 141/302, 46.7%; AOR 1.05 p = 0.79, respectively). MALDITOF-MS, in the absence of an antimicrobial stewardship programme, did not improve the proportion on optimal antimicrobial therapy at 24 or 48 h after first growth in a lower-middle income setting with high rates of antibiotic resistance. |
Author | Wertheim, Heiman F.L. Hang, Nguyen Thi Thuy Hoi, Le Thi Trinh, Dao Tuyet Wolbers, Marcel Lan, Nguyen Phu Huong Campbell, James I. Tu, Nguyen Thi Cam Torre, Alessandro Van, Ninh Thi Thanh Chau, Nguyen Van Vinh Trung, Nguyen Vu van Doorn, H. Rogier Van Kinh, Nguyen Thwaites, Guy E. Nadjm, Behzad Dat, Vu Quoc Baker, Stephen Dung, Vu Tien Viet |
AuthorAffiliation | c Department of Infectious Diseases, Hanoi Medical University, Hanoi, Viet Nam d National Hospital for Tropical Diseases, Hanoi, Viet Nam e Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam f Department of Medical Microbiology, RadboudUMC, Nijmegen, The Netherlands b Centre for Tropical Medicine & Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom a Oxford University Clinical Research Unit, Hanoi & Ho Chi Minh City, Viet Nam |
AuthorAffiliation_xml | – name: d National Hospital for Tropical Diseases, Hanoi, Viet Nam – name: f Department of Medical Microbiology, RadboudUMC, Nijmegen, The Netherlands – name: b Centre for Tropical Medicine & Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom – name: c Department of Infectious Diseases, Hanoi Medical University, Hanoi, Viet Nam – name: e Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam – name: a Oxford University Clinical Research Unit, Hanoi & Ho Chi Minh City, Viet Nam |
Author_xml | – sequence: 1 givenname: Behzad surname: Nadjm fullname: Nadjm, Behzad email: bnadjm@oucru.org organization: Oxford University Clinical Research Unit, Hanoi & Ho Chi Minh City, Viet Nam – sequence: 2 givenname: Vu Quoc surname: Dat fullname: Dat, Vu Quoc organization: Oxford University Clinical Research Unit, Hanoi & Ho Chi Minh City, Viet Nam – sequence: 3 givenname: James I. surname: Campbell fullname: Campbell, James I. organization: Oxford University Clinical Research Unit, Hanoi & Ho Chi Minh City, Viet Nam – sequence: 4 givenname: Vu Tien Viet surname: Dung fullname: Dung, Vu Tien Viet organization: Oxford University Clinical Research Unit, Hanoi & Ho Chi Minh City, Viet Nam – sequence: 5 givenname: Alessandro surname: Torre fullname: Torre, Alessandro organization: Oxford University Clinical Research Unit, Hanoi & Ho Chi Minh City, Viet Nam – sequence: 6 givenname: Nguyen Thi Cam surname: Tu fullname: Tu, Nguyen Thi Cam organization: Oxford University Clinical Research Unit, Hanoi & Ho Chi Minh City, Viet Nam – sequence: 7 givenname: Ninh Thi Thanh surname: Van fullname: Van, Ninh Thi Thanh organization: Oxford University Clinical Research Unit, Hanoi & Ho Chi Minh City, Viet Nam – sequence: 8 givenname: Dao Tuyet surname: Trinh fullname: Trinh, Dao Tuyet organization: National Hospital for Tropical Diseases, Hanoi, Viet Nam – sequence: 9 givenname: Nguyen Phu Huong surname: Lan fullname: Lan, Nguyen Phu Huong organization: Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam – sequence: 10 givenname: Nguyen Vu surname: Trung fullname: Trung, Nguyen Vu organization: National Hospital for Tropical Diseases, Hanoi, Viet Nam – sequence: 11 givenname: Nguyen Thi Thuy surname: Hang fullname: Hang, Nguyen Thi Thuy organization: National Hospital for Tropical Diseases, Hanoi, Viet Nam – sequence: 12 givenname: Le Thi surname: Hoi fullname: Hoi, Le Thi organization: National Hospital for Tropical Diseases, Hanoi, Viet Nam – sequence: 13 givenname: Stephen surname: