Ringraziamo i tecnici del laboratorio di batteriologia del Centro Ospedaliero Universitario di Losanna per il loro aiuto per attuare le tecniche in laboratorio.

Questo protocollo è stato sviluppato e validato seguendo i processi di ricerca e sviluppo e le regole etiche della nostra istituzione, prima di essere implementato come strumento di routine. 1 Preparazione di una cultura Sangue batterica pellet da Ammonio Cloruro Procedura eritrociti-lisi <ol><li> Preparazione di una coltura ematica positiva per la successiva centrifugazione. <ol><li> Sterilizzare il tappo cultura del sangue. Aggiungere etanolo al 70% sul tappo della bottiglia e bruciarlo. NOTA: Non eseguire questo passaggio sotto una cappa a flusso laminare. </li><li> Spostare la bottiglia di una cappa a flusso laminare. Raccogliere 5 ml della coltura di sangue con una siringa da 20 G. </li><li> Aggiungere i 5 ml di coltura di sangue in un tubo da centrifuga da 50 ml contenente 45 ml di acqua sterile (H 2 O) e miscelare il campione. </li></ol></li><li> Preparazione di una coltura sangue pellet batterico per lisi centrifugazione. <ol><li> Centrifugare il campione a 1000 xg per 10 minuti a temperatura ambiente. </li><li> Remove il surnatante (contenente principalmente H 2 O e cellule del sangue) con una pompa a vuoto laboratorio. </li><li> Risospendere il pellet in 1 ml di fatto in casa di cloruro di ammonio Soluzione di Lisi (0,15 M NH 4 Cl, 1 KHCO mm 3). Abbattere il pellet mediante raschiatura e vortex la provetta e centrifugare il campione a 140 xg per 10 minuti a temperatura ambiente. </li><li> Eliminare il surnatante contenente principalmente detriti globuli rossi. <ol><li> Se il pellet rimasto emorragica, risospendere il pellet in 2 ml di acqua distillata sterile e H 2 0 per lisare i globuli rossi ulteriori residui e lavare il pellet. Centrifugare il campione a 140 xg per 10 min a RT e scartare il surnatante. </li></ol></li><li> Risospendere il pellet in 200 ml di H 2 O </li></ol></li><li> Subculture della cultura sangue su vari supporti agar selettivo e non selettivo. <ol><li> Raccogliere 1 ml della cultura di sangue con una siringa da 20 G. </li><li> Inoculare 1 goccia di sangue cultura into quattro quadranti su agar sangue, agar cioccolato, McConkey agar e agar Schaedler. </li><li> Incubare a 37 ° C l&#39;agar sangue e piastre di agar cioccolato in una atmosfera di CO 2 5%, l&#39;agar McConkey in ambiente normale, e la piastra di agar Schaedler in condizioni anaerobiche. </li><li> Seguire la crescita batterica sui diversi media. </li><li> Verificare la purezza batterica. </li></ol></li></ol> 2 Identificazione mediante MALDI-TOF MS <ol><li> Identificazione diretta dal pellet sangue. <ol><li> Trasferire 1 ml di pellet di sangue su una piastra segnale MALDI e lasciarlo asciugare su una piattaforma di riscaldamento 42 ° C. </li><li> Sovrapporre il campione con 1 ml del 70% di acido formico e lasciarlo asciugare su una piattaforma di riscaldamento 42 ° C. </li><li> Sovrapporre il campione con 1 ml di matrice MALDI (soluzione satura di α-ciano-4-idrossicinnamico acido nel 50% acetonitrile-2.5% di acido trifluoroacetico) e lasciarlo asciugare su una piattaforma C di riscaldamento 42 °. </li><li> Procedere alla MALDI-TOF MS analisi di un sistema MALDI-TOF MS, come descritto dai produttori. </li><li> Se il punteggio di identificazione non è valida a livello di specie (ad esempio con un punteggio &lt;2), eseguire una estrazione di proteine ​​del campione di pellet di sangue. </li></ol></li><li> Identificazione dopo l&#39;estrazione di proteine ​​dal sangue pellet cultura. <ol><li> Mescolare 20 ml di pellet con 1 ml di etanolo al 70% e centrifugare a 13.000 xg per 2 minuti a temperatura ambiente. </li><li> Eliminare il surnatante e aggiungere 25 ml di 70% di acido formico e 25 ml di acetonitrile 100% al pellet. Vortex vigorosamente per risospendere il pellet. Risospendere pellet difficili da rompere giù con puntali delle pipette prima di vortex. </li><li> Centrifugare a 13.000 xg per 2 