Validation of a novel molecular diagnostic panel for pediatric musculoskeletal infections: Integration of the Cepheid Xpert MRSA/SA SSTI and laboratory-developed real-time PCR assays for clindamycin resistance genes and Kingella kingae detection

Pathogen detection in pediatric patients with musculoskeletal infections relies on conventional bacterial culture, which is slow and can delay antimicrobial optimization. The ability to rapidly identify causative agents and antimicrobial resistance genes in these infections may improve clinical care...

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Vydané v:Journal of microbiological methods Ročník 156; s. 60 - 67
Hlavní autori: Searns, Justin B., Robinson, Christine C., Wei, Qi, Yuan, Ji, Hamilton, Stacey, Pretty, Kristin, Donaldson, Nathan, Parker, Sarah K., Dominguez, Samuel R.
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: Netherlands Elsevier B.V 01.01.2019
Predmet:
Anti-Bacterial Agents - therapeutic use
antibiotic resistance
antibiotic resistance genes
Bacterial Proteins - genetics
Child
children
clindamycin
Clindamycin - therapeutic use
Colorado
Diagnostics
Drug Resistance, Bacterial
Female
hospitals
Humans
Infection
Kingella kingae
Kingella kingae - genetics
Kingella kingae - isolation & purification
Male
methicillin-resistant Staphylococcus aureus
Methyltransferases - genetics
microbial detection
musculoskeletal system
Neisseriaceae Infections - diagnosis
Osteoarthritis - microbiology
Osteomyelitis
Osteomyelitis - microbiology
patients
Pediatric
phenotype
quantitative polymerase chain reaction
Septic arthritis
Colorado
Osteomyelitis
Infection
Diagnostics
NPV
Septic arthritis
PPV
MDP
qPCR
Pediatric
CHCO
ISSN:0167-7012, 1872-8359, 1872-8359
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Shrnutí:Pathogen detection in pediatric patients with musculoskeletal infections relies on conventional bacterial culture, which is slow and can delay antimicrobial optimization. The ability to rapidly identify causative agents and antimicrobial resistance genes in these infections may improve clinical care. Convenience specimens from bone and joint samples submitted for culture to Children's Hospital Colorado (CHCO) from June 2012 to October 2016 were evaluated using a “Musculoskeletal Diagnostic Panel” (MDP) consisting of the Xpert MRSA/SA SSTI real-time PCR (qPCR, Cepheid) and laboratory-developed qPCRs for Kingella kingae detection and erm genes A, B, and C which confer clindamycin resistance. Results from the MDP were compared to culture and antimicrobial susceptibility testing (AST) results. A total of 184 source specimens from 125 patients were tested. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the Xpert MRSA/SA SSTI compared to culture and AST results were 85%, 98%, 93%, and 95% respectively for MSSA and 82%, 100%, 100%, and 99% for MRSA. Compared to phenotypic clindamycin resistance in S. aureus isolates, the erm A, B, and C gene PCRs collectively demonstrated a sensitivity, specificity, PPV, and NPV of 80%, 96%, 67%, and 98%. In comparison to clinical truth, Kingella PCR had a sensitivity, specificity, PPV, and NPV of 100%, 99.5%, 100%, and 100%. This novel MDP offers a rapid, sensitive, and specific option for pathogen detection in pediatric patients with musculoskeletal infections.
Bibliografia:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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ISSN:0167-7012
1872-8359
1872-8359
DOI:10.1016/j.mimet.2018.12.004