El hemocultivo es el principal método de diagnóstico de bacteriemias, sin embargo el largo periodo del resultado del diagnóstico conlleva a una inadecuada o nula administración de tratamiento, provocando en muchos casos el fallecimiento del paciente. La implementación de nuevos métodos pueden contribuir con un diagnóstico rápido y seguro, para disminuir la mortalidad y resistencia antimicrobiana. Por ello, la implementación de un programa que adiciona mejoras en los métodos convencionales e integra métodos moleculares como FilmArray y GenXpert, pretende generar un impacto en el diagnóstico de bacteriemias verdaderas. Es por esto que el objetivo del siguiente estudio es evaluar la efectividad de un programa de evaluación y tipificación de cultivos positivos utilizando los nuevos métodos moleculares. Hasta el momento, son escasas las investigaciones y no existe un protocolo establecido que llegue a este objetivo, por lo que se pretende realizar un estudio observacional descriptivo de corte transversal que permita analizar las posibles mejoras en el tiempo y diagnóstico del programa que se está implementando actualmente. De manera que se pueda contribuir en un futuro a la generación de investigaciones posteriores que analicen el impacto del mismo en la salud pública.

En bakteriell ledinfektion kallas för septisk artrit och utan snabb behandling kan tillståndet leda till irreversibla ledskador och flera allvarliga komplikationer. Snabb diagnostik är viktigt för en god prognos och med nuvarande metod för odling av ledvätska tar det upp till fem dygn för detektion av mikroorganismer. Metoden inkluderar odling på fasta substrat och i blododlingsflaskor. Med en ny metod som använder multiplex PCR (polymerase chain reaction) skulle analystiden kunna minskas till en timme. BioFire Joint Infection (JI) Panel är ett test som kan detektera flera mikroorganismer samtidigt genom amplifiering av DNA. Mikroorganismer detekteras och identifieras genom cellysering, DNA-rening, PCR-reaktioner i två steg och smältanalys. Syftet med arbetet var att utvärdera BioFire JI Panel för detektion av mikroorganismer i ledvätska och jämföra metodens känslighet med standardiserad odling respektive odling i buljong, och svara på frågeställningen hur känslig JI-panelen är jämfört med standardiserad odlingsmetod. Prov konstruerades genom att suspendera målbakterierna Staphylococcus aureus, Escherichia coli, Streptococcus pyogenes, Neisseria gonorrhoeae, Haemophilus influenzae, Kingella kingae och Finegoldia magna i natriumklorid. Suspensionerna seriespäddes och odlades ut på fasta substrat, inokulerades i blododlingsflaskor och buljonger samt analyserades med JI-panelen för att identifiera metodernas detektionsgränser. Fasta substrat, blododlingsflaskor och buljonger visade likvärdig känslighet för majoriteten av bakterieisolaten medan JI-panelen generellt visade en sämre eller likvärdig känslighet i jämförelse med standardmetod. Panelen visade potential för detektion av svårodlade bakterier och skulle vara ett bra komplement till nuvarande odlingsmetod. Ytterligare studier hade behövts men den snabba analystiden som möjliggör snabbare behandling framhävde metodens kliniska potential. / Bacterial joint infections are called septic arthritis and without rapid diagnosis and treatment the condition could lead to irreversible joint damage and other serious complications. With the current method for synovial fluid cultivation, which includes both solid substrates and culture vials, detection of microorganisms takes up to five days. With a new method utilizing multiplex polymerase chain reaction (PCR), the time to detection could decrease to an hour. BioFire Joint Infection (JI) Panel can detect multiple microorganisms simultaneously through amplification of DNA. Microorganisms are detected and identified by cell lysis, DNA purification and two consecutive PCR reactions with subsequent melting curve analysis. The aim of the study was to evaluate the BioFire JI Panel for detection of microorganisms in synovial fluid and compare the method’s sensitivity to standard and broth cultivation. Samples were constructed by suspending target bacteria, Staphylococcus aureus, Escherichia coli, Streptococcus pyogenes, Neisseria gonorrhoeae, Haemophilus influenzae, Kingella kingae and Finegoldia magna, in sodium chloride. The suspensions were serially diluted and cultivated on solid substrates, in culture vials, broth and analyzed with the JI panel to find the detection limits for each method. Solid substrates, culture vials and broth exhibited similar sensitivity while the JI panel generally had a lower or similar sensitivity compared to standard methods. The panel showed potential detecting difficult to grow bacteria and would be a good complement to current methods. Further studies are required but the quick analysis enabling faster treatment highlighted the clinical potential.

Abstract Background: Gastroenteritis is a common infection and the leading cause of morbidity worldwide and is mostly caused by viruses. Outbreaks appear in both developed and developing countries and result in large economic costs. Rapid detection is important for appropriate treatment, control and to prevent the spread of infection.  Objective: Evaluation and performance comparison between the BioFire®FilmArray® Torch System gastrointestinal panel and the Molecular BD MAXTMenteric viral panel to indicate a multiplex method for viral gastroenteritis diagnostic in a routine laboratory setting.  Material and methods: In this study, 58 different samples were used which consisted of selected stool specimens from patients who were tested and treated for gastroenteritis infection at Uppsala Academic Hospital and Norrlands University Hospital in Umeå during 2018-2021, samples from Quality control for molecular diagnostics viral gastroenteritis EQA pilot study during 2018-2019 and cultivated strains of different adenovirus species from 2018. All samples were analyzed with both systems for comparison of detected pathogens.  Results: Sensitivity and specificity values were 95% and 100% respectively for the BioFire®FilmArray®Torch System and 100% and 93.3% for the BD MAXTMSystem.   Conclusions: Bothsystems are rapid and adequate diagnostic tools. The BioFire®FilmArray®Torch System with greater coverage has the ability of detecting more pathogens and is more promising particularly in the occasional infection circumstance. The BD MAXTMSystem demonstrated almost the same results and seems to be a better option in times of an outbreak when the numbers of patients are significantly higher.