minuti a temperatura ambiente. Trasferire 1 ml di surnatante (che contengono proteine ​​estratte) su una piastra segnale MALDI e lasciarlo asciugare su una piattaforma di riscaldamento 42 ° C. Procedere come descritto in 2.1.2. </li></ol></li></ol> 3. batterica Identificazione e antibiotici test di suscettibilità con un sistema automatizzato microbica <ol><li> Preparazione di una sospensione batterica di identificazione batterica e AST con un sistema automatizzato microbica. <ol><li> Preparare una provetta di plastica contenente 3 ml di soluzione sterile 0,45% NaCl compatibile con il sistema automatizzato microbica. </li><li> Aggiungere un volume sufficiente di pellet cultura sangue nella soluzione di NaCl 0,45% per ottenere una sospensione batterica corrispondente ad una torbidità McFarland di 0,6 e 0,8. Misurare la torbidità utilizzando una macchina densitometro. NOTA: Il volume del pellet batterico coltura sangue varia da 50 a 200 microlitri per ottenere una torbidità McFarland di 0,6 e 0,8. </li></ol></li><li> Inoculare i Gram-positivi (GP) o Gram-negativi (GN) schede automatizzate per l&#39;identificazione e le schede AST automatizzati per i test di sensibilità antimicrobica di cocchi Gram-positivi e Gram-negativi batteri come descritto dal produttore. NOTA: IDENTIFICAZIONEn con il medico di famiglia o carte GN non si applica se il MALDI-TOF MS valore punteggio di identificazione è&gt; 2. Controllare la purezza della sospensione batterica subcoltura la sospensione batterica su agar sangue (GP e GN) e MacConkey agar (GN) piatti. </li></ol> 4. antibiotici test di suscettibilità da Disk Diffusion Assay Il test di diffusione del disco è descritto dal Comitato europeo sui test di suscettibilità antimicrobica (EUCAST, versione 3.0, aprile 2013, www.eucast.org). <ol><li> Preparazione di una sospensione batterica di eseguire il test di sensibilità antimicrobica mediante saggio disco-diffusione. <ol><li> Preparare un tubo di vetro contenente 3 ml di soluzione di NaCl allo 0,9% sterile. </li><li> Aggiungere un volume sufficiente di pellet cultura sangue nella soluzione di NaCl allo 0,9% per ottenere una sospensione batterica corrispondente ad una torbidità McFarland 0,5. Misurare la torbidità utilizzando una macchina densitometro. NOTA: Il volume della coltura sanguepellet batterico varia da 50 a 200 microlitri per ottenere una torbidità McFarland di 0,6 e 0,8. </li><li> Agitare la sospensione batterica. </li></ol></li><li> Inoculazione di sospensione batterica su agar Mueller-Hinton (MH) o Mueller-Hinton agar-agar esigenti organismi (MHF) (MH integrato con 5% di sangue defibrinato di cavallo e 20 mg / L di β-nicotinamide adenina dinucleotide). <ol><li> Immergere un tampone di cotone sterile nella sospensione batterica e rimuovere delicatamente il liquido in eccesso ruotando il tampone sulla parete interna del tubo di vetro. </li><li> Distribuire la sospensione batterica in modo uniforme su tutta la superficie della piastra di agar MH / MHF tamponando in tre direzioni o utilizzando una piastra rotatore automatizzato. </li></ol></li><li> Applicazione di dischi antimicrobici su piastre di agar inoculate. <ol><li> Applicare da vicino i dischi sulla superficie delle piastre di agar inoculate secchi manualmente o utilizzando un dispenser disco di suscettibilità. </li><li> Incubare la piastra a tempe appropriatoratura e l&#39;atmosfera come descritto nel metodo di diffusione su disco EUCAST test di suscettibilità antimicrobica (Versione 3.0, aprile 2013, www.eucast.org). </li></ol></li></ol> 5. Automated PCR-based Test diagnostico per la rilevazione di MRSA <ol><li> Usando una micropipetta, trasferire 50 ml di pellet cultura di sangue nel flacone di reagente esempio fornito con l&#39;MRSA automatizzato kit diagnostico basato su PCR e vortex per 20 sec. </li><li> Usando una micropipetta 1 ml, dispensare il campione nella porta campione della cartuccia. Inserire la cartuccia nel sistema PCR automatico e avviare il test come descritto dal produttore. </li></ol>

