Preliminary antimicrobial susceptibility: possibility of early and effective therapy during treatment of septic patients

Blood cultures have the drawback of requiring long time to be carried out. Our study was designed with the aim of early reports on both causing agents and preliminary antimicrobial susceptibility. We carried out a direct antimicrobial susceptibility on 79 positive blood cultures (42 for Gram-negative bacteria of which 21 MDRO; 22 for staphylococci of which 15 S. aureus; and 15 Enterococci/Streptococci) employing E-test strips deposited on Müller-Hinton Agar for staphylococci and Gram-negative bacteria, and Müller-Hinton Agar + 5% of blood for enterococci/streptococci. MICs were compared to the antimicrobial susceptibility tests carried out using Vitek2. On the basis of the interpretative criteria (SIR), the comparison between the direct antimicrobial susceptibility and the routine antimicrobial susceptibility, showed a concordance from 92.6% up to 100% for Gram-negative bacteria; from 90.0% up to 100% for staphylococci; from 86.7% up to 100% for streptococci/enterococci, respectively. With regard to MICs comparison, good concordance was detected on the basis of ± 1 doubling dilution. Moreover, this work allowed, in the case of Gram-negative bacteria, either the early identification of multidrug-resistant organisms or providing the MIC evaluation in a broader interval than it would be possible by the reference antimicrobial susceptibility.