Vitek 2 automated system

The study was conducted at King Fahd Hospital of the University Al-Khobar, a 550-bed secondary care and academic training centre. All patient age groups were included. Charts were individually reviewed to include cases that had clinically significant isolates. For the enrolled cases, the patients’ chart data (age, sex, and location of patients when specimens were collected) and microbiological results available in the laboratory information system were evaluated. Routine testing of candidemia isolates in the laboratory included speciation by the automated VITEK 2 system (bioMe ´rieux Inc., Durham, NC, USA) between 2013 and 2016 and the VITEK MS (bioMe ´rieux Inc.) between 2016 and 2018.¹⁶ Susceptibility testing was performed on all strains using the automated VITEK 2 system throughout the study period and was interpreted based on the FDA/CLSI breakpoints.¹⁷ Intrinsic resistance patterns were excluded from the analysis e.g. resistance to amphotericin B in Candida lusitaniae and to fluconazole in Candida krusei. Only the first episode of candidemia per patient was included in the analysis. Two or more Candida species episodes per patient were counted separately. All cause crude mortality was recorded at 14, 30, 60, and 90 days.

Blood culture was performed using the automated BACTEC FX system (Becton Dickinson, Sparks, MD, USA) or a BacT/Alert 3D system (bioMérieux, Marcy l'Etoile, France). Bacterial identification and antimicrobial susceptibility tests were performed using the Vitek II automated system (bioMérieux). The results of the antimicrobial susceptibility test were interpreted based on the Clinical and Laboratory Standards Institute (CLSI) guidelines, and all the results were re-evaluated based on the revised CLSI guidelines.20 Intermediate susceptibility was defined as being non-susceptible.10 (link)

All blood cultures were obtained from peripheral veins or central venous catheters (CVCs). A Bactec-9240 system (Becton Dickinson, Sparks, MD) or a BacT/Alert 3D system (bioMérieux Inc., Marcy l’Etoile, France) was used for blood cultures. A Vitek II automated system (bioMérieux Inc.) was used for antibiotic susceptibility testing.

Ascitic fluid was drawn by paracentesis using an aseptic technique and inoculated into blood culture bottles placed beside the bed. The ascitic fluid specimens obtained were also sent to the laboratory for biochemical profiles. Ascitic fluid and blood were incubated in the BacT/Alert 3D automated blood culture system (bioMérieux, Marcy l’Etoile, France). Microbiological identification was performed using a standard identification card. Antimicrobial susceptibility was tested using the modified broth microdilution method on the VITEK II automated system (bioMérieux). Minimum inhibitory concentration breakpoints and quality-control protocols were used according to the standards established by the Clinical and Laboratory Standard Institute [12 ].