<ol>
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Gli autori dichiarano di non avere interessi finanziari in competizione.

Rispetto a emocoltura positiva approcci diagnostici convenzionali, la rapida acquisizione di un pellet batterico utilizzando il cloruro di lisi approccio centrifugazione ammonio ridurre il tempo di segnalare l&#39;identificazione da 16 a 24 ore e il tempo di riferire AST per 24 per 48 ore (figure 1 e 3). Rapida introduzione di un&#39;appropriata terapia antibiotica è fondamentale per migliorare la prognosi dei pazienti affetti da infezioni del sangue. Così, l&#39;identific...

Infezioni del sangue e sepsi nei pazienti ospedalizzati sono una delle principali cause di morbilità e mortalità. Così, la mortalità correlata al flusso sanguigno infezioni si osserva in circa il 14% al 37% dei pazienti ricoverati in ospedale e può aumentare fino al 35% in unità di terapia intensiva dei pazienti 1-3. La rapida identificazione dell&#39;agente infettivo è fondamentale per guidare il trattamento antimicrobico ottimale e di aumentare il buon esito della terapia antimicrobica 4,5. La rapida analisi delle macchie di Gram da emocoltura positiva ha già un impatto significativo sull&#39;adattamento della terapia antimicrobica 6,7 ma accurata identificazione dell&#39;agente infettivo è tenuto a fornire il trattamento antibiotico più adatto ai pazienti. Per esempio, diversi regimi di trattamento antibiotico deve essere attuato a seguito batteriemia con enterococchi e streptococchi che sono difficili da distinguere da colorazione di Gram. Allo stesso modo, l&#39;identificazione alle specie Level è tenuto a rilevare enterobatteri Gram negativi che codifica per una cromosomico AMPC gene che conferisce una maggiore resistenza ai β-lattamici 8. Con una emocoltura positiva, l&#39;approccio diagnostico convenzionale è di sottocultura l&#39;agente infettivo su diverse piastre di agar, che richiede diverse ore di incubazione supplementare prima identificazione con vari metodi tra cui i test biochimici, la crescita su diversi terreni selettivi e di sistemi di identificazione microbica automatizzati. Il tempo per i risultati di un approccio diagnostico convenzionale è di circa 1 a 3 giorni. L&#39;emergere della tecnologia matrix-assisted laser desorbimento / spettrometria di massa a ionizzazione a tempo di volo (MALDI-TOF) per una rapida identificazione dei microrganismi ha fornito un nuovo strumento per identificare rapidamente microrganismi da colonie cresciute su piastre di agar, ma anche direttamente dal sangue positivo culture (Figura 1) 9-12. The l&#39;uso di MALDI-TOF per identificare un agente infettivo da colture di sangue ha ridotto significativamente il tempo di risultati per alcuni minuti invece delle ore e dei giorni richiesti dai metodi tradizionali. Come discusso da Croxatto et al. 13, l&#39;efficienza di identificazione MALDI-TOF si basa su diversi parametri compresa la purezza e la quantità del microrganismo. Questi due criteri sono facilmente ottenuti da colonie discrete cresciute su piastre di agar, ma richiedevano un trattamento pre-analitico per l&#39;arricchimento batterica e purificazione da campioni complessi come la cultura del sangue, che contengono più componenti cellulari e proteine ​​che possono interferire con l&#39;identificazione MALDI-TOF. Metodi di isolamento vari microrganismi &#39;di coltura sangue sono stati utilizzati in un certo numero di studi inclusi saponina o altro metodo detergenti delicati per l&#39;estrazione batterica 9,14, siero metodo separatore 10, lisi metodi di centrifugazione 12 </sup&gt; e soluzioni commercialmente, come il kit sepsityper. Il nostro laboratorio diagnostico batteriologico ha sviluppato un semplice sangue-coltura preparazione pellet batterico base di cloruro di ammonio eritrociti-lisi che consentono rapida identificazione di batteri e lieviti mediante MALDI-TOF e sistemi di identificazione automatizzati (Figura 2) 15. Questa preparazione sangue-cultura pellet anche fornire un campione per altre applicazioni a valle diretti come colorazione di Gram, test automatizzati basati sulla PCR diagnostici come POCT-PCR per il rilevamento rapido di meticillino-resistente Staphyloccocus aureus (MRSA), e test di sensibilità agli antibiotici con sistemi automatizzati di AST e / o mediante saggi di diffusione del disco su piastre di agar (Figura 3). In questo lavoro, descriviamo le fasi per la preparazione del pellet batterico sangue-cultura come spiegato da Prod&#39;hom et al. 15 (Figura 4). Ci sarà anche descrivano i protocolli per tre delle principali applicazioni che possono essere eseguite sul pellet cultura del sangue: Identificazione mediante MALDI-TOF 15, di identificazione (ID) e test di sensibilità agli antibiotici (AST) con i sistemi automatizzati 16 per Enterobacteriaceae e stafilococchi e PCR-automatizzato test diagnostico basato per la rilevazione di MRSA 17.

<table border="0" cellpadding="0" cellspacing="0" width="1130">
	<tbody>
		<tr height="20">
			<td height="20" style="height:20px;width:268px;">20 needle gauge&#160;</td>
			<td style="width:268px;">Terumo, Leuven, Belgium</td>
			<td style="width:239px;">NN-2038R</td>
			<td style="width:355px;"></td>
		</tr>
		<tr height="19">
			<td height="19" style="height:19px;">50 ml Falcon tube</td>
			<td>BD, Franklin Lakes, NJ, USA</td>
			<td>352070</td>
			<td>50 ml centrifuge tubes</td>
		</tr>
		<tr height="19">
			<td height="19" style="height:19px;">Ammonium chlorure</td>
			<td>Merck, Darmstadt, Germany</td>
			<td>101145</td>
			<td></td>
		</tr>
		<tr height="19">
			<td height="19" style="height:19px;">Potassium hydrogen carbonate</td>
			<td>Fluka, St. Louis, MO, USA&#160;</td>
			<td>60340</td>
			<td></td>
		</tr>
		<tr height="19">
			<td height="19" style="height:19px;">Formic acid</td>
			<td>Sigma-Aldrich, St. Louis, MO, USA&#160;</td>
			<td>F0507</td>
			<td>Flammable, corrosive</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">a-Cyano-4-hydroxycinnamic acid</td>
			<td>Fluka, St. Louis, MO, USA&#160;</td>
			<td>70990</td>
			<td>Acute toxicity</td>
		</tr>
		<tr height="19">
			<td height="19" style="height:19px;">Acetonitrile</td>
			<td>Sigma-Aldrich, St. Louis, MO, USA&#160;</td>
			<td>271004</td>
			<td>Flammable, acute toxicity</td>
		</tr>
		<tr height="19">
			<td height="19" style="height:19px;">Trifluoroacetic acid</td>
			<td>Sigma-Aldrich, St. Louis, MO, USA&#160;</td>
			<td>T6508</td>
			<td>Corrosive, acute toxicity</td>
		</tr>
		<tr height="19">
			<td height="19" style="height:19px;">Vitek 2 60 instrument</td>
			<td>Biom&#233;rieux, Marcy-l&#39;Etoile, France</td>
			<td>27202</td>
			<td>automated microbial system instrument</td>
		</tr>
		<tr height="19">
			<td height="19" style="height:19px;">Vitek 2 Gram-positive (GP) card</td>
			<td>Biom&#233;rieux, Marcy-l&#39;Etoile, France</td>
			<td>21342</td>
			<td>automated GP&#160; identification card</td>
		</tr>
		<tr height="19">
			<td height="19" style="height:19px;">Vitek 2 AST-P580 card</td>
			<td>Biom&#233;rieux, Marcy-l&#39;Etoile, France</td>
			<td>22233</td>
			<td>automated microbial AST system</td>
		</tr>
		<tr height="19">
			<td height="19" style="height:19px;">Vitek 2 Gram-negative (GN) card</td>
			<td>Biom&#233;rieux, Marcy-l&#39;Etoile, France</td>
			<td>21341</td>
			<td>automated GN&#160; identification card</td>
		</tr>
		<tr height="19">
			<td height="19" style="height:19px;">Vitek 2 AST-N242 card</td>
			<td>Biom&#233;rieux, Marcy-l&#39;Etoile, France</td>
			<td>413391</td>
			<td>automated microbial AST system</td>
		</tr>
		<tr height="19">
			<td height="19" style="height:19px;">Xpert MRSA</td>
			<td>Cepheid, Sunnyvale, Ca, USA</td>
			<td>&#160;GXMRSA-100N-10</td>
			<td>nucleic acid amplification technology MRSA</td>
		</tr>
		<tr height="19">
			<td height="19" style="height:19px;">GeneXpert IV instrument</td>
			<td>Cepheid, Sunnyvale, Ca, USA</td>
			<td>GXIV-4-D</td>
			<td>nucleic acid amplification technology instrument</td>
		</tr>
		<tr height="19">
			<td height="19" style="height:19px;">Microflex LT MALDI-TOF MS instrument</td>
			<td>Bruker Daltonics, Bremen, Germany</td>
			<td>BDAL microflex LT/SH</td>
			<td></td>
		</tr>
		<tr height="19">
			<td height="19" style="height:19px;">MSP 96 target&#160; steel BC</td>
			<td>Bruker Daltonics, Bremen, Germany</td>
			<td>280799</td>
			<td>MALDI target plate</td>
		</tr>
		<tr height="19">
			<td height="19" style="height:19px;">Densitometer Densicheck instrument</td>
			<td>Biom&#233;rieux, Marcy-l&#39;Etoile, France</td>
			<td>27208</td>
			<td></td>
		</tr>
		<tr height="19">
			<td height="19" style="height:19px;">MALDI Sepsityper kit 50</td>
			<td>Bruker Daltonics, Bremen, Germany</td>
			<td>8270170</td>
			<td></td>
		</tr>
		<tr height="19">
			<td height="19" style="height:19px;">Mac Conkey agar</td>
			<td>Biolife, Milano, Italy</td>
			<td>4016702</td>
			<td></td>
		</tr>
		<tr height="19">
			<td height="19" style="height:19px;">Mueller-Hinton agar</td>
			<td>Oxoid, Hampshire, England</td>
			<td>CM0337</td>
			<td>Mueller-Hinton agar (MH)&#160;</td>
		</tr>
		<tr height="19">
			<td height="19" style="height:19px;">MHF agar</td>
			<td>Biom&#233;rieux, Marcy-l&#39;Etoile, France</td>
			<td>43901</td>
			<td>Mueller-Hinton agar-fastidious organisms agar (MHF)</td>
		</tr>
		<tr height="19">
			<td height="19" style="height:19px;">BD columbia III agar</td>
			<td>BD, Franklin Lakes, NJ, USA</td>
			<td>254071</td>
			<td>blood agar</td>
		</tr>
		<tr height="19">
			<td height="19" style="height:19px;">BD chocolate agar</td>
			<td>BD, Franklin Lakes, NJ, USA</td>
			<td>254089</td>
			<td>chocolate agar</td>
		</tr>
		<tr height="19">
			<td height="19" style="height:19px;">BD schaedler agar</td>
			<td>BD, Franklin Lakes, NJ, USA</td>
			<td>254084</td>
			<td>Schaedler agar</td>
		</tr>
	</tbody>
</table>

preparation of a blood culture pellet for rapid bacterial identification and antibiotic susceptibility testing

Infezioni del sangue e sepsi sono una delle principali cause di morbilità e mortalità. Il buon esito dei pazienti affetti da batteriemia dipende da una rapida identificazione dell&#39;agente infettivo per guidare il trattamento antibiotico ottimale. L&#39;analisi delle macchie di Gram da emocoltura positiva può essere rapidamente condotto e già un impatto significativamente il regime antibiotico. Tuttavia, l&#39;accurata identificazione dell&#39;agente infettivo è ancora necessaria per stabilire il trattamento ottimale mirato. Presentiamo qui una preparazione pellet batterico semplice e veloce da una cultura del sangue positivo che può essere utilizzato come campione per diverse applicazioni a valle essenziali quali l&#39;identificazione mediante MALDI-TOF MS, test di sensibilità agli antibiotici (AST) mediante saggio di diffusione del disco o sistemi automatizzati AST e automatizzato PCR-based test diagnostici. Le prestazioni di questi diversi sistemi di identificazione e AST applicati direttamente sulle emocolture pellet batterico è molto SImilar alla performance, normalmente ottenuto da colonie isolate cresciute su piastre di agar. Rispetto ai metodi tradizionali, la rapida acquisizione di un pellet batterico riduce notevolmente il tempo di segnalare sia l&#39;identificazione e AST. Così, seguendo la cultura positività del sangue, l&#39;identificazione mediante MALDI-TOF può essere segnalato in meno di 1 ora, mentre i risultati di AST da sistemi automatizzati o AST test di diffusione del disco entro 8 a 18 ore, rispettivamente. Allo stesso modo, i risultati di un test rapido basato su PCR possono essere comunicati ai medici meno di 2 ore a seguito della relazione di una batteriemia. Insieme, questi risultati dimostrano che la rapida preparazione di un pellet batterico cultura del sangue ha un impatto significativo sulla identificazione e AST turnaround tempo e quindi sul buon esito dei pazienti affetti da infezioni del sangue.

