ArticleMicrobiology spectrum2025
Performance of direct-from-blood-culture disk diffusion antibiotic susceptibility testing and its impact on antibiotic adjustment in bloodstream infections at a Malaysian tertiary center.
Article in Microbiology spectrum, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed.
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11 authors.
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Abstract
Delayed antibiotics increase mortality in bloodstream infection (BSI). Direct-from-blood-culture disk diffusion antibiotic susceptibility testing (dAST) forecasts susceptibility earlier than conventional susceptibility testing (cAST). The study aimed to evaluate dAST performance and its impact on antibiotic adjustment in BSI. In this Malaysian single-center prospective study, dAST was performed and interpreted according to breakpoints by Clinical and Laboratory Standards Institute (CLSI) guidelines. The turnaround time (TAT), categorical agreements (CA), and predictive values of dAST for susceptibility by cAST were determined among positive blood cultures (PBC) between November 2022 and November 2023. The active and WHO AWaRe antibiotics administered before and after dAST results were compared. Of the 318 PBCs, the median of TAT was earlier than cAST by 35 hours. The CA for 3,561 organism-antibiotics combinations was 91.5%, with 3.6% very major errors (VME), 3.3% major errors (ME), and 5.2% minor errors (mE). The dAST achieved CA above 90% for IMPORTANCE: Global deaths attributable to antimicrobial resistance are rising. Hence, rapid susceptibility testing is essential for timely antibiotic de-escalation to mitigate antimicrobial resistance (AMR) development from exposure to broad-spectrum antibiotics. Compared to the costly advanced technology, direct disk diffusion from blood culture (diffusion antibiotic susceptibility testing [dAST]) is an affordable method that can be quickly adopted. However, the reliability of dAST in informing susceptibility was mainly reported from Western countries and scarcely from other regions, including Southeast Asia, where the AMR burden is high. This study from Malaysia adds insights into the performance of dAST and the potential to apply it in similar resource-limited settings from the same region. Furthermore, assessing the dAST's influence on antibiotic prescribing identifies the gap in implementation to guide areas of improvement for optimizing clinical utility.
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