Baker fullname: Baker, Stephen organization: Oxford University Clinical Research Unit, Hanoi & Ho Chi Minh City, Viet Nam – sequence: 14 givenname: Marcel surname: Wolbers fullname: Wolbers, Marcel organization: Oxford University Clinical Research Unit, Hanoi & Ho Chi Minh City, Viet Nam – sequence: 15 givenname: Nguyen Van Vinh surname: Chau fullname: Chau, Nguyen Van Vinh organization: Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam – sequence: 16 givenname: Nguyen surname: Van Kinh fullname: Van Kinh, Nguyen organization: National Hospital for Tropical Diseases, Hanoi, Viet Nam – sequence: 17 givenname: Guy E. surname: Thwaites fullname: Thwaites, Guy E. organization: Oxford University Clinical Research Unit, Hanoi & Ho Chi Minh City, Viet Nam – sequence: 18 givenname: H. Rogier surname: van Doorn fullname: van Doorn, H. Rogier organization: Oxford University Clinical Research Unit, Hanoi & Ho Chi Minh City, Viet Nam – sequence: 19 givenname: Heiman F.L. surname: Wertheim fullname: Wertheim, Heiman F.L. organization: Centre for Tropical Medicine & Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom |
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CitedBy_id | crossref_primary_10_1017_ice_2021_149 crossref_primary_10_3390_microorganisms11092136 crossref_primary_10_1016_j_ijantimicag_2023_106816 crossref_primary_10_1039_C9NJ04432A crossref_primary_10_1099_acmi_0_000192 crossref_primary_10_1111_jpc_15272 crossref_primary_10_3390_antibiotics12121660 crossref_primary_10_1093_cid_ciab910 |
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Keywords | Bacteraemia Vietnam Matrix-assisted laser desorption-ionization mass spectrometry Microbiological techniques Antibacterial agents |
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Snippet | •MALDITOF MS provided more rapid identification of invasive bacterial and fungal pathogens than conventional microbiology.•MALDITOF MS did not increase the... We assessed the impact of MALDITOF-MS on the timeliness of optimal antimicrobial therapy through a parallel-arm randomised controlled trial in two hospitals in... OBJECTIVESWe assessed the impact of MALDITOF-MS on the timeliness of optimal antimicrobial therapy through a parallel-arm randomised controlled trial in two... • MALDITOF MS provided more rapid identification of invasive bacterial and fungal pathogens than conventional microbiology. • MALDITOF MS did not increase the... |
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SubjectTerms | Adult Anti-Bacterial Agents - therapeutic use Antibacterial agents Antifungal Agents - therapeutic use Bacteraemia Bacteremia - diagnosis Bacteremia - drug therapy Bacteremia - microbiology Bacteria - drug effects Bacteria - isolation & purification Female Fungi - drug effects Fungi - isolation & purification Humans Male Matrix-assisted laser desorption-ionization mass spectrometry Microbiological Techniques Middle Aged Mycoses - diagnosis Mycoses - drug therapy Mycoses - microbiology Prospective Studies Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization Time Factors Treatment Outcome Vietnam |
Title | A randomised controlled trial of matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDITOF-MS) versus conventional microbiological methods for identifying pathogens: Impact on optimal antimicrobial therapy of invasive bacterial and fungal infections in Vietnam |
URI | https://dx.doi.org/10.1016/j.jinf.2019.03.010 https://www.ncbi.nlm.nih.gov/pubmed/30914268 https://search.proquest.com/docview/2198557619 https://pubmed.ncbi.nlm.nih.gov/PMC6529875 |
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