Nello studio effettuato da Prod&#39;hom et al. 15, pellet batterici ottenuti da cloruro di ammonio lisi centrifugazione di 122 emocoltura positiva da 78 pazienti sono stati analizzati mediante MALDI-TOF MS. Su 122 emocoltura positiva, 95 (77,9%) sono stati correttamente identificati a livello di specie e uno (0,8%) a livello di genere. I restanti 26 (21,3%) Pellets emocoltura non hanno dato un&#39;identificazione affidabile mediante MALDI-TOF. Tra questi, 21 sono stati i batteri Gram-positivi, tra cu...

Watch this Scientific Journal Video about Preparation of a Blood Culture Pellet for Rapid Bacterial Identification and Antibiotic Susceptibility Testing at JoVE.com

Preparation of a Blood Culture Pellet for Rapid Bacterial Identification and Antibiotic Susceptibility Testing

Una rapida preparazione pellet batterico da una emocoltura positiva può essere utilizzato come campione per le applicazioni quali l&#39;identificazione mediante MALDI-TOF, colorazione di Gram, test di sensibilità agli antibiotici e test di PCR-based. I risultati possono essere tempestivamente ai medici di migliorare la prognosi dei pazienti affetti da infezioni del sangue.

Preparazione di un Sangue cultura pellet per il Rapid batterica identificazione e test di sensibilità agli antibiotici

Bloodstream infections and sepsis are a major cause of morbidity and mortality. The successful outcome of patients suffering from bacteremia depends on a ...

preparation-blood-culture-pellet-for-rapid-bacterial-identification

Research

JoVE Journal

Immunology and Infection

35.4K Views.  University Hospital Center and University of Lausanne.  Una rapida preparazione pellet batterico da una emocoltura positiva può essere utilizzato come campione per le applicazioni quali l'identificazione mediante MALDI-TOF, colorazione di Gram, test di sensibilità agli antibiotici e test di PCR-based. I risultati possono essere tempestivamente ai medici di migliorare la prognosi dei pazienti affetti da infezioni del sangue. 

Video: Preparation of a Blood Culture Pellet for Rapid Bacterial Identification and Antibiotic Susceptibility Testing

A 96 Well Microtiter Plate-based Method for Monitoring Formation and Antifungal Susceptibility Testing of Candida albicans Biofilms

Candida albicans remains the most frequent cause of fungal infections in an expanding population of compromised patients and candidiasis is now the third most common infection in US hospitals. Different manifestations of candidiasis are associated with biofilm formation, both on host tissues and/or medical devices (i.e. catheters). Biofilm formation carries negative clinical implications, as cells within the biofilms are protected from host immune responses and from the action of antifungals. We have developed a simple, fast and robust in vitro model for the formation of C. albicans biofilms using 96 well microtiter-plates, which can also be used for biofilm antifungal susceptibility testing. The readout of this assay is colorimetric, based on the reduction of XTT (a tetrazolium salt) by metabolically active fungal biofilm cells. A typical experiment takes approximately 24 h for biofilm formation, with an additional 24 h for antifungal susceptibility testing. Because of its simplicity and the use of commonly available laboratory materials and equipment, this technique democratizes biofilm research and represents an important step towards the standardization of antifungal susceptibility testing of fungal biofilms.

A 96 Well Microtiter Plate-based Method for Monitoring Formation and Antifungal Susceptibility Testing of Candida albicans Biofilms

We describe a simple, rapid and robust method for the formation of Candida albicans biofilms using 96 well microtiter plates and its utility in antifungal susceptibility testing of cells within biofilms.

A 96 Beh microtest piastra a base di Metodo per la Formazione di monitoraggio e test di suscettibilità antifungini Candida albicans Biofilm

Candida albicans remains the most frequent cause of fungal infections in an expanding population of compromised patients and candidiasis is now the third ...

Ricerca

Immunologia e infezioni

Protocol for Recombinant RBD-based SARS Vaccines: Protein Preparation, Animal Vaccination and Neutralization Detection

Based on their safety profile and ability to induce potent immune responses against infections, subunit vaccines have been used as candidates for a wide variety of pathogens 1-3. Since the mammalian cell system is capable of post-translational modification, thus forming properly folded and glycosylated proteins, recombinant proteins expressed in mammalian cells have shown the greatest potential to maintain high antigenicity and immunogenicity 4-6.
Although no new cases of SARS have been reported since 2004, future outbreaks are a constant threat; therefore, the development of vaccines against SARS-CoV is a prudent preventive step and should be carried out. The RBD of SARS-CoV S protein plays important roles in receptor binding and induction of specific neutralizing antibodies against virus infection 7-9. Therefore, in this protocol, we describe novel methods for developing a RBD-based subunit vaccine against SARS. Briefly, the recombinant RBD protein (rRBD) was expressed in culture supernatant of mammalian 293T cells to obtain a correctly folded protein with proper conformation and high immunogenicity 6. The transfection of the recombinant plasmid encoding RBD to the cells was then performed using a calcium phosphate transfection method 6,10 with some modifications. Compared with the lipid transfection method 11,12, this modified calcium phosphate transfection method is cheaper, easier to handle, and has the potential to reach high efficacy once a transfection complex with suitable size and shape is formed 13,14. Finally, a SARS pseudovirus neutralization assay was introduced in the protocol and used to detect the neutralizing activity of sera of mice vaccinated with rRBD protein. This assay is relatively safe, does not involve an infectious SARS-CoV, and can be performed without the requirement of a biosafety-3 laboratory 15.
The protocol described here can also be used to design and study recombinant subunit vaccines against other viruses with class I fusion proteins, for example, HIV, respiratory syncytial virus (RSV), Ebola virus, influenza virus, as well as Nipah and Handra viruses. In addition, the methods for generating a pseudovirus and subsequently establishing a pseudovirus neutralization assay can be applied to all these viruses.

This protocol describes a general procedure for studying recombinant receptor-binding domain (RBD)-based subunit vaccines against SARS. It includes methods for transfection and expression of RBD protein in 293T cells, immunization of mice with RBD and detection of neutralization activity of mouse sera using an established SARS pseudovirus neutralization assay.

Protocollo per ricombinante RBD-based Vaccines SARS: Preparazione di proteine, vaccinazione degli animali e la rivelazione di neutralizzazione

Based on their safety profile and ability to induce potent immune responses against infections, subunit vaccines have been used as candidates for a wide ...

A 1.5 Hour Procedure for Identification of Enterococcus Species Directly from Blood Cultures

Enterococci are a common cause of bacteremia with E. faecalis being the predominant species followed by E. faecium. Because resistance to ampicillin and vancomycin in E. faecalis is still uncommon compared to resistance in E. faecium, the development of rapid tests allowing differentiation between enterococcal species is important for appropriate therapy and resistance surveillance. The E. faecalis OE PNA FISH assay (AdvanDx, Woburn, MA) uses species-specific peptide nucleic acid (PNA) probes in a fluorescence in situ hybridization format and offers a time to results of 1.5 hours and the potential of providing important information for species-specific treatment. Multicenter studies were performed to assess the performance of the 1.5 hour E. faecalis/OE PNA FISH procedure compared to the original 2.5 hour assay procedure and to standard bacteriology methods for the identification of enterococci directly from a positive blood culture bottle.

A 1.5 Hour Procedure for Identification of Enterococcus Species Directly from Blood Cultures

A rapid protocol for the direct identification of Enterococcus faecalis and other Enterococcus species from a positive blood culture using a Peptide Nucleic Acid fluorescent in situ hybridization assay (PNA FISH).

Una procedura 1,5 ore per l&#39;identificazione di Enterococcus Specie Direttamente da emocolture

Enterococci are a common cause of bacteremia with E. faecalis being the predominant species followed by E. faecium.  Because resistance to ampicillin and ...

Antimicrobial Susceptibility Testing of Mycobacterium Tuberculosis Complex for First and Second Line Drugs by Broth Dilution in a Microtiter Plate Format

The rapid detection of antimicrobial resistance is important in the effort to control the increase in resistant Mycobacterium 
tuberculosis (Mtb). Antimicrobial susceptibility testing (AST) of Mtb has traditionally been performed by the agar method of proportion or by 
macrobroth testing on an instrument such as the BACTEC (Becton Dickinson, Sparks, MD), VersaTREK (TREK Diagnostics, Cleveland, OH) or BacT/ALERT (bioM&eacute;rieux, Hazelwood, MO). The agar proportion method, while considered the &#x201C;gold&#x201D; standard of AST, is labor intensive and requires calculation of resistance by performing colony counts on drug-containing agar as compared to drug-free agar. If there is &ge;1% growth on the drug-containing medium as compared to drug-free medium, the organism is considered resistant to that drug. The macrobroth methods require instrumentation and test break point ("critical") drug concentrations for the first line drugs (isoniazid, ethambutol, rifampin, and pyrazinamide). The method described here is commercially available in a 96 well microtiter plate format [MYCOTB (TREK Diagnostics)] and contains increasing concentrations of 12 antimicrobials used for treatment of tuberculosis including both first (isoniazid, rifampin, ethambutol) and second line drugs (amikacin, cycloserine, ethionamide, kanamycin, moxifloxacin, ofloxacin, para-aminosalicylic acid, rifabutin, and streptomycin). Pyrazinamide, a first line drug, is not included in the microtiter plate due to its need for acidic test conditions. Advantages of the microtiter system include both ease of set up and faster turn around time (14 days) compared with traditional agar proportion (21 days). In addition, the plate can be set up from inoculum prepared using either broth or solid medium. Since the microtiter plate format is new and since Mtb presents unique safety challenges in the laboratory, this protocol will describe how to safely setup, incubate and read the microtiter plate.

Antimicrobial susceptibility testing of Mycobacterium tuberculosis is challenging but critical for patient care. This microtiter plate format offers testing of 12 antimycobacterial drugs and provides minimum inhibitory concentration (MIC) values, which will aid in appropriate treatment.

Test di suscettibilità antimicrobica del complesso Mycobacterium tuberculosis delle droghe prima e seconda linea per diluizione brodo in un formato micropiastra

The rapid detection of antimicrobial resistance is important in the effort to control the increase in resistant Mycobacterium 
tuberculosis (Mtb). ...

Introducing Shear Stress in the Study of Bacterial Adhesion

During bacterial infections a sequence of interactions occur between the pathogen and its host. Bacterial adhesion to the host cell surface is often the initial and determining step of the pathogenesis. Although experimentally adhesion is mostly studied in static conditions adhesion actually takes place in the presence of flowing liquid. First encounters between bacteria and their host often occur at the mucosal level, mouth, lung, gut, eye, etc. where mucus flows along the surface of epithelial cells. Later in infection, pathogens occasionally access the blood circulation causing life-threatening illnesses such as septicemia, sepsis and meningitis. A defining feature of these infections is the ability of these pathogens to interact with endothelial cells in presence of circulating blood. The presence of flowing liquid, mucus or blood for instance, determines adhesion because it generates a mechanical force on the pathogen. To characterize the effect of flowing liquid one usually refers to the notion of shear stress, which is the tangential force exerted per unit area by a fluid moving near a stationary wall, expressed in dynes/cm2. Intensities of shear stress vary widely according to the different vessels type, size, organ, location etc. (0-100 dynes/cm2). Circulation in capillaries can reach very low shear stress values and even temporarily stop during periods ranging between a few seconds to several minutes 1. On the other end of the spectrum shear stress in arterioles can reach 100 dynes/cm2 2. The impact of shear stress on different biological processes has been clearly demonstrated as for instance during the interaction of leukocytes with the endothelium 3. To take into account this mechanical parameter in the process of bacterial adhesion we took advantage of an experimental procedure based on the use of a disposable flow chamber 4. Host cells are grown in the flow chamber and fluorescent bacteria are introduced in the flow controlled by a syringe pump. We initially focused our investigations on the bacterial pathogen Neisseria meningitidis, a Gram-negative bacterium responsible for septicemia and meningitis. The procedure described here allowed us to study the impact of shear stress on the ability of the bacteria to: adhere to cells 1, to proliferate on the cell surface 5and to detach to colonize new sites 6 (Figure 1). Complementary technical information can be found in reference 7. Shear stress values presented here were chosen based on our previous experience1 and to represent values found in the literature. The protocol should be applicable to a wide range of pathogens with specific adjustments depending on the objectives of the study.

During the infection process, a key step is the adhesion of pathogens with host cells. In most instances this adhesion step occurs in the presence of mechanical stress generated by flowing liquid. We describe a technique that introduces shear stress as an important parameter in the study of bacterial adhesion.

L&#39;introduzione di shear stress nello studio di adesione batterica

During bacterial infections a sequence of interactions occur between the pathogen and its host. Bacterial adhesion to the host cell surface is often the ...

One-day Workflow Scheme for Bacterial Pathogen Detection and Antimicrobial Resistance Testing from Blood Cultures

Bloodstream infections are associated with high mortality rates because of the probable manifestation of sepsis, severe sepsis and septic shock1. Therefore, rapid administration of adequate antibiotic therapy is of foremost importance in the treatment of bloodstream infections. The critical element in this process is timing, heavily dependent on the results of bacterial identification and antibiotic susceptibility testing. Both of these parameters are routinely obtained by culture-based testing, which is time-consuming and takes on average 24-48 hours2, 4. The aim of the study was to develop DNA-based assays for rapid identification of bloodstream infections, as well as rapid antimicrobial susceptibility testing. The first assay is a eubacterial 16S rDNA-based real-time PCR assay complemented with species- or genus-specific probes5. Using these probes, Gram-negative bacteria including Pseudomonas spp., Pseudomonas aeruginosa and Escherichia coli as well as Gram-positive bacteria including Staphylococcus spp., Staphylococcus aureus, Enterococcus spp., Streptococcus spp., and Streptococcus pneumoniae could be distinguished. Using this multiprobe assay, a first identification of the causative micro-organism was given after 2 h.
Secondly, we developed a semi-molecular assay for antibiotic susceptibility testing of S. aureus, Enterococcus spp. and (facultative) aerobe Gram-negative rods6. This assay was based on a study in which PCR was used to measure the growth of bacteria7. Bacteria harvested directly from blood cultures are incubated for 6 h with a selection of antibiotics, and following a Sybr Green-based real-time PCR assay determines inhibition of growth. The combination of these two methods could direct the choice of a suitable antibiotic therapy on the same day (Figure 1). In conclusion, molecular analysis of both identification and antibiotic susceptibility offers a faster alternative for pathogen detection and could improve the diagnosis of bloodstream infections.

The design of a straightforward one-day workflow scheme for bacterial pathogen diagnostics enables the rapid recognition of bloodstream infections. The inclusion of eight clinically relevant bacterial targets and their antibiotic resistance profiles offers the clinician an initial insight on the same day, which can lead to more adequate therapy.

Un giorno Scheme flusso di lavoro per batterica Rilevazione dei patogeni e test di resistenza antimicrobica dalle emocolture

Bloodstream infections are associated with high mortality rates because of the probable manifestation of sepsis, severe sepsis and septic shock1. ...

Rapid Identification of Gram Negative Bacteria from Blood Culture Broth Using MALDI-TOF Mass Spectrometry

An important role of the clinical microbiology laboratory is to provide rapid identification of bacteria causing bloodstream infection. Traditional identification requires the sub-culture of signaled blood culture broth with identification available only after colonies on solid agar have matured. MALDI-TOF MS is a reliable, rapid method for identification of the majority of clinically relevant bacteria when applied to colonies on solid media. The application of MALDI-TOF MS directly to blood culture broth is an attractive approach as it has potential to accelerate species identification of bacteria and improve clinical management. However, an important problem to overcome is the pre-analysis removal of interfering resins, proteins and hemoglobin&#160;contained in blood culture specimens which, if not removed, interfere with the MS spectra and can result in insufficient or low discrimination identification scores. In addition it is necessary to concentrate bacteria to develop spectra of sufficient quality. The presented method describes the concentration, purification, and extraction of Gram negative bacteria allowing for the early identification of bacteria from a signaled blood culture broth.

The application of matrix-assisted laser desorption/ionization time of flight (MALDI-TOF) mass spectrometry (MS) directly to blood culture broth expedites the identification of bacteria. The presented method is a rapid and reliable method for identification of Gram negative bacteria directly from blood culture broth.

Rapida identificazione dei batteri Gram-negativi dal sangue brodo di coltura Uso MALDI-TOF

An important role of the clinical microbiology laboratory is to provide rapid identification of bacteria causing bloodstream infection. Traditional ...

