CliniCon Oral Presentation Australian Society for Microbiology Annual Scientific Meeting 2023

 Assessing performance of EUCAST rapid antimicrobial susceptibility testing (RAST) at Northern Pathology (92944)

Taylor Corocher 1 , Mikayla Kingston 1 , Helen Williams 1 , Yvonne Hersusianto 1
  1. Northern Pathology Victoria, Thomastown, VICTORIA, Australia

Bacterial multi-drug resistance is an increasing threat to human health, particularly among severely ill patients with blood stream infections (BSIs). Delays in the use of appropriate antibiotics has been linked to higher mortality rates, so there is urgent need to reduce the turn-around-time (TAT) for bacterial identification and susceptibility testing. Traditional antimicrobial susceptibility testing (AST) at Northern Pathology Victoria (NPV) currently takes 24 hours after bacteria are detected in a positive blood culture. A method developed by the European Committee for Antimicrobial Susceptibility Testing (EUCAST) enables Rapid Antimicrobial Susceptibility Testing (RAST) for the most commonly occurring organisms causing BSIs. The RAST technique was validated for use within the microbiology department at NPV, and successfully incorporated into the daily workflow, recording disc zone results from RAST plates after 8 hours of incubation. The identification of the organism was performed on the Bruker MALDI-TOF and appropriate susceptibility testing was performed using the Vitek XL2. The TAT for completing positive blood cultures was reduced from 5 to 3 days within 4 months of introducing the protocol. Further, the average percentage of blood culture reports completed in ≤ 2 days was increased to 47.4% from 39.8% when compared to the prior year. This was despite antibiotic susceptibilities not yet being reported directly from the RAST. This data, collected during the verification stage, clearly showed that changes to workflow had improved TAT of positive blood culture reporting. The susceptibilities from RAST had 100% concordance with those determined by the Vitek XL2, with the exception of E. coli, which had a 97.5% matching rate with 1.6% major errors and 0.8% very major errors. These error rates were comparable with those published by EUCAST. The RAST read at 8 hours gave guidance regarding the presence of MRSA, VRE, or ESBLs, with the aim to release preliminary reports when enough data has been obtained. RAST has been an invaluable addition to the routine testing at NPV, by reducing the TAT of these critical results, and will continue to enhance patient care through extended testing hours and further verification.