Company insight Advance of sepsis testing
Sepsis is a global killer, and its mortality rate requires special testing so treatment can be tailored to the microorganisms causing infection. Ike Northern, director of infectious disease testing and immunology at CompuNet Clinical Laboratories, explains how his company has used Bruker’s matrix-assisted laser desorption/ionisation time-of-fl ight mass spectrometer with the aim to optimise patient treatment.
Species level 74/106 = 70% S. aureus S. capitis
S. epidermidis S. haemolyticus S. hominis M. Iuteus S. faecalis
17 2 8 2 2 3 4
E. faecium S. anginosis
Group A Streptococcus Group B Streptococcus E. cloacae E. coli
K. pneumoniae
2 1 1 1 1
18 5
The CompuNet MALDI Sepsityper Kit 50 validation-identifi ed organisms. A total of 87 out of 106 (82%) were identifi ed.
ffecting between 47 and 50 million people every year, 20% of all deaths worldwide are associated with sepsis, according to the World Sepsis Day organisation. Early identification and appropriate treatment of sepsis will result in improved patient outcomes – for every hour that correct treatment is delayed, patient survival decreases by 7.6%, per one 2006 paper in Critical Care Medicine. The standard procedure for treating sepsis should begin with broad-spectrum antimicrobials, but, without knowing the identity of the microorganism, their effectiveness is limited and potentially exposes the patient to adverse health effects. Many diseases that were once easily treated with novel antibiotics are re-emerging as resistant. CompuNet Clinical Laboratories provides advanced diagnostic services, including testing for sepsis. The laboratory has significantly increased throughput using Bruker’s matrix-assisted laser desorption/ionisation time-of-flight (MALDI-TOF) mass spectrometry (MS) to generate a mass spectrum pattern, which can be used as a ‘molecular fingerprint’ to identify a microorganism. CompuNet also uses Bruker’s MALDI Sepsityper Kit 50 (for research use only), which can rapidly identify organisms
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directly from positive blood cultures (PBC). The time to identification from PBC with the MALDI Sepsityper Kit 50 is considerably shorter than traditional phenotypical methods.
Patients can be switched faster to targeted treatment. In addition to minimising prolonged exposure to potentially aggressive treatment, another advantage of de-escalating from broad- spectrum antimicrobials sooner is to reduce the risk of developing multidrug- resistant microorganisms, which aligns with the WHO global action plan on antimicrobial resistance.
High validity
CompuNet performed a validation study of the MALDI Sepsityper Kit 50 using the MALDI Biotyper, which resulted in an identification for 82% of the samples, and allowed physicians to optimise patient treatment up to 48 hours sooner. CompuNet also plans to adopt the new FDA-cleared MBT Sepsityper Kit US IVD for rapid and affordable identification of over 400 microorganisms from positive blood cultures in the US. Instead of using a multiplex PCR test for routine testing of PBCs, a more cost-effective option is to use MALDI Sepsityper as a screen to determine what further testing should be performed.
M. morganella P. aeruginosa P. vulgaris
S. marcescens C. albicans
1 3 1 2 1
Genus level 13/106 = 12% Coagulase-Neg Staph Alpha Streptococcus Beta Streptococcus Bacillus sp.
Corynebacterium sp. Enterobacter sp. Bacteroides sp.
3 1 1 3 3 1 1
Bruker’s MALDI Sepsityper Kit 50.
Future developments from Bruker are set to include increased resistance markers to help fight MDR organisms, including the Klebsiella pneumoniae carbapenemase enzyme-producing Enterobacteriaceae, MRSA, Bacteroides fragilis cfiA positive strains, Elizabethkingia species and Mycobacterium chimaera, to further extend microorganism testing capability. ●
The Bruker MALDI Sepsityper Kit 50 is for research use only. CompuNet Clinical Laboratories purchases the MALDI Sepsityper Kit 50 (RUO) from Bruker. CompuNet Clinical Laboratories developed and validated their own in-house assay for clinical diagnostic use. The Sepsityper assay is used only within the laboratory using protocols developed in-house. This product is not for use in clinical diagnostic procedures.
www.bruker.com Practical Patient Care /
www.practical-patient-care.com
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