A Reference Broth Microdilution Method for Dalbavancin In Vitro Susceptibility Testing of Bacteria that Grow Aerobically

Antimicrobial susceptibility testing (AST) is performed to assess the in vitro activity of antimicrobial agents against various bacteria. The AST results, which are expressed as minimum inhibitory concentrations (MICs) are used in research for antimicrobial development and monitoring of resistance development and in the clinical setting for antimicrobial therapy guidance. Dalbavancin is a semi-synthetic lipoglycopeptide antimicrobial agent that was approved in May 2014 by the Food and Drug Administration (FDA) for the treatment of acute bacterial skin and skin structure infections caused by Gram-positive organisms. The advantage of dalbavancin over current anti-staphylococcal therapies is its long half-life, which allows for once-weekly dosing. Dalbavancin has activity against Staphylococcus aureus (including both methicillin-susceptible S. aureus [MSSA] and methicillin-resistant S. aureus [MRSA]), coagulase-negative staphylococci, Streptococcus pneumoniae, Streptococcus anginosus group, &#946;-hemolytic streptococci and vancomycin susceptible enterococci. Similar to other recent lipoglycopeptide agents, optimization of CLSI and ISO broth susceptibility test methods includes the use of dimethyl sulfoxide (DMSO) as a solvent when preparing stock solutions and polysorbate 80 (P80) to alleviate adherence of the agent to plastic. Prior to the clinical studies and during the initial development of dalbavancin, susceptibility studies were not performed with the use of P-80 and MIC results tended to be 2-4 fold higher and similarly higher MIC results were obtained with the agar dilution susceptibility method. Dalbavancin was first included in CLSI broth microdilution methodology tables in 2005 and amended in 2006 to clarify use of DMSO and P-80. The broth microdilution (BMD) procedure shown here is specific to dalbavancin and is in accordance with the CLSI and ISO methods, with step-by-step detail and focus on the critical steps added for clarity.

A Reference Broth Microdilution Method for Dalbavancin In Vitro Susceptibility Testing of Bacteria that Grow Aerobically

Here, we present a protocol for determination of dalbavancin susceptibility of clinically relevant Gram-positive bacteria using a broth microdilution reference methodology.

Un riferimento brodo di microdiluizione per Dalbavancina<em&gt; In Vitro</em&gt; Test della Sensibilità di batteri che crescono aerobico

Antimicrobial susceptibility testing (AST) is performed to assess the in vitro activity of antimicrobial agents against various bacteria. The AST results, ...

A RAPID Method for Blood Processing to Increase the Yield of Plasma Peptide Levels in Human Blood

Research in the field of food intake regulation is gaining importance. This often includes the measurement of peptides regulating food intake. For the correct determination of a peptide&#39;s concentration, it should be stable during blood processing. However, this is not the case for several peptides which are quickly degraded by endogenous peptidases. Recently, we developed a blood processing method employing Reduced temperatures, Acidification, Protease inhibition, Isotopic exogenous controls and Dilution (RAPID) for the use in rats. Here, we have established this technique for the use in humans and investigated recovery, molecular form and circulating concentration of food intake regulatory hormones. The RAPID method significantly improved the recovery for 125I-labeled somatostatin-28 (+39%), glucagon-like peptide-1 (+35%), acyl ghrelin and glucagon (+32%), insulin and kisspeptin (+29%), nesfatin-1 (+28%), leptin (+21%) and peptide YY3-36 (+19%) compared to standard processing (EDTA blood on ice, p&#160;&#60;0.001). High performance liquid chromatography showed the elution of endogenous acyl ghrelin at the expected position after RAPID processing, while after standard processing 62% of acyl ghrelin were degraded resulting in an earlier peak likely representing desacyl ghrelin. After RAPID processing the acyl/desacyl ghrelin ratio in blood of normal weight subjects was 1:3 compared to 1:23 following standard processing (p&#160;= 0.03). Also endogenous kisspeptin levels were higher after RAPID compared to standard processing (+99%, p&#160;= 0.02). The RAPID blood processing method can be used in humans, yields higher peptide levels and allows for assessment of the correct molecular form.

The RAPID blood processing method can be used in humans and yields higher peptide levels as well as allows for assessment of the correct molecular form. Therefore, this method will be a valuable tool in peptide research.

Un metodo rapido per la lavorazione del sangue per aumentare la resa dei livelli plasmatici del peptide nel sangue umano

Research in the field of food intake regulation is gaining importance. This often includes the measurement of peptides regulating food intake. For the ...

Culture of Macrophage Colony-stimulating Factor Differentiated Human Monocyte-derived Macrophages

A protocol is presented for cell culture of macrophage colony-stimulating factor (M-CSF) differentiated human monocyte-derived macrophages. For initiation of experiments, fresh or frozen monocytes are cultured in flasks for 1 week with M-CSF to induce their differentiation into macrophages. Then, the macrophages can be harvested and seeded into culture wells at required cell densities for carrying out experiments. The use of defined numbers of macrophages rather than defined numbers of monocytes to initiate macrophage cultures for experiments yields macrophage cultures in which the desired cell density can be more consistently attained. Use of cryopreserved monocytes reduces dependency on donor availability and produces more homogeneous macrophage cultures.

A protocol is presented for cell culture of macrophage colony-stimulating factor (M-CSF) differentiated human monocyte-derived macrophages. The protocol utilizes cryopreservation of monocytes coupled with their bulk differentiation into macrophages. Then harvested macrophages can then be seeded into culture wells at required cell densities for carrying out experiments.

Cultura dei macrofagi macrofagi colony-stimulating factor differenziata umana derivate da monociti

A protocol is presented for cell culture of macrophage colony-stimulating factor (M-CSF) differentiated human monocyte-derived macrophages. For